Literature Review: Pregnant and breastfeeding ... - Eat For Health

Reference Hill 2005Dietary patterns Low allergen maternal diet: mothers excluded cow’s milk, eggs, peanuts, tree nuts, wheat, soy and fish from their dietControl diet: mothers in the control group consumed the foods listed aboveStudy typeRCTLevel of evidence II (intervention)SettingCommunity based infant health centres in Melbourne, AustraliaFundingRicegrowers’ Cooperative Ltd (Leeton, Australia)Participants107 exclusively breastfed infants presenting with colic (first six weeks of life); recruited between 2000 and 2002 – infants were well, term (> 37 weeks),singleton pregnancy, no significant obstetric complications or history of maternal substance abuse, no perinatal morbidity other than distress:Colic was defined as parent-reported infant distress exceeding 180 minutes per 24 hours on 3 days in the week before presentation;Mothers on strict vegan diets were excluded; three mothers on balanced ovo-lacto-vegetarian diets were included in the studyBaseline comparisons NADietary assessment NATimingAll except three mother-child dyads commenced the intervention before infant was six weeks old (three infants were assigned at 7.4, 8.0 and 8.6 weeksrespectively); intervention lasted 7 daysComparisonLow allergen maternal diet (mothers asked to exclude all foods containing dairy products, soy, wheat, eggs, peanuts, tree nuts and fish from their diet;their diet included a rice mild drink (supplied), meats, vegetables, fruits and cereals (corn and rice) and calcium supplement) versus maternal diet(mothers received 7 days rations of a soy and cow’s milk powder and were asked to consume 1 serve of peanuts, 1 serve of wheat and 1 chocolatemuesli bar a day, which were supplied)Both diets avoided food preservatives, colours and additives; Adherence to the diet was monitored with diet diaries on the last 2 days of the interventionOutcomesChange in cry/fuss duration over 48 hours, after 7 daysResults Improvement of ≥ 25% in cry/fuss score (two days before intervention versus days 6 and 7)Low allergen diet: 35/47 (74%)Control diet: 16/43 (37%)ARR 0.37 95% CI 0.18 to 0.56, p < 0.001- This analysis restricted to women fully adhering to dietsLow allergen diet: 33/44 (75%)Control diet: 14/24 (58%)p = 0.15Cry/fuss duration ≥ 360 min per 48 hr (days 6 and 7)Low allergen diet: 30/47 (64%)Control diet: 31/43 (72%)ARR 0.08 95% CI -0.11 to 0.27, p = 0.402No significant differences seen in maternal assessmentsNoncompliance in the control arm was associated with a lack of early response (i.e. these women chose to eliminate some of the foods)Followup7 days (duration of intervention)ConfoundingNARisk of biasLow risk of bias; randomisation schedule provided by statistician, third party randomisation; 90/107 infants completed the trial (47 in the low allergengroup and 43 in the control group); infants of noncompleters in the control group had a higher distress score at baselineRelevanceRelevant to Australian women and infants; low allergen diet may difficult to sustainOther commentsPregnancy and Breastfeeding Dietary Patterns35