Study on the relationship of thallium exposure and outcomes of births / 中华流行病学杂志

Objective To investigate the relationship of thallium exposure and outcomes of births.Methods A total of 3 236 mothers who had visited in Ma'anshan Maternal and Child Health-Care Hospital between May 2013 and September 2014 were included in this study and their thallium concentrations measured from samples of maternal and umbilical cord blood by inductively coupled plasma mass spectrometry.The results were correlated and evaluated with birth outcomes of the infants,using the multiple linear regression method.Results The median (P25-P75) of thallium levels in first trimester,second trimester and umbilical cord blood were 61.7 (50.8-77.0),60.3 (50.8-75.2) and 38.5 (33.6-44.1) ng/L,respectively.After adjustment for potential confounders,the thallium levels showed an inversely significant association with birth head circumference (unstandardized β coefficient=-0.41,95％ CI:-0.76--0.06) in thc first trimester blood,and associated with reduced birth length (unstandardizedβ coefficient=-0.65,95％ CI:-1.25--0.05) in umbilical cord blood.However,there appeared no significantly associations with birth weight,length and head circumference (P＞0.05) in second trimester.On stratification by sex,in girls but not in boys,the thallium levels were adversely associated with birth head circumference (unstandardized β coefficient=-0.53,95％ CI:-1.05--0.01) in the first trimester and were associated with decreased birth weight (unstandardized β coefficient =-277.08,95％CI:-485.13--69.03) and length (unstandardized β coefficient=-1.39,95％CI:-2.26--0.53) in umbilical cord blood thallium.Conclusions Thallium exposure appeared a gender difference in newborn birth outcomes.In the first trimester,it was negatively associated with the birth head circumference,in the umbilical cord blood,and reduced birth weight and length in girls.

Study on the relationship of thallium exposure and outcomes of births / 中华流行病学杂志

Objective To investigate the relationship of thallium exposure and outcomes of births.Methods A total of 3 236 mothers who had visited in Ma'anshan Maternal and Child Health-Care Hospital between May 2013 and September 2014 were included in this study and their thallium concentrations measured from samples of maternal and umbilical cord blood by inductively coupled plasma mass spectrometry.The results were correlated and evaluated with birth outcomes of the infants,using the multiple linear regression method.Results The median (P25-P75) of thallium levels in first trimester,second trimester and umbilical cord blood were 61.7 (50.8-77.0),60.3 (50.8-75.2) and 38.5 (33.6-44.1) ng/L,respectively.After adjustment for potential confounders,the thallium levels showed an inversely significant association with birth head circumference (unstandardized β coefficient=-0.41,95％ CI:-0.76--0.06) in thc first trimester blood,and associated with reduced birth length (unstandardizedβ coefficient=-0.65,95％ CI:-1.25--0.05) in umbilical cord blood.However,there appeared no significantly associations with birth weight,length and head circumference (P＞0.05) in second trimester.On stratification by sex,in girls but not in boys,the thallium levels were adversely associated with birth head circumference (unstandardized β coefficient=-0.53,95％ CI:-1.05--0.01) in the first trimester and were associated with decreased birth weight (unstandardized β coefficient =-277.08,95％CI:-485.13--69.03) and length (unstandardized β coefficient=-1.39,95％CI:-2.26--0.53) in umbilical cord blood thallium.Conclusions Thallium exposure appeared a gender difference in newborn birth outcomes.In the first trimester,it was negatively associated with the birth head circumference,in the umbilical cord blood,and reduced birth weight and length in girls.

The effect of pre-pregnancy weight and the increase of gestational weight on fetal growth restriction: a cohort study / 中华预防医学杂志

Objective@#To investigate the effect of pre-pregnancy weight and the increase of gestational weight on fetal growth restriction.@*Methods@#From May 2013 to September 2014, a total of 3 474 pregnant women who took their first antenatal care and willing to undergo their prenatal care and delivery in Ma 'anshan Maternity and Child Care Centers were recruited in the cohort study. Excluding subjects without weight data before delivery (n=54), pregnancy termination (n=162), twins live births (n=39), without fetal birth weight data (n=7), 3 212 maternal-singleton pairs were enrolled for the final data analysis. Demographic information of pregnant woman, pregnancy history, disease history, height and weight were collected. In the 24th-28th, 32nd-36th gestational week and childbirth, three follow-up visits were undertaken to collect data of pregnancy weight, pregnancy vomiting, gestational hypertension, gestational diabetes mellitus, newborn gender and birth weight. χ2 test was used to compare the detection rate of fetal growth restriction in different groups. Multivariate unconditional logistic regression model and spreadsheet were used to analyze the independent and interaction effect of pre-pregnancy weight and the increase of gestational weight on fetal growth restriction.@*Results@#The incidence of fetal growth restriction was 9.7%(311/3 212). The incidence of fetal growth restriction in pre-pregnancy underweight group was 14.9% (90/603), higher than that in normal pre-pregnancy weight group (8.7% (194/2 226)) (χ2=24.37, P<0.001). The incidence of fetal growth restriction in inadequate increase of gestational weight group was 17.9% (50/279), higher than the appropriate increase of weight group (11.8% (110/932)) (χ2=36.89, P<0.001). Multivariate unconditional logistic regression analysis showed that compared with normal pre-pregnancy weight group, pre-pregnancy underweightwas a risk factor for fetal growth restriction, with RR (95%CI) at 1.76 (1.34-2.32); Compared with the appropriate increase of gestational weight group, inadequate weight increase during pregnancy was a risk factor for fetal growth restriction, with the RR (95%CI) at 1.70 (1.17-2.48). No additive model interaction [relative excess risk of interaction, attributable proportions of interaction, the synergy index and their 95%CI were 0.75 (-2.14-3.63), 0.21 (-0.43-0.86) and 1.43 (0.45-4.53), respectively] or multiplication model interaction (RR (95%CI): 1.00 (0.44-2.29)) existed between pre-pregnancy underweight and inadequate increase of gestational weight on fetal growth restriction.@*Conclusion@#Pre-pregnancy underweight and inadequate increase of gestational weight would increase the risk of fetal growth restriction without interaction.

The relationship between maternal emotional symptoms during pregnancy and emotional and behavioral problems in preschool children: a birth cohort study / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the related influencing factors of preschool children's emotional and behavioral problems in early life and explore the associations between the symptoms of depression or anxiety during pregnancy and emotional and behavioral problems in preschool children.</p><p><b>METHODS</b>Based on the Ma'anshan Birth Cohort Study of the China-Anhui Birth Cohort Study (C-ABCS), women were recruited at their first clinical visit between October 2008 and October 2010 in four municipal medical and health institutions of Ma'anshan City, a total of 5 084 pregnant women and 4 669 singletons live births were included in the birth cohort. Women completed measures of depressive (Self-Rating Anxiety scale) and anxious (Center for Epidemiologic Studies Depression) symptoms in pregnancy. By the age of 3-6 follow-up, 3 653 children were followed with completed information between April 2014 and April 2015, strengths and difficulties questionnaires were used to assessed offspring emotional and behavioral problems. Logistics regression was used to investigate the relationship between the symptoms of depression or anxiety during pregnancy and emotional and behavioral problems in preschool children.</p><p><b>RESULTS</b>The detected rates of emotional symptoms, conduct problems, hyperactivity and peer problems in preschool children were 6.3% (229/3 653), 7.5% (274/3 653), 7.6% (278/3 653) and 2.8% (103/3 653), while 7.6% (277/3 653) for total difficulties, 10.9%(398/3 653) for prosocial behavior and 27.4%(981/3 557) for impact respectively. Prevalence of anxiety and depression in the first trimester was 2.7%(100/3 653) and 4.7%(171/3 653) respectively, and in the second trimester was 2.0%(66/3 375) and 3.6%(122/3 375) respectively. After we controlled the confoundings of gestation age, place of residence, family income, maternal education, paternal education, premature birth and folic acid supplement before pregnancy, multinomial logistic regression analysis showed that the risk of children's emotional symptoms in maternal anxiety in both first-trimester and second-trimester group was higher than the group of no depression and anxiety symptoms, and OR(95%CI) was 5.90(2.00-17.48). Compared with whose mother no depression in both first-trimester and second-trimester, the risk of children's emotional symptoms in maternal depression in both first-trimester and second-trimester group was higher, and OR(95% CI) was 3.07 (1.30-7.28). And the risk of children's total difficulties of maternal anxiety in second-trimester was 2.27 (95%CI: 1.10-4.71) times of no anxiety in second-trimester. While the risk of children's total difficulties of maternal depression in second-trimester was 2.20 (95%CI: 1.24-3.93) times of no depression in second-trimester. Maternal emotional symptoms were not significant associations with conduct problems, hyperactivity, peer problems and prosocial behaviors (P> 0.05).</p><p><b>CONCLUSION</b>There was a negative impact of maternal anxiety and depression symptoms during pregnancy on emotional and behavioral problems in preschool children. These findings highlight the need for additional clinical and research attention to both maternal depression and anxiety in pregnancy, which may be helpful to reduce the incidence of children's emotional and behavioral problems and act as an important measure in prevention.</p>

Effect of parents' occupational and life environment exposure during six months before pregnancy on executive function of preschool children / 中华预防医学杂志

<p><b>OBJECTIVE</b>To examine the effect of parents' occupational and life exposure during six months before pregnancy on executive function of preschool children.</p><p><b>METHODS</b>Pregnant women involved in the study came from the Ma'anshan Birth Cohort Study,a part of the China-Anhui Birth Cohort Study. Between October 2008 and October 2010, pregnant women who accepted pregnancy care in four municipal medical and health institutions in Ma'anshan city were recruited as study objects. A total of 5,084 pregnant women and 4,669 singleton live births entered in this cohort. Between April 2014 and April 2015, a total of 3,803 pre-school children were followed up. Finally, except 32 preschool children did not have EF evaluation result, there were 3,771 children included in this study. By using self-designed " Maternal health handbook", we researched parents' general demographic characteristics, and life and occupational exposure during six months before pregnancy. To research preschool children's executive function, we used the Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P). Univariate and multivariate statistical method was used to analyze the association of parents' life and occupational exposure during six months before pregnancy and preschool children's EF.</p><p><b>RESULTS</b>3,771 preschool children's detected rate of inhibitory self-control index (ISCI), flexibility index (FI), emergent metacognition index (EMI) and global executive composite (GEC) dysplasia were 4.8% (182), 2.3% (88), 16.5% (623) and 8.6% (324) respectively. During six months before pregnancy, children whose parents were lived in a noise environment (OR=1.86, 95% CI: 1.36-2.54), whose maternal were exposed to pesticides were the risk of ISCI dysplasia(OR=3.60, 95% CI: 1.45-8.95). During six months before pregnancy, children whose maternal were exposed to pesticides (OR=6.72, 95% CI: 2.50-18.07) and whose father were exposed to occupational lead (OR=2.10, 95% CI: 1.25-3.54) were the risk of FI dysplasia. During six months before pregnancy, children whose parents were lived in a noise environment (OR=1.42, 95%CI: 1.18-1.71) and whose father were exposed to occupational lead (OR=1.30, 95%CI: 1.02-1.65) were the risk of EMI dysplasia. During six months before pregnancy, children whose parents were lived in a noise environment (OR=1.58, 95% CI: 1.24-2.01) and whose maternal were exposed to pesticides (OR=2.39, 95% CI: 1.02-5.58) were the risk of GEC dysplasia.</p><p><b>CONCLUSION</b>The development of executive function is worse among preschool children whose parents live in noise environment, mother exposed to pesticides, and father exposed to occupational lead during six months before pregnancy.</p>

Mid-gestational glucose levels and newborn birth weight: birth cohort study / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the association between the blood glucose levels of pregnant women in second trimester detected by 75 gram oral glucose tolerance test (OGTT) and the birth weight of neonates.</p><p><b>METHODS</b>Demographic information collection and OGTT were conducted for 3 081 pregnant women at ≤14 gestational weeks and 24-28 gestational weeks respectively. Multiple logistic regression analysis was done to identify the factors associated with the birth weight and the risks of large for gestational age (LGA) in three levels (FPG, OGTT-1 h and OGTT-2 h) of OGTT percentile group, multiple linear regression analysis was used to evaluate the relationships between maternal glucose levels and neonate birth weight.</p><p><b>RESULTS</b>Pre-pregnancy obesity (24.0 kg/m2≤BMI<28.0 kg/m2) (OR=1.4, 95%CI:1.0-2.0, P=0.029) and gestational diabetes mellitus (OR=2.4,95% CI: 1.8-3.2, P<0.001) were the risk factors. Pre-pregnancy underweight (BMI<18.5 kg/m2) (OR=1.6, 95%CI: 1.2-2.2, P=0.003), preeclampsia (OR=4.0, 95%CI: 1.9-8.4, P<0.001) increased the risk for small for gestational age (SGA). Multiple linear regression analysis showed neonate birth weight was positive correlated with maternal glucose levels (β were 91.99, 33.60, 32.00, respectively, P<0.001). Percentile groups of each OGTT level was linearly positive associated with increased mean value of neonate birth weight, and so with the risk of LGA.</p><p><b>CONCLUSIONS</b>There were positive correlations between maternal glucose levels and neonate birth weight. The risk of LGA increased with the maternal glucose levels, but there was no statistical association between SGA and maternal glucose levels. FPG level is one of the predictors of LGA. Active surveillance and control of maternal glucose level can effectively reduce the risk of LGA.</p>

Associations between adverse childhood experiences with early puberty timing and possible gender difference / 中华流行病学杂志

Objective To explore the association of adverse childhood events with early puberty timing and possible gender differences.Methods Data was gathered through questionnaires,physical and secondary sexual characteristics,examination with breast stage in girls and testicular volume in boys measured under informed consent among children in grade 3 to grade 5 from a largescale primary school.Information regarding adverse childhood experiences (ACEs),time of screening and physical activity was included in the questionnaire.Age limits on secondary sexual characteristics for defining early puberty established under the "China Puberty Research Collaboration Project" were used to classify early puberty timing.Body mass index was calculated and used to classify both overweight and obesity,in each gender.Results Among the 1 744 children aged 8.2-12.2 years old (957 boys),the prevalence rates of early puberty timing among boys and girls were 7.5％ and 14.6％,respectively,with gender differences (x2＝ 11.671,P＜ 0.001).Boys who reported having experienced serious adverse family events and girls with physical abuse were more likely to develop early puberty.Results from multivariate logistic regression analysis showed that family life events were associated with a higher risk of early puberty timing in boys (odds ratio:2.531,95％ CI:1.276-5.020) while experience related to physical abuse appeared a risk factor of early puberty timing in girls (odds ratio:2.453,95％CI:1.588-3.788).Conclusion Physical abuse and adverse family life events seemed to be associated with early puberty timing,suggesting further longitudinal study should be carried out to understand the nature of these findings and gender differences.