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60 CPD ACTIVITY PROBIOTICS AND DHA FOR HEALTHY PREGNANCY Dr Treasure McGuire Treasure is Assistant Director of Pharmacy, Mater Health Services, South Brisbane, a Conjoint Lecturer, School of Pharmacy, University of Queensland, and Associate Professor of Pharmacology, Faculty of Health, Sciences & Medicine, Bond University. Dr Brett MacFarlane Brett is the Chief Pharmacist at the Australasian College of Pharmacy. He also contributes to the college’s development activities and its educational products. Dr MacFarlane is also a visiting fellow in the School of Clinical Sciences, Faculty of Health at the Queensland University of Technology. He graduated with honours from the School of Pharmacy at the University of Queensland and has worked for the Therapeutics Research Group at the Princess Alexandra Hospital Southern Clinical School in Brisbane where he gained a PhD in skin science. Inquiries: brett.macfarlane@acp.edu.au Development of this CPD activity was supported by an unrestricted educational grant from Bayer Australia. LEARNING OBJECTIVES After completing this CPD activity, pharmacists should be able to: • Describe the influence of maternal nutrition on epigenetic programming in the offspring’s first 1000 days of life. • Describe the evidence base for omega-3 fatty acid supplementation in pregnancy and breastfeeding. • Describe the evidence base for probiotic supplementation in pregnancy and breastfeeding. 2016 Competency Standards: 2.1, 2.3, 3.2, 3.5, 3.6. Accreditation Number: A2105RP3 (exp: 30/04/2023). Introduction The first 1000 days of life covers gestation and the first two years of life. Poor nutrition during this period can negatively impact human health and function in the short and long term. The problem of maternal and child undernutrition was highlighted in The Lancet in 20081 and recognition of the term ‘1000 days’ increased when former US secretary of state Hillary Clinton subsequently launched a foundation of the same name (thousanddays.org). Since then, consumer and health professional understanding of the importance of nutrition in pregnancy and lactation has been increasing. Nutritional requirements change throughout pregnancy such that: • During the first two to eight weeks, maternal nutrition impacts early embryonic development, particularly organogenesis, and neural development. • During the second and third trimesters, nutrients accumulate to sustain the baby during and after birth. To achieve the desired nutritional support for the foetus and the breastfeeding infant, mothers need an adequate preconception supply of all essential nutrients, as well as during pregnancy and postpartum. History repeats: the epigenetic effect of nutrient depletion The US Centres for Disease Control and Prevention defines epigenetics as: “The study of how your behaviours and environment can cause changes that affect the way your genes work. Unlike genetic changes, epigenetic changes are reversible and do not change your DNA sequence, but they can change how your body reads a DNA sequence.” Interest in adverse epigenetic outcomes in children born to parents who have experienced pathophysiological stressors is increasing. During World War II, the German occupied Netherlands experienced a severe famine, commonly referred to as the ‘hungry winter’. The famine affected some 4.5 million previously well-nourished citizens. Detailed information was kept on the weekly rations for the western Netherlands population during the famine and professional obstetric care was generally maintained. The detailed records of pregnancy outcomes, including birth weights, are a valuable source of longitudinal data that can be analysed for the effect of nutrient depletion on the various stages of gestation.2 Health of offspring of women pregnant during the ‘hungry winter’ (those receiving an average daily ration during any 13-week period of gestation below 1000 calories) was investigated at the ages of 50 and 58 years. Their results were compared with controls who were born before or after the famine or to mothers who had received greater than 1000 calories per day during the famine.3 Results indicated that offspring of RETAIL PHARMACY • MAY 2021 2 CPD CREDITS