optimize outcomes for high-risk infants. Access and Information For a consultation, more information on our neonatologists, or to refer a patient, please call (617) 732-9894 or email bwhreferrals@partners.org. | 3 In an effort to improve short- and long-term outcomes of babies and mothers impacted by maternal obesity, neonatologists in the Brigham and Women’s Hospital (BWH) Department of Pediatric Newborn Medicine are devising strategic interventions to address metabolic dysregulation in pregnant and lactating obese women. “Obesity has become one of the most pressing public health issues of our time and is associated with increased risks for preterm birth, birth defects, and the development of significant medical conditions in childhood,” said Sarbattama Sen, MD, a neonatologist in the Department of Pediatric Newborn Medicine at Brigham and Women’s Hospital (BWH). “We believe that the abnormal metabolic environment in obesity, which is characterized by increased inflammation and oxidative stress, may improve with tailored nutritional supplementation, thus reducing some risks posed by maternal obesity.” BMI-based Prenatal Vitamin Study (The PNV Study) Dr. Sen is the Principal Investigator of a current double-blind randomized control trial including 100 obese women early in pregnancy and 100 obese women planning pregnancy. Trial participants receive either a standard prenatal vitamin and a placebo or a standard prenatal vitamin and a vitamin supplement with additional amounts of specific antioxidant micronutrients. Primary outcomes of the study include: • Vitamin levels; • Markers of oxidative stress and inflammation in mothers and infants; • Cord blood levels. Secondary outcomes of the study include: • Infant growth and adiposity via body composition assessment; • Breastfeeding success and breastmilk composition; • Infant development. As part of the study, monthly urine samples are collected, and blood samples are taken at three points throughout pregnancy. Infant body composition is measured shortly after birth (see sidebar), and the infants will then be followed at six months and at one year with samples to include blood for metabolic assays. Maternal Obesity and Postnatal Health The team also is examining the impact of maternal obesity on postnatal health of infants through breastmilk composition. Previously, Dr. Sen and colleagues measured pro-inflammatory The Impact of Nutritional Supplementation on the Metabolic Environment in Pregnant and Lactating Obese Women nutritional substances in the breastmilk of lean and obese women one-to-two months postpartum and found: • Ratio of omega-6 to omega-3 fatty acids increased as maternal BMI increased (J Perinatal. 2016 Jan 7. doi: 10.1038/jp.2015.199.); • Lower concentrations of the neuroprotective substances DHA, ARA, and lutein (J Perinatal. 2016 Jan 7. doi: 10.1038/jp.2015.199.) in the breastmilk of obese women. Follow-up research is being planned to assess whether maternal perinatal nutritional supplementation and targeted dietary modification can improve breastmilk composition in obese mothers. “These studies are designed to test feasible and practical interventions to decrease inflammation pre- and post-natally and, hopefully, improve outcomes in children of obese mothers,” said Dr. Sen. Sarbattama Sen, MD Neonatologist, Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital Infant Body Composition Assessment Neonatologists in the Neonatal Intensive Care Unit (NICU) at BWH employ an air displacement plethysmography system using whole body densitometry to determine body composition, including total weight, fat mass, and fat-free mass. Data derived from the system is being used in multiple research studies, including the breastmilk analyzer study described on page 5. Brigham and Women’s Hospital | 4 Neonatologists in the Department of Pediatric Newborn Medicine at Brigham and Women’s Hospital (BWH) are leading studies to better understand underlying brain abnormalities in babies with congenital heart disease (CHD) and ultimately improve neurodevelopmental outcomes. “Congenital heart disease is associated with long-term neurodevelopmental impairment, including deficits in attention, executive function, social cognition, and academic skills,” said Cynthia M. Ortinau, MD, a neonatologist in the Department of Pediatric Newborn Medicine. “Through our research, we are striving to identify neuroprotective strategies to mitigate these risks in babies with congenital heart disease.” Large-scale Fetal Brain Development Study A research team at BWH led by Dr. Ortinau is collaborating with specialists at Boston Children’s Hospital on a current large-scale fetal brain development study (Fetal Brain Development and Connectivity in Congenital Heart Disease) incorporating all forms of CHD that will likely require surgery during infancy. The study is enrolling up to 150 pregnant women, including 2/3 with fetal CHD and 1/3 as healthy controls. “Most published data on CHD and brain development has been done after babies are born and are derived from smaller studies that are often restricted to a few select conditions,” said Dr. Ortinau. “Our study is designed to understand brain development in many