Experts on preliminary results from new longitudinal study
The first results from the new Auckland-based longitudinal study "Growing Up in New Zealand" were released today at Parliament.
The study will follow more than 7000 Kiwi families over two decades, through pregnancy, birth, childhood and adolescence, until participating children reach adulthood. This first report presents data from extensive interviews with expectant mothers and their partners before the birth of the child.
It addresses a wide range of topics, from plans for immunisation, breastfeeding and parental leave from work, through to ethnic identity, family relationships, economic status and diet, tobacco and alcohol use during pregnancy.
Gathering data before children are born --
instead of relying on parents to recall their experiences
during pregnancy months or years later -- is a unique aspect
of this study's design. Also unique is the involvement of
fathers and partners throughout the study, which has not
been typical in previous longitudinal
studies.The SMC approached a number of
local scientists to look more closely at the various aspects
of the report, which can be downloaded here.
Dr Nikki Turner,
director of the Immunisation Advisory Centre at Auckland
University, comments on parents' plans for immunisation, and
their sources of information on the
subject:
"The trends are consistent with
what we're seeing in our other research, which is that
immunisation coverage in New Zealand is currently improving
and continuing to improve.
"There's some really good news: the majority of parents are keen to immunize and are expressing a decision to immunise, which is very positive.
"There are some concerning aspects of it. I think that the underpinning is that we know that nearly 90% of parents make their decision in the antenatal period, so the antenatal period is really important and it's crucial to get that right. Some of the concerns that come out of this, particularly, are that about 12% of mothers are still undecided, and more so with the partners. Our antenatal services should be able to offer good clear information and decision-making support tools for parents, and clearly, for a significant minority of parents, it's still not happening.
"I think the other piece of concern is that parents had expressed that they had been given discouraging information, from various sources, which is no surprise because there's a huge amount of information out there in the world. However, it's particularly concerning if they're picking up discouraging information from health professionals or from antenatal classes, considering that immunisation is probably the strongest evidence-base we have in all of child medicine currently. We have immunization programmes in every country in the world, strongly supported by all international health authorities.
"Finally, there
is a significantly higher percentage of people undecided if
it's their first child. It is really important that parents
having their first child are clearly informed of the issues
around immunization with good information and good
decision-making tools. We clearly do need to do more in the
antenatal arena to support parents in
decision-making." Dr Murray Skeaff, Professor of
Human Nutrition at the University of Otago, comments on the
intake by mothers of folic acid:
"For women
to benefit from the protective effect of folate on neural
tube defects (eg Spina Bifida), folic acid must be consumed
before and through the first month of pregnancy. Folic acid
taken after the first month of pregnancy will not prevent
neural tube defects. Thus, by the time most women know they
are pregnant it is too late. The results of the "Growing Up
in New Zealand" study showed that slightly more than half of
women (58%) who planned a pregnancy took folate at the
correct time before pregnancy. Thus, even amongst women
planning a pregnancy, 40% of them were not getting the
benefit of folic acid. Of greater concern is that amongst
women with unplanned pregnancies, which represented 40% of
all pregnancies, only 9% of them took folic acid before
pregnancy.
"These results reinforce those from previous
smaller surveys of pregnant women, that only about 1/3 of
New Zealand women who become pregnant benefit from the NTD
protective effects of folic acid supplements. The advantage
with folic acid supplementation is that women can receive
the optimum daily dose, 400 µg; however, the obvious
disadvantage, for which the "Growing Up in New Zealand"
study provides convincing evidence, is that the vast
majority of women do not use folic acid supplements at the
correct time. A proven alternative exists, mandatory folic
acid fortification of bread. Programmes have been
implemented recently in Australia and more than ten years
ago in the USA and Canada. Mandatory fortification of bread
in New Zealand will deliver about 140 µg/d of folic acid -
the amount in three slices of bread - to women of
childbearing age. This amount has dropped NTD rates by
almost 50% in Canada." Lisa Houghton, of the
Department of Human Nutrition at the University of Otago,
comments on the use of folic acid
supplements:
"In addition to the presentation of the data in the planned and unplanned sub-categories, it would also be useful to summarise and/or at least highlight in the text, the total number of women who took a folic acid supplement before pregnancy ie, overall, only 39% of mothers took a folic acid supplement before pregnancy
"This is really the most important aspect of neural tube defect prevention. With respect to the closure of the neural tube (complete within 28 days postconception), it would be useful to know how many (total) pregnancies have been exposed to folic acid supplementation prior to pregnancy since post-conception supplementation likely has little preventative impact with regard to NTDs.
"This overall
exposure statement would be quite meaningful in light of the
recent deferral of the mandatory folic acid bread
fortification program, which would serve to increase the
exposure of all pregnancies (planned and unplanned) to folic
acid prior to conception."
Dr Marewa Glover,
Senior Research Fellow at School of Population Health at The
University of Auckland, comments on aspects relating to
maternal smoking:
"The report says about
half the women quit smoking by last trimester, except for
Maori women. However, it should be pointed out that the
percentage amongst European was only 16%, dropping by 8%.
Maori women, while not halving, saw a higher total drop in
smoking (13%) from 47% to 34%.
"As the majority of
partners are men, there are 2 key important findings (given
that it is very rare that information is collected on
partner smoking):
1. "It appears that smoking among
Pacific women in the sample is the same or greater than
Pacific male smoking (but was ethnicity the ethnicity of the
partner or mother?) .. this is very concerning. I have been
speaking out, trying to warn people that smoking among
Pacific women is on the rise and risks imitating what's
happened to Maori women.
2. "It is fantastic that so many
partners [changed their smoking habits]! This must be one of
the most effective cessation triggers around. It points to
the potential for a lot more to be made of this - by the
quit campaigns, health promotion etc."
Susan Pullon, Senior Lecturer at Primary Care and General Practice at the University of Otago, (Wellington) comments on the maternal nutrition, proportion of unplanned pregnancies, and maternal care:
"This is a comprehensive and good quality report that will be of great use, and further reports will be welcome.
"Specifically, it highlights the need to get more mothers taking folic acid whenever they are not using a reliabel method of contraception - as opposed to actively planning a pregnancy.
"40 % unplanned sounds a lot but in practice there is a difference between unintended and unplanned - which could be made clearer in the report.
"I would have liked to see more data as to the timing of enrolment with an LMC (lead maternity carer): the figures for enrolment by third trimester only tell part of the story. What care did women receive in first trimester? First trimester care is best practice, whether by enrolment with LMC or other care, yet this data is not presented in the report."
ENDS