Search Results (575)

Background/Objectives: Iron deficiency early in life can impair infant growth and cognitive development. Here, we follow infants’ plasma ferritin levels—an indicator of iron stores—over the first year of life and relate these to birth characteristics, maternal characteristics, and infant feeding. Methods: Children and their mothers enrolled in the Swedish birth cohort NICE (ClinicalTrials.gov identifier: NCT05809479) were followed from pregnancy to twelve months postpartum. Plasma ferritin was quantified in umbilical cord blood at birth (n = 345), in venous plasma at four months after birth (mother–infant dyads, n = 133), and at twelve months of age (n = 158), using sandwich ELISA. Perinatal and postnatal growth, together with infant and maternal characteristics, were extracted from medical birth records. Breastfeeding and formula feeding were assessed using repeated monthly questionnaires during the first year. Longitudinal changes were analyzed using linear mixed-effects models, and factors associated with ferritin concentrations were examined using Spearman correlations, linear regression models, and segmented generalized additive models. Results: The ferritin concentration declined over time (birth: 267 ng/mL; four months: 146 ng/mL; twelve months: 30 ng/mL). Boys had lower ferritin levels than girls at all timepoints. Ferritin status at four and twelve months was positively associated with ferritin concentrations in cord blood and with gestational age. Breastfeeding and formula feeding were not associated with ferritin concentrations. Conclusions: Infant sex, cord ferritin concentrations, and maternal ferritin concentrations were independently associated with infant ferritin concentrations across the first year of life, whereas neither breastfeeding nor formula feeding was associated with ferritin concentrations in the present analyses. Infant sex, cord ferritin, and maternal ferritin measured four months postpartum may help identify children at risk of low iron stores, with maternal ferritin potentially offering a less intrusive alternative to repeated infant sampling. However, the clinical relevance and potential use of maternal ferritin as a proxy for infant ferritin concentrations require further investigation. Full article

Background: Dental caries remain a major public health issue among Italian children, with prevalence exceeding 60% in specific subgroups and marked socioeconomic gradients. Objectives: This multicenter study aimed to describe baseline caries experience, malocclusions, and oral hygiene status in pediatric populations residing in three Italian regions and to develop and preliminarily evaluate the feasibility of an integrated care pathway for the prevention and management of caries and malocclusions. Materials and Methods: Within the CCM 2024 program (ID 10), a cross-sectional baseline assessment was conducted on 795 children aged 6–11 years, examined in school settings and via mobile dental units. Caries experience was assessed using the dmft/DMFT indices and International Caries Detection and Assessment System (ICDAS) criteria. Malocclusions were evaluated using the Index of Orthodontic Treatment Need (IOTN). Oral hygiene was assessed through standardized clinical indices. The proposed care pathway comprises three tiers: (1) universal, school-based oral health education; (2) targeted clinical preventive and interceptive interventions; and (3) telemedicine/AI-supported follow-up for high-risk children. Descriptive and multivariable statistical analyses were performed. Results: At baseline, overall caries burden was low. No statistically significant differences in dmft/DMFT were observed between males and females. A non-significant trend toward higher caries indices was found among children with a positive breastfeeding history. By contrast, oral hygiene level was strongly associated with caries indices: children with insufficient hygiene had the highest dmft/DMFT, those with moderate hygiene showed intermediate values, and those with optimal hygiene presented the lowest caries experience. In multivariable models, oral hygiene emerged as the main independent predictor of dmft/DMFT. Conclusions: In this low-caries cohort, oral hygiene was confirmed as the principal modifiable determinant of caries risk. A tiered, school- and community-based care pathway focused on hygiene promotion, early screening, and minimally invasive clinical interventions appears feasible at baseline and may be scalable, with the aim of reducing the burden of caries and malocclusions and improving equity in pediatric oral health. Full article

Background: Functional gastrointestinal disorders (FGIDs) are highly prevalent among infants. Exclusive breastfeeding has been consistently associated with better gastrointestinal health. However, current evidence regarding the associations between early feeding practices and infant gastrointestinal development remains limited. Objectives: To examine the associations between early feeding practices at 1 month of age and gastrointestinal symptoms and overall gastrointestinal burden in infants during the first 12 months of life. Methods: In this multicenter prospective cohort study, 669 healthy mother–infant pairs were finally included. According to feeding practices at 1 month of age, infants were categorized into three groups: exclusive direct breastfeeding (EDB, n = 236, 35.28%), bottle-fed expressed breastmilk (EBB, n = 150, 22.42%), and mixed feeding (MF, n = 283, 42.30%). Gastrointestinal (GI) symptoms were assessed using the Infant Gastrointestinal Symptom Questionnaire (IGSQ) and symptom items from the PedsQL™ Infant Scales. Generalized estimating equations (GEEs) were used to assess the associations. Results: Infants in the EDB group had the lowest incidence of GI symptoms and lower IGSQ scores throughout the follow-up period. Compared with EDB, the MF group showed higher IGSQ scores (β = 0.95, p = 0.002) and higher odds of constipation (OR = 1.64, p < 0.001), vomiting (OR = 1.70, p < 0.001), and swallowing difficulty (OR = 1.79, p = 0.002); these associations remained robust across multiple sensitivity analyses. The EBB group showed higher odds of certain symptoms in the main analysis, but sensitivity analyses (e.g., time-varying exposure) indicated that these associations were not robust, except for bloating (OR = 1.31, p = 0.042). Conclusions: The EDB is the optimal strategy for infant gastrointestinal health and should be prioritized. The MF is robustly associated with increased odds of constipation, vomiting, swallowing difficulty, and overall gastrointestinal burden. The EBB may slightly increase the odds of bloating, which can be mitigated by paced feeding and adequate burping. Full article

Background/Objectives: Children and adolescents exposed to criminal victimization are at increased risk for depression; however, the contribution of nutritional status to depressive symptom severity in this vulnerable population remains poorly understood. Therefore, we aimed to examine the associations between depression severity and nutritional parameters in child and adolescent victims of crime. Methods: This cross-sectional study included 72 children and adolescents (aged 10–16 years) referred to a forensic medicine department in Türkiye. Nutritional status was assessed using anthropometric measurements (body weight, body mass index [BMI], BMI-Z score, and body fat percentage), three-day dietary records, and the Mediterranean Diet Quality Index (KIDMED). Depression severity was evaluated using the Kutcher Adolescent Depression Scale (KADS). The associations were analyzed using Pearson’s rho correlation and forward stepwise linear regression. Potential confounding variables, including age, gender, socioeconomic status, and trauma-related characteristics, were recorded and considered during the analysis; however, due to the limited sample size and to avoid model overparameterization, they were not fully adjusted for in the final model. Results: Depression severity was positively correlated with the body weight, BMI, BMI-Z score, body fat percentage, and dietary energy, carbohydrate, protein, and fat intakes (all p < 0.05). In contrast, the vitamin C and dietary fiber intakes, breastfeeding duration, and KIDMED scores were negatively correlated with the KADS scores (p < 0.05). Regression analysis revealed that the lower KIDMED scores, higher body fat percentage, and greater body weight were significantly associated with depression severity, collectively explaining 82.2% of the variance in the KADS scores. Conclusions: Poor diet quality and adverse body composition are strongly associated with depression severity in child and adolescent victims of crime. These findings suggest that nutritional factors may be associated with depression severity in child and adolescent victims of crime; however, the results should be interpreted as preliminary and hypothesis-generating. Full article

Background/Objectives: Sufficient sleep quantity/quality in infancy is crucial for healthy development, so it is important to identify early associated predictive factors. Research findings highlight salient endogenous (infant temperament) and exogenous (breastfeeding) influences, though no known studies have examined nuanced and interactive relations among these variables from early to late infancy/toddlerhood. Thus, the current study examined the main and interaction effects of these variables on infant sleep at 6 and 14 months while controlling for prenatal cortisol exposure. Methods: Data from a subsample (n = 79) of the Infant Development and Healthy Outcomes in Mothers Study were used, including prenatal maternal saliva samples assayed for cortisol and maternal questionnaires that included retrospective reporting of infant temperament, sleep quality and quantity, and breastfeeding frequency. Results: Multiple linear regression results include a statistically significant negative relation between prenatal maternal cortisol area under the curve and 6-month infant sleep quantity. A greater breastfeeding frequency at 6 months was associated with decreased 6-month sleep quality via conditional but not interaction effects. Greater 6-month infant Surgency was associated with better sleep quality at 14 months. There were no statistically significant interaction effects. Conclusions: The findings suggest that maternal psychophysiological stress has a significant influence on infant sleep duration, while research should further investigate the role of infant temperament and breastfeeding in shaping infant sleep quality. Significant conditional effects highlight patterns that should be re-examined with a larger sample to determine whether infant temperament may buffer against negative associations between breastfeeding frequency and infant sleep quality in early and late infancy in a developmental stage-consistent manner. Future replication studies should include a multi-method, longitudinal assessment of all key study variables, as well as a larger, more sociodemographically diverse sample of maternal–infant dyads. Full article

Background: This study aimed to contribute to the growing empirical interest in the role of positive body image in the context of breastfeeding. Research Aim: We examined the association between positive attitudes toward breastfeeding and breastfeeding intentions among postpartum women and investigated the mediation of functionality appreciation. Method: A total of 305 women who had given birth within the past 1 to 3 months (M = 34.11 years) participated in the study. Women completed a questionnaire assessing breastfeeding attitudes, appreciation of breastfeeding functionality, breastfeeding intentions, previous breastfeeding experience, as well as Body Mass Index and sociodemographic and obstetric characteristics. A mediation model was used to examine direct and indirect associations between attitudes toward breastfeeding, breastfeeding intentions, and functionality appreciation. Results: Results showed significant associations between positive attitudes towards breastfeeding, breastfeeding intentions, and functionality appreciation. Positive attitudes toward breastfeeding were positively associated with breastfeeding intentions (β = 0.63, p < 0.001) and with functionality appreciation (β = 0.51, p < 0.001), with functionality appreciation accounting for a significant indirect association (β = 0.21, 95% CI [0.14, 0.29]). Finally, previous breastfeeding experience was positively associated with breastfeeding intentions (β = 0.15, p < 0.001). Conclusions: This study marks the initial attempt to examine the significance of functionality appreciation in postpartum women, highlighting potential associations between breastfeeding attitudes and breastfeeding intentions. These findings may offer preliminary insights for future research and for informing the development of targeted interventions, although further evidence from more diverse populations is needed. Full article

Background/Objectives: Breastfeeding initiation after cesarean section is frequently delayed due to postoperative routines and early mother–infant separation. Enhanced Recovery After Surgery (ERAS) protocols have been introduced in obstetrics to improve maternal recovery and may facilitate practices aligned with a family-centered model of care. The aim of this study was to evaluate the association between ERAS implementation and breastfeeding outcomes, including early feeding patterns and effective breastfeeding at discharge. Methods: An analytical longitudinal study was conducted including women undergoing scheduled cesarean section between January 2025 and November 2025 at Quirón Salud Málaga Hospital (Spain). A total of 131 women were enrolled in this study. Two groups were compared: an exposed group that received an ERAS protocol (n = 65) for scheduled cesarean section and a control group (n = 66) managed with conventional in-hospital care. An intrasubject analysis was conducted, and associations were assessed using odds ratios (ORs) with 95% confidence intervals (CIs). Multivariable logistic regression was performed to identify factors independently associated with effective breastfeeding. Results: The ERAS group showed a stable feeding pattern over time, with a high persistence of exclusive breastfeeding (Stuart–Maxwell χ²(2) = 1.14; p = 0.565). In multivariable analysis, ERAS implementation remained an independent factor (adjusted OR 3.79; 95% CI 1.50–9.55; p = 0.005), together with early skin-to-skin (adjusted OR 2.68; 95% CI 1.13–6.36; p = 0.026), as was breastfeeding support (adjusted OR 2.72; 95% CI 1.02–7.22; p = 0.045). LATCH scores were also higher in the ERAS group (p = 0.0005; r = 0.34). Conclusions: Women managed under ERAS presented a higher prevalence of exclusive breastfeeding at hospital discharge and better breastfeeding performance. ERAS implementation was associated with improved breastfeeding outcomes, possibly through clinical conditions that facilitate early contact and structured breastfeeding support. Full article

Background/Objectives: Emerging evidence suggests that ultra-processed food (UPF) consumption may be associated with depressive symptoms, yet data in the early postpartum period remain limited. This pilot study aimed to examine the association between UPF intake and postpartum depressive symptoms among women in the early postpartum. Methods: In this cross-sectional pilot study, 137 women within 6–8 weeks postpartum were recruited from hospitals, maternity clinics, and online support networks in Greece. Dietary intake was assessed using a validated food frequency questionnaire and classified according to the NOVA system. UPF consumption was categorized into quartiles. Postpartum depressive symptoms were evaluated using the Edinburgh Postnatal Depression Scale (EPDS), with clinically significant symptoms defined as EPDS ≥ 13. Multivariable logistic regression analyses were conducted, adjusting for sociodemographic and lifestyle factors. Results: The prevalence of clinically significant postpartum depressive symptoms was 29.9%. No statistically significant associations were observed in adjusted models. However, a higher prevalence of depressive symptoms was observed among women in the highest UPF intake quartile (40.0%) compared with lower quartiles (25.7–28.1%). Poor sleep quality was independently associated with higher odds of depressive symptoms, whereas breastfeeding was associated with lower odds. Confidence intervals were wide, indicating limited statistical precision due to the small sample size. Conclusions: While no statistically significant association was observed in multivariable analyses, a higher prevalence of depressive symptoms was noted among women in the highest UPF intake quartile. The wide confidence intervals indicate substantial uncertainty, and the findings should be interpreted with caution. Larger, adequately powered studies are required to confirm these findings. Full article

Background: Vitamin B12 deficiency is a recognized but frequently under-integrated cause of global developmental delay (GDD) in infancy and early childhood. Early diagnosis is critical because neurological impairment may be partially or completely reversible with timely treatment. Objective: This narrative review aims to synthesize current evidence on the role of vitamin B12 deficiency in the diagnostic evaluation of GDD, with a focus on clinical phenotype, risk factors, biomarkers, treatment outcomes, and practical integration into contemporary diagnostic algorithms. Methods: A structured, non-systematic search of PubMed/MEDLINE, Embase, and Web of Science was performed to identify clinical studies, case series, reviews, and guideline documents addressing pediatric vitamin B12 deficiency and neurodevelopmental delay. Results: Vitamin B12 deficiency in early childhood is most commonly associated with maternal deficiency and exclusive breastfeeding without adequate supplementation. Evidence from recent clinical and observational studies indicates that vitamin B12 deficiency may present with nonspecific neurological symptoms, including developmental regression, hypotonia, and feeding difficulties. Incorporating vitamin B12 assessment—using serum vitamin B12, holotranscobalamin, methylmalonic acid, and homocysteine—into early diagnostic algorithms for GDD may facilitate timely identification of a treatable cause of neurodevelopmental impairment. The proposed diagnostic framework emphasizes early biochemical evaluation in infants with unexplained developmental delay, thereby supporting prompt treatment during a critical window of neurological reversibility. Conclusions: Targeted assessment of vitamin B12 status in children with GDD, together with evaluation of maternal status, represents a clinically relevant approach to identifying a potentially preventable and treatable cause of neurodevelopmental impairment. Integration of functional biomarkers into diagnostic pathways and the development of pediatric-specific reference standards are key priorities for future research and clinical practice. Full article

Background: Ankyloglossia is a congenital anomaly characterized by restricted tongue mobility due to a short, thick, or tight lingual frenulum. Methods: This narrative review synthesizes current concepts on etiology, clinical presentation, diagnostic approaches, functional implications, and management for ankyloglossia in newborns. Results: Ankyloglossia can compromise breastfeeding dynamics, manifesting as suboptimal latch, maternal nipple pain, and inefficient milk transfer, and may influence orofacial function if unrecognized. Because anatomical appearance alone does not reliably predict function, evaluation should prioritize structured functional assessments over purely morphological descriptors. Management should be individualized and stepwise, beginning with lactation support and positioning strategies, and progressing to frenotomy when clear functional limitation persists. In appropriately selected cases, timely intervention can improve feeding efficiency and caregiver comfort while minimizing disruptions to early bonding and nutrition. Post-procedure follow-up is important to confirm functional gains and address residual feeding mechanics. Conclusions: A coordinated, multidisciplinary approach aligns diagnosis and treatment with the infant’s functional needs and family goals, promoting safe, effective, and patient-centered care. Full article

Objective: Nutrition is a key determinant of women’s health across all life stages. Clinical practice remains heterogeneous because of lack of evidence and non-homogeneous guidelines. Despite growing research on micronutrient supplementation, skeptical opinions persist around universal versus individualized approaches, optimal dosages, and life-stage-specific recommendations. Material and methods: This is a modified Delphi process conducted under the supervision of the Italian Association of University Gynecologists and Obstetricians (AGUI). Thirteen Italian experts in gynecology and obstetrics completed two rounds of anonymous online surveys (September–November 2025). The questionnaire, developed through a scoping review, covered six domains: pre-/periconception, pregnancy, postpartum, routine supplementation in non-pregnant women, nutrition in gynecological conditions, and menopause. Consensus was defined as ≥75% agreement on a 10-point Likert scale. Quantitative data were summarized descriptively, and qualitative comments contextualized findings. Results: Experts strongly supported personalized nutritional strategies across all life stages. Consensus was reached on individualized micronutrient supplementation in the preconception period and on the prescription of active folates for women undergoing assisted reproduction. In pregnancy, agreement emerged for universal DHA supplementation (200–300 mg/day); however, universal vitamin D supplementation lacked consensus except in gestational diabetes. In the postpartum period, iron supplementation for non-breastfeeding women reached consensus, while micronutrient recommendations for breastfeeding women remained uncertain. Strong agreement supported personalized dietary approaches for PCOS, endometriosis, and gestational diabetes, including inositol use, while evidence for interventions in severe premenstrual syndrome remained insufficiently supported. In menopause, consensus was reached for macronutrient adjustments and universal calcium and vitamin D supplementation. Conclusions: This Delphi consensus highlights shared expert perspectives on nutritional care in women and identifies key evidence gaps, particularly regarding vitamin D in physiological pregnancy, postpartum micronutrient needs during breastfeeding, and nutritional strategies for premenstrual disorders. Unified life-course guidelines and future research on standardized nutritional assessments are necessary for nutritional approach management. Full article

Background: Many countries in sub-Saharan Africa are at risk of inadequate calcium intake, yet no data exist for vulnerable population groups in Madagascar. We aimed to assess daily calcium intake, the major contributing food sources, and the prevalence of inadequate intake in young children, adolescents, and women of reproductive age. Methods: The 2024 National Micronutrient Survey used a two-stage probabilistic design across all 23 regions. The daily calcium intake was estimated using a food frequency questionnaire that focused on calcium-rich foods that are commonly consumed in Madagascar and the calcium concentration measured in drinking water. Results: Calcium intake was low across all population groups, averaging 200–300 mg/d in adolescents and women and below 180 mg/d in young children. The prevalence of inadequate intake exceeded 96% in every population group. While calcium intake increased with increasing household wealth in children, the opposite pattern was observed for adolescents and women, whose intake decreased with increasing wealth. The main contributors to calcium intake were cassava leaves, cassava roots, small fresh and dried fish eaten with bones, drinking water across all population groups, and breastmilk in young children. Conclusions: The calcium intake is low throughout Madagascar and across all demographic groups. Strategies to improve intake are urgently needed and should include promoting continued breastfeeding and the consumption of calcium-rich, locally available, affordable foods such as small fish eaten with bones and leafy green vegetables, alongside a consideration of wheat flour fortified with calcium. Full article

Background/Objectives: In Japan, hospital births predominate, with home births comprising only 0.1% of deliveries. This study assessed how documented practices for planned home births attended by independent midwives align with national guidelines and WHO intrapartum care recommendations, and assess maternal and neonatal differences before and after the COVID-19 pandemic. Methods: Records of 430 low-risk pregnant women who received continuous care at a private midwifery home over 25 years were reviewed. After excluding 8 maternal and 22 neonatal transfers, 400 records were analyzed. Descriptive statistics were compared with WHO recommendations and between the pre-pandemic (1999–2019) and post-pandemic (2020–2024) periods. Results: All women experienced spontaneous singleton cephalic labors with intermittent fetal heart rate auscultation. The mean gestational age was 277.3 days and the median labor duration was 303.5 min. Labor onset was spontaneous in 83.5% of cases. Nearly half of the women had no perineal lacerations. Postpartum blood loss ≥500 mL occurred in 14.1% of cases. Family presence was nearly universal. Neonates had a mean birth weight of 3129.0 g and high Apgar scores. Skin-to-skin contact occurred in 52.9%; exclusive breastfeeding reached 93.8% at 1 month. Post-pandemic births showed higher maternal age and higher neonatal birth weight, although these differences should be interpreted cautiously due to the small post-pandemic sample. Conclusions: Independent midwives provided evidence-based, physiologically oriented care, partially aligning with selected WHO intrapartum recommendations during planned home births. Midwife-led home births may support positive childbirth experiences and favorable maternal/neonatal outcomes for low-risk women. Post-pandemic shifts underscore the need for continued monitoring and flexible, community-based perinatal support, while recognizing the limitations of retrospective, single-site data. Full article

While breastfeeding is strongly recommended for infant health, uncertainty remains regarding its independent association with early childhood caries after accounting for sugar exposure. Objective: This study aimed to evaluate the controlled direct effect of breastfeeding on dental caries. Methods: Data were drawn from two population-based birth cohort studies: the 2015 Pelotas Birth Cohort Study (Brazil) and the SMILE Study (Australia). The exposure was any breastfeeding at 3, 6, and 12 months, with sugar consumption at 12 and 24 months as the mediator. The outcome was dental caries at ages 4/5, assessed as early childhood caries (ECC), severe ECC, any disease experience, or any decayed teeth. Marginal Structural Models with inverse probability of treatment weight were used to estimate the controlled direct effect of breastfeeding on dental caries, accounting for sociodemographic confounders and sugar consumption. Results: A total of 751 Australian and 3545 Brazilian children were included in at least one sub-analysis. Findings indicate a contextual difference: in Australia, breastfeeding had no effect on dental caries after considering sugar consumption as mediator, whereas in Brazil, children not breastfed had a lower risk of dental caries. For instance, adjusted Brazilian estimates showed a reduced relative risk ranging from 0.63 (95% CI 0.55; 0.72) for ECC to 0.43 (95% CI 0.34; 0.55) for severe ECC. Conclusions: The association between breastfeeding and dental caries appears to vary across socio-environmental contexts. In settings with high caries burden, prolonged breastfeeding may increase caries risk independently of sugar consumption; however, breastfeeding remains strongly recommended given its substantial overall health benefits. These findings highlight the importance of integrating early oral health guidance such as oral health education into breastfeeding support programs. Full article

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. Despite the availability of effective treatments and advances in diagnostic methods, TB remains the leading cause of death from infectious disease globally, with its incidence tending to increase. Pregnant women constitute a population group with particular characteristics, as the diagnosis and treatment of certain conditions can be challenging. Early diagnosis and monitoring of TB by a multidisciplinary team are crucial to guide treatment and reduce complications. Congenital TB, although uncommon, is a serious complication that should be assessed in neonates, especially when the mother has previously been diagnosed with the disease. First-line anti-TB drugs are considered safe during pregnancy and lactation. In contrast, second-line drugs have a less well-established safety profile during breastfeeding, and the available evidence regarding their excretion in breast milk remains limited; therefore, their use requires individualised risk-benefit assessment. Data on this specific population group are limited, as physiological changes during pregnancy alter the pharmacokinetics/pharmacodynamics (PK/PD) of drugs and the inclusion of pregnant women in clinical trials remains contentious. Routine TB screening in prenatal care, particularly in high-prevalence regions, is crucial to improving maternal and neonatal outcomes. This narrative review was based on a structured search of PubMed, Scopus, and Web of Science (January 2000–June 2025), using the keywords tuberculosis, Mycobacterium tuberculosis, pregnancy, and breastfeeding. Eligible articles included original studies, reviews, and international guidelines. Full article