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BMC Gastroenterology
Published in: BMC Gastroenterology 1/2020

Open Access 01-12-2020 | Ulcerative Colitis | Research article

Intake of dairy protein during pregnancy in IBD and risk of SGA in a Norwegian population-based mother and child cohort

Authors: May-Bente Bengtson, Margaretha Haugen, Anne Lise Brantsæter, Geir Aamodt, Morten H. Vatn

Published in: BMC Gastroenterology | Issue 1/2020

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Abstract

Background

Patients with inflammatory bowel disease (IBD) tend to avoid dairy products to minimize abdominal pain and diarrhea. The aim of this study was to estimate the proportion of protein from dairy sources (PPDS) in mothers with and without IBD, and to explore the impact of PPDS on inadequate gestational weight gain (GWG) or small for gestational age (SGA) in IBD compared to non-IBD in the population-based Norwegian Mother, Father and Child Cohort Study (MoBa).

Methods

MoBa includes about 95,000 pregnant women recruited throughout Norway from 1999 to 2008. IBD phenotype and complications during pregnancy and delivery were ascertained. This study included 148 mothers with Crohn disease (CD) and 194 with ulcerative colitis and 68,858 non-IBD mothers. In mid-pregnancy participants answered a comprehensive semi-quantitative food frequency questionnaire assessing diet since the start of pregnancy. PPDS was ranked in quartiles. The two lowest quartiles were merged and considered to represent the lowest of three PPDS groups. We used logistic regression analyses to model multivariate associations, adjusting for potential confounders.

Results

The risk of belonging to the lowest PPDS group was twice as high in IBD mothers compared to non-IBD mothers (aOR = 2.02, 95% CI: 1.53, 2.67). Low compared to high PPDS strongly predicted inadequate GWG in CD (aOR = 4.22, 95% CI: 1.28, 13.92). Surprisingly, and in opposition to the non-IBD mothers, PPDS was positively associated with the risk of SGA in IBD mothers. IBD mother with low PPDS was associated with significantly lower risk of SGA than non-IBD mothers and IBD mothers with high PPDS (aOR = 0.19, 95% CI: 0.07, 0.50). The interaction term IBD/PPDS was the factor that linked SGA to IBD compared to non-IBD, and increased the association between IBD and SGA with a factor of three.

Conclusion

This study shows that intake of dairy products is lower in IBD mothers than in non-IBD mothers, and further, that low intake of dairy products in IBD mothers is associated with reduced risk of SGA compared to non-IBD and IBD mothers with high PPDS.
Literature
1.
Bush MC, Patel S, Lapinski RH, Stone JL. Perinatal outcomes in inflammatory bowel disease. J Matern-fetal Neonatal Med. 2004;15(4):237–41.PubMedCrossRef
2.
Morales M, Berney T, Jenny A, Morel P, Extermann P. Crohn's disease as a risk factor for the outcome of pregnancy. Hepato-Gastroenterol. 2000;47(36):1595–8.
3.
Mahadevan U, Sandborn WJ, Li DK, Hakimian S, Kane S, Corley DA. Pregnancy outcomes in women with inflammatory bowel disease: a large community-based study from northern California. Gastroenterology. 2007;133(4):1106–12.PubMedCrossRef
4.
Molnar T, Farkas K, Nagy F, Lakatos PL, Miheller P, Nyari T, Horvath G, Szepes Z, Marik A, Wittmann T. Pregnancy outcome in patients with inflammatory bowel disease according to the activity of the disease and the medical treatment: a case-control study. Scand J Gastroenterol. 2010;45(11):1302–6.PubMedCrossRef
5.
Norgard B, Hundborg HH, Jacobsen BA, Nielsen GL, Fonager K. Disease activity in pregnant women with Crohn's disease and birth outcomes: a regional Danish cohort study. Am J Gastroenterol. 2007;102(9):1947–54.PubMedCrossRef
6.
Suchy FJ, Brannon PM, Carpenter TO, Fernandez JR, Gilsanz V, Gould JB, Hall K, Hui SL, Lupton J, Mennella J, et al. National Institutes of Health consensus development conference: lactose intolerance and health. Ann Intern Med. 2010;152(12):792–6.PubMedCrossRef
7.
Naganuma M, Kunisaki R, Yoshimura N, Nagahori M, Yamamoto H, Kimura H, Sako M, Kawaguchi T, Takazoe M, Yamamoto S, et al. Conception and pregnancy outcome in women with inflammatory bowel disease: a multicentre study from Japan. J Crohn's Colitis. 2011;5(4):317–23.CrossRef
8.
Stephansson O, Larsson H, Pedersen L, Kieler H, Granath F, Ludvigsson JF, Falconer H, Ekbom A, Sorensen HT, Norgaard M. Crohn's disease is a risk factor for preterm birth. Clin Gastroenterol Hepatol. 2010;8(6):509–15.PubMedCrossRef
9.
Stephansson O, Larsson H, Pedersen L, Kieler H, Granath F, Ludvigsson JF, Falconer H, Ekbom A, Sorensen HT, Norgaard M. Congenital abnormalities and other birth outcomes in children born to women with ulcerative colitis in Denmark and Sweden. Inflamm Bowel Dis. 2011;17(3):795–801.PubMedCrossRef
10.
Brasil Lopes M, Rocha R, Castro Lyra A, Rosa Oliveira V, Gomes Coqueiro F, Silveira Almeida N, Santos Valois S, Oliveira Santana G. Restriction of dairy products; a reality in inflammatory bowel disease patients. Nutr Hosp. 2014;29(3):575–81.PubMed
11.
Filippi J, Al-Jaouni R, Wiroth JB, Hebuterne X, Schneider SM. Nutritional deficiencies in patients with Crohn's disease in remission. Inflamm Bowel Dis. 2006;12(3):185–91.PubMedCrossRef
12.
13.
Dzakpasu S, Fahey J, Kirby RS, Tough SC, Chalmers B, Heaman MI, Bartholomew S, Biringer A, Darling EK, Lee LS, et al. Contribution of prepregnancy body mass index and gestational weight gain to adverse neonatal outcomes: population attributable fractions for Canada. BMC Pregnancy Childbirth. 2015;15:21.PubMedPubMedCentralCrossRef
14.
Haugen M, Brantsaeter AL, Winkvist A, Lissner L, Alexander J, Oftedal B, Magnus P, Meltzer HM. Associations of pre-pregnancy body mass index and gestational weight gain with pregnancy outcome and postpartum weight retention: a prospective observational cohort study. BMC Pregnancy Childbirth. 2014;14:201.PubMedPubMedCentralCrossRef
15.
Bengtson MB, Aamodt G, Mahadevan U, Vatn MH. Inadequate gestational weight gain, the hidden link between maternal IBD and adverse Pregnancy outcomes: results from the Norwegian mother and child cohort study. Inflamm Bowel Dis. 2017;23(7):1225–33.PubMedCrossRef
16.
Brantsaeter AL, Olafsdottir AS, Forsum E, Olsen SF, Thorsdottir I. Does milk and dairy consumption during pregnancy influence fetal growth and infant birthweight? A systematic literature review. Food Nutr Res. 2012;56:20050.CrossRef
17.
Vidarsdottir JB, Johannsdottir SE, Thorsdottir I, Bjornsson E, Ramel A. A cross-sectional study on nutrient intake and -status in inflammatory bowel disease patients. Nutr J. 2016;15(1):61.PubMedPubMedCentralCrossRef
18.
Magnus P, Birke C, Vejrup K, Haugan A, Alsaker E, Daltveit AK, Handal M, Haugen M, Hoiseth G, Knudsen GP, et al. Cohort profile update: the Norwegian mother and child cohort study (MoBa). Int J Epidemiol. 2016;45(2):382–8.PubMedCrossRef
19.
Brantsaeter AL, Haugen M, Alexander J, Meltzer HM. Validity of a new food frequency questionnaire for pregnant women in the Norwegian mother and child cohort study (MoBa). Matern Child Nutr. 2008;4(1):28–43.PubMedCrossRef
20.
Brantsaeter AL, Haugen M, Julshamn K, Alexander J, Meltzer HM. Evaluation of urinary iodine excretion as a biomarker for intake of milk and dairy products in pregnant women in the Norwegian mother and child cohort study (MoBa). Eur J Clin Nutr. 2009;63(3):347–54.PubMedCrossRef
21.
Lauritsen J. FoodCalc-data program from the project “diet, Cancer and health”. The Danish Cancer Society; 1999.
22.
Meltzer HM, Brantsaeter AL, Ydersbond TA, Alexander J, Haugen M. Methodological challenges when monitoring the diet of pregnant women in a large study: experiences from the Norwegian mother and child cohort study (MoBa). Matern Child Nutr. 2008;4(1):14–27.PubMedCrossRef
23.
National Research Council. Weight Gain During Pregnancy: Reexamining the guidelines. Washington DC: National Academy of Sciences; 2009.
24.
Jowett SL, Seal CJ, Pearce MS, Phillips E, Gregory W, Barton JR, Welfare MR. Influence of dietary factors on the clinical course of ulcerative colitis: a prospective cohort study. Gut. 2004;53(10):1479–84.PubMedPubMedCentralCrossRef
25.
Zallot C, Quilliot D, Chevaux JB, Peyrin-Biroulet C, Gueant-Rodriguez RM, Freling E, Collet-Fenetrier B, Williet N, Ziegler O, Bigard MA, et al. Dietary beliefs and behavior among inflammatory bowel disease patients. Inflamm Bowel Dis. 2013;19(1):66–72.PubMedCrossRef
26.
Olmedo-Requena R, Gomez-Fernandez J, Mozas-Moreno J, Lewis-Mikhael AM, Bueno-Cavanillas A, Jimenez-Moleon JJ. Factors associated with adherence to nutritional recommendations before and during pregnancy. Women Health. 2017;58:1–18.
27.
Jowett SL, Seal CJ, Phillips E, Gregory W, Barton JR, Welfare MR. Dietary beliefs of people with ulcerative colitis and their effect on relapse and nutrient intake. Clin Nutr (Edinburgh, Scotland). 2004;23(2):161–70.CrossRef
28.
Ripoli J, Miszputen SJ, Ambrogini O Jr, Carvalho L. Nutritional follow-up of patients with ulcerative colitis during periods of intestinal inflammatory activity and remission. Arq Gastroenterol. 2010;47(1):49–55.PubMedCrossRef
29.
Holt DQ, Strauss BJ, Moore GT. Patients with inflammatory bowel disease and their treating clinicians have different views regarding diet. J Hum Nutr Diet. 2017;30(1):66–72.PubMedCrossRef
30.
Cuco G, Arija V, Iranzo R, Vila J, Prieto MT, Fernandez-Ballart J. Association of maternal protein intake before conception and throughout pregnancy with birth weight. Acta Obstet Gynecol Scand. 2006;85(4):413–21.PubMedCrossRef
31.
Moore VM, Davies MJ, Willson KJ, Worsley A, Robinson JS. Dietary composition of pregnant women is related to size of the baby at birth. J Nutr. 2004;134(7):1820–6.PubMedCrossRef
32.
Rao S, Yajnik CS, Kanade A, Fall CH, Margetts BM, Jackson AA, Shier R, Joshi S, Rege S, Lubree H, et al. Intake of micronutrient-rich foods in rural Indian mothers is associated with the size of their babies at birth: Pune maternal nutrition study. J Nutr. 2001;131(4):1217–24.PubMedCrossRef
33.
Olmedo-Requena R, Amezcua-Prieto C, Luna-Del-Castillo Jde D, Lewis-Mikhael AM, Mozas-Moreno J, Bueno-Cavanillas A, Jimenez-Moleon JJ. Association between low dairy intake during Pregnancy and risk of small-for-gestational-age infants. Matern Child Health J. 2016;20(6):1296–304.PubMedCrossRef
34.
Olsen SF, Halldorsson TI, Willett WC, Knudsen VK, Gillman MW, Mikkelsen TB, Olsen J. Milk consumption during pregnancy is associated with increased infant size at birth: prospective cohort study. Am J Clin Nutr. 2007;86(4):1104–10.PubMedCrossRef
35.
Nazmi A, Diez Roux A, Ranjit N, Seeman TE, Jenny NS. Cross-sectional and longitudinal associations of neighborhood characteristics with inflammatory markers: findings from the multi-ethnic study of atherosclerosis. Health Place. 2010;16(6):1104–12.PubMedPubMedCentralCrossRef
36.
Campbell AK, Waud JP, Matthews SB. The molecular basis of lactose intolerance. Sci Prog. 2009;92(Pt 3–4):241–87.PubMedCrossRef
37.
Eadala P, Matthews SB, Waud JP, Green JT, Campbell AK. Association of lactose sensitivity with inflammatory bowel disease--demonstrated by analysis of genetic polymorphism, breath gases and symptoms. Aliment Pharmacol Ther. 2011;34(7):735–46.PubMedCrossRef
38.
Bernstein CN, Ament M, Artinian L, Ridgeway J, Shanahan F. Milk tolerance in adults with ulcerative colitis. Am J Gastroenterol. 1994;89(6):872–7.PubMed
39.
Gupta R, Makharia G, Khadgawat R, Yadav RK. Evaluation of lactose and milk intolerance, and bone mineral density in Indian patients with inflammatory bowel disease. Natl Med J India. 2012;25(6):327–31.PubMed
40.
Waud JP, Matthews SB, Campbell AK. Measurement of breath hydrogen and methane, together with lactase genotype, defines the current best practice for investigation of lactose sensitivity. Ann Clin Biochem. 2008;45(Pt 1):50–8.PubMedCrossRef
41.
Cohen-Mekelburg S, Tafesh Z, Coburn E, Weg R, Malik N, Webb C, Hammad H, Scherl E, Bosworth BP. Testing and Treating Small Intestinal Bacterial Overgrowth Reduces Symptoms in Patients with Inflammatory Bowel Disease. Dig Dis Sci. 2018;63(9):2439.PubMedCrossRef
42.
Misselwitz B, Butter M, Verbeke K, Fox MR. Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut. 2019;68(11):2080.PubMedCrossRef
43.
Teruel C, Garrido E, Mesonero F. Diagnosis and management of functional symptoms in inflammatory bowel disease in remission. World J Gastrointest Pharmacol Ther. 2016;7(1):78–90.PubMedPubMedCentralCrossRef
44.
Moum B, Vatn MH, Ekbom A, Fausa O, Aadland E, Lygren I, Sauar J, Schulz T. Incidence of inflammatory bowel disease in southeastern Norway: evaluation of methods after 1 year of registration. Southeastern Norway IBD study Group of Gastroenterologists. Digestion. 1995;56(5):377–81.PubMedCrossRef
45.
Bengtson MB, Martin CF, Aamodt G, Vatn MH, Mahadevan U. Inadequate gestational weight gain predicts adverse Pregnancy outcomes in mothers with inflammatory bowel disease: results from a prospective US Pregnancy cohort. Dig Dis Sci. 2017;62(8):2063–9.PubMedCrossRef
Metadata
Title
Intake of dairy protein during pregnancy in IBD and risk of SGA in a Norwegian population-based mother and child cohort
Authors
May-Bente Bengtson
Margaretha Haugen
Anne Lise Brantsæter
Geir Aamodt
Morten H. Vatn
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Gastroenterology / Issue 1/2020
Electronic ISSN: 1471-230X
DOI
https://doi.org/10.1186/s12876-020-1182-y

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