Birth Cohort Research Articles

Young adult reflections on life experiences following preterm birth: a cross-sectional descriptive study

BackgroundIncreasingly, preterm-born children are entering adulthood as survival at earlier gestational ages improves. However, there is little understanding of the lived experience in preterm-born adults.MethodsA cross-sectional descriptive study was conducted...

Stability and predictability of Bayley Scales of Infant and Toddler Development: evidence from a south Indian birth cohort prospective study

ObjectivesThere is limited information about the stability and predictability of Bayley Scales of Infant and Toddler Development (BSID) assessing child development in low- and middle-income settings. The objective of the...

Increased adverse pregnancy outcomes among decreased assisted reproductions during the COVID-19 pandemic: insights from a birth cohort study in Southwest China

ObjectivesWe elucidate the impact of the coronavirus disease 2019 (COVID-19) pandemic on assisted reproductive technology (ART) services and birth outcomes and establish an evidence-based framework to maintain the high quality of ART healthcare services and ensure continuous improvement of birth outcomes.MethodsA total of 19,170 pregnant women from Sichuan, Guizhou and Chongqing in Southwest China between 2018 and 2021 were included in this study. The log-binomial regression model was employed to analyse the changes in the probability of adverse birth outcomes, such as low birth weight (LBW), preterm birth (PTB), Apgar score < 7 at 1 min and congenital anomalies (CAs) and their relationship with ART before and after the pandemic. In this analysis, confounding factors such as family annual income, maternal ethnicity, delivery age, subjective prenatal health status, vitamin or mineral supplementation during pregnancy and level of prenatal care provided by the hospital were controlled.ResultsART mothers had the highest probability of giving birth to LBW babies (relative risk (RR): 2.82, 95% confidence interval (CI): 2.32–3.41), experiencing PTB (RR: 2.72, 95% CI: 2.78–3.22) and delivering babies with an Apgar score < 7 at 1 min (RR: 1.73, 95% CI: 1.05–2.69). Before the pandemic, the ART rate increased from 4.42% in 2018 to 6.71% in 2019 (rate difference of 2.29%, P < 0.001). After the pandemic, the ART rate decreased from 6.71% in 2019 to 6.55% in 2020 (rate difference of − 0.16%, P = 0.752). Compared with the pre-pandemic period, the rate difference for LBW decreased from − 0.21% (P = 0.646) in 2018–2019 to an increase of + 0.89% (P = 0.030) in 2019–2020. Similarly, PTB showed an increase in rate difference from + 0.20% (P = 0.623) before the pandemic to + 0.53% (P = 0.256) afterwards. Apgar score < 7 at 1 min had a negative rate difference of − 0.50% (P = 0.012), which changed to a positive value of + 0.20% (P = 0.340). For CAs, the rate difference increased from + 0.34% (P = 0.089) prior to the outbreak to + 0.59% (P = 0.102) at post-outbreak. In 2018 (pre-pandemic), ART was the most significant predictor of LBW, exhibiting an RR of 3.45 (95% CI: 2.57–4.53). Furthermore, in 2020, its RR was 2.49 (95% CI: 1.78–3.42). Prior to the onset of the pandemic (2018), ART (RR: 3.17, 95% CI: 2.42–4.08) was the most robust predictor of PTB. In 2020, its RR was 2.23 (95% CI: 1.65–2.97).ConclusionART services have been significantly impacted by the COVID-19 pandemic, and the resulting delays in ART services have had notable implications for maternal birth outcomes.

Association between the occupation of pregnant women’s partners and risks of infant low birth weight and preterm birth in a prospective birth cohort: the Japan Environment and Children’s Study

Association between the occupation of pregnant women’s partners and risks of infant low birth weight and preterm birth in a prospective birth cohort: the Japan Environment and Children’s Study

School performance and the social gradient in young adult death in Norway.

Young adults from low socioeconomic backgrounds face an increased risk of early mortality. Here we utilize population-wide data from 17 Norwegian birth cohorts (N = 986,573) to assess whether this risk gradient was explained by early-life educational performance, specifically grade point average at 16 years of age. We show that the gradients in both parental education and income largely disappeared when adjusting for school performance in the models. Specifically, among boys, those with the lowest parental education had an unadjusted hazard ratio (HR) of 2.04 (95% confidence interval (CI) 1.86-2.22) compared with peers with the highest parental education, while for girls, the HR was 1.64 (95% CI 1.35-1.93). After adjusting for school performance, these estimates dropped to 0.99 (95% CI 0.79-1.19) for boys and 0.87 (95% CI 0.55-1.19) for girls. Similarly, the mortality risk for those from the lowest parental income quartile decreased from 1.79 (95% CI 1.67-1.91) to 1.25 (95% CI 1.12-1.38) for boys and from 1.63 (95% CI 1.44-1.83) to 1.24 (95% CI 1.03-1.46) for girls. Low educational performance remained strongly associated with early mortality in analyses accounting for unobserved heterogeneity at the family level; boys with a grade point average in the lowest quartile had an HR of 3.04 (95% CI 2.38-3.89), while for girls, the HR was 1.79 (95% CI 1.22-2.63). External causes of death, particularly accidents and poisoning, were most overrepresented among individuals with poor school performance.

Immigrant Generation, Ethnicity, and Early-life Education Outcomes: Evidence from the Born in Bradford Family Cohort Study

Abstract This paper examines the relationship between ethnicity and immigrant generation in relationship to early educational outcomes and their potential determinants. Using Born in Bradford, a large longitudinal birth cohort, and its linked education and health records, we investigated the associations between ethnicity, immigration generations and education measures (Early Years Foundation Stage Profile and National Curriculum Key Stage One). We looked at the children of both first- and second-generation immigrants and compared them with White British non-immigrant children. Logistic regressions were used to examine the explanatory factors of the differences. On the Early Years Foundation Stage Profile, children of first-generation Pakistani immigrants did less well than White British non-immigrant children. This was largely related to language barriers. There were no significant differences between the children of second-generation Pakistani families and children of White British non-immigrant families. In Key Stage One results, there were no differences in reading and maths between children of first-generation Pakistani immigrants and the White British children, however, children of first-generation Pakistani immigrants had better scores in Key Stage One writing. Children of second-generation Pakistani immigrants had better odds of achieving expected standards in most models for reading and writing (but not maths) than the White British children. This might be attributed to better socioeconomic circumstances. Immigrant generation is an independent predictor for early educational outcomes. There are different patterns associated with different immigrant generations. Early life policy interventions to help children of first-generation immigrant with their English language before school could improve these children’s school readiness.

In vitro fertilization and long-term child health and development: nationwide birth cohort study in Japan

The aim of this study is to compare long-term health outcomes between IVF-conceived children and non-IVF-conceived children in Japan, in the context of strong recommendation for single embryo transfer. Using data from a nationwide birth cohort linked with perinatal database, this study analyzed 2140 children born in Japan in May 2010. It compared child health and development outcomes up to 9 years of age between IVF-conceived and non-IVF-conceived children (binary exposure). A Poisson regression with robust variance to estimate the risk ratios for the association between IVF and various long-term child health and developmental outcomes. After adjusting for confounding factors, no significant differences were observed between IVF-conceived and naturally conceived children for most outcomes, including hospitalization, obesity, and developmental milestones. IVF-conceived children showed a slightly lower risk of attention problems at 8 years (adjusted Risk Ratio [aRR]: 0.73, 95% CI: 0.53–1.00). In subgroup analyses, IVF-conceived term children and singletons demonstrated reduced risk of cognitive delays at 5.5 years (aRR: 0.31, 95% CI: 0.10–0.96 and aRR: 0.37, 95% CI: 0.14–0.98, respectively).Conclusion: In this Japanese cohort, IVF conception was not associated with adverse long-term health or developmental outcomes. These findings provide reassurance about the safety of IVF, particularly in the context of single embryo transfer policies. Further research is needed to explore specific IVF protocols and subgroups.What is known:• Long-term health and developmental outcomes of IVF-conceived children remain inconsistent across studies and populations, despite the widespread use of this technology.What is new:• A nationwide population-based cohort study in Japan did not show adverse effects of IVF on long-term child health and development through age 9.• These findings provide reassurance about the safety of IVF, while indicating the need for careful monitoring in specific subgroups such as preterm and multiple births.

Associations of fat and fat-free mass at birth and accretion from 0-5 years with cognitive function at later childhood: The Ethiopian iABC birth cohort

Abstract Early childhood growth is associated with cognitive function. However, the independent associations of fat mass (FM) and fat-free mass (FFM) with cognitive function are not well understood. We investigated associations of FM and FFM at birth and 0-5 years accretion with cognitive function at 10 years. Healthy term newborns were enrolled in this cohort. FM and FFM were measured at birth, 1.5, 2.5, 3.5, 4.5, 6 months, 4 and 5 years. Cognitive function was assessed using Peabody Picture Vocabulary Test (PPVT) at 10 years. FM and FFM accretion were computed using statistically independent conditional accretion from 0-3 months, 3-6 months, 6 months-4 years, and 4-5 years. Multiple linear regression was used to assess associations. At the 10-year follow-up, we assessed 318 children with mean (SD) age of 9.8 (1.0) years. A 1 SD higher birth FFM was associated with a 0.14 SD (95% CI: 0.01, 0.28) higher PPVT at 10 years. FFM accretion from 0-3 and 3-6 months was associated with PPVT at 10 year, β = 0.5 SD (95% CI: 0.08, 0.93) and β = -0.48 SD (95% CI: -0.90, -0.07, respectively. FFM accretion after 6 months showed no association with PPVT. Neither FM at birth nor 0-5 years accretion showed association with PPVT. Overall, birth FFM, but not FM was associated with cognitive function at 10 years, while the association of FFM accretion and cognitive function varied across distinct developmental stages in infancy. The mechanisms underlying this varying association between body composition and cognitive function need further investigation.

Machine learning model‐based preterm birth prediction and clinical nomogram: A big retrospective cohort study

AbstractObjectiveThis study sought to develop a multifactorial predictive model for preterm birth risk, with the goal of providing clinical practitioners with early prevention.MethodsThis retrospective cohort study utilized 2022 and 2018 National Vital Statistics System (NVSS) birth data, with the 2022 cohort arbitrarily split into training (70%) and internal verification (30%) subsets, and the 2018 cohort for external validation. Four machine learning algorithms—logistic regression, adaptive lasso regression, bootstrap forest, and boosted trees—identified features associated with preterm birth. The study then integrated the consensus features identified across the four models to construct a logistic regression‐based preterm birth prediction nomogram. To evaluate the model's efficacy, calibration, receiver operating characteristic (ROC), and decision curve analysis were applied to both the internal and external validation sets.ResultsThe study included 2 567 040 mother–infant pairs from the 2022 cohort and 2 688 568 mother–infant pairs from the 2018 cohort. All four machine learning models demonstrated high accuracy (area under the curve [AUC] &gt;0.7) in predicting preterm birth, and the internal validation results indicated good model generalizability. Feature selection identified nine common risk factors associated with preterm birth. The prediction nomogram based on these nine common features achieved AUCs of 0.701, 0.702, and 0.704 in the training, internal validation, and external validation sets, respectively. The calibration curves showed good agreement, and the decision curve analysis confirmed the model's net clinical benefits.ConclusionThis study developed a reliable preterm birth prediction tool using large‐scale birth cohort data, filling the gap of lacking external validation for existing preterm birth prediction models.

Deficiency of FABP7 Triggers Premature Neural Differentiation in Idiopathic Normocephalic Autism Organoids.

Autism spectrum disorder (ASD), which is caused by heterogeneous genetic and environmental factors, is characterized by diverse clinical phenotypes linked to distinct pathological mechanisms. ASD individuals with a shared clinical phenotype might contribute to revealing the molecular mechanism underlying ASD progression. Here, it is generated induced pluripotent stem cell (iPSC)-derived cerebral organoids from normocephalic individuals with ASD in a prospective birth cohort with a shared clinical diagnosis. Multiple cell lines and time series scRNA-seq combined with a histomorphological analysis revealed premature neural differentiation of neural stem cells (NSCs) and decreased expression of Fatty acid binding protein 7 (FABP7) in ASD organoids. It is subsequently revealed alterations in the phosphorylation levels of Mitogen-Activated Protein Kinase Kinase 1/2 (MEK1/2), which are downstream of FABP7, and the regulation of the FABP7/MEK pathway reversed improper neural differentiation in the ASD organoids. Moreover, both Fabp7-knockdown and MEK2-overexpressing mice exhibited repetitive stereotyped behaviors and social defects relevant to autism. This study reveals the role of the FABP7/MEK pathway in abnormal NSC differentiation in normocephalic individuals with ASD, which might provide a promising therapeutic target for ASD treatment.

Maternal Thyroid Hormones as Mediators between Phthalate Exposure and Neonatal Birth Weight: A Cross-Sectional Study from the Zunyi Birth Cohort.

Studies have shown that exposure to phthalates can affect neonatal birth weight. However, epidemiological evidence on the mediating role of maternal thyroid hormones is limited. Therefore, this study, based on the Compliance Birth Cohort, aimed to reveal the potential mediating function of maternal thyroid hormones during pregnancy between phthalic acid ester (PAE) exposure and neonatal birth weight. The study included 1274 mother-infant pairs. Linear regression analysis revealed a negative association between MIBP and neonatal birth weight (β = -62.236; 95% CI: -118.842, -5.631). Bayesian kernel-machine regression (BKMR) indicated a nonlinear negative association between PAE metabolites (PAEs) and birth weight. Linear regression analysis revealed a positive association between neonatal birth weight and FT3 (β = 41.605; 95% CI: 2.631, 80.380). The BKMR model also found a positive association between thyroid hormones and birth weight but in a nonlinear manner. Additionally, linear regression analyses showed that TSH, TT3, TT4, FT3, and FT4 were associated with PAEs. The BKMR model revealed an inverted U-shaped association of PAEs with TT3 and FT3 and a nonlinear association with TSH, TT4, and FT4. Structural equation modeling revealed that MMP, MIBP, MBP, MEHP, MOP, MBZP, and MEOHP contributed to a net reduction in neonatal birth weight of 32 g through the TT3, FT3, TT4, and FT4 pathways. The findings suggest that exposure to PAEs during pregnancy leads to a reduction in neonatal birth weight, possibly due to the involvement of maternal thyroid hormones as mediators. Controlling maternal thyroid hormone levels during pregnancy may be a viable method to reduce the harmful effects of phthalate exposure on the developing fetus.

A prospective multicenter birth cohort in China: pregnancy health atlas.

The China Prospective Multi-Center Birth Cohort Study was launched in 2022. In collaboration with medical centers in 12 cities, it aims to establish a high-quality, multidimensional cohort comprising 20,000 natural pregnancy and assisted reproductive families. As of June 26, 2024, 12,911 pregnant women have participated in this study, and 161,122 biological samples have been collected. These samples cover four critical periods (early pregnancy, mid-pregnancy, late pregnancy, and postpartum) and comprise 10 different types such as serum, plasma, and urine. The study has collected comprehensive information from early pregnancy to newborns. The participants have an average age of 29.76years, an average height of 160.46cm, an average pre-pregnancy BMI of 23.11, and an average BMI of 27.25 before delivery. The cohort includes individuals from 26 ethnic groups, with 25 minority groups comprising 5.03% of the population. Guizhou Province exhibits the highest percentage of ethnic minorities at 24.96% and Guangdong Province owns the highest proportion (12.22%)of women with two or more children. The prevalence of thalassemia in Guangdong Province is seven times higher than in other provinces. Among pregnant women over 35years old, the prevalence of gestational diabetes mellitus is twice that of women under 35. Additionally, the prevalence of preeclampsia in women with assisted reproductive pregnancies is more than twice that of those with natural pregnancies. The study extensively collected diverse data and biological samples, making this cohort an ideal candidate for DOHaD field and multi-omics research.

Mental health, risk behaviors, and social life factors in relation to adolescents' suicide ideation, plans and attempt.

This study investigated differences in mental health and well-being, risk behaviors, and social life factors among adolescents who experienced different forms of suicidality. We examined 18-years-olds in the Danish National Birth Cohort (N = 47,852). Suicidality was defined with mutually exclusive categories ranging from no suicidality, self-reported suicide ideation, plans, and attempt as well as hospital-recorded suicide attempt. The proportion of adolescents with self-reported poor mental health and well-being, risk behaviors, and social life factors were compared across forms of suicidality. Sample weights were applied. Depressive symptoms were reported by 14% (95% CI 13%;14%) of girls with no suicidality, 44% (95% CI 43%;45%) of girls with suicide ideation, and 68% (95% CI 65%;72%) 66% (95% CI 60%;72%) of girls with self-reported suicide attempt or hospital-recorded suicide attempt respectively. Among boys, depressive symptoms were reported by 5% (95% CI 4%;5%) of those with no suicidality, 27% (95% CI 26%;28%) of those with suicide ideation, and 51% (95% CI 45%;57%) and 40% (95% CI 22%;58%) of those with self-reported suicide attempt or hospital-recorded suicide attempt respectively. Likewise, other aspects of poor mental health and well-being gradually increased relative with more severe forms of suicidality, while no notable differences were identified between adolescents with self-reported and hospital-recorded suicide attempt. Similar tendencies were observed for risk behaviors and social life factors. These findings suggest that adolescents with suicidality, including the large proportion with suicide ideation only, faces challenges across several parameters of mental health and well-being, risk behavior, and social life factors. This emphasizes the need for community-based interventions to identify and support the large group of adolescents experiencing both more and less severe forms of suicidality. Clinicians should prioritize comprehensive psychiatric intervention to address the complex needs of suicidal adolescents effectively.

The Legacy of Redlining: Increasing Childhood Asthma Disparities through Neighborhood Poverty.

Rationale: Identifying the root causes of racial disparities in childhood asthma is critical for health equity. Objectives: To determine whether the racist policy of redlining in the 1930s led to present-day disparities in childhood asthma by increasing community-level poverty and decreasing neighborhood socioeconomic position (SEP). Methods: We categorized census tracts at the birth address of participants from the Children's Respiratory and Environmental Workgroup birth cohort consortium into categories A, B, C, and D as defined by the Home Owners Loan Corporation, with D being the highest perceived risk. Surrogates of present-day neighborhood-level SEP were determined for each tract, including the percentage of low-income households, the CDC's Social Vulnerability Index, and other tract-level variables. We performed causal mediation analysis, which, under the assumption of no unmeasured confounding, estimates the direct and mediated pathways by which redlining may cause asthma disparities through tract-level mediators adjusting for individual-level covariates. Measurements and Main Results: Of 4,849 children, the cumulative incidence of asthma through age 11 was 26.6%, and 13.2% resided in census tracts with a Home Owners Loan Corporation grade of D. In mediation analyses, residing in Grade-D tracts (adjusted odds ratio = 1.03 [95% confidence interval = 1.01, 1.05]) was significantly associated with childhood asthma, with 79% of this increased risk mediated by percentage of low-income households; results were similar for the Social Vulnerability Index and other tract-level variables. Conclusions: The historical structural racist policy of redlining led to present-day asthma disparities in part through decreased neighborhood SEP. Policies aimed at reversing the effects of structural racism should be considered to create more just, equitable, and healthy communities.

Snus and cardiometabolic health markers among Swedish young adults.

Snus is suggested as a risk factor for cardiometabolic disease, but little is known about health effects in young populations, particularly in women. We aimed to investigate associations between snus and cardiometabolic health markers among young men and women. This study was conducted within the BAMSE birth cohort and included participants followed up around 24 years (n=2256) and 26 years (n=1011). Snus use was assessed at 24 years by questionnaires. Cardiometabolic health markers were recorded at clinical examinations at 24 and 26 years. Associations between snus use and cardiometabolic markers were assessed by multivariable linear regression. Snus was used by 6.4% (n=81) among women and 21.9% (n=219) among men. Compared to no tobacco use, daily exclusive snus use among women at 24 years was associated with higher body mass index (BMI) (adjusted β: 1.93kg/m2, 95% CI: 0.54, 3.33) and waist circumference (WC) (aβ: 3.80cm, 95% CI: 0.41, 7.18) at 24 years, and with higher BMI (aβ: 2.73kg/m2, 95% CI: 0.53-4.93) at 26 years. Among men, using ≥4 cans/week was associated with increased BMI (aβ: 2.48kg/m2, 95% CI: 0.73, 4.24) and a tendency toward increased body fat (aβ: 2.31%, 95% CI: -0.53, 5.14) at 26 years. Snus use was not associated with glycemic status or blood pressure. Our results suggest that snus is associated with increased BMI, and possibly other measures of adiposity, among young women and heavy using young men. Given the cross-sectional study design, the results should be interpreted with caution. We found cross-sectional associations between snus use and measures of increased adiposity in a cohort of Swedish young adults, including BMI and waist circumference among women and BMI among heavy snus using men. We did not find associations between snus use and body fat %, glycemic status or blood pressure. This is one of few studies to investigate health effect of snus among both women and men as well as cardiometabolic health markers in young adults. Given the recent trends of increased snus use among young adults, our findings highlight the need for further research on snus on cardiometabolic health.

Establishing a Multifaceted Comprehensive Maternity Cohort Facilitates Understanding of How Environmental Exposures Impact Perinatal Health.

China's "three-child policy", implemented in response to population aging, has made the protection of maternal and infant health an urgent priority. In this environmental and medical big-data era, the Zhejiang Environmental and Birth Health Research Alliance (ZEBRA) maternity cohort was established with the aim of identifying risk factors for perinatal morbidity and mortality from the perspectives of both observational epidemiology and experimental etiology. Compared with conventional birth cohorts, the inclusion of a maternity cohort allows greater scope for research and places an emphasis on maternal health. In particular, it allows us to focus on pregnant women with a history of pregnancy-related illnesses and those planning to have a second or third child. There are currently many pressing issues in perinatal health, including the risk associations between exogenous together with endogenous factors and the occurrence of perinatal abnormalities, pregnancy complications, and adverse pregnancy outcomes. It is crucial to explore the interaction between environmental exposures and genetic factors affecting perinatal health if we are to improve it. It is also worthwhile to assess the feasibility of the early stage prediction of major perinatal abnormalities. We hope to study this in the ZEBRA cohort and also seek nationwide and international collaborations to establish a multicenter cohort consortium, with the ultimate goal of contributing epidemiological evidence to literature and providing evidence-based insights for global maternal and child healthcare.

Trends of extreme hyperbilirubinemia related infant mortality in select European countries (1990-2019).

Limited data exist on population-level mortality outcomes related to extreme neonatal hyperbilirubinemia (EHB) and this study examines trends in annual infant mortality rate (IMR) attributed to hemolytic and perinatal jaundice among Germany, France, Italy, Portugal, Greece and Spain from 1990 to 2019. Data on annual incident cases and disability-adjusted life years were collected from the 2019 Global Burden of Disease study. Live birth cohort data were sourced from UN World Population Prospects. We quantified temporal trends, with relative percent changes. Average annual percent changes (AAPCs) were evaluated using the Joinpoint Regression Program. EHB-related infant mortality decreased from 21.4 (95%CI: 16.1, 27.1) in 1990 to 4.2 (95%CI: 1.9, 7.6) per million live births in 2019. Germany demonstrated lowest AAPC of -3.2% (95% CI: -3.8, -2.5), while Portugal had the highest AAPC of -8.6% (95% CI -11.9, -5.1) in reducing infant mortality due to EHB. There were distinct divergences in the trajectories of declining EHB mortality among the studied countries. This study highlights a significant decline in infant mortality due to extreme hyperbilirubinemia, emphasizing the need for national surveillance and tailored guidelines to prevent bilirubin induced neurological damage. This cross-sectional analysis revealed a marked decline in infant mortality rates attributed to extreme hyperbilirubinemia across the selected European countries. The rates of decline varied significantly between countries, demonstrating notable heterogeneity in mortality trends when stratified by age at death. Implementing data-driven surveillance systems can optimize the alignment of equitable healthcare services, strengthen accountability measures, and identify critical operational inefficiencies. In the European Union, country-specific hyperbilirubinemia guidelines should be reinforced to ensure effective screening and post-discharge follow-up protocols that are tailored to risk burden and available healthcare resources.

Long term links between maternal diet during pregnancy and offspring health.

The developmental origins of health and disease hypothesis propose that lifelong health is programmed during foetal development, in utero. The world's population is ageing due to increased longevity but expanding morbidity and the associated burden on health systems around the planet, are associated with this. Consequently, resources are strained and spent largely on treating patients rather than preventing chronic diseases at their source. Research on early life exposures, starting in the womb, is needed to identify new potential biomarkers linked with the development of chronic diseases during adulthood. Evidence from maternal-offspring cohorts investigating associations between pregnancy exposures and childhood metabolic health is reviewed (The GUSTO study in Singapore, the Copenhagen Prospective Studies on Asthma in Childhood, a mother-child cohort in rural Gambia, the MINIMat study in Bangladesh, The Iodine Status in Pregnancy and Offspring Health Cohort in China, the OBESO cohort in Mexico, the Pune Nutrition study in India, The Reus-Tarragona Birth Cohort study in Spain). Collectively, evidence from prospective observational studies, randomised controlled trials and animal studies, supports the hypothesis that maternal diet, lifestyle and nutritional status during pregnancy are associated with childhood metabolic health in the offspring. However, the evidence is scant and further research is needed.

No Socioeconomic Inequalities in Mortality among Catholic Monks: A Quasi-Experiment Providing Evidence for the Fundamental Cause Theory.

We propose a novel approach to test the fundamental cause theory (FCT) by analyzing the association between socioeconomic status (SES), as measured by the order titles "brothers" and "padres," and mortality in 2,421 German Catholic monks born between 1840 and 1959. This quasi-experiment allows us to study the effect of SES on mortality in a population with largely standardized living conditions. Mortality analyses based on Kaplan-Meier product limit estimation show that there were no statistically significant survival differences between the high and lower SES monks. This holds for all birth cohorts, indicating that monastic life offers health protection for monks with a lower SES regardless the disease patterns, causes of death, or main risk factors in a given period. These findings support the FCT: Whereas SES-related differences in mortality are a widely confirmed finding in the general population, a context with largely standardized conditions eliminates the importance of SES-related resources.

Trends in the practice environment of Chinese healthcare professionals from 2008 to 2023: an age period cohort analysis

BackgroundHealthcare practice environment plays a vital role in evaluation and the development of health sector in China. However, there are few comprehensive reviews and studies focusing on its state and changing trends. This study aimed to examine the dynamic trends in Chinese healthcare professionals’ perceptions of their practice environment from 2008 to 2023 using age period cohort (APC) analysis.MethodsFour national cross-sectional surveys of healthcare professionals were conducted in 2008, 2013, 2018, and 2023. APC analysis was performed to distinguish effects of age, period and cohort. Covariates like gender, department, job satisfaction, and doctor–patient relationships were also analyzed.ResultsBetween 2008 and 2023, healthcare professionals' perceptions of their practice environment first declined and then improved. Those aged 28–38 during 2013–2018 and born between 1978 and 1988 had the most negative perceptions. After 2018, perceptions improved, peaking in 2023. Those under 23 and over 43 exhibited larger age effects. Birth cohorts after 1993 also had more positive effects. Controlling for covariates attenuated APC effects. Females, those in obstetrics and emergency medicine, nurses, technicians, and administrators perceived better environments. Higher job satisfaction and doctor–patient relationship harmony are also associated with more positive perceptions. Income matching efforts and perceptions of promotion fairness had positive impacts, while increasing severity of physical fatigue and psychological anxiety negatively influenced perceptions of the practice environment.ConclusionsThe APC analysis provided nuanced insights into evolving practitioner perceptions amid healthcare reforms in China. Tailored policies focused on career stage and generation are needed to address disruptions and sustain improvements. Monitoring feedback on reforms and changes is essential for optimizing the practice environment over time.