Background Human milk oligosaccharides (HMOs) are unconjugated glycans associated with infant health and development. Objective To investigate the associations between HMO concentrations at one month and infant development throughout the first year of life. Methods A prospective cohort of Brazilian women between 18–40 years of age and their infants was studied from baseline (between 28–35 gestational weeks) and followed at one (n = 73), six (n = 51), and twelve months (n = 45). A total of 19 HMOs were quantified by high-performance liquid chromatography with fluorescence detection. Infant development was evaluated by Ages & Stages Questionnaires (ASQ-BR). A directed acyclic graph was used to define the minimally sufficient adjustment (gestational age at birth, gestational weight gain, prepregnancy BMI, maternal age, parity, and the mode of breastfeeding at one month). Cox regression models with hazard ratios and Benjamini-Hochberg multiple corrections were performed to estimate associations of HMOs with the cumulative risk of inadequate development for 5 developmental domains or for ≥ 2 developmental domains in all women and in the subset of secretor women (defined as the presence or near absence of 2′FL and INFP I). Results The multivariate models with multiple corrections revealed an inverse association between lacto-N-tetrose (LNT) and the risk of inadequate development for personal-social skills (0.06; 95% CI: 0.01, 0.76) and for ≥ 2 developmental domains (0.06; 95% CI: 0.01, 0.59). The secretor mothers analysis also showed inverse associations with slightly different results: personal-social skills (0.09; 95% CI: 0.02, 0.84) and ≥ 2 developmental domains (0.05; 95% CI: 0.01, 0.70). Conclusion Higher concentrations of LNT HMOs in Brazilian women are associated with their infants being less likely to be at risk of inadequate development for personal-social skills or for ≥ 2 developmental domains during the first year of life.

In this 2 × 2 factorial, outcome-assessor blinded, feasibility randomised trial we explored the effect of a non-pharmaceutical multi-component intervention on periodontal health and metabolic and inflammatory profiles among pregnant women with periodontitis receiving prenatal care in a Brazilian public health centre. 69 pregnant women (gestational age ≤20 weeks, T0) were randomly allocated into four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus periodontal therapy during pregnancy (early PT) (n = 17); (2) placebo sachet and powdered milk plus early PT (n = 15); (3) fortified sachet and powdered milk plus late PT (after delivery) (n = 19); (4) placebo sachet and powdered milk plus late PT (n = 18). Third trimester (T1) and 6–8 weeks postpartum (T2) exploratory outcomes included periodontal health (% sites with bleeding on probing (BOP)), glucose, insulin, C-Reactive Protein, serum calcium and vitamin D. The mean BOP was significantly reduced in the early PT groups, while BOP worsened in the late PT groups. No significant effect of fortification on BOP was observed. Changes in glucose levels and variation on birthweight did not differ among groups This feasibility trial provides preliminary evidence for estimating the minimum clinically important differences for selected maternal outcomes. A large-scale trial to evaluate the interventions’ clinical benefits and cost-effectiveness is warranted.

This study aims to assess the acceptability, adherence, and retention of a feasibility trial on milk fortification with calcium and vitamin D (Ca+VitD) and periodontal therapy (PT) among low income Brazilian pregnant women with periodontitis (IMPROVE trial). This 2 × 2 factorial feasibility trial used a mixed-methods evaluation. In total, 69 pregnant women were randomly allocated to four groups: 1. fortified sachet with Ca+VitD and milk plus early PT (throughout gestation); 2. placebo and milk plus early PT; 3. fortified sachet with Ca+VitD and milk plus late PT after childbirth; 4. placebo and milk plus late PT. Data were collected via questionnaires, field notes, participant flow logs, treatment diary, and focal group discussions. Quantitative and qualitative data were analysed using appropriate descriptive statistics and content analysis, respectively. Eligibility rate (12%) was below the target of 15%, but participation (76.1%) and recruitment rate (2 women/week) exceeded the targets. Retention rate (78.6%) was slightly below the target (80%). Adherence to the PT was significantly higher in the early treatment groups (98.8%) compared to the late treatment groups (29%). All women accepted the random allocation, and baseline groups were balanced. There was no report of adverse events. This multi-component intervention is acceptable, well-tolerated, and feasible among low-risk pregnant women in Brazil.

Objectives To evaluate the association of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on infant gut microbiota diversity and abundance and the role of breastfeeding on this association. Methods Prospective cohort conducted in Rio de Janeiro, Brazil. Maternal pre-pregnancy BMI (< 25; ≥ 25 kg/m², normal/excessive) and GWG adequacy (adequate; excessive) were the exposures and breastfeeding practice status (exclusively breastfeeding EBF; predominant/complementary feeding PCF) was analyzed as an effect modifier. Infant stool samples were collected for 56 infants between 26–45 days. Samples were sequenced using 16S rRNA gene sequencing (MiSeq). Analysis included alpha diversity indexes (Shannon, Faith-PD, and Observed species), beta diversity metrics and Wilcoxon-Mann-Whitney Test, linear regression, permutational multivariate analysis of variance and linear discriminant analysis effect size. Results A higher median alpha diversity in infants born from mothers with excessive GWG was observed (Mann-Whitney Test: P = 0.005) and infants born from mothers with excessive GWG were positively associated with alpha diversity (β = 0.351; SE = 0.146; p-value = 0.020). Gut microbiota of infants born from mothers with excessive pre-pregnancy BMI were enriched with Dialister genus and Lactobacillus Ruminis, Haemophilus Parainfluenzae and Veillonella Parvula species and those born from mother with excessive GWG had higher abundance of Staphylocococcus genus, Staphylococcaceae family, Bacillales order and Bacilli class. Infant gut microbiota diversity and abundance did not differ according to combined categories of pre-pregnancy BMI and breastfeeding status and GWG and breastfeeding. Conclusions Maternal gestational weight gain was associated with diversity of the infant gut microbiota. Breastfeeding did not an effect modifier in this association. Funding Sources Foundation for the Support of Research of the State of Rio de Janeiro, National Council for Scientific and Technological Development and Columbia University Grant.