Surveillance decision

Surveillance decision

We will plan an update of the guideline on maternal and child nutrition.

During surveillance editorial or factual corrections were identified. Details are included in appendix A: summary of evidence from surveillance.

Reason for the decision

In 2014, the previous surveillance decision was that the guideline should be updated but that the update should wait until the following reports had published:

  • Scientific Advisory Committee on Nutrition (SACN) working group review of the dietary reference values for vitamin D intake.

  • NICE public health guideline on vitamin D.

  • The Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) report on assessing the health benefits and risks of the introduction of peanut and hen's egg into the infant diet before six months of age in the UK.

  • SACN sub-group on Maternal and Child Nutrition (SMCN) report on feeding in the first year of life.

The first 3 listed reports have published, and the SACN's report on feeding in the first year of life is expected to publish in mid-2018. Additionally, several of NICE's maternity-related guidelines are currently being updated and there are plans to update NICE guidance on weight management before during and after pregnancy.

Assessing the evidence

Because the key driver to update this guideline is the overlaps with other NICE guidelines, new government policies (such as the commissioning of infant feeding services), and the work of other organisations (such as SACN), a broad literature search was thought not to be necessary. However, a search of relevant Cochrane reviews was conducted.

Folic acid

Folic acid supplementation

An update on folic acid was published by the SACN in July 2017. This document recommends mandatory fortification of flour with folic acid in the UK, although recommendations on folic acid supplementation before and during pregnancy were unchanged.

Findings that folic acid supplementation before and during pregnancy reduces neural tube defects are consistent with current recommendations. However, the update of this guideline should investigate effective interventions to increase the uptake of folic acid supplementation, with consideration of SACN's work in this area.

Healthy Start

Healthy Start vitamins for pregnant women and children under 4 years

Evidence identified in the surveillance review indicates that vitamin A supplementation during or after pregnancy, or in infants, appears to provide little benefit to mothers or infants, although major adverse effects were not apparent. Vitamin A is currently included in the Healthy Start children's vitamin drops. Additionally, SACN's report on feeding in the first year of life (in-development, publication expected in mid-2018) may provide further information around vitamin A supplementation in children.

The update to the guideline on maternal and child nutrition should investigate effective interventions to increase the uptake of Healthy Start supplementation, and appropriate vitamin A supplementation in children, with consideration of SACN's report on feeding in the first year of life.

Diet in pregnancy

Dietary advice and information

In addition to the guideline on maternal and child nutrition, NICE also has guidance on weight management before, during and after pregnancy (NICE guideline PH27), which is currently being updated. This guideline has detailed recommendations on dietary advice during pregnancy. The update to the guideline on maternal and child nutrition should consider removing dietary advice for pregnant women from the scope of this guideline, and instead cross-refer to the guideline on weight management before, during and after pregnancy.

Obesity

Obesity in pregnant women, mothers, and women who may become pregnant

In addition to the guideline on maternal and child nutrition, NICE also has guidance on weight management before, during and after pregnancy (NICE guideline PH27), which is currently being updated. This guideline has detailed recommendations on dietary advice during pregnancy. The update to the guideline on maternal and child nutrition should consider removing obesity from the scope this guideline, and instead cross-refer to the guideline on weight management before, during and after pregnancy.

Breastfeeding

Approaches to increase uptake and continuation of breastfeeding

Public Health England has published comprehensive information to support commissioning of local infant feeding services. The commissioning guide was, in part, informed by the guideline on maternal and child nutrition. Additionally, several of NICE's maternity-related guidelines are currently being updated.

Therefore, an update of the section of the guideline on maternal and child nutrition that covers breastfeeding will complement the updated maternity guidelines. NICE's guidelines on antenatal care, intrapartum care, and postnatal care cover distinct periods, ending at 8 weeks after birth. However, the guideline on maternal and child nutrition covers these periods and beyond, and extends to settings other than health services. The update should investigate effective interventions to increase the uptake and continuation of breastfeeding, with consideration of related recommendations in NICE's in-development guidelines and Public Health England's information to support commissioning of local infant feeding services.

Link workers

Link workers for pregnant women and mothers whose first language is not English.

The update to the guideline on maternal and child nutrition should consider whether recommendations in this area should be stood down and replaced with a cross-reference to patient experience in adult NHS services (NICE guideline CG138).

Infant formula

Advice and education for mothers using infant formula

Public Health England has published comprehensive information to support commissioning of local infant feeding services. Therefore, the update should investigate effective interventions to provide advice and education for mothers using infant formula, with consideration of related recommendations in NICE's in-development maternity guidelines and Public Health England's information to support commissioning of local infant feeding services.

Allergies

Introduction of potential allergens

Evidence suggests that avoiding potentially allergenic foods, in particular, peanuts, early in life may be associated with an increased likelihood of developing allergies to those foods. Current guidance does not include recommendations about eating potentially allergenic food, so this area should be considered as an addition to the scope of the update.

Oral health

The update to the guideline on maternal and child nutrition should investigate effective interventions to improve oral health in children, with consideration of SACN's report on feeding in the first year of life (in-development, publication expected in mid-2018).

Pre-school settings

Increasing breastfeeding in pre-school settings

Public Health England has published comprehensive information to support commissioning of local infant feeding services, which covers supporting breastfeeding or provision of expressed breast milk in pre-school settings. The update to the guideline on maternal and child nutrition should investigate effective interventions to increase breastfeeding in pre-school settings, with consideration of Public Health England's information to support commissioning of local infant feeding services.

Healthy eating in pre-school settings

SACN plans to review the evidence supporting current recommendations on feeding children aged 12–60 months, which may overlap with this section of the guideline. The update to the guideline on maternal and child nutrition should investigate effective interventions to increase healthy eating in pre-school settings, with consideration of SACN's planned work in this area.

Family nutrition

Promoting healthy eating in families with children aged up to 5 years

SACN plans to review the evidence supporting current recommendations on feeding children aged 12–60 months, which may overlap with this section if the guideline. The update to the guideline on maternal and child nutrition should investigate effective interventions to increase healthy eating in families with children aged up to 5 years, with consideration of SACN's planned work in this area.

Overall update plan

Improving maternal and child nutrition remains an important public health concern. Surveillance of this guideline indicates that the guideline on maternal and child nutrition has substantial overlaps with other NICE guidelines as detailed in the sections above, new government policies, such as the Public Health England guidance on commissioning of infant feeding services, and the work of other organisations, such as SACN.

Overall, a full update of the guideline to provide advice on interventions to improve the nutritional status of pregnant women, breastfeeding mothers, and their children is necessary, taking into account these identified overlaps.

Equalities

No equalities issues were identified during the surveillance process.

Overall decision

After considering all the evidence and views of topic experts, we decided that a full update is necessary for this guideline.

See how we made the decision for further information.


This page was last updated: 14 December 2017