"We have an amazing research environment"

Anna Chmielewska came to Umeå from Poland for a postdoc position some eight years ago. She was looking for environments with expertise and exciting research related to iron metabolism in children.

“I was interested in the connection between iron and brain development. The brain grows rapidly during the first years of life, not only in size but also in complexity. Iron is crucial in many of these processes.”

No advantage of iron supplements for breastfeeding infants

The SIDBI study (Supplementing Iron and Development in Breastfed Infants) is based on the finding that iron deficiency can be harmful to children’s development. The project investigated whether it would be beneficial to give iron supplements to healthy breastfeeding infants who might be at risk of iron deficiency. At the time of this interview, Anna Chmielewska has just had the results published in the prestigious journal JAMA Pediatrics. The study shows that healthy breastfeeding infants do not need iron supplements to develop normally – results that contradict recommendations in countries like the USA, where it is suggested that all breastfeeding infants should receive iron supplements.

“I am very proud that we got the results published in such a highly ranked journal. You can tell that these are important results that generate great interest. It’s so rewarding to work on these issues, to contribute to understanding and recommendations for children and pregnant women,” says Anna Chmielewska.

Many researchers work with smaller groups, such as individuals with a specific diagnosis or disease. Anna Chmielewska, however, sees the entire group of children when she thinks about her research.

“I am passionate about optimizing children’s health. I think optimization is a good word because it’s about making children’s health as good as possible to give them the best conditions to develop, contribute to society, and live a good life. Nutrition is also a clear example of how simple interventions can have significant effects on an entire population. Nowadays, for example, vitamin D supplements are recommended for all young children because it has been shown to be effective,” she explains.

Intervention studies show cause and effect

Anna Chmielewska is also involved in research on how another nutrient, iodine, affects children’s development. It is known that the need for iodine increases during pregnancy and that mild iodine deficiency is common among pregnant women, but there is still a lack of knowledge about how it affects the child’s development. In the SWIDDICH study, iodine supplements are given to pregnant women while a control group does not receive extra iodine. The children are then followed up to about 15 years of age. This type of study, called an intervention study, is a way to identify cause and effect, explains Anna Chmielewska.

“Imagine starting with a case study: here we have a child with both iron deficiency and low IQ. Then you move on to observational studies where you look at a large group, and you might see that certain characteristics overlap and that there might be some correlations. But it’s only when you do an intervention study, and actually intervene in a controlled way, that you can say something about cause and effect in medicine. That’s what I find so exciting, that you can climb that ‘ladder.’ With the right methodology, you can show how things actually are.”

Infrastructure provides good conditions for research

In the future, Anna Chmielewska will continue working with the data collected in the SIDBI study. Next, she will study whether iron supplements have affected the child’s behavior, as an additional outcome to psychomotor development. She will primarily examine behavioral traits that may represent neurodevelopmental disorders, such as hyperactivity, the ability to manage emotions and stimuli, or potential difficulties with social interaction. Anna Chmielewska is also active in Northpop, a research infrastructure with data from over 25,000 parents and children in Västerbotten. She highlights the pediatric research clinic as a success factor in her work.

“I feel fortunate to be part of this research environment. We have amazing infrastructure with competent staff who handle all the practical aspects of recruiting participants, scheduling patient visits, and more. Our research nurses especially are fantastic in their interactions with children participating in clinical studies. This allows researchers to focus on other parts of the research, which is incredibly important for things to run smoothly, so the effort made by patients and their families is not wasted.”

Today, Anna divides her time between research and clinical work and says she has achieved a good balance.

“When I became a lecturer, I wondered if I would lose the clinical aspect. But I can still work clinically as much as I want while having the opportunities I need to continue researching and supervising. This stability characterizes my work life right now – I feel very content.”