Maternal urinary fluoride during pregnancy and birth weight and length: Results from ELEMENT cohort study.

Epidemiological studies assessing prenatal fluoride exposure and anthropometry at birth are scarce, inconsistent and with methodological limitations. The aim of this study was to evaluate associations between maternal urinary fluoride (MUF) at each trimester of pregnancy and birth weight and length in 536 mother-child pairs in the Early Life Exposures in Mexico to Environmental Toxicants (ELEMENT) cohort study. MUF (mg/L) was measured using microdiffusion/fluoride-specific electrode from at least one trimester of pregnancy. Non-linear associations were assessed through segmented regression models (MUF and birth weight Z-score) and we used linear regression models for MUF and birth length Z-score. Models were adjusted for potential confounders including urinary creatinine concentrations as a covariate. Non-creatinine adjusted MUF levels at each trimester of pregnancy were 0.81, 0.86, and 0.82 mg/L, mean concentrations for first, second and third trimester, respectively. For birth weight, we identified a MUF breakpoint at 0.99, 0.68 and 0.58 mg/L, for first, second and third trimester of pregnancy, respectively. In the first trimester, an increase of 1 mg/L in MUF concentrations ≥0.99 mg/L was associated with an increase in weight Z-score at birth (ß = 0.79; 95% CI: 0.10, 1.48; p = 0.02). Second trimester MUF (≥0.68 mg/L) was marginally associated with birth weight decrease (ß = -0.25; 95% CI: -0.55, 0.04; p = 0.09) and third trimester MUF (≥0.58 mg/L) was significantly associated with birth weight decrease (ß = -0.33; 95% CI: -0.63, -0.03; p = 0.03). We observed a linear and significant association between MUF and Z-score of length at birth only for the first trimester of pregnancy (ß = 0.55; 95% CI: 0.07, 1.04; p < 0.02). Prenatal fluoride exposure was associated with birthweight z-score with different susceptibility windows. Our findings reinforce the hypothesis that maternal fluoride exposure may affect birth anthropometry.

Birth Characteristics Among Children Diagnosed with Neurofibromatosis Type 1 and Tuberous Sclerosis.

OBJECTIVE: To evaluate whether children with neurofibromatosis type 1 (NF1) and tuberous sclerosis have different birth characteristics compared with the general population. STUDY DESIGN: We identified all individuals born in Sweden between 1973 and 2014 from the nationwide Medical Birth Register for whom information on both biological parents was available (n = 4 242 122). Individuals with NF1 and individuals with tuberous sclerosis were identified using data from Swedish population-based health data registers. Using logistic regression models, we assessed the associations between these 2 neurocutaneous syndromes and birth characteristics in a cohort that included 1804 subjects with NF1 and 450 with tuberous sclerosis. RESULTS: Children with NF1 and tuberous sclerosis were significantly more likely to be born preterm and via cesarean delivery. In addition, children with NF1 were also more likely to be born with other birth characteristics, such as short length, a large head circumference, and a low Apgar score. Moreover, children with NF1 had an increased odds of being born with a high birth weight or large for gestational age (OR, 1.61; 95% CI, 1.42-1.82 and OR, 1.82; 95% CI, 1.60-2.06, respectively). CONCLUSION: Children with NF1 and tuberous sclerosis differ from the general population in terms of several birth characteristics, with the strongest associations observed for high birth weight and large for gestational age in individuals with NF1.

Female infants are more susceptible to the effects of maternal antenatal depression; findings from the Pelotas (Brazil) Birth Cohort Study.

BACKGROUND: We utilised data from the 2015 Pelotas Birth Cohort, a large prospective cohort in southern Brazil, to examine the association of moderate and severe antenatal depression with child birth outcomes and explore interactions with sociodemographic characteristics. METHODS: Data was available for n = 3046 participants and their infants. We measured antenatal depression using the Edinburgh Postnatal Depression Scale (EPDS, ≥13 for moderate and ≥17 for severe depression). Outcome measures included gestational age, birth weight, length and head circumference, using the Intergrowth-21st standards. We controlled for known confounders including obstetric risk. RESULTS: We did not find differences in childbirth outcomes by maternal depression status for participants with at least moderate depression, although there was an increased risk for female offspring to be small for gestational age (SGA, OR 2.33[1.37,3.97]). For severe depression (EPDS≥17) we found an increased risk for lower APGAR scores (OR 1.63[1.02,2.60]) and being SGA (OR 1.77[1.06,2.97], with an increased risk for female offspring in particular to be in lower weight centiles (-10.71 [-16.83,-4.60]), to be SGA (OR 3.74[1.89, 7.44]) and in the lower 10th centile for length (OR 2.19[1.25,3.84]). LIMITATIONS: include the use of a maternal report questionnaire to ascertain depressive symptoms. CONCLUSIONS: In this recent large longitudinal cohort in Brazil we did not find independent effects of depression on adverse birth outcomes or interactions with sociodemographic characteristics. We found an increased risk of being SGA for female offspring of women with moderate and severe depression, in line with other research suggesting females may be more susceptible to antenatal disturbances. FUNDING: This work was supported by the Wellcome Trust, United Kingdom (095582), the Brazilian National Research Council (CNPq) and the Coordination for the Improvement of Higher Education Personnel (CAPES). EN was supported by the UK Economic and Social Research Council GCRF Postdoctoral Fellowship (ES/P009794/1).

Prepregnancy Dietary Patterns and Their Association with Perinatal Outcomes: A Prospective Cohort Study.

BACKGROUND: Dietary intake may be associated with neonatal outcomes, yet little is known about the influence of prepregnancy dietary pattern (DP). OBJECTIVES: To evaluate the association between prepregnancy DPs and perinatal outcomes. DESIGN: Prospective cohort study during pregnancy (baseline between 5 and 13 gestational week and three follow-up visits: 20 to 26 gestational weeks, 30 to 36 gestational weeks, and 30 to 40 days postpartum, respectively). Diet was assessed in the first trimester using a food frequency questionnaire and having prepregnancy as the time frame. PARTICIPANTS/SETTING: Two hundred fifty-three pregnant women met the following eligibility criteria (20 to 40 years of age, 5 to 13 weeks of gestation at baseline, free of chronic [except obesity] or infectious diseases, and with a singleton pregnancy). The final sample was composed of 193 pregnant women attending a public health care center in Rio de Janeiro, Brazil, from 2009 to 2012. MAIN OUTCOME MEASURES: Type of delivery, large for gestational age (LGA), birth length (BL)>90th percentile, Apgar score<7 at 1 minute, and preterm birth. STATISTICAL ANALYSES: Reduced rank regression was used to identify prepregnancy DPs that explain the following response variables: fiber density (daily dietary fiber intake in grams, divided by total daily energy intake in kilocalories), dietary energy density, and percent energy from saturated fat. Statistical analyses included multiple logistic regression models. The following covariates were defined as confounders based on a unique Direct Acyclic Graph for each outcome: maternal age, current smoker, alcohol consumption, years of education, and first-trimester leisure physical activity. RESULTS: The prevalence of normal delivery was 56.7%. LGA occurred in 16%, BL>90th percentile in 24.3%, Apgar score<7 at 1 minute in 14.2%, and preterm birth in 9.5% of the study population. Three DPs were identified: "fast food and candies" was associated with higher odds of LGA (odds ratio [OR]=4.38, 95% CI: 1.32 to 14.48) and BL>90th percentile (OR=4.81, 95% CI: 1.77 to 13.07); "beans, bread, and fat" was inversely associated with Apgar score<7 at 1 minute (OR=0.14, 95% CI: 0.03 to 0.70); and "vegetables and dairy" was inversely associated with preterm birth (OR=0.24, 95% CI: 0.06 to 0.97). There was no association between adherence to DPs and type of delivery. CONCLUSIONS: Higher adherence to fast food and candies prepregnancy DP increased the odds of LGA birth, while a higher adherence to vegetables and dairy DP decreased the odds of preterm birth.

The Association of Early Life Factors with Body Composition in Peripubertal Jamaican Children / Asociación de los Factores de los Primeros Años de Vida con la Composición Corporal de los Niños Jamaicanos Peripúberes

ABSTRACT Objective: To explore the relationships among early life factors (ie maternal weight, height and body mass index, child's birthweight, birth length and ponderal index) and body composition in peripubertal Jamaican children. Methods: One hundred and seventy-six healthy Jamaican children, 9-12 years of age were recruited from a longitudinal cohort. Their birth anthropometric and maternal anthropometric data during pregnancy were available for analysis. Measurements of anthropometry and body composition using bioelectrical impedance analysis were made. Pubertal stage was also recorded. Multiple linear regression analyses were performed. Results: Adjusting for age and gender of the children, maternal weight and birthweight were positively associated with child's weight, height, body mass index (BMI) and lean body mass (LBM); maternal height was positively associated with child's height and LBM; and maternal BMI was positively associated with BMI and LBM of the child. Also, birth length was positively related to child's height. When child's current height was further added to the models, child's LBM was no longer associated with weight and height of mothers and birthweight but was related to child's current height (p = 0.00). Adjustment for pubertal stage in all models did not significantly change these associations. Conclusion: In this Afro-Caribbean cohort, we found that higher maternal weight, height and birthweight are associated with greater height and LBM in the peripubertal period.

RESUMEN Objetivo: Explorar las relaciones entre los factores de los primeros años de vida (ie el índice de masa corporal materno (IMC) y la altura, el peso al nacer del niño, su longitud al nacer y el índice ponderal) y la composición corporal en niños jamaicanos peripúberes. Métodos: Ciento setenta y seis niños jamaicanos sanos, de 9 a 12 años de edad fueron reclutados de una cohorte longitudinal. Sus datos antropométricos de nacimiento y los datos antropométricos maternos durante el embarazo estaban disponibles para el análisis. Las mediciones de la antropometría y la composición corporal se realizaron usando el análisis de impedancia bioeléctrica. El período de pubertad fue también registrado. Se hicieron análisis de regresión lineal múltiple. Resultados: El ajuste por edad y el género de los niños, el peso materno y el peso al nacer estuvieron positivamente asociados con el peso del niño, la altura, IMC, y la MCM; la altura materna estuvo positivamente asociada con la altura y la MCM del niño; y el IMC materno estuvo positivamente asociado con el IMC y la MCM. Asimismo, la longitud al nacer estuvo relacionada positivamente con la altura del niño. Cuando la altura actual del niño se añadió a los modelos, la MCM del niño no se relacionó ya con el peso y la estatura de las madres y el peso al nacer, sino con la altura actual del niño (p = 0.00). El ajuste por etapa puberal en todos los modelos no cambió significativamente estas asociaciones. Conclusión: En esta cohorte afrocaribeña, encontramos que un mayor peso materno, altura, y peso al nacer se asocian con mayor altura y MCM en el período peripuberal.

The specific and combined role of domestic violence and mental health disorders during pregnancy on new-born health.

BACKGROUND: Addressing impaired foetal growth is recognized as a public health priority. Certain risk factors for this condition, such as poor nutritional status at birth, have been found to be highly correlated with poverty. However, the role of psychosocial factors, specifically the mother's mental health and exposure to violence during pregnancy, have yet to be further explored. Our objective was to determine if there is a measurable association between combined psychosocial factors, specifically domestic violence and mental disorders, and birth outcomes, specifically birth nutritional status and preterm delivery. METHODS: We followed 775 women from an underserved, urban area, beginning their 28th week of gestation. Diagnostic interviews were performed to determine if any of the mothers had any of the following disorders: mood disorder, anxiety, obsessive-compulsive disorder (OCD), substance dependence, psychotic disorder, or anti-social personality disorder. Physical, psychological, and sexual domestic violence were also assessed. RESULTS: Domestic violence and mental disorders were highly correlated in our sample. About 27.15% of the women in our study experienced domestic violence, and about 38.24% of them were diagnosed with mental disorders. The main association we found between combined psychosocial factors and neonate outcomes was between anxiety (IRR = 1.83; 95%CI = 1.06-3.17)/physical violence (IRR = 1.95; 95%CI = 1.11-3.42) and the rate of small-for-gestational age (SGA) in new-borns. More specifically, the combination of anxiety (beta = -0.48; 95%CI = -0.85/-0.10) and sexual violence (beta = -1.58; 95%CI = -2.61/-0.54) was also associated with birth length. Maternal risk behaviours such as smoking, drinking, inadequate prenatal care, and inadequate weight gain could not sufficiently explain these associations, suggesting that these psychosocial factors may be influencing underlying biological mechanisms. CONCLUSION: Domestic violence against women and mental disorders amongst pregnant women are extremely prevalent in under-resourced, urban areas and ultimately, have detrimental effects on birth outcomes. It is imperative that actions be taken to prevent violence and improve mental health during pregnancy.

Pregnancy outcomes and the use of two standards to assess adequacy of maternal body mass index in early gestation.

The maternal weight gain chart proposed by Rosso and Mardones (RM) was subsequently modified by Atalah et al. (AEA). Both charts are widely used in Latin America. The purpose of this study was to compare birth length (BL) and birth weight (BW) outcomes of both charts. A prospective study of pregnant women and their offspring's was performed in Santiago, Chile. From a total sample of 27,613 pregnant women a sub-sample of 11,465 term healthy singleton pregnant women was selected for additional analyses. κ statistics was used to study the degree of agreement of both charts in the diagnosis of maternal nutritional status. Obese and underweight women were classified using both standards at the beginning of pregnancy and compared in terms of BL4250 g proportions. Sensitivity and specificity values of at risk newborns, whose categories were considered as gold standard, were obtained for obese and underweight women of each chart. There was a moderate agreement in the nutritional classification of these charts. Proportions of BL4250 g were similar at each nutritional category; however, absolute figures for at risk newborns were much higher in the RM underweight and obese women. The RM chart showed higher sensitivity values than the AEA chart. The higher sensitivity of the RM chart would support its use for prevention purposes. This chart is advisable for Latin American countries and also for most developing countries.

Size at birth and blood pressure in young adults: findings from a Brazilian birth cohort study / Tamanho ao nascer e pressão arterial em adultos jovens: achados de uma coorte de nascimentos brasileira

OBJECTIVE: To describe the prevalence of borderline blood pressure (BBP) and hypertension (HT) among young adults and to assess the association between size at birth and BBP/HT. METHODS: Data were collected from the fi rst Ribeirão Preto Birth Cohort Study conducted in the city of Ribeirão Preto, southeastern Brazil, that started in 1978-1979. Of the 6,827 singletons born in hospitals, 2,060 were assessed at 23-25 years of age. Blood samples were collected, an anthropometric assessment was performed, and information was obtained regarding occupation, schooling, life habits and chronic diseases. Blood pressure (BP) was classifi ed as: 1) BBP: systolic BP (SBP) ≥ 130 mm Hg and < 140 mm Hg and/or diastolic BP (DBP) ≥ 85 mm Hg and < 90 mm Hg; and 2) HT: SBP ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg. A polytomic logistic regression model was used. RESULTS: BBP prevalence was 13.5% (males: 23.2%) and HT prevalence 9.5% (males: 17.7%). BBP was independently associated with male gender (relative risk [RR] 8.84; 95%CI 6.09;12.82); birth length ≥ 50 cm (RR 1.97; 1.04;3.73); body mass index (BMI) ≥ 30 kg/m2 (RR 3.23; 2.02;5.15); and high waist circumference (RR 1.61; 1.13;2.29), while HT was associated with male gender (RR 15.18; 8.92;25.81); BMI ≥ 30 kg/m2 (RR 3.68; 2.23;6.06); high waist circumference (RR 2.68; 1.77;4.05); and elevated blood glucose (RR 2.55; 1.27; 5.10), but not with birth length. CONCLUSIONS: The prevalence of BBP and HT among young adults of this cohort was higher in males than females. Greater birth length was associated with BBP, but not with HT, whereas birth weight was not associated with either BBP or HT. Adult risk factors explained most of the increase in the levels of BBP and HT.

OBJETIVO: Descrever a prevalência de pressão arterial limítrofe (PAL) e hipertensão (HT) entre adultos jovens e avaliar a associação entre tamanho ao nascer e PAL/HT. MÉTODOS: Dados foram coletados do primeiro estudo brasileiro de coorte de nascimentos em Ribeirão Preto (sudeste do Brasil), iniciado em 1978/79. De 6.827 recém-nascidos de parto único hospitalar, 2.060 foram avaliados aos 23/25 anos. Foram realizadas coleta de sangue, avaliação antropométrica e obtidas informações sobre ocupação, escolaridade, hábitos de vida e doenças crônicas. Pressão arterial (PA) foi classificada em: 1) PAL: PA sistólica (PAS) ≥ 130 e < 140 mm Hg e/ou PA diastólica (PAD) ≥ 85 e < 90 mmHg; 2) HT: PAS ≥ 140 e/ou PAD ≥ 90 mm Hg. Foi aplicado modelo de regressão logística politômica. RESULTADOS: A prevalência de PAL foi de 13,5% (homens 23,2%) e a de HT, 9,5% (homens 17,7%). PAL foi independentemente associada com sexo masculino (RR 8,84; IC95%: 6,09;12,82), comprimento ao nascer ≥ 50 cm (RR 1,97; 1,04; 3,73), índice de massa corporal (IMC) ≥ 30 kg/m² (RR 3,23; 2,02; 5,15) e circunferência de cintura alterada (RR 1,61; 1,13;2,29), enquanto HT associou-se com sexo masculino (RR 15,18; 8,92;25,81), IMC ≥ 30 kg/m² (RR 3,68; 2,23;6,06), circunferência de cintura alterada (RR 2,68; 1,77;4,05) e glicemia elevada (RR 2,55; 1,27;5,10), mas não com comprimento ao nascer. CONCLUSÕES: As prevalências de PAL e HT entre os adultos jovens dessa coorte foram maiores em homens que em mulheres. Maior comprimento ao nascer foi associado com PAL, mas não com HT, enquanto peso ao nascer não foi associado com PAL ou HT. Fatores de risco do adulto explicaram a maioria dos aumentos de PAL ou HT.

Influência do peso e comprimento ao nascer na determinação do estado nutricional de adultos jovens do sexo masculino / Influence of weight and birth length on determining the nutritional statusof young male adults

Considering the increase in obesity worldwide and the need for studying its determinants, this study aimed to investigate the possible influence of weight and birth length in determining the nutritional status of young male adults in Viçosa-MG. One hundred individuals were evaluated in two stages of life: birth and adult age. From the records of the military recruitment database in the city, information on birth weight (BW) and birth length (BL) was searched at the maternity ward and the adult individuals were identified.The values of BMI, waist and hip circumferences, body fat calculated from BMI, fat-free body mass index and waist / hip ratio were measured in theadults. The percentage of body fat was obtained by bioelectrical impedance. Biceps skinfold (BSF), triceps skinfold (TSF), subscapular skinfold (SSSF) and suprailiac (SISF) were measured for determination of central fat (SSSF + SISF) and peripheral fat (BSF + TSF). Blood samples were collected for lipid profile analysis. Blood pressure was measured by an automatic equipment. Statistical analysis was performed using Sigma Stat 2.0 software, p <0.05. A Pearson or Spearman correlation test was used, according to the variable distribution. Means were compared by using a Student t testand ANOVA (parametric variables) or Mann Whitney and Kruskal Wallistest (nonparametric variables). The results obtained showed that 9% of the adults were obese and 39% presented increased body fat. Reduced HDL (62%) was the most frequent biochemical alteration. It was observed that individuals with BMI> 25kg/m2 and increased blood pressure had average BL values higher than the other individuals. The results suggest that BL may reflect the nutritional status in the future and thus should be considered in further studies.

Considerando el elevado aumento de la obesidad en el mundo y la necesidad de investigar sus determinantes, este estudio tuvo por objetivo averiguar una posible influencia de la talla y el peso al nacer con el estado nutricional de jóvenes adultos del sexo masculino del municipio de Viçosa-Minas Gerais - Brasil. Fueron evaluados cien individuos en dos etapas de la vida: al nacimiento y en la edad adulta. De los registros de reclutamiento militar del municipio y de los nacimientos en la maternidad local se levantaron informaciones sobre el peso (PN) y la talla (NC) al nacer y se identificaron los individuos adultos. En la fase adulta, se determinaron el índicede masa corporal (IMC), las circunferencias de cintura y cadera, el IMC libre de grasa y la relación cintura/cadera. El porcentaje de grasa corporal se obtuvo por medio de la bioimpedancia eléctrica. Se determinaron los pliegues cutáneos del bíceps (PCB), tríceps (PCT), subescapular (SST) y suprailíaco (PCSI) para la determinación de la grasa central (TSM + PCSI) y periférica (PCB + PCT). Se cogieron muestras de sangrepara análisis del perfil de lípidos. La presión arterial se midió con un sistema automático. Para el análisis estadístico (p <0,05; Sigma Stat2.0,) fue utilizado test de correlación de Pearsono Spearman, respectivamente, para las variables con y sin distribución normal; ANOVA y test t deStudent (en caso de variables paramétricas) o Mann Whitney y Kruskal Wallis (para variablesno paramétricas) fueron empleados para comparación de las medias. En la muestra evaluada, 9% de los individuos eran obesos y 39% fueron clasificados como portadores de grasa corporal aumentada. La alteración bioquímica más frecuente (62%) fue la reducción de HDL. Se observó que los individuos con IMC> 25kg/m2 y con presión arterial elevada presentan media de NC superior a los demás. Los resultados sugieren que el NC puede relacionar se al futuro estado nutricional del individuo adulto y por tanto debeser considerado en futuros estudios.

Considerando o aumento da obesidade em todo o mundo e a necessidade de se estudar seus determinantes, este trabalho teve como objetivo investigar a possível influência do peso e comprimento ao nascer na determinação do estado nutricional de adultos jovens do sexo masculino do município de Viçosa-MG. Foram avaliados cem indivíduos, em duas fases da vida: ao nascer e na vida adulta. A partir dos registros do banco de dados de alistamento militar do município, buscaram-se, na maternidade, informações sobre peso (PN) e comprimento ao nascer (CN) e identificaram-se os indivíduos, quando adultos. Na vida adulta, avaliaram-se IMC, circunferência da cintura e quadril, IMC de gordura, IMC livre de gordura e relação cintura/quadril. O percentual de gordura corporal foi obtido por bioimpedância elétrica. Aferiram-se pregas cutâneas biciptal (PCB), triciptal (PCT), subescapular (PCSE) e suprailíaca (PCSI) para determinação de gordura central (PCSE + PCSI) e periférica (PCB + PCT). Amostras de sangue foram coletadas para análise do perfil lipídico. A pressão arterial foi aferida por aparelho automático. A análise estatística foi realizada no software Sigma Stat 2.0, p < 0,05. Utilizou-se teste de correlação de Pearson ou Spearman, segundo distribuição das variáveis. O test t'Student e Anova (variáveis paramétricas) ou Mann Whitneye Kruskal Wallis (variáveis não paramétricas) foram utilizados para comparação de médias. Obteve-se, 9% de obesidade e 39% de gordura corporal aumentada. A alteração bioquímica mais frequente foi o HDL reduzido (62%).Observou-se que indivíduos com IMC > 25kg/m2 e com pressão arterial aumentada apresentaram médias de CN superior aos demais. Os resultados obtidos sugerem que o CN pode refletir no estado nutricional futuro e, desta forma, deve ser considerado em estudos posteriores.