BACKGROUND:Neonatal hypoglycemia is common and associated with adverse neurodevelopmental outcomes, but it is unclear which glycemic measures best explain this association. METHODS:Blood glucose concentrations (BGC) from three prospective cohorts of late preterm and term babies born at risk of hypoglycemia, all screened and treated to maintain BGC ≥ 2.6 mmol/L, were used to derive both continuous (maximum, minimum, range, mean, median, standard deviation and variability metrics) and dichotomous glycemic measures (any, severe, recurrent and late hypoglycemic episodes). Generalized linear models adjusted for socioeconomic deprivation, site, primary risk of hypoglycemia and multiple birth related glycemic measures to outcomes at 2 years. RESULTS:We analyzed 18,947 BGCs from 2,894 babies. Higher gradient variability was associated with poorer neurodevelopment, but dichotomous indicators were more strongly predictive; e.g. 1 SD increase in gradient variability was associated with -0.9-point adjusted mean Bayley motor score (95% confidence interval -1.4, -0.3), compared to -3.1 (-4.8, -1.5) for severe and -2.1 (-3.6, -0.6) for recurrent hypoglycemia. Associations were similar for Bayley cognitive and language and Brief P global executive composite scores. CONCLUSIONS:Continuous glycemic measures derived from intermittent capillary sampling are not stronger predictors of neurodevelopment at 2 years than dichotomous measures, although glycemic variability warrants further investigation. IMPACT:Beyond simple dichotomous classifications (e.g., hypoglycemic or not), little is known about how blood glucose profiles derived from intermittent heel-prick measurements relate to later neurodevelopmental outcomes in infants at risk of neonatal hypoglycemia. Prespecified glycemic measures were related to neurodevelopmental outcomes at 2 years using data from three longitudinal studies of children born at risk of neonatal hypoglycemia. While the dichotomous indicators of severe (<2.0 mmol/L) and recurrent (≥3 episodes) hypoglycemia are most strongly related to neurodevelopmental outcome, measures of glycemic variability also relate to neurodevelopmental risk in infants at risk of neonatal hypoglycemia.

To assess the impact of gestational diabetes(GDM) detection thresholds on infant growth, nutrition, and neurodevelopment at 12-18 months. Prospective cohort study within the GEMS trial(ACTRN12615000290594), which randomized pregnant women to detection of GDM using lower or higher glycemic criteria. The main outcomes were overweight/rapid weight gain; food approach appetitive score; energy intake; cognitive z-score. Compared to control infants, those exposed to GDM detected and treated by higher criteria or by lower but not higher criteria that was untreated, were less likely to have increased overweight/rapid weight gain, possibly with lower energy intake. There were no important differences in appetite and cognition. Infants exposed to GDM by lower but not higher criteria that was treated were similar to controls. Exposure to treated GDM or untreated GDM detected by lower but not higher criteria, was not associated with increased infant risk factors for obesity or adverse cognitive outcomes.

AIM:Neonatal hypoglycaemia is a common metabolic disorder in newborns; if severe or prolonged, it can lead to brain injury. Formula is sometimes used to treat neonatal hypoglycaemia. This study aims to synthesise evidence on the effectiveness of infant formula for the prevention and treatment of neonatal hypoglycaemia. METHODS:Randomised controlled trials (RCTs) and cohort studies comparing infants given formula to those who were not were included. Four databases and four trial registries were searched. Study quality was evaluated using the Cochrane Risk of Bias-1 tool for RCTs and the Newcastle-Ottawa Scale for cohort studies. RESULTS:We screened titles and abstracts of 6711 records and full texts of 56 records. We included 12 studies: one RCT and 11 cohort studies. For prevention, the evidence is very uncertain about the effect of formula on neonatal hypoglycaemia (621 infants, OR 3.01 [0.53 to 17.13], p = 0.21, I2 = 85%, very low certainty evidence). One RCT showed that formula may be more likely to correct neonatal hypoglycaemia than oral dextrose gel (222 infants, RR 1.27 [1.11 to 1.46], p = 0.0004, low certainty evidence). CONCLUSIONS:The effect of formula in preventing neonatal hypoglycaemia remains uncertain; although formula may be more effective than oral dextrose gel in correcting hypoglycaemia. TRIAL REGISTRATION:This review was registered in PROSPERO (CRD42024581348).

OBJECTIVE:To determine if, after adjusting for potential confounders, child health outcomes differ between children exposed to maternal gestational diabetes mellitus (GDM) and their unexposed peers. STUDY DESIGN:Prospective cohort study. Recruitment took place between June 2022 and May 2024. The primary outcome was overweight or obesity. The secondary outcomes were other measures of size, eating behavior, behavioral and emotional problems, neurodevelopmental disorders, atopic disorders, and diabetes. Between-group differences were determined with generalized linear mixed models adjusted for gestational weight gain and socioeconomic status. RESULTS:Of the 699 children who participated at a mean age of 5.6 years, 295 (42.2%) were exposed to GDM. There was no difference in the risk of being overweight or obese in children exposed to GDM compared with those unexposed (adjusted relative risk [95% CI]: 0.69 [0.44, 1.08]). Children exposed to GDM had lower body mass index z scores (adjusted relative risk [95% CI]: -0.30 [-0.53, -0.60]), enjoyment of food scores (adjusted relative risk [95% CI]: -0.17 [-0.31, -.04]), and risk of abnormal hyperactivity scores (adjusted relative risk [95% CI]: 0.23 [0.06, 0.87])] Other outcomes were similar between exposure groups. CONCLUSIONS:After accounting for confounders, children exposed to treated GDM had a risk of being overweight or obese comparable with their unexposed peers. Our findings are reassuring for parents and health practitioners caring for women who experience GDM and their children.

INTRODUCTION:Gestational diabetes mellitus (GDM) is associated with poor long-term maternal metabolic health. However, there is limited evidence on the effect of GDM on later maternal mental health. We, therefore, aimed to compare mental health outcomes between women who had GDM and women who did not five years after the index pregnancy. METHODS:A follow-up study of women diagnosed with GDM using the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria matched to a random sample of women not diagnosed with GDM for maternal age, ethnicity, and BMI. Participants completed questionnaires screening for anxiety (6-item State-Trait Anxiety Inventory), depression (Edinburgh Postnatal Depression Scale), or health-related quality of life (SF-36). RESULTS:Of the 563 participants, 233 (41.4%) were diagnosed with GDM in their index pregnancy. At follow-up, 152/563 (27.0%) reported an increased risk of symptoms of poor mental health, and this was similar in women who were and were not diagnosed with GDM. There was no difference between the two groups for risk of anxiety, [aRR: 0.76 (0.50, 1.22)] or depression [aRR: 1.11 (0.74, 1.66)]. However, women diagnosed with GDM reported lower mean SF- 36 scores for general health [aMD: -3.91 (-7.14, -0.68)] and social functioning [aMD: -3.61 (-7.05, -0.16)] than women without GDM. CONCLUSION:The risk of poor mental health is common five years after birth. However, GDM diagnosis was not associated with an increased risk for anxiety or depression, although GDM may affect women's perception of their later general health and social functioning.

Importance Neonatal protein intake following very preterm birth has long lasting effects on brain development. However, it is uncertain whether these effects are associated with improved or impaired brain maturation. Objective To assess the association of neonatal protein intake following very preterm birth with brain structure at 7 years of age. Design, Setting, and Participants This cohort study involved children born very preterm before or after a change in neonatal intensive care unit nutritional protocol that increased protein intake at the National Women's Hospital in Auckland, New Zealand. The children completed magnetic resonance imaging (MRI) scanning at 7 years. There were 128 children who were initially eligible. MRI data were ineligible for analysis if excessive head motion or clinical brain abnormalities were present. Data were collected from July 2012 to January 2016, and data analysis took place from January 2017 to March 2024. Exposure Neonatal intensive care unit nutritional protocol. Those who were born before the protocol change took place (July 2005 to December 2006) were in the old protocol group, while those who were born after the protocol change (January 2007 to October 2008) were in the new protocol group. Observers were blind to participant grouping. Main Outcomes and Measures All actual enteral and parenteral intakes of protein, fat, energy, and breast milk for days 1 to 7 and days 1 to 14, and growth velocity to postnatal day 28 were calculated for each infant. Preplanned outcomes were group comparisons between regional brain volumes and diffusion parameters of major white matter tracts along with analyses with both groups combined exploring associations of nutrition with brain metrics. Results Data from 99 children were analyzed, including 42 in the old protocol group (26 female [55%]; mean [SD] gestational age at birth, 27 [2] weeks) and 57 in the new protocol group (27 female [47%]; mean [SD] gestational age at birth, 26 [2] weeks). Protein intake differed between the groups at both 7 days (old protocol: mean [SD] intake, 17 [2] g/kg(-1); new protocol: mean [SD] intake, 21 [2] g/kg(-1)) and 14 days after birth (old protocol: mean [SD] intake, 41 [6] g/kg(-1); new protocol: mean [SD] intake, 45 [7] g/kg(-1)). The new protocol group had smaller brain volume as a percentage of intercranial volume than the old protocol group (mean [SD], 80% [4%] vs 86% [7%]) but absolute brain volumes were similar. The new protocol group had significantly thinner lateral occipital and lateral parietal cortices than the old protocol group. With both groups combined, those with greater protein, fat, energy, and breast milk intake had more mature diffusion tensor metrics (higher fractional anisotropy and less diffusion) across multiple tracts, although this finding did not reach statistical significance for every tract. Conclusions and Relevance In this cohort of children born very preterm, children with greater neonatal protein intake had a more mature profile of brain metrics assessed with MRI at 7 years of age. These results contribute to the ongoing evaluation of optimal nutrition for infants born very preterm and suggest that the protein intake experienced by the new protocol group may promote brain maturation in a way that is still observable at 7 years of age.

Neonatal hypoglycaemia is the most common metabolic disorder of infants worldwide. In Aotearoa New Zealand, Asian infants are at increased risk due to predisposing factors, including maternal diabetes and low birthweight. Little is known regarding the experience of parents of infants born at risk for neonatal hypoglycaemia, including finding their infant is at risk, testing, treatment, and follow-up. This qualitative study aimed to explore Asian families' experiences of having an infant born at risk of hypoglycaemia in Aotearoa New Zealand. Twelve interviews involving 14 participants were conducted and transcribed. Content analysis highlighted eight key themes that summarised families' experiences of the care pathway: complex circumstances, adequate information sharing, varied attitudes towards neonatal hypoglycaemia, cultural openness, confronting testing, acceptable gel treatment, importance of support, and continued monitoring. Our findings demonstrate the importance of comprehensive and culturally sensitive care of neonates born at risk for hypoglycaemia and their families.

Antenatal corticosteroids are given to pregnant people at risk of preterm birth to reduce newborn morbidity, including respiratory distress syndrome. However, there has been concern surrounding potential adverse effects on subsequent generations. Animal studies have demonstrated endocrine and metabolic changes in those exposed to corticosteroids in utero ( F 1 ) and in the second generation ( F 2 ). We aimed to assess the effects of parental antenatal corticosteroid exposure on health of the second generation ( F 2 ) of Auckland Steroid Trial (AST) participants. In the AST, women ( F 0 ) expected to birth between 24 and 36 weeks’ gestation were randomised to betamethasone or placebo. When their children ( F 1 ) were 50 years old, they and their children ( F 2 ) were followed up with a self-report questionnaire and data linkage. The primary outcome for this analysis was body mass index (BMI) z-score in the F 2 generation. Secondary outcomes included respiratory, cardiovascular, neurodevelopmental, mental and general health, and social outcomes. Of the 213 F 2 participants, 144 had BMI data available. There was no difference in BMI z-score between participants whose parent was exposed to betamethasone versus placebo (mean ( SD ) 0.63 (1.45), N = 77 vs 0.41 (1.28), N = 67, adjusted mean difference (95% confidence interval) = 0.16 (-0.37, 0.69)). There was no evidence of a difference in rates of overweight, diabetes, respiratory disease, cardiometabolic risk factors, neurodevelopmental difficulties, mental health difficulties and social outcomes between parental betamethasone versus placebo exposure groups, but confidence intervals were wide. These findings are reassuring regarding the intergenerational safety of antenatal corticosteroids.

BACKGROUND:For women who have received a course of antenatal corticosteroids ≥7 days prior and have ongoing risk of preterm birth within the next 7 days, repeat dose(s) of corticosteroids up to 32 weeks' gestation have been shown to reduce neonatal respiratory distress syndrome and serious health problems in the neonatal period but not other neonatal morbidities such as chronic lung disease, death, severe intraventricular haemorrhage or necrotising enterocolitis. Repeat antenatal corticosteroids were not associated with either benefit or harms in mid-childhood. However, this may have been too early to evaluate potential adverse effects on respiratory and other long-term outcomes. We aimed to assess if exposure to repeat dose(s) of antenatal corticosteroids administered to pregnant women up to 32 weeks' gestation has beneficial or harmful effects on respiratory and general health of the offspring in adulthood. METHODS AND FINDINGS:We assessed the adult offspring of New Zealand participants in the Australasian Collaborative Trial of Repeat Doses of Corticosteroids for the Prevention of Neonatal Respiratory Disease (ACTORDS), a multicentre, placebo-controlled trial where women at risk of preterm birth within the next week, 7 or more days after having received a single course of corticosteroids were randomised to a repeat dose of intramuscular betamethasone or placebo, that could be repeated weekly if at ongoing preterm birth risk. Follow-up at 20 years included a health questionnaire and consent to access administrative data sources. The primary outcome was any asthma diagnosis. Secondary outcomes included neurodevelopmental, cardiovascular, mental and general health, functional difficulties and social outcomes. Of 352 infants born to 290 maternal trial participants, we assessed 214 (61%; 96 (45%) female) at mean (standard deviation) age 20.5 (1.5) years. The rate of any asthma diagnosis was similar in both groups (58/107 (54%) repeat bethamethasone versus 50/107 (47%) placebo; risk ratio adjusted for gestational age at trial entry, multiplicity and birth centre 1.13, 95% confidence interval, 0.87, 1.46). Differences between the groups for the secondary outcomes were generally small and confidence intervals included the possibility of no difference between groups. CONCLUSIONS:In this follow-up of a randomised clinical trial, our data suggest neither major harm nor benefit for the offspring in early adulthood following exposure to repeat dose(s) of antenatal corticosteroids compared with a single course prior to 32 weeks' gestation. Smaller effects cannot be excluded and follow-up of adult offspring from other trials of repeat antenatal corticosteroids is recommended. TRIAL REGISTRATION:International Standard Randomized Controlled Trial, number ISRCTN48656428.

BACKGROUND:Punctate white matter injury on brain magnetic resonance imaging (MRI) is described in very preterm infants (< 32 weeks' gestation) and is predictive of poorer developmental outcomes. The reliability of scoring and the incidence and evolution of white matter injury in moderate-late preterm infants is unknown. OBJECTIVE:To assess inter-observer variability in white matter injury using a published scoring system (UCSF system), and to describe changes over time in moderate-late preterm infants. MATERIALS AND METHODS:Infants born between 32 + 0 and 36 + 6 weeks' gestation in the Auckland region underwent MRI scans as soon as clinically feasible after birth and again at term-equivalent age. De-identified scans were scored independently by two observers. White matter injury was graded as minimal (< 3 lesions measuring < 2 mm), moderate (> 3 lesions or lesions > 2 mm), or severe (> 5% hemispheric involvement). Scores were compared between reviewers using weighted and unweighted kappa statistics interpreted using Cohen's criteria. Incidences were compared between scans using generalised estimating equations. RESULTS:Scans of 101 infants were assessed. Inter-observer agreement was near perfect for the presence of white matter injury (k = 0.88 and 0.81 for the first and second scan respectively), and for the severity of white matter injury was near perfect at the first scan (k = 0.85) and substantial at the second scan (k = 0.80). The incidence of white matter injury detected by the two observers decreased between the first and second scans (30% to 22% and 29% to 19%), and severity also decreased. CONCLUSIONS:This scoring system can be reliably applied in moderate-late preterm infants. White matter injury is common in moderate-late preterm infants but may be underestimated when MRI is performed close to term-equivalent age.

OBJECTIVE:Moderate-to-late preterm (MLP) infants contribute to the greatest proportion of preterm children with neurodevelopmental impairments. White matter injury (WMI) is common and predicts adverse outcomes in very preterm (VP) infants. However, little is known about white matter abnormality (WMA) in MLP infants. We investigated the burden and distribution of WMA in MLP infants. METHODS:MLP infants were recruited from a randomized trial on neonatal nutrition and a prospective observational cohort in New Zealand, and underwent brain magnetic resonance imaging (MRI) soon after birth and at term-equivalent age (TEA). WMA was manually segmented using an established method. Total and regional WMA volumes and percentage of WMA to total cerebral volume were calculated. Probabilistic WMA maps were generated and compared with WMI in VP infants and term infants with congenital heart disease. RESULTS:Of 101 infants (32 females), 40 (39.6%) had WMA on at least 1 scan. In 37 infants with WMA who had both scans, WMA was less visible in 22 (59.5%) or undetectable in 7 (18.9%) infants with a mean reduction of 72.7 ± 207.5 mm3 in WMA volume from early-life to term. Infants with and without WMA had mostly comparable pregnancy and neonatal characteristics. Probabilistic maps demonstrated a characteristic WMA topology, with most lesions in posterior followed by central and anterior regions. Trigonal areas were vulnerable across neonatal populations. INTERPRETATION:WMA is much more common in MLP infants than previously reported and occurs in a characteristic topology. WMA may be missed on TEA MRI, and its relationship with outcomes in MLP infants warrants attention. ANN NEUROL 2025;98:329-340.

Neonatal hypoglycaemia is the primary metabolic disorder affecting newborns. It has severe implications including cerebral injury when left untreated. Pacific newborns have the second-highest prevalence of risk factors for hypoglycaemia amongst all ethnic groups in New Zealand, and therefore disproportionately suffer its effects. However, Pacific voices remain largely unheard regarding experiences with at-risk infants. This qualitative study aims to amplify Pacific families' stories. Nine interviews involving ten participants were transcribed and analyzed. Seven central themes were revealed: Teu Le Vā: Nurturing relationships by healthcare professionals, Complex circumstances, Family decision-making, Talanoa: Culturally congruent information sharing, Cultural beliefs related to medical care in pregnancy, Relevance of faith and spirituality, and Continued follow-up. The findings of this study highlight the pivotal role of healthcare professionals in nurturing Vā or relational space and underscore the necessity of culturally responsive practices to improve Pacific families' experience of neonatal hypoglycaemia care.

The dorsal stream vulnerability hypothesis suggests that preterm birth may preferentially impair development of the dorsal visual pathway. We explored the effects of early nutrition on dorsal stream development in a well-characterized cohort of 7-year-old children born very preterm. The children had been admitted to a tertiary hospital neonatal intensive care unit either before (OldPro group) or after (NewPro group) a parenteral nutrition protocol change that was intended to increase protein intake and reduce fluid volume intake. We assessed dorsal stream function using the blood oxygen level-dependent (BOLD) response in V1 and V5 to coherent and incoherent random dot kinematograms (RDKs), quantified using functional magnetic resonance imaging. V1 and V5 regions of interest could be localized in 24 children (OldPro n = 11, NewPro n = 13). Motion coherence thresholds, a psychophysical measure of global motion perception, were also available for 22 of these children (OldPro n = 9, NewPro n = 13). The NewPro group demonstrated a higher V5 BOLD response to RDK stimuli (OldPro: mean = 0.5%, SD = 0.2%; NewPro: mean = 1.0%, SD = 0.6%) and exhibited lower (better) motion coherence thresholds (OldPro: median = 74.0%, IQR: 59.5%-81.2%; NewPro: median = 36.8%, IQR: 27.5%-44.5%), compared to the OldPro group. The V1 BOLD response did not differ between the groups. There was a significant association between V5 ΔBOLD (coherent minus incoherent stimulus BOLD response) and motion coherence threshold. Together, these findings suggest that early nutrition may influence dorsal stream development in children born very preterm.

BackgroundFor the follow-up of participants in randomised trials, data linkage is thought a more cost-efficient method for assessing outcomes. However, researchers often encounter technical and budgetary challenges. Data requests often require a significant amount of information from researchers, and can take several years to process. This study aimed to determine the feasibility, direct costs and the total time required to access administrative datasets for assessment of outcomes in a follow-up study of two randomised trials.MethodsWe applied to access administrative datasets from New Zealand government agencies. All actions of study team members, along with their corresponding dates, were recorded prospectively for accessing data from each agency. Team members estimated the average time they spent on each action, and invoices from agencies were recorded. Additionally, we compared the estimated costs and time required for data linkage with those for obtaining self-reported questionnaires and conducting in-person assessments.ResultsEight agencies were approached to supply data, of which seven gave approval. The time from first enquiry to receiving an initial dataset ranged from 96 to 854 days. For 859 participants, the estimated time required to obtain outcome data from agencies was 1,530 min; to obtain completed self-reported questionnaires was 11,025 min; and to complete in-person assessments was 77,310 min. The estimated total costs were 20,827 NZD for data linkage, 11,735 NZD for self-reported questionnaires, and 116,085 NZD for in-person assessments. Using this data, we estimate that for a cohort of 100 participants, the costs would be similar for data linkage and in-person assessments. For a cohort of 5,000 participants, we estimate that costs would be similar for data linkage and questionnaires, but ten-fold higher for in-person assessments.ConclusionsObtaining administrative datasets demands a substantial amount of time and effort. However, data linkage is a feasible method for outcome ascertainment in follow-up studies in New Zealand. For large cohorts, data linkage is likely to be less costly, whereas for small cohorts, in-person assessment has similar costs but is likely to be faster and allows direct assessment of outcomes.

Neonatal hypoglycaemia can cause substantial morbidity and mortality. Pēpi Māori (Indigenous infants from Aotearoa New Zealand) are at increased risk. This study explored the lived experience of whānau (extended family kinship groups) Māori having a pēpi at risk of hypoglycaemia. Whānau Māori collectives were interviewed, and transcripts analysed using NVivo software and the Reflexive Thematic Analysis. There were 11 participants (10 whānau collectives; 10 Māmā (mothers) and one Pāpā (father)). The overarching concept of Pā Harakeke (flax bush) framed three superordinate themes, each with subordinate themes. Themes were Whānau, (desire to do the best for pēpi, whakapapa (geneology), collective decision making and whānau led solutions), Shifting the narrative (whānau as part of the team, communication, mana motuhake (self-determination), fully informed) and Health system (colonial health structures, navigation, racism and tikanga (customs)). Whānau Māori narratives provided insight into opportunities for optimising care for those with pēpi at risk of neonatal hypoglycaemia.

(1) Background: Most studies including health data have relied on reducing all variables to manifest scores, ignoring the latent nature of variables. Moreover, relying only on manifest variables is a limitation of longitudinal studies where identical measures cannot be collected at each time point. (2) Objective: This scoping review aims to identify latent variable statistical methods for longitudinal studies of multi-dimensional health and educational data investigating early health predictors of long-term educational outcomes and developmental trajectories that lead to better or worse than expected outcomes. (3) Eligibility criteria: We included peer-reviewed health and education journal articles, doctoral theses, and book chapters of longitudinal studies of children under 12 years of age that adopted latent variable, multivariate analysis of three or more waves of data. We only included full-text-available, English-written articles, without restriction on date of publication. (4) Sources of evidence: We searched five databases, Scopus, MEDLINE, PsycINFO, ERIC, and Web of Science, and identified 4836 publications for screening. (5) Results: After title, abstract, and full-text screening, nine studies were included in the review, reporting seven statistical methods. These methods were categorised into two groups—variable-oriented modelling and person-oriented modelling. (6) Conclusions: Variable-oriented modelling methods are useful for determining predictors of long-term educational outcomes. Person-oriented modelling methods are effective in detecting trajectories to better or worse than expected outcomes. (7) Registration: Open Science Framework.

There are inconsistent recommendations in available guidelines and uncertainty regarding the exact nutrient requirements for preterm infants, partly because of inconsistent outcome reporting in nutrition intervention studies. To support development of a minimum reporting set, we undertook a scoping review to identify measures of nutrition intake and growth outcomes reported in recent preterm nutrition studies. We searched for publications from 2018 to 2023 reporting individuals born preterm at any gestational age and study location whose nutrition intake was assessed before first hospital discharge and whose growth was assessed at any age. One reviewer screened articles and extracted the measures. Any uncertainties were resolved by a second reviewer. The results were tabulated and analyzed descriptively. We identified 6365 records, and included 250 studies. Only 10 of 236 studies (4%) reported how nutrition intake was calculated. There were five different ways of reporting weight and 13 of weight gain, each at many different time points. Furthermore, 27 of 105 studies (26%) did not report how weight gain was calculated, and those that did reported five different calculation methods. Our findings demonstrate significant variation and incomplete reporting of nutrition intake and growth outcomes in preterm nutrition studies. This lack of standardization limits the utility of existing evidence and highlights the need for a standardized reporting framework to improve comparability and support evidence-based guidelines in preterm nutrition.

There is limited high-quality evidence about perinatal mental health among women with gestational diabetes. We aimed to assess the risks and longitudinal changes in anxiety, depression, and health-related quality of life comparing women with gestational diabetes and those without among a contemporary cohort of pregnant women. Prospective cohort study of participants in the GEMS Trial. Women with a singleton pregnancy were eligible if they had a 75-g diagnostic oral glucose-tolerance test between 24 and 32 weeks’ gestation, provided written informed consent, and completed questionnaires about anxiety, depression, and health-related quality of life at the study time points. There were no differences in risk for anxiety (RR 1.13, 95

Background: Poor feeding, among other factors, predisposes neonates to hypoglycaemia. Early feeding is widely recommended to prevent hypoglycaemia in those at risk, but the effectiveness of this is uncertain. This review aimed to summarise and analyse the evidence on the effectiveness of early feeding for prevention of neonatal hypoglycaemia. Methods: Four databases and three clinical trial registries were searched from inception to May 24, 2023. Published and unpublished randomised controlled trials (RCTs), quasi-RCTs, cluster randomised trials, non-randomised studies of interventions, and observational studies with comparison groups were considered for inclusion with no language or publication date restrictions. We included studies of neonates who were fed early (within 60 min of birth or study defined) versus delayed. Study quality was assessed using the Cochrane Risk of Bias 1 tool or Effective Public Health Practice Project Quality Assessment tool. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RevMan 5.4.1 or R was used to synthesise results in random-effects meta-analyses. This review was registered prospectively with PROSPERO (CRD42022378904). Results: A total of 175,392 participants were included across 19 studies, of which two were RCTs, 14 cohort studies, two cross-sectional studies, and one a case-control study. Most studies (13/19) were conducted in low- or lower-middle-income countries. Early feeding may be associated with reduced neonatal hypoglycaemia (four cohort studies, 744 infants, odds ratio [OR] 0.19 (95% CI: 0.10–0.35), p < 0.00001, I2 = 44%) and slightly reduced duration of initial hospital stay (one cohort study, 1,673 infants, mean difference: –0.20 days [95% CI: −0.31 to −0.09], p = 0.0003), but the evidence is very uncertain. One RCT found early feeding had little or no effect on the risk of neonatal mortality, but three cohort studies found early feeding may be associated with reduced risk (136,468 infants, OR 0.51 [95% CI: 0.37–0.72]; low certainty evidence; p <0.0001; I2 = 54%). Conclusion: We found that early feeding may reduce the incidence of neonatal hypoglycaemia, but the evidence is very uncertain. Given its many other benefits, early feeding should continue to be recommended. This review was primarily funded by the Aotearoa Foundation and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health.