Diet and Probiotics during Pregnancy - Endorsing developmental Programming

Maternal obesity has been shown to increase the risk for adverse reproductive health outcomes such as gestational diabetes, hypertension, and preeclampsia. Moreover, several studies have indicated that overnutrition and maternal obesity adversely program the development of offspring by predisposing them to obesity and other chronic diseases later in life. The exact molecular mechanisms leading to developmental programming are not known, but it has recently been suggested that obesity-related low-grade inflammation, gut microbiota and epigenetic gene regulation (in particularly DNA methylation) participate in the developmental programming phenomenon. The aim of this thesis was to evaluate the effect of diet, dietary counseling and probiotic intervention during pregnancy in endorsing favorable developmental programming. The study population consisted of 256 mother-child pairs participating in a prospective, double-blinded dietary counselling and probiotic intervention (Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb12) NAMI (Nutrition, Allergy, Mucosal immunology and Intestinal microbiota) study. Further overweight women were recruited from maternal welfare clinics in the area of Southwest Finland and from the prenatal outpatient clinic at Turku University Hospital. Dietary counseling was aimed to modify women’s dietary intake to comply with the recommended intake for pregnant women. Specifically, counseling aimed to affect the type of fat consumed and to increase the amount of fiber in the women’s diets. Leptin concentration was used as a marker for obesity-related low-grade inflammation, antioxidant vitamin status as an efficiency marker for dietary counselling and epigenetic DNA methylation of obesity related genes as a marker for probiotics influence. Results revealed that dietary intake may modify obesity-associated low-grade inflammation as measured by serum leptin concentration. Specifically, dietary fiber intake may lower leptin concentration in women, whereas the intakes of saturated fatty acids and sucrose have an opposite effect. Neither dietary counselling nor probiotic intervention modified leptin concentration in women, but probiotics tended to increase children’s leptin concentration. Dietary counseling was an efficient tool for improving antioxidant vitamin intake in women, which was reflected in the breast milk vitamin concentration. Probiotic intervention affected DNA methylation of dozens of obesity and weight gain related genes both in women and their children. Altogether these results indicate that dietary components, dietary counseling and probiotic supplementation during pregnancy may modify the intrauterine environment towards favorable developmental programming.

Implementing The KiVa Antibullying Program: What Does It Take?

There is variation in how teachers and schools implement bullying prevention programs. Although this variation has been discussed, there has been little empirical research concerning the relationship between implementation fidelity and program outcomes. This thesis contains three studies, each of them in the context of implementing the KiVa antibullying program, and examines teachers’ actions in preventing and intervening in school bullying. The first aim of this thesis is to examine implementation degree of the KiVa curriculum and its’ association with reductions in victimization and bullying perpetration (Study I). The second aim is to clarify why teachers displayed different degrees of adherence to the KiVa curriculum during a school year (Study II). Thirdly, it is investigated whether recognizing victimization can be difficult for school staff (Study III). In addition to these peer-reviewed studies, the thesis includes a qualitative analysis (unpublished) of the teachers’ open answers concerning their implementation experiences. The data were collected from elementary school teachers (Studies I–II; the unpublished study), elementary school students (Study I), and students on the elementary and middle school levels (Study III) during the evaluation of the effectiveness of KiVa antibullying program between 2007 and 2009. The findings demonstrate that a larger reduction in victimization can be achieved in classrooms where teachers display higher levels of adherence to the KiVa curriculum and invest more time for preparing the lessons. Bullying perpetration, however, was not equally affected by the level of curriculum implementation. With respect to the implementation process over one year, there was significant variation between individual teachers’ activity—ranging from systematic and high implementation to declining delivery from lesson to lesson. The sustained actions (high and moderate levels of implementation) were premised on principal support for antibullying work. Lesson preparation was associated with keeping implementation high throughout the school year. The findings also implied that the belief in the effectiveness of the program is important for a higher implementation degree at starting point of the process. Finally, there are severe flaws in teachers’ ability to identify students who are victimized. As it turns out, it is possible that only one-fourth of chronically victimized students are helped by the school staff. Especially when the victims are middle-school-aged girls, when they bully others themselves, or when they do not tell adults about bullying, reaching out for them is difficult. Implementation and dissemination of research-based interventions will take a good deal of time and effort. The findings demonstrate that active implementation is important for improving program outcomes. They also show how implementation can be sustained—there are both individual and interpersonal factors that facilitate or inhibit high-quality implementation. Thus, implications for future research regarding the implementation of school-based programs are suggested.