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all critical outcomes, there is a net benefit resulting primarily from prevention of eczema (conditional recommendation, very- low-quality evidence).” The December 2016 RACGP HANDI limited the recommendation to probiotics containing only Lactobacillus species taken by women during pregnancy, and for women and infants during the postpartum period.40 Conclusion Knowledge of the interrelationship between micro- and macronutrient repletion and maintenance of a healthy microbiome in pregnant and breastfeeding women and potential long-term implications for the postpartum infant is rapidly evolving. Relying on a healthy diet is no longer sufficient for women planning pregnancy. The evidence for the role of nutrition in epigenetic programming and its impact on the first 1000 days of life is becoming clearer. Pharmacists need to understand the evidence supporting nutrient and probiotic supplementation in pregnancy, in order to educate patients, answer their enquiries and support women in their supplement choice. References 1. Vitora CG, Adair L, Fall C, et al. ‘Maternal and child undernutrition: Consequences for adult health and human capital’. Lancet 2008; 371: 340-57. 2. Smith C. ‘The effects of wartime starvation in Holland on pregnancy and its product’. Am J Obstet Gynecol, 1947; 53: 599-608. 3. Roseboom T, de Rooij S, Painter R. ‘The Dutch famine and its long-term consequences for adult health’. Early Hum Dev 2006; 82: 485-91. 4. Hoek HW, Susser EZ, Buck K, et al. ‘Schizoid personality disorder after prenatal exposure to famine’. Am J Psych, 1996; 153: 1637-9. 5. Painter RC, Osmond C, Gluckman P, et al. ‘Transgenerational effects of prenatal exposure to the Dutch famine on neonatal adiposity and health in later life’. BJOG, 2008; 115: 1243-9. 6. Barker DJ. ‘Foetal origins of coronary heart disease’. Br Med J, 1995; 311: 171-4. 7. Linnér A, Almgren M. ‘Epigenetic programming: The important first 1000 days’. Acta Paediatrica, 2019; 109: 443-52. 8. Lieberman DE. ‘The story of the human body’. New York: Pantheon Books, 2013. 9. Prescott SL. ‘Early life environmental determinants of allergic diseases and the wider pandemic of inflammatory non-communicable diseases’. J Allergy Clin Immunol, 2013; 131: 23-30. 10. Macpherson AJ, Agüero MG de, Ganal-Vonarburg SC. ‘How nutrition and the maternal microbiota shape the neonatal immune system’. Nat Rev Immunol, 2017; 17: 508-17. 11. Schwarzenberg SJ, Georgieff MK, AAP Committee on Nutritiion. ‘Advocacy for improving nutrition in the first 1000 days to support childhood development and adult health’. Pediatrics, 2018; 141: e20173716. 12. Harris WS. ‘Omega-3 fatty acids’. In: Coates PM, Betz JM, Blackman MR, et al, eds. Encyclopedia of Dietary Supplements. 2nd ed. London and New York: Informa Healthcare; 2010: 577-86. 13. National Health and Medical Research Council, Australian Government Department of Health and Ageing, New Zealand Ministry of Health. Nutrient Reference Values for Australia and New Zealand: Executive Summary: Extract of Table 20. Canberra: National Health and Medical Research Council; 2006. Version 1.2 Updated September 2017 nhmrc.gov.au/guidelines-publications/n35- n36-n37. Cited 8/4/20. 14. Meyer BJ. ‘Australians are not meeting the recommended intakes for omega-3 long chain polyunsaturated fatty acids: Results of an analysis from the 2011-2012 National Nutrition and Physical Activity survey. Nutrients, 2016; 8: 111. 15. Martinez M. ‘Tissue levels of polyunsaturated fatty acids during early human development’. J. Pediatr, 1992; 120: S129-38. 16. Meyer BJ, Onyiaodike CC, Brown EA, et al. ‘Maternal plasma DHA levels increase prior to 29 days post-LH surge in women undergoing frozen embryo transfer: A prospective, observational study of human pregnancy’. J Clin Endo Metab, 2016; 101: 1745-53. 17. Koletzko B, Cetin I, Brenna JT. ‘The Perinatal Lipid Intake Working Group Consensus Statement: Dietary fat intakes for pregnant and lactating women. Br J Nutr, 2007; 98: 873-7. 18. Saccone G, Saccone I, Berghella V. ‘Omega-3 long-chain polyunsaturated fatty acids and fish oil supplementation during pregnancy: Which evidence? J Matern Fetal Med, 2016; 29: 2389-97. 19. Middleton P, Gomersall JC, Gould JF, Shepherd E, Olsen SF, Makrides M. ‘Omega-3 fatty acid addition during pregnancy’. Cochrane Database Syst Rev. 2018 Nov 15; 11(11): CD003402. 20. Bakouei F, Delavar MA, Mashayekh-Amiri S, Esmailzadeh S, Taheri Z. ‘Efficacy of n-3 fatty acids supplementation on the prevention of pregnancy induced- hypertension or preeclampsia: A systematic review and meta-analysis’. Taiwan J Obstet Gynecol, 2020 Jan; 59 (1): 8-15. 21. Garcia-Larsen V, Ierodiakonou D, Jarrold K, Cunha S, Chivinge J, Robinson Z, Geoghegan N, Ruparelia A, Devani P, Trivella M, Leonardi-Bee J, Boyle RJ. ‘Diet during pregnancy and infancy and risk of allergic or autoimmune disease: A systematic review and meta-analysis’. PLoS Med, 2018 Feb 28; 15 (2): e1002507. 22. Lehner A, Staub K, Aldakak L, Eppenberger P, Rühli F, Martin RD, Bender N. ‘Impact of omega-3 fatty acid DHA and EPA supplementation in pregnant or breast-feeding women on cognitive performance of children: Systematic review and meta-analysis’. Nutr Rev, 2020 Sep 11: nuaa060. TO PAGE 64 CPD ACTIVITY 63 RETAIL PHARMACY • MAY 2021