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Prenatal Vitamin

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1242. Recommendations for practices utilizing gestational carriers: a committee opinion

. Certain situations may dictate the use of a carrier older than 45 years of age, but all parties involvedmustbeinformedaboutthepotential risks of pregnancy with advancing maternal age. 3. Ideally, the carrier should have had at least one, term, uncomplicated pregnancy before being considered as a gestational carrier for another couple. 4. Ideally, the carrier should not have had more thanatotalof?vepreviousdeliveriesorthree deliveries via cesarean section. 5. Ideally,thecarriershouldhaveastablefamily (...) should be discussed before treatment. f. Behaviorofthegestationalcarrier:Individuals who smoke, consume alcohol (>1 drink per day), or have other potentially harmful habits should not be considered as gestational car- riers. Activity of the carrier (travel, exercise, diet, sexual activity, vitamin supplements, etc.) should be discussed between the parties and agreed upon in advance of treatment. g. Compensation to the gestational carrier: Compensation to the gestational carrier should be agreed upon

2017 Society for Assisted Reproductive Technology

1243. Human Milk Storage Information for Home Use for Full-Term Infants

indefinitely from bacterial contamination, although enzymatic processes inherent in food could persist, with possible changes in milk quality. Fat, protein, and calories decrease in human milk when frozen for 90 days compared to fresh human milk. Frozen human milk has a significant increase in acidity by 3 months, likely due to ongoing lipase activity, that increases free fatty acids in the milk. Based on a few studies with very small samples sizes, vitamin E appears stable in frozen milk over time (...) , and vitamin C levels decrease significantly after 1–5 months of storage. , There is a paucity of research on how freezer storage affects nearly all vitamins and minerals in human milk. Bioactive factors in human milk variably diminish with freezing. Lactoferrin levels and bioactivity are significantly lower in human milk frozen at −20°C for 3 months. , , However, several cytokines, IgA and growth factors from colostrum are stable for at least 6 months at −20°C (−4°F). , One trial evaluating milk frozen

2017 Academy of Breastfeeding Medicine

1244. Supplementary Feedings in the Healthy Term Breastfed Neonate Full Text available with Trip Pro

to the needs of an individual patient. Definitions Used in This Protocol • Exclusive breastfeeding: Feeding only breast milk (at the breast or own mothers' expressed breast milk), no food or water except vitamins, minerals, and medications. • Supplementary feedings: Additional fluids provided to a breastfed infant before 6 months (recommended duration of exclusive breastfeeding). These fluids may include donor human milk, infant formula, or other breast milk substitutes (e.g., glucose water (...) days) with 97.5% having regained their birth weight by 21 days. Infants should be followed closely to identify those who lie outside the predicted pattern, but the majority of those breastfed infants will not require supplementation. It should also be noted that excess newborn weight loss is correlated with positive maternal intrapartum fluid balance (received through intravenous fluids) and may not be directly indicative of breastfeeding success or failure. , Early management of the new

2017 Academy of Breastfeeding Medicine

1245. American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis

. We used a group consensus process to determine the final recommendations and grade their strength. Theguidelineaddressesinitialassessmentandreassess- mentinpatientsbeginningorcontinuinglong-term(‡3 months) glucocorticoid (GC) treatment, as well as the relativebenefitsandharmsoflifestylemodification and of calcium, vitamin D, bisphosphonate, raloxifene, teri- paratide,anddenosumabtreatmentinthegeneraladult populationreceivinglong-termGCtreatment,aswellas inspecialpopulationsoflong-termGCusers (...) . Results. Because of limited evidence regarding the benefits and harms of interventions in GC users, most recommendationsinthisguideline areconditional (uncertain balance between benefits and harms). Rec- ommendations include treating only with calcium and vitamin D in adults at low fracture risk, treating with calcium and vitamin D plus an additional osteoporosis medication(oralbisphosphonatepreferred)inadultsat moderate-to-high fracturerisk,continuing calcium plus

2017 American College of Rheumatology

1246. 2017 Antithrombotic Therapy in Atrial Fibrillation Associated with Valvular Heart Disease: A Joint Consensus Document from EHRA and ESC Working Group on Thrombosis

and variable management strategies, including non-vitamin K antagonist oral anticoagulants (NOACs) in patients with VHD other than prosthetic heart valves or haemodynamically significant mitral valve disease, there is a need to provide expert recommendations for professionals participating in the care of patients presenting with AF and associated VHD. To address this topic, a Task Force was convened by the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group (...) practice for different forms of VHD. This consensus document proposes that the term ‘valvular AF’ is outdated and given that any definition ultimately relates to the evaluated practical use of oral anticoagulation (OAC) type , we propose a functional Evaluated Heartvalves, Rheumatic or Artificial (EHRA) categorization in relation to the type of OAC use in patients with AF, as follows: (i) EHRA Type 1 VHD, which refers to AF patients with ‘VHD needing therapy with a Vitamin K antagonist (VKA); and (ii

2017 Heart Rhythm Society

1247. Arrhythmias in Congenital Heart Disease: A Position Paper of EHRA, AEPC, and ESC Working Group on Grown-up Congenital Heart Disease

Congenital complete heart block may occur in a structurally normal heart (isolated CCHB) or in association with a variety of CHD. The frequent aetiologies of CCHB are listed in Table3. Symptoms are related to underlying anatomy and ventricular rate and include heart failure prenatally and in infancy, and reduced exercise tolerance, presyncope, or syncope (Stokes–Adams attacks) at any age. 93–97 Long-term conventional right ventricular apical pacing may result in desynchronization of ventricular

2017 Heart Rhythm Society

1248. NASPGHAN Clinical Practice Guideline for the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease in Children: Recommendations from the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nu

for NAFLD. The first study showed that fibrosis remained stable or resolved in 11 of 18 patients after an average of 28 months (17). Worsening fibrosis was reported in 4 out of 5 patients reviewed in a retrospective study at a mean time frame of 41 months (18). The natural history of pediatric NAFLD in the setting of lifestyle counseling was represented by the placebo arm of the TONIC trial, a 2-year randomized control trial designed to compare vitamin E, metformin, and placebo with liver biopsies (...) do not occur under the age of 21 years, studies determining clinical outcomes from pediatric NAFLD will require long-term follow-up into adulthood. Extrapolation from adult natural history studies may not be sufficient because today’s children are more likely to experience early onset of obesity, increased severity of obesity, and exposure in utero to maternal obesity and insulin resistance compared to children of prior decades (24). SCREENINGFORNONALCOHOLICFATTYLIVER DISEASE IN CHILDREN Similar

2017 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

1249. AIM Clinical Appropriateness Guidelines for Pharmacogenetic Testing and Genetic Testing for Thrombotic Disorders

(eg, *28, *36, *37) 81355 VKORC1 (vitamin K epoxide reductase complex, subunit 1) (eg, warfarin metabolism), gene analysis, common variant(s) (eg, -1639G>A, c.173+1000C>T) 81291 MTHFR (5,10-methylenetetrahydrofolate reductase) (eg, hereditary hypercoagulability) gene analysis, common variants (eg, 677T, 1298C) 81240 F2 (prothrombin, coagulation factor II) (eg, hereditary hypercoagulability) gene analysis, 20210G>A variant 81241 F5 (coagulation factor V) (eg, hereditary hypercoagulability) gene (...) anticoagulant prophylaxis unless they were found to have a genotype associated with a high risk of VTE recurrence (FVL homozygosity, F2 G20210A homozygosity, or compound heterozygosity for FVL and F2 G20210A). Genetic testing for these patients is indicated. There may also be benefit to screening pregnant women with a family history of known thrombophilia, as those women found to have a high risk genotype would be offered antenatal prophylactic anticoagulant therapy even in the absence of a personal history

2017 AIM Specialty Health

1250. Guideline for the Evaluation of Cholestatic Jaundice in Infants: Joint Recommendations of NASPGHAN and ESPGHAN

hyperbilirubinemia Prenatal history Prenatal ultrasonography ?ndings Presence of choledochal cyst, cholelithiasis, bowel anomalies or concern for syndrome Cholestasis of pregnancy May be seen in heterozygotes for PFIC gene mutations; mitochondrial disorder Acute fatty liver of pregnancy Neonatal long-chain 3-hydroxyacyl-coenzyme A dehydrogenase (LCHAD) de?ciency Maternal infections TORCH infections Infant history Gestational age Prematurity as a risk factor for neonatal hepatitis SGA Increased risk of neonatal (...) Neurologic Note overall vigor and tone PFIC¼ progressive familial intrahepatic cholestasis; TJP ¼ tight-junction protein. JPGN Volume 64, Number 1, January 2017 Guideline for the Evaluation of Cholestatic Jaundice in Infants www.jpgn.org 159 Copyright © ESPGHAL and NASPGHAN. All rights reserved. HISTORY Obtaining a detailed prenatal and infant history is funda- mental and should include details of the neonatal screening and any medication including vitamin K supplementation. Details of feed- ing history

2017 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

1251. Review of Prader-Willi syndrome: the endocrine approach Full Text available with Trip Pro

on the endocrine and neurologic systems, metabolism, and behavior. The estimated prevalence of PWS is 1 in 10,000 to 30,000, with equal numbers of male and females affected. PWS results from lack of expression of the paternally-inherited genes on chromosome 15q11.2-q13 due to paternal deletion, maternal uniparental disomy, or imprinting defect of this region ( ). Early in life, PWS is characterized by hypotonia and failure to thrive, followed by obesity and hyperphagia ( ). Patients with PWS develop (...) of subnormal GH reserve and IGF-1 generation in individuals with PWS leading to subnormal growth response. Pituitary GH reserve may progressively decline with age in PWS children and GH levels are noted to be relatively lower in obese PWS patients than those who are non-obese ( ). Additionally, one study has shown genotypic differences in GH secretary responses on GH stimulation testing, with higher GH response in PWS patients with paternal deletion of 15q11-q13 than in those with maternal UPD15

2017 Pediatric Endocrine Society

1252. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline Full Text available with Trip Pro

identity, the prevalence of GD/gender incongruence was much greater in this group than in the general population without a DSD. This supports the concept that there is a role for prenatal/postnatal androgens in gender development ( – ), although some studies indicate that prenatal androgens are more likely to affect gender behavior and sexual orientation rather than gender identity per se ( , ). Researchers have made similar observations regarding the potential role of androgens in the development

2017 Pediatric Endocrine Society

1253. European Society of Endocrinology Clinical practice guidelines for the care of girls and women with Turner syndrome

mosaicism diagnosed postnatally has a more severe presentation than when identified prenatally, as many of these are found incidentally due to karyotyping for other indications, such as for advanced maternal age ( , , ). 45,X/47,XXX mosaicism has a milder phenotype ( ). The presence of a Y chromosome detected by standard karyotype or FISH (fluorescent in situ hybridization) is associated with an increased risk of gonadoblastoma ( ). A ring X chromosome is sometimes associated with variable intellectual (...) for advanced maternal age, abnormal serum markers or the presence of multiple anomalies. Regardless of the indication, test procedure or specific result, genetic counseling by a geneticist or genetic counselor should be provided before and after any prenatal diagnostic procedure. Ultrasonography can play an important role that suggests an increased likelihood of TS. In the first trimester, increased nuchal translucency is common in fetuses with TS, but is also observed in the autosomal trisomy syndromes

2017 European Society of Endocrinology

1255. Improving Health and Wellbeing Outcomes in the Early Years

years refers to the period from prenatal development to eight years of age. The discussions that follow in some cases extend to include prevention and early intervention beyond age eight. This chapter sets the context for a focus on early years and summarises the most important recent policy developments in this area across the island of Ireland. At the outset it is important to state that while the terms health inequality and health inequity are often used interchangeably, there is a distinction (...) Strategy for Affordable and Integrated Childcare 2015-2025 has a dual focus on children’s development, through affordable and integrated quality childcare, and on ensuring that childcare costs are not a barrier to parents working outside the home. This forthcoming strategy will follow on from the work of Bright Start. In addition, Northern Ireland’s paternity and maternity statutory leave entitlements have now been extended to ‘shared parental leave’ which is a progressive policy encouraging the caring

2017 Institute of Public Health in Ireland

1256. Use of multiple micronutrient powders for point-of-use fortification of foods consumed by infants and young children aged 6?23 months and children aged 2?12 years

% and 48%, respectively, of children aged 6–59 months suffering from anaemia. Iron deficiency is thought to be the most common cause of anaemia. It is also estimated that 29% of preschool-age children in low- and middle-income countries are affected by vitamin A deficiency. The highest burden occurs in Saharan Africa and South Asia, with approximately 48% and 44% of children aged 6–59 months being vitamin A deficient. 4 T o date, no direct estimates of zinc deficiency are available for these age groups (...) take place. 7 This guideline is intended to help Member States and their partners in their efforts to make evidence- informed decisions on the appropriate nutrition actions to improve the nutritional status of infants and children aged 6 months to 12 years. It will also support their efforts to achieve the Sustainable Development Goals, 6 the global targets set by the Comprehensive implementation plan on maternal, infant and young child nutrition, 7 and the Global strategy for women’s, children’s

2017 World Health Organisation Guidelines

1257. National Research Agenda on the Health Impacts of Non-Medical Cannabis Use

of Indigenous peoples; and ? Presence of mental and physical health comorbidities? ? Polysubstance use: How do the effects (e.g., brain, behaviour) of cannabis vary: 1 Example areas cited included the impact of: sex differences on cannabis use and its impacts; maternal cannabis use in pregnancy; concurrent alcohol and cannabis use. 2 For example, strains, derivatives. 3 For example, vaping, edibles, concentrates, second-hand smoke. 4 Examples of data collection tools and surveys include the 2012 Canadian (...) A nutraceutical is a pharmaceutical-grade, standardized nutrient, isolated or purified from foods that is generally sold in medicinal forms (e.g., pills, powders) not generally associated with food. Examples include vitamins, minerals, herbal and non-herbal dietary supplements. 6 For example, leverage and build on work conducted and data collected by the U.S. National Institutes of Health, U.S. National Institutes of Mental Health, and within the PhenX Toolkit National Research Agenda on the Health Impacts

2017 Canadian Centre on Substance Abuse

1258. Folic Acid for the Prevention of Neural Tube Defects: Preventive Medication

supplement containing 0.4 to 0.8 mg (400 to 800 µg) of folic acid. Grade: A Risk Assessment All women of childbearing age are at risk of having a pregnancy affected by neural tube defects. Some factors increase this risk, including a personal or family history of neural tube defects, use of particular antiseizure medications, maternal diabetes, obesity, and mutations in folate-related enzymes. Preventive Medication Folic acid is the synthetic form of folate, a water-soluble B vitamin. Folic acid (...) is usually given as a multivitamin, prenatal vitamin, or single supplement, and is also used to fortify cereal grain products. Folate occurs naturally in foods such as dark green leafy vegetables, legumes, and oranges. However, most women do not receive the recommended daily intake of folate from diet alone. Timing The critical period for supplementation starts at least 1 month before conception and continues through the first 2 to 3 months of pregnancy. Dosage Supplementation with a multivitamin

2017 U.S. Preventive Services Task Force

1259. Obesity: identification, assessment and management

bariatric surgery. The report also noted that clear post- operative dietary advice should be provided to people because of the potential for significant metabolic change (such as vitamin B12 and iron deficiency) after surgery. It has been suggested that resolution of type 2 diabetes may be an additional outcome of surgical treatment of morbid obesity. It is estimated that about 60% of patients with type 2 diabetes achieve remission after Roux-en-Y gastric bypass surgery. It has also been suggested (...) in primary care for example with a shared care protocol if local circumstances and/or licensing allow. [2006, amended [2006, amended 2014] 2014] 1.9 Continued prescribing and withdrawal Adults and children Adults and children 1.9.1 Pharmacological treatment may be used to maintain weight loss rather than to continue to lose weight. [2006] [2006] 1.9.2 If there is concern about micronutrient intake adequacy, a supplement providing the reference nutrient intake for all vitamins and minerals should

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

1260. 2016 Canadian Cardiovascular Society guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult

(Strong Recommendation; Low-Quality Evidence). 2. We recommend that vitamins, minerals, or supple- ments for symptoms of myalgia perceived to be statin- associated not be used (Strong Recommendation; Low-Quality Evidence). Anderson et al. 1277 2016 CCS Dyslipidemia GuidelinesPractical Approach The backbone of risk reduction involves a concerted effort to affect lifestyle choices. 121 We recognize that there is con- troversy when it comes to the use of treatment targets. The primary panel continues

2016 CPG Infobase

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