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64 CPD ACTIVITY FROM PAGE 63 23. RACGP Handbook of Non-Drug Interventions (HANDI) monograph: Intervention for omega-3 fatty acid supplementation in pregnancy to reduce pre-term birth, July 2019. Available at: racgp.org.au/clinical-resources/clinical- guidelines/handi/handi-interventions/nutrition/omega-3-fatty-acid-addition-in- pregnancy-to-reduce, cited 13/5/20. 24. Robertson RC, Manges AR, Finlay BB, Prendergast AJ. ‘The human microbiome and child growth: First 1000 days and beyond’. Trends Microbiol, 2019; 27: 131-47. 25. Koren O, Goodrich JK, Cullender TC, et al. ‘Host remodelling of the gut microbiome and metabolic changes during pregnancy’. Cell, 2012; 150: 470-80. 26. 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. 27. Logan AC, Jacka FN, Prescott SL. ‘Immune-microbiota interactions: Dysbiosis as a global health issue’. Curr Allergy Asthma Rep, 2016; 16: 13. 28. West CE, Jenmalm MC, Prescott SL. ‘The gut microbiota and its role in the development of allergic disease: A wider perspective’. lin Exp Allergy, 2015; 45: 43-53. 29. Baldassarre ME, Palladino V, Amoruso A, et al. ‘Rationale of probiotic supplementation during pregnancy and neonatal period’. Nutrients, 2018; 10: 1693. 30. Pelucchi C, Chatenoud L, Turati F, et al. ‘Probiotics supplementation during pregnancy or infancy for the prevention of atopic dermatitis: A meta-analysis’. Epidemiology, 2012; 23: 402-14. 31. Osborn DA, Sinn JKH. ‘Probiotics in infants for prevention of allergic disease and food hypersensitivity’. Cochrane Database Syst Rev, 2007; Art. No.: CD006475. DOI: 10.1002/14651858.CD006475. 32. Panduru M, Panduru NM, Sălăvăstru CM, Tiplica G-S. ‘Probiotics and primary prevention of atopic dermatitis: A meta-analysis of randomised controlled studies’. J Eur Acad Dermatol Venereo, 2015; 29: 232–42. 33. Zuccotti G, Meneghin F, Aceti A, Barone G, Callegari ML, Di Mauro A, Fantini MP, Gori D, Indrio F, Maggio L, Morelli L, Corvaglia L; Italian Society of Neonatology. ‘Probiotics for prevention of atopic diseases in infants: Systematic review and meta-analysis’. Allergy, 2015 Nov; 70 (11): 1356-71. 34. Barthow C, Wickens K, Stanley T, et al.’ The Probiotics in Pregnancy Study (PiP Study): rationale and design of a double-blind randomised controlled trial to improve maternal health during pregnancy and prevent infant eczema and allergy’. BMC Preg Childbirth, 2016; 16. doi.org/10.1186/s12884-016-0923-y. 35. Lindsay KL, Walsh CA, Brennan L, McAuliffe FM. ‘Probiotics in pregnancy and maternal outcomes: A systematic review’. J Matern Fetal Neonatal Med, 2013 May; 26 (8): 772-8. doi: 10.3109/14767058.2012.755166. 36. Taylor BL, Woodfall GE, Sheedy KE, O’Riley ML, Rainbow KA, Bramwell EL, Kellow NJ. ‘Effect of probiotics on metabolic outcomes in pregnant women with gestational diabetes: A systematic review and meta-analysis of randomized controlled trials’. Nutrients, 2017 May 5; 9 (5): 461. 37. Fischer LM, da Costa KA, Galanko J, et al. ‘Choline intake and genetic polymorphisms influence choline metabolite concentrations in human breast milk and plasma’ Am J Clin Nutr, 2010; 92:336-46. 38. Gomez Arango LF, Barrett HL, et al. ‘Probiotics and pregnancy’. Curr Diab Rep, 2015; 15: 567. 39. Fiocchi A, Pawankar R, Cuello-Garcia C, et al. World Allergy Organization- McMaster University guidelines for allergic disease prevention (GLAD-P): Probiotics. World Allergy Organ J, 2015; 8: 4. e-Collection 2015. 40. RACGP Handbook of Non-Drug Interventions (HANDI) monograph: Intervention for oral probiotics (containing only Lactobacillus species) taken by women during pregnancy, and women and infants during the postpartum period. Available at: racgp.org.au/clinical-resources/clinical-guidelines/handi/ handi-interventions/children/probiotics-in-pregnancy-for-infant-atopic-eczema. cited 13/5/20. Accreditation number: A2105RP3 (exp: 30/04/2023). This activity has been accredited for 1 hour of Group One CPD (or 1 CPD credit) suitable for inclusion in an individual pharmacist’s CPD plan which can be converted to 1 hour of Group Two CPD (or 2 CPD credits) upon successful completion of relevant assessment activities. 1. Which of the following statements about the first 1000 days is CORRECT? A) Epigenetics is the study of the environment of a human changing the structure of their DNA. B) The first 1000 days starts from the birth of the neonate. C) Nutritional stressors experienced during pregnancy have been linked to adverse health outcomes in offspring. D) Nutritional deficiency in pregnant women caused by famine has been linked to lower birth weight and increased obesity in offspring but not increased risk of psychological conditions. E) Nutritional status during pregnancy does not influence foetal growth and development. 2. Complete the sentence. The omega-3 long chain poly-unsaturated fatty acid docosahexaenoic acid (DHA) A) Is produced in large quantities in human tissues from alpha-linolenic acid. B) Should represent five per cent of total omega-3 fatty acid intake. C) Is not required for normal development of the human foetus. D) Has been found to be taken in insufficient quantities in the Australian diet. E) Causes adverse effects in women of reproductive age with intakes up to 1000mg daily. 3. Evidence supports maternal fish oil supplementation prevents all the following adverse pregnancy outcomes EXCEPT. A) Preterm birth. B) Pre-eclampsia. C) Intra-uterine growth retardation. D) Gestational diabetes. E) Poor cognition in offspring. 4. Which of the following statements about the maternal microbiome is CORRECT? A) The maternal gastrointestinal microbiome remains static in make-up throughout the pregnancy. B) The maternal gastrointestinal microbiome plays an important role in growth and development of the mother and baby. C) Babies born by caesarean section have microbiomes that resemble that of their mother’s uterus. D) Changes in vaginal microbiota has not been linked to preterm birth. E) The maternal gastrointestinal microbiome increases energy yield from the diet but is not involved with vitamin production. 5. Meta-analysis indicates that supplementation with probiotics during pregnancy and to the neonate reduces the risk of which of the following atopic diseases? A) Eczema. B) Asthma. C) Rhinoconjunctivitis. D) Wheezing. Probiotics and DHA for healthy pregnancy 2 CPD CREDITS RETAIL PHARMACY • MAY 2021