Research progress on shortened telomere length in newborns and impaired cardiovascular metabolic health in children caused by exposure to cadmium during pregnancy / 环境与职业医学

Cadmium exposure during pregnancy is a non-negligible public health problem which may increase the risk of shortened telomere length in newborns and cardiovascular metabolic health damage in children, and has attracted attention from many researchers in recent years. This article reviewed recent studies both domestically and internationally on the associations among cadmium exposure during pregnancy, shortened telomere length in newborns, and cardiovascular metabolic abnormalities in children, and briefly outlined possible mechanisms of shortened telomere length in newborns by cadmium exposure during pregnancy. Current research results showed that cadmium exposure during pregnancy is related to shortened telomere length in newborns and cardiovascular metabolic abnormalities in children, and shortened telomere length in newborns is also related to cardiovascular metabolic abnormalities in children. It suggested that telomere length in newborns may be a biomarker reflecting cardiovascular metabolic abnormalities in children caused by cadmium exposure during pregnancy. In addition, the current potential mechanisms of cadmium exposure during pregnancy accelerating neonatal telomere length shortening include inflammatory reaction, mitochondrial dysfunction, antioxidant consumption/antioxidant enzyme inactivation, and DNA methylation, and these biological mechanisms are associated with cardiovascular metabolic abnormalities through certain factors, such as obesity, elevated blood pressure, impaired fasting blood glucose, and dyslipidemia in children, suggesting that cardiovascular metabolic abnormalities in children may be programmed in early life, but there are still few relevant studies. In the future, research should be conducted on the association among cadmium exposure during pregnancy, telomere length, and offspring cardiovascular metabolism, as well as possible mediating efficacy and related biological mechanisms of telomere length, aiming to provide early-life biological information for the prevention of cardiovascular and metabolic diseases.

Protective effects of breastfeeding on behavior at four years old in children exposed to maternal gestational diabetes mellitus: a birth cohort study / 中华围产医学杂志

Objective:To explore the protective effects of breastfeeding on behavioral problems at 4 years in children born to mothers with gestational diabetes mellitus (GDM).Methods:Based on the Ma' anshan Birth Cohort (MABC) study, 305 GDM women and their children were recruited in this study from Ma' anshan Maternal and Child Health Care Hospital from May 2013 to September 2014. Total breastfeeding duration was followed up at 42 d, 3, 6, 12, and 18 months postpartum as well as the breastfeeding intensity within 6 months. All the subjects were divided into breastfeeding group ( n=256, including exclusive breastfeeding and mixed feeding) or bottle feeding group ( n=49). Internalizing and externalizing behavioral problems at age 4 were assessed using Achenbach Child Behavior Checklist (CBCL/1.5~5) and their association with breastfeeding were analyzed using robust Poisson regression. Controlling false discovery rate was applied for multiple test correction. Results:Compared with bottle feeding, breastfeeding was a protective factor for depression in children ( RR=0.23, 95% CI: 0.05-0.98, q=0.048) when the duration was 4-5 months; for somatic complaints ( RR=0.36, 95% CI: 0.14-0.95, q=0.047) and anxiety ( RR=0.19, 95% CI: 0.06-0.62, q=0.010) with a breastfeeding duration of 6-11 months; and for depression ( RR=0.46, 95% CI: 0.25-0.83, q=0.039) and anxiety ( RR=0.12, 95% CI: 0.03-0.49, q=0.006) with a breastfeeding duration of 12 months and above. Compared with bottle feeding within 6 months, mixed feeding had a protective effect on somatic complaints ( RR=0.29, 95% CI: 0.13-0.64, q=0.026) and anxiety ( RR=0.18, 95% CI:0.07-0.52, q=0.002). Conclusions:The findings suggested that breastfeeding had a protective effect on behavioral problems at age 4 in children exposed to GDM. Women with GDM should be encouraged to breastfeed.

Maternal subclinical hypothyroidism and behavioral problems in preschoolers: A cohort study / 中华内分泌代谢杂志

Objective:To investigate the effects of maternal subclinical hypothyroidism (SCH) on preschoolers′ behavioral problems.Methods:Based on the Ma′ anshan Birth Cohort, pregnant women who had their first antenatal checkup in Maternal and Child Health Center in Ma′ anshan were recruited from May 2013 to September 2014. Data on demographic, obstetric information, and maternal exposure were collected. Women′s fasting venous blood in the first, second, and third trimesters of pregnancy was collected. The levels of thyroid hormones [thyrotropin (TSH), free thyroxine (FT 4)] and thyroid autoantibodies [thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb)] in maternal blood were retrospectively detected by electrochemiluminescence immunoassay. Preschoolers′ behavioral problems were assessed by Achenbach Child Behavior Checklist (CBCL/1.5-5). Poisson regression models were adopted to examine the effect of maternal SCH on preschoolers′ internalizing and externalizing problems and the critical period. Results:In this study, the reference of maternal thyroid indexes was established (between 2.5 th and 97.5 th percentile). The reference of TSH in the first, second, and third trimester of pregnancy was 0.04-4.90 μIU/mL, 0.75-6.08 μIU/mL, and 0.58-5.59 μIU/mL respectively; and the reference of FT 4 was 13.19-23.27 pmol/L, 9.14-15.32 pmol/L, and 9.53-17.45 pmol/L respectively. In the first, second, and third trimester of pregnancy, the prevalence of SCH was found to be 2.0% (25/1 224), 1.6% (19/1 218), and 1.7% (21/1 220), respectively. After adjusting for confounding factors, maternal SCH in the first trimester was associated with the risk of anxiety and depression in preschool children ( OR=3.06, 95% CI 1.05-8.98). Maternal SCH in the second trimester was found to be associated with the risk of overreaction in preschool children ( OR=2.65, 95% CI 1.13-6.21). Conclusions:The establishment of thyroid hormones reference range for pregnant women in Ma′ anshan area is beneficial to the screening, diagnosis, and treatment of thyroid diseases during pregnancy in this area. Maternal SCH during pregnancy is associated with increased risk of behavioral problems in preschool children. In the first trimester, maternal SCH was associated with preschoolers′ anxiety and depression, and in the second trimester, maternal SCH was associated with preschoolers′ emotional reactivity.

Early childhood screen time as a predictor of emotional and behavioral problems in children at 4 years: a birth cohort study in China

BACKGROUND@#Previous studies have suggested that screen time (ST) has a negative effect on children's emotional and behavioral health, but there are few longitudinal studies that have been conducted with infants and toddlers. This study sought to examine the effect of ST in early childhood on emotional and behavioral problems in children aged 4 years, based on a birth cohort study in China.@*METHODS@#A total of 2492 children aged 4 years were enrolled in this study. The parents and guardians of each child completed a questionnaire that included items eliciting information on children's birth information, socio-demographic information at baseline, and ST at each follow-up. Emotional and behavioral problems were assessed using the Strengths and Difficulties Questionnaire (SDQ) at 4 years of age. Multivariate logistic analysis was used to explore the effects of ST on emotional and behavioral problems.@*RESULTS@#The percentages of children with ST > 0 h/day at age 0.5 years, ST > 2 h/day at age 2.5 years, and ST > 2 h/day at age 4 years were 45.7, 55.5, and 34.5% respectively. The prevalence of emotional and behavioral problems was 10.8%. ST at 6 months was a risk factor for emotional symptoms and hyperactivity at the age of 4 years. ST at age 2.5 years was a risk factor for hyperactivity at the age of 4 years. However, ST at age 4 years was a risk factor for total difficulties, conduct problems, peer problems, hyperactivity, and prosocial behavior.@*CONCLUSIONS@#Higher ST exposure at early childhood is associated with later emotional and behavioral problems. In particular, sustained high ST exposure is a risk factor for behavioral problems. These findings suggested the importance of controlling ST to prevent the occurrence of emotional and behavioral problems in the early years.

Early adiposity rebound is associated with indices of obesity and metabolic risk in 5-year-old children: a birth cohort study in Ma’anshan / 公共卫生与预防医学

Objective To assess the association between early adiposity rebound (AR) and indices of obesity and metabolic risk in 5-year-old children. Methods Based on Ma’anshan Birth Cohort Study (MABC), single live births born in Ma'anshan of Anhui province from October 2013 to April 2015 were followed for up to 5 years consecutively. As of August 2019, 720 children with continuous measurements (≥8 times) and metabolic indicators were obtained. Physical examination and laboratory tests were used to obtain information on the birth status, length/height, weight, waist circumference, body composition and metabolic indicators of children. The 2 test, F test, t-test, non-parametric test, general linear model and logistic regression model were used for statistical analysis. Results 43.5% of the children had AR≤4 years. After controlling for gender, it was found that earlier AR was associated with overweight/obesity (OR=2.71, 95%CI: 1.81~4.05), larger waist circumference (OR=1.88, 95%CI: 1.25~2.82), and body fat percentage ≥90th percentile (OR=2.09, 95%CI: 1.26~3.48). In the earlier AR group, the insulin resistance and metabolic score were higher, but the difference was not statistically significant. At 5 years of age, the prevalence of obesity and overweight was 6.0% and 12.8%, respectively. Children with overweight/obesity, larger waist circumference, higher waist-to-weight ratio and body fat percentage ≥ 90th percentile were associated with higher insulin resistance and metabolic score, and all the differences were statistically significant (all P<0.001). Conclusion Earlier AR increased the risk of overweight/obesity, larger waist circumference, and body fat percentage ≥90th percentile at age of 5 years. Each index of the commonly used measures of childhood obesity was closely related with insulin resistance and metabolic risk factors at 5 years old.

A cohort study on the differences of developmental behavior between early term infants and full-term infants / 中华健康管理学杂志

Objective:To investigate the developmental behavior of early term infants at 6 months and its difference from that of complete full-term infants.Methods:A healthy maternal and infant birth cohort in maanshan city, established in Maanshan Maternal and Child Health Hospital from June 2015 to June 2016. Birth outcomes were copied from the hospital electronic medical record system after delivery. The Chinese Ages and Stages Questionnaires was used to assess developmental behavior. The chi-square test and multivariate unconditional logistic regression model were used to analyze the differences in the behavioral development of early and full term infants.Results:The birth rate of early term infants was 24.74% (500/2 021). The detection rates of communication, gross motor, fine motor, problem solving and individual-social areas in early term infants were 2.1%, 3.2%, 6.1%, 6.3% and 2.7%, respectively. The detection rate of problem-solving area in early term infants was significantly higher than that in the full-term infants (6.3% vs. 3.7%, χ 2=5.42, P<0.05). After controlling for confounding factors, compared with full-term infants, the risk of problem-solving area in early infants was significantly increased ( OR=1.65, 95%CI:1.01-2.70, P<0.05). Conclusion:The risk of behavioral retardation in Early term infants is significantly higher than that in full-term infants, and long-term follow-up and appropriate early development promotion interventions are needed to improve their quality of life.

Physical activity status of early stage pregnant women and its influential factors / 中华健康管理学杂志

Objective To understand the physical activity of early stage pregnant women and explore its influential factors. Methods From June 2015 to June 2016, 2122 pregnant women with early pregnancy card in Ma An Shan Maternal and Child Health Hospital were selected and surveyed with a questionnaire. The Physical Activity Questionnaire was used to understand the physical activity of pregnant women in their early pregnancy. Analysis of variance and t-test were used to describe the distribution of energy expenditures of physical activity of pregnant women with different demographic characteristics, and multiple linear regression analysis was used to analyze the factors influencing the energy expenditure of their physical activity. Result The duration of activities of sleep and sitting type was (16.56 ± 3.54) h, accounting for 83.38％of total activity time;the energy consumption value was (17.17±5.59) METs·h;mild physical activity time was (2.62±1.86) h, accounting for total time. 13.19％and the energy consumption value was (6.06±4.43) METs·h;the average time of moderate to severe physical activity was (0.68±0.93) h, accounting for 3.42％of total physical activity time, and the energy consumption value was (3.22±4.58) METs·h. In the univariate analysis, the energy expenditures of physical activity between the different groups (t=-3.551), education level (F=1.347), and occupation type (F=1.485) were different, and the difference was statistically significant (P<0.05). In multiple linear regression analysis, different occupational types and education were the energy expenditure levels of physical activity during early pregnancy. Influencing factors (P<0.05). Conclusion Pregnant women have longer periods of sleep and meditation during the first trimester, and shorter duration of physical activity than mild and above;the energy expenditure of physical activity during the first trimester of pregnancy is affected by the occupational type and educational level of the pregnant woman.

Practice of parenting and related factors on children aged 0-5 in the urban areas of China / 中华流行病学杂志

Objective@#To characterize the relations between the practice of parenting and associated factors on children (0-5 years old) in urban areas of China, in order to provide evidence for promoting the early development of children and to provide positive guidance and service programs on parenting.@*Methods@#A total of 4 515 parents from 15 cities (14 provinces) were surveyed with a self-administered questionnaire. Parenting and Family Adjustment Scales (PAFAS) was used, including parameters as: consistency and coercive parenting, positive encouragement, parent-child relationship and parental emotion adjustment, family relationship and parental teamwork aspects, etc. Both single factor analysis and multiple linear regression were used to examine the associations between parenting practice, individual, parental and family factors.@*Results@#The mean score of PAFAS was 21.00 (15.00-28.00), associated with factors as children’s age, only-child family, premature delivery, father’s education level, confidence on parenting, problems regarding the parental mood, annual family income, family structure and behavior on seeking professional help, etc. Results showed that there were big differences on the practice of parenting in China and influenced by variety of factors.@*Conclusions@#The general situation of parenting was well, in the urban areas of China. The practice of parenting was associated with a series of individual, parental and family factors. Programs on improving the parenting skills and promoting the early development of children, should be highlighted.

Association between elective cesarean delivery and duration of breastfeeding in Ma′anshan City from 2013 to 2014 / 中华预防医学杂志

Objective@#To analyze the correlation between elective cesarean delivery and duration of breastfeeding in Ma′anshan city from 2013 to 2014.@*Methods@#From May 2013 to September 2014, a total of 3 474 pregnant women with the first prenatal checkup were recruited from Ma′anshan maternal and child health care hospital. Finally, 3 109 pregnant women were included after exclusion of those with terminated pregnancies, adverse birth outcomes, twin or multiple pregnancies, breech traction, breech midwifery and loss of delivery information. Demographic data of pregnant women, mode of delivery and breast feeding of children were collected through questionnaires and hospital records. Logistic regression model was used to analyze the relationship between elective cesarean delivery and duration of breastfeeding in children, with the mode of delivery as independent variable and the duration of breastfeeding as dependent variable.@*Results@#The age of 3 109 subjects was (26.6±3.6) years old, the rate of vaginal delivery was 51.1% (1 589), and the rate of elective cesarean delivery was 46.4% (1 443), among which the rate of non-indicative elective cesarean delivery was 26.4% (820), the rate of indicative elective cesarean delivery was 20.0% (623), and the rate of emergency cesarean delivery was 2.5% (77). The proportion of breastfeeding lasting until 4, 12 and 18 months was 45.0% (1 348/2 998), 23.7% (702/2 962) and 5.2% (154/2 944), respectively. After adjusting the confounding factors, compared with vaginal delivery, the OR (95%CI) values of breastfeeding for 4 months in indicative elective cesarean delivery and non-indicative elective cesarean delivery women were 0.870(0.714-1.059), 0.795(0.665-0.949), and the OR (95%CI) values of breastfeeding for 12 months were 0.772(0.611-0.975), 0.755(0.610-0.934), respectively.@*Conclusion@#Elective cesarean delivery may result in shorter duration of breastfeeding in children.

Pregnancy-related anxiety associated with small-for-gestational-age infants / 中华流行病学杂志

Objective To investigate the second or third trimester pregnancy-related anxiety on small-for-gestational-age infants.Methods This study was based on Ma'anshan Birth Cohort Study (MABC),with 3 040 maternal-singleton pairs finally selected for data analysis,from May 2013to September 2014.The psychological state of pregnancy was evaluated according to a self-developed ‘ anxiety scale for gestation'.Small-for-gestational-age was defined as ‘ having birth weight below the 10th percentile at a particular gestational week',while large-for-gestational-age infants was defined as ‘having birth weight above the 90th percentile'.Birth weight between the 10th and 90th percentile was classified as appropriate-for-gestational age infants.x2 test was used to compare the distribution of characteristics in pregnancy among three groups with different birth weights.Multivariate logistic regression models were conducted to evaluate the associations between third trimester pregnancy-related anxiety and birth weight.Results The incidence rates of small-and large-gestational-age infants were 9.6％ and 16.6％,respectively.Difference between women with only one of the second or third trimester pregnancy-related anxiety syndromes and small-for-gestational-age infants showed no statistical significance.Women with both second and third trimester pregnancy-related anxieties might increase the risk of small-for-gestational-age infants (OR=1.39,95％CI:1.04-1.87).However,there was no significant difference between pregnancy-related anxiety and large-for-gestational-age infants (OR=1.05,95％ CI:0.81-1.35) noticed.Conclusion Women with second and third trimesterpregnancy-related anxiety appeared a risk factor for small-for-gestational-age infants.

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.

Developmental characteristics of circadian rhythms in hypothalamic-pituitary-adrenal axis during puberty / 中华流行病学杂志

Objective To explore the developmental characteristics of circadian rhythms in hypothalamus-pituitary-adrenal (HPA) axis during puberty.Methods A total of 1 070 students from Grade 2-3 in 3 primary schools in Ma'anshan city,Anhui province,were selected for physical examination and circadian rhythm of HPA axis checked from 2015 to 2017.Saliva samples were collected at each of the following three time points:immediately upon wakening,30 minutes after wakening and bedtime,with the index of circadian rhythm of HPA axis calculated,which including cortisol awake response (CAR),cortisol in puberty priming and diurnal cortisol slope (DCS).Testicular volume,palpation and visual inspection of breast development were used to assess the state of purbety development on boys and girls.Information on gender,date of birth,time to fall asleep,wake-up time and weekly physical activity were gathered through questionnaire survey.Nonparametric test was used to compare the differences of baseline,follow-up period and different adolescent developmental processes of each index on circadian rhythm of HPA axis.Results During the period of follow-up program and comparing with the continuous undeveloped group,CAR and the changes of CAR showed significantly increase,both in the puberty priming group and continuous development group,with statistically significant differences (CAR:Z=8.551,4.680,respectively;P＜0.01;the changes of CAR:Z=4.079,2.700,respectively,P＜0.01).There were no significant differences noticed in CAR and the changes of CAR between puberty priming group or continuous development group.The area under the curve (AUC) of cortisol in puberty priming group was slightly higher than that in the persistent undeveloped group (Z=2.591,P=0.010).Both the changes of daily cortisol slope (DCS) in puberty priming group and continuing developed group decreased significantly,when comparing with those in continuous undeveloped group (Z=2.450,Z=2.151;all P＜0.05).There was no significant difference noticed in the changes of cortisol in puberty priming and DCS between different puberty development stages (the changes ofAUC:x2=2.747,P=0.253;DCS:x2=4.554,P=0.032).Conclusions The indexes of circadian rhythm of HPA axis were associated with the development of puberty.Both the cortisol awakening response and the total amount of diurnal cortisol secretion showed an increase,along with the puberty development.The change of diurnal cortisol slope declined with the development of puberty.

Association between pregnancy-related anxiety of pregnant women and autism-like behavior in their offspring at 18 months of age / 中华流行病学杂志

Objective To investigate the relationship of pregnancy-related anxiety of pregnant women in second/third trimesters and autism-like behaviors in their offspring at 18 months of age.Methods Based on a prospective cohort study design,we evaluated the situation of pregnancy-related anxiety of women during second and third trimesters through a Pregnancy-Related Anxiety Questionnaire.Subjects under study were classified into three groups,1) those with pregnancy-related anxiety during both trimesters,2) those with pregnancy-related anxiety at one trimester and 3) those without pregnancy-related anxiety in either trimester.When their children were 18 months,autism-like behaviors (ALB) were evaluated,using the part A of Checklist for Autism in Toddlers-23,and then classified into three groups as non-ALB group,minor ALB group and major ALB group.Multi-nominal logistic Regression was used to analyze the relationship of pregnancy-related anxiety with autism-like behaviors.Results Compared with non-ALB group,children whose mother with pregnancy-related anxiety during both trimesters presented significant higher risk on ALB than children whose mother without pregnancy-related anxiety in these two periods (relative risk,RR=2.43,95％ CI:1.21-4.86,P=0.012),major factors as pregnant women's IQ and gestational diabetes mellitus,premature delivery and education levels of fosterers on these pregnant women were under control.Our results from the stratified analysis showed:when in the subgroup that mother was the main fosterer of the child,there was an significant increase of risk in children whose mothers with pregnancy-related anxiety during both trimesters (RR=4.22,95％ CI:1.73-10.32,P=0.002).Conclusion The association between pregnancy-related anxiety and autism-like behavior was not strong but influenced by the fosterer of the child.

Potential interaction effect on attention-deficit/hyperactivity disorder between mother's educational level and preschoolers' dietary pattern / 中华流行病学杂志

Objective To explore the interaction effect between mother's educational level and preschoolers' dietary pattern on attention-deficit/hyperactivity disorder (ADHD).Methods In 2014,there were 16 439 children aged 3-6 years old from 91 kindergartens in Ma'anshan municipality of China.A semi-quantitative food frequency questionnaire and the 10-item Chinese version of the Conners' Abbreviated Symptom Questionnaire (C-ASQ) were administered to assess the usual dietary intake and symptoms on ADHD.Social-demographic information was collected through questionnaires.Unconditional logistic regression was used to analyze the multiplication interaction effect between mother's educational level and preschoolers' dietary pattern on ADHD.Excel software was used to analyze the additive interaction effect of mother's educational level and preschoolers' dietary pattern on ADHD.Results Results showed that factors as:mother's low educational level [aOR=1.31 (1.13-1.52)],scores related to preschoolers in the top quintile of "food processing" [aOR=l.31 (1.16-1.48)] and "snack" [aOR=l.45 (1.29-1.63)]patterns showed greater odds while preschoolers in the top quintile of "vegetarian" [aOR=0.80 (0.71-0.90)] showed less odds for having ADHD symptoms.Both multiplication and additive interactions were observed between mothers with less education.The processed dietary patterns (OR=1.17,95％CI:1.11-1.25),relative excess risk of interaction (RERI),attributable proportion (AP) and the interaction index (SI)appeared as 0.21,0.13 and 1.47,respectively.Multiplication interaction was observed between levels of mother's low education and the snack dietary pattern (OR=1.21,95％CI:1.14-1.29),with RERI,AP and SI as 0.49,0.26 and 2.36,respectively.However,neither multiplication interaction or additive interaction was noticed between levels of mother's low education and the vegetarian dietary pattern (OR=0.97,95％CI:0.92-1.03),with RERI,AP and SI as 0.09,0.05 and 1.15,respectively.Conclusions Levels of mother's low education presented a risk factor for ADHD symptoms in preschool children.Both multiplication interaction and additive interaction were observed between mother's low education levels and the processed dietary pattern.Multiplication interaction was noticed between mother's education levels and the snack dietary pattern but not with the vegetarian dietary pattern.

Exposure to bisphenol A during maternal pregnancy and the emotional and behavioral impact on their preschool children / 中华流行病学杂志

Objective To explore the long-term effects of maternal pregnancy bisphenol A (BPA) exposure on emotional and behavioral problems appeared in their preschool children.Methods The study sample was a subset of the China-Anhui Birth Cohort Study (C-ABCS).A unified questionnaire was used to collect basic information on both pregnant women and their children.Free BPA concentration in maternal serum was determined by high-performance liquid chromatographytandem mass spectrometry (HPLC-MS/MS).The parent-report version of the Strengths and Difficulties Questionnaire (SDQ) was used to estimate the emotional and behavioral problems in preschool children.A total of 1 713 pairs of mothers and children were included in this study.Association between BPA exposure during pregnancy and the emotional and behavioral problems in preschool children was evaluated with multinomial logistic regression model.Results Prevalence rates in 1 713 preschool children appeared as:6.48％ of emotional problems,8.11％ for conduct problems,8.35％ for hyperactivity/ inattention,2.86％ for peer problems,11.38％ for prosocial behaviors and 7.94％ for total difficulties.Subjects were divided according to the degrees of exposure and the results showed as:low exposure group (≤0.120 ng/ml),medium exposure group (0.120＜BPA＜0.400 ng/ ml) and high exposure group (≥0.400 ng/ml) according to the serum BPA concentration in tertile.Results from the multivariate logistic regression analysis showed that high level of maternal BPA exposure appeared a risk factor on children's abnormal conducts (OR=1.876,95％CI:1.161-3.029),more obvious in boys (OR=2.291,95％CI:1.126-4.661).Conclusion Maternal exposure to high level of BPA during pregnancy might increase the detrimental effects of abnormal conducts in their preschool children,more obviously seen in boys.

Pregnancy-related anxiety associated with small-for-gestational-age infants / 中华流行病学杂志

Objective To investigate the second or third trimester pregnancy-related anxiety on small-for-gestational-age infants.Methods This study was based on Ma'anshan Birth Cohort Study (MABC),with 3 040 maternal-singleton pairs finally selected for data analysis,from May 2013to September 2014.The psychological state of pregnancy was evaluated according to a self-developed ‘ anxiety scale for gestation'.Small-for-gestational-age was defined as ‘ having birth weight below the 10th percentile at a particular gestational week',while large-for-gestational-age infants was defined as ‘having birth weight above the 90th percentile'.Birth weight between the 10th and 90th percentile was classified as appropriate-for-gestational age infants.x2 test was used to compare the distribution of characteristics in pregnancy among three groups with different birth weights.Multivariate logistic regression models were conducted to evaluate the associations between third trimester pregnancy-related anxiety and birth weight.Results The incidence rates of small-and large-gestational-age infants were 9.6％ and 16.6％,respectively.Difference between women with only one of the second or third trimester pregnancy-related anxiety syndromes and small-for-gestational-age infants showed no statistical significance.Women with both second and third trimester pregnancy-related anxieties might increase the risk of small-for-gestational-age infants (OR=1.39,95％CI:1.04-1.87).However,there was no significant difference between pregnancy-related anxiety and large-for-gestational-age infants (OR=1.05,95％ CI:0.81-1.35) noticed.Conclusion Women with second and third trimesterpregnancy-related anxiety appeared a risk factor for small-for-gestational-age infants.

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.

Developmental characteristics of circadian rhythms in hypothalamic-pituitary-adrenal axis during puberty / 中华流行病学杂志

Objective To explore the developmental characteristics of circadian rhythms in hypothalamus-pituitary-adrenal (HPA) axis during puberty.Methods A total of 1 070 students from Grade 2-3 in 3 primary schools in Ma'anshan city,Anhui province,were selected for physical examination and circadian rhythm of HPA axis checked from 2015 to 2017.Saliva samples were collected at each of the following three time points:immediately upon wakening,30 minutes after wakening and bedtime,with the index of circadian rhythm of HPA axis calculated,which including cortisol awake response (CAR),cortisol in puberty priming and diurnal cortisol slope (DCS).Testicular volume,palpation and visual inspection of breast development were used to assess the state of purbety development on boys and girls.Information on gender,date of birth,time to fall asleep,wake-up time and weekly physical activity were gathered through questionnaire survey.Nonparametric test was used to compare the differences of baseline,follow-up period and different adolescent developmental processes of each index on circadian rhythm of HPA axis.Results During the period of follow-up program and comparing with the continuous undeveloped group,CAR and the changes of CAR showed significantly increase,both in the puberty priming group and continuous development group,with statistically significant differences (CAR:Z=8.551,4.680,respectively;P＜0.01;the changes of CAR:Z=4.079,2.700,respectively,P＜0.01).There were no significant differences noticed in CAR and the changes of CAR between puberty priming group or continuous development group.The area under the curve (AUC) of cortisol in puberty priming group was slightly higher than that in the persistent undeveloped group (Z=2.591,P=0.010).Both the changes of daily cortisol slope (DCS) in puberty priming group and continuing developed group decreased significantly,when comparing with those in continuous undeveloped group (Z=2.450,Z=2.151;all P＜0.05).There was no significant difference noticed in the changes of cortisol in puberty priming and DCS between different puberty development stages (the changes ofAUC:x2=2.747,P=0.253;DCS:x2=4.554,P=0.032).Conclusions The indexes of circadian rhythm of HPA axis were associated with the development of puberty.Both the cortisol awakening response and the total amount of diurnal cortisol secretion showed an increase,along with the puberty development.The change of diurnal cortisol slope declined with the development of puberty.

Association between pregnancy-related anxiety of pregnant women and autism-like behavior in their offspring at 18 months of age / 中华流行病学杂志

Objective To investigate the relationship of pregnancy-related anxiety of pregnant women in second/third trimesters and autism-like behaviors in their offspring at 18 months of age.Methods Based on a prospective cohort study design,we evaluated the situation of pregnancy-related anxiety of women during second and third trimesters through a Pregnancy-Related Anxiety Questionnaire.Subjects under study were classified into three groups,1) those with pregnancy-related anxiety during both trimesters,2) those with pregnancy-related anxiety at one trimester and 3) those without pregnancy-related anxiety in either trimester.When their children were 18 months,autism-like behaviors (ALB) were evaluated,using the part A of Checklist for Autism in Toddlers-23,and then classified into three groups as non-ALB group,minor ALB group and major ALB group.Multi-nominal logistic Regression was used to analyze the relationship of pregnancy-related anxiety with autism-like behaviors.Results Compared with non-ALB group,children whose mother with pregnancy-related anxiety during both trimesters presented significant higher risk on ALB than children whose mother without pregnancy-related anxiety in these two periods (relative risk,RR=2.43,95％ CI:1.21-4.86,P=0.012),major factors as pregnant women's IQ and gestational diabetes mellitus,premature delivery and education levels of fosterers on these pregnant women were under control.Our results from the stratified analysis showed:when in the subgroup that mother was the main fosterer of the child,there was an significant increase of risk in children whose mothers with pregnancy-related anxiety during both trimesters (RR=4.22,95％ CI:1.73-10.32,P=0.002).Conclusion The association between pregnancy-related anxiety and autism-like behavior was not strong but influenced by the fosterer of the child.

Potential interaction effect on attention-deficit/hyperactivity disorder between mother's educational level and preschoolers' dietary pattern / 中华流行病学杂志

Objective To explore the interaction effect between mother's educational level and preschoolers' dietary pattern on attention-deficit/hyperactivity disorder (ADHD).Methods In 2014,there were 16 439 children aged 3-6 years old from 91 kindergartens in Ma'anshan municipality of China.A semi-quantitative food frequency questionnaire and the 10-item Chinese version of the Conners' Abbreviated Symptom Questionnaire (C-ASQ) were administered to assess the usual dietary intake and symptoms on ADHD.Social-demographic information was collected through questionnaires.Unconditional logistic regression was used to analyze the multiplication interaction effect between mother's educational level and preschoolers' dietary pattern on ADHD.Excel software was used to analyze the additive interaction effect of mother's educational level and preschoolers' dietary pattern on ADHD.Results Results showed that factors as:mother's low educational level [aOR=1.31 (1.13-1.52)],scores related to preschoolers in the top quintile of "food processing" [aOR=l.31 (1.16-1.48)] and "snack" [aOR=l.45 (1.29-1.63)]patterns showed greater odds while preschoolers in the top quintile of "vegetarian" [aOR=0.80 (0.71-0.90)] showed less odds for having ADHD symptoms.Both multiplication and additive interactions were observed between mothers with less education.The processed dietary patterns (OR=1.17,95％CI:1.11-1.25),relative excess risk of interaction (RERI),attributable proportion (AP) and the interaction index (SI)appeared as 0.21,0.13 and 1.47,respectively.Multiplication interaction was observed between levels of mother's low education and the snack dietary pattern (OR=1.21,95％CI:1.14-1.29),with RERI,AP and SI as 0.49,0.26 and 2.36,respectively.However,neither multiplication interaction or additive interaction was noticed between levels of mother's low education and the vegetarian dietary pattern (OR=0.97,95％CI:0.92-1.03),with RERI,AP and SI as 0.09,0.05 and 1.15,respectively.Conclusions Levels of mother's low education presented a risk factor for ADHD symptoms in preschool children.Both multiplication interaction and additive interaction were observed between mother's low education levels and the processed dietary pattern.Multiplication interaction was noticed between mother's education levels and the snack dietary pattern but not with the vegetarian dietary pattern.