Etude Longitudinale Research Articles

Defining neighborhood walkability for children in the ELFE cohort study

Abstract Background Although walkability is known to be associated with obesity in adults, there is a paucity of data evaluating the association of walkability and health outcomes in children. In particular, little is known regarding the possible association with children’s mental health. Methods We used data from the Etude Longitudinale Française depuis l’Enfance (ELFE) cohort study. Participating mothers gave birth in 2011 in a representative sample of 320 maternity hospitals in mainland France. This pilot study is limited to participants in Paris and children at 5.5 years old. Walkability is defined by three parameters: population density (defined by census data), street connectivity (defined by intersection density), and land-use mix (entropy index). To approximate walkable areas, 500-meter street-network buffer zones were created around each participants address using a geographic information system. Children’s mental health was assessed using parent-reported Strengths and Difficulties Questionnaire at age 5.5 years. Results There was a total of 280 children in this pilot study. On measures of land-use mix, we found a mean of 0.79 (SD: 0.12), representing high accessibility. Residential and intersection density were highly correlated (p < 0.01). The walkability index demonstrated high variability among participants (mean: 10.6; SD: 10.44; range: -1.67 - 30.59). Conclusions Developing a walkability index is a multifactorial measure to describe a children’s neighborhood environment. Future work includes determining the association with children’s mental health disorders, while accounting for individual and neighborhood variables. This ecological model can inform social epidemiology and contextual disparities in children’s health. Key messages • Little is known about neighborhood walkability and the association with children’s mental health. • Using objective measures to calculate neighborhood composition and help elucidate this relationship.

Differences in birth weight between immigrants’ and natives’ children in Europe and Australia: a LifeCycle comparative observational cohort study

ObjectiveResearch on adults has identified an immigrant health advantage, known as the ‘immigrant health paradox’, by which migrants exhibit better health outcomes than natives. Is this health advantage transferred from...

The influence of paternity leave uptake on parental post-partum depression: An ELFE cohort study

IntroductionMany countries are currently expanding their paternity leave policies, which have positive effects on parental mental health.ObjectivesWe examined whether two weeks of paid paternity leave are associated with post-partum depression (PPD) in mothers and fathers at two months after the birth of their child.MethodsData originated from The Etude Longitudinale Française depuis l’Enfance (ELFE) cohort study. A total of 10 975 fathers and 13 075 mothers with reported information on paternity leave and PPD at two months were included in the statistical analyses. Logistic regression models, using survey-weighted data and adjusted for confounders using Inverse Probability Weights (IPW), yielded Odds Ratios.ResultsFathers had a median age of 32∙6 (inter-quartile range (IQR) 36∙9 – 22∙6 years), and mothers had a median age of 30∙5 years (IQR 34∙0 – 27∙1 years) at the time of the ELFE child’s birth. Fathers who took paternity leave had reduced odds of PPD [0∙74 (95% CI: 0∙70 -0∙78)] as well as fathers who intended to take paternity leave [0∙76 (95 CI%: 0∙70 – 0∙82)] compared to fathers who did not take paternity leave. Mothers had an increased likelihood of PPD at two months if their partners took paternity leave [1∙13 (95 CI%: 1∙05 – 1∙20)]. Fathers’ educational level, work contract type nor the number of children in the family were found to be interactions (p>0.25).ConclusionsTaking and intending to take a two-week paid paternity leave is associated with lower odds of PPD in fathers. Mothers whose partners take paternity leave experience borderline higher odds of PPD at two months. Offering only a two-week paternity leave may protect fathers against PPD but does not significantly protect may increase mothers’ risk of against PPD onset.Disclosure of InterestNone Declared

Paternity leave uptake and parental post-partum depression: findings from the ELFE cohort study

Several countries are expanding their paternity leave policies, which can have positive effects on parental mental health. We examined whether 2 weeks of paid paternity leave are associated with post-partum depression in mothers and fathers at 2 months after the birth of their child. We used data from the Etude Longitudinale Française depuis l'Enfance (ELFE) cohort study. Participating mothers gave birth in 2011 in a representative sample of 320 maternity hospitals in mainland France. Inclusion criteria were single or twin livebirths born after at least 33 weeks' gestation; mother's age at least 18 years; no plans to leave metropolitan France within 3 years. Mothers were interviewed face-to-face shortly after the child's birth. Fathers and mothers were both interviewed by telephone 2 months after the child's birth, reporting whether the father had the right to paternity leave and if yes, if he had taken or intended to take it. We used the Edinburgh Postnatal Depression Scale to assess post-partum depression among fathers and mothers at 2 months. Logistic regression models, using survey-weighted data and adjusted for confounders using inverse probability weights, yielded odds ratios (ORs). We included 10 975 fathers and 13 075 mothers with reported information on paternity leave and post-partum depression at 2 months in the statistical analyses. Fathers had a median age of 32·6 years (IQR 36·9-22·6) and mothers had a median age of 30·5 years (34·0-27·1) at the time of the ELFE child's birth. The prevalence of depression in fathers according to paternity leave status was 4·5% among those who used paternity leave, 4·8% among those who intended to use paternity leave, and 5·7% among those who did not use paternity leave. For mothers, the prevalence of post-partum depression was 16·1% among those whose partner used paternity leave, 15·1% among those whose partner intended to use paternity leave, and 15·3% among those whose partner did not use paternity leave. Fathers who took paternity leave had reduced odds of post-partum depression (OR 0·74 [95% CI 0·70-0·78]) as did fathers who intended to take paternity leave (0·76 [0·70-0·82]) compared with fathers who did not take paternity leave. However, we did not find such beneficial effects for mothers whose partners took (1·13 [1·05-1·20]) or intended to take paternity leave (1·02 [0·96-1·08]). Taking and intending to take 2-weeks' paid paternity leave was associated with a reduced likelihood of reporting post-partum depression in fathers. However, offering 2-weeks' paternity leave might place mothers at a greater risk of post-partum depression, suggesting that optimal length and timing of the leave, among other factors, need further investigation. The French National Research Agency.

Boy's math performance, compared to girls', jumps at age 6 (in the ELFE's data at least).

The mathematics achievement discrepancy between girls and boys, with its subsequent occupational consequences, is an issue that has received considerable attention in the literature. It is often referred to as the 'math-gap' and favours boys. A major component of the explanation of this gap resides in determining its age of onset. We analyse here data from more than 10,000 (cross-sectional study) and 2000 (longitudinal study) French students aged 4-7 years, tested in the framework of the Etude Longitudinale Française depuis l'Enfance (ELFE). The results allow to precisely determine the age of onset, since the gender difference, non-existent (or even slightly in favour of girls) in kindergarten (4-5 years), is clearly in favour of boys in first grade (6-7 years). They could therefore provide an important element in the controversial debate on the origin of gender-differentiated performance in mathematics.

Enrichment of Formula in Probiotics or Prebiotics and Risk of Infection and Allergic Diseases up to Age 5.5 Years in the Nationwide Etude Longitudinale Française depuis l'Enfance (ELFE) Cohort

BackgroundAn increasing number of infant and follow-on formulas are enriched with probiotics and/or prebiotics; however, evidence for health effects of such enrichment in early childhood remains inconclusive. ObjectivesThe present study aimed to assess whether the consumption of formula enriched with probiotics or prebiotics was associated with the risk of infection and allergic diseases in early childhood. MethodsAnalyses involved data for 8389 formula-fed children from the Etude Longitudinale Française depuis l'Enfance (ELFE) cohort. Enrichment of the formula with probiotics or prebiotics that was consumed from the age of 2–10 mo was identified by the formula ingredient list. Lower respiratory tract infection (LRTI), upper respiratory tract infection (URTI), gastrointestinal infection, wheezing, asthma, food allergy, and itchy rash were prospectively reported by parents up to the age of 5.5 y. Adjusted logistic regression models were used to assess associations between the consumption of enriched formula and risk of infection and allergic diseases. ResultsAged 2 mo, more than half of formula-fed infants consumed the probiotic-enriched formula and only 1 in 10 consumed the prebiotic-enriched formula. Consumption of the Bifidobacterium lactis-enriched formula at 2 mo was associated with a lower risk of LRTI [OR (95% CI) = 0.84 (0.73–0.96)]. Consumption of the Bifidobacterium breve-enriched formula up to 6 mo was associated with a higher risk of LRTI [OR (95% CI) = 1.75 (1.29–2.38)] and asthma [OR (95% CI) = 1.95 (1.28–2.97)], whereas its consumption from 6 to 10 mo was associated with a lower risk of LRTI [OR (95% CI) = 0.64 (0.48–0.86)] and asthma [OR (95% CI) = 0.59 (0.40–0.88)]. Moreover, the consumption of Streptococcus thermophilus from 6 to 10 mo was associated with a higher risk of asthma [OR (95% CI) = 1.84 (1.29–2.63)]. No significant association was found for gastrointestinal infection, food allergy, and itchy rash. Overall, the consumption of prebiotic-enriched formula was not significantly associated with infection and allergy risk. ConclusionsAssociations between the consumption of probiotic-enriched formula and risk of respiratory symptoms differ according to the strain considered and consumption period. Further well-designed studies are needed to confirm these results.

Association between residential proximity to agricultural crops and adaptive behaviors in children with autism spectrum disorder from the French ELENA cohort

Influences of pesticide exposures on the clinical expression of children with ASD not known. The aim of this study was to analyze the associations between early residential proximity to agricultural crops, proxy of exposure to pesticides, and adaptive behaviors in children with ASD. Children with ASD were recruited within the Etude Longitudinale de l’Enfant avec Autisme (ELENA) French cohort. Adaptive behaviors were assessed with the second edition of the Vineland Adaptive Behavior Scales (VABS-II). Baseline subscores in communication, daily living skills and socialization were considered. Residential exposure to agricultural crops was estimated by crops acreage within a 1000m radius around homes. We ran multiple linear regression models to investigate the associations between exposures to agricultural crops during the pregnancy (n = 183), the first two years of life (n = 193) and adaptive behaviors in children with ASD. The mean (SD) age of children at the inclusion in the ELENA cohort was 6.1 (3.5) years, 39% of them presented an intellectual disability (ID). The mean communication score was 73.0 (15.8). On average, the crop acreage covered 29(27)% of the acreage formed by the 1000m radius around homes. Each increase of 20% in the crop acreage was associated with a significant decrease in communication score of the VABS-II in children without ID for the pregnancy (β = −2.21, 95%CI: 4.16 to −0.27) and the first two years of life (β = −1.90, 95%CI: 3.68 to −0.11) periods. No association was found in children with ID. This study opens perspectives for future works to better understand ASD phenotypes.

Association of Nutrition in Early Childhood with Body Composition and Leptin in Later Childhood and Early Adulthood.

Objectives: Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), this study aimed to replicate the finding of the Etude Longitudinale Alimentation Nutrition Croissance des Enfants (ELANCE) that low fat intake in early childhood was associated with increased adiposity in adulthood. Methods: Diet was assessed at 8 and 18 months using 3-day food records. Body composition variables were measured at 9 and 17 years, and serum leptin at 9 years. Associations were modelled using adjusted linear regression. Results: In replication analyses, in contrast to ELANCE, there was a positive association between fat intake (% energy) at 18 months and fat mass (FM) at 9 years (B coefficient 0.10 (95% CI 0.03, 0.20) kg, p = 0.005). There was no association with serum leptin. In extended analyses fat intake at 18 months was positively associated with FM in boys (0.2 (0.00, 0.30), p = 0.008) at 9 years but not in girls. Fat intake was positively associated with serum leptin concentration in boys (0.2 (0.1, 0.4) ng/mL, p = 0.011) but not in girls. Conclusions: Our results did not corroborate the findings from the ELANCE study. A high fat diet in early life may have implications for later childhood and adolescent obesity.

Residential proximity to agricultural crops and adaptive behaviors in children with autism spectrum disorder from the French ELENA cohort

BACKGROUND AND AIM: Exposures to pesticides during key periods of brain development (pregnancy and early childhood) have been associated with increased risk of autism spectrum disorder (ASD) in children. No study has yet investigated the influence of these exposures on the clinical expression of children with ASD. The aim of this study was to investigate the associations between early residential exposure to agricultural crops and adaptive behaviors in children with ASD. METHODS: Children with ASD were recruited within the Etude Longitudinale de l’Enfant avec Autisme (ELENA) French cohort. Adaptive behaviors were assessed with the second edition of the Vineland Adaptive Behavior Scales (VABS-II). Baseline subscores in communication, daily living skills and socialization were considered. Residential exposure to agricultural crops was estimated by crops acreage within a 1000m radius around homes. We used multiple linear regression models to analyze the associations between exposures to agricultural crops during the pregnancy (n=183), the first two years of life (n=193) and adaptive behaviors in children with ASD. RESULTS:The mean (SD) age of children at the inclusion in the ELENA cohort was 6 (3) years, 39% of them presented an intellectual disability (ID). The mean communication score was 73.0 (15.8). On average, the crop acreage covered 29(27)% of the acreage formed by the 1000m radius around homes. Each increase of 20% in the crop acreage was associated with a significant decrease in communication score of the VABS-II in children without ID for pregnancy (β= -2.21, 95%CI: -4.16 to -0.27) and the first two years of life (β= -1.90, 95%CI: -3.68 to -0.11). No association was found in children with ID. CONCLUSIONS:This is the first study in children with ASD investigating and showing an association between early residential exposure to agricultural crops and impairments in adaptive behaviors. This study opens perspectives for future works to better understand ASD phenotypes. KEYWORDS: Exposure assessment, Pesticides, Neurodevelopmental outcomes, Children's environmental health, Environmental epidemiology

Maternal post-natal depressive symptoms at 2 months: Effects of French antenatal preventive measures in the E.L.F.E. cohort

BackgroundGiven the high incidence of perinatal maternal depression, implementation of preventive actions is crucial. In France, two prenatal preventive measures are available to the general population: early prenatal interview (EPI) and antenatal classes (ANC). ObjectiveTo explore the independent associations between EPI and / or ANC and maternal depressive symptoms at 2 months postpartum. MethodWe used data from the Etude Longitudinale Française depuis l'Enfance (ELFE), a French national representative cohort of children and their parents, followed-up from birth to early adulthood. Data concerning characteristics were collected from the mothers during the maternity stay and between 6/8 weeks’ post-partum. The level of depressive symptoms was scored by the French version of the Edinburgh Postnatal Depression Scale (EPDS) between 6/8 weeks’ post-partum. We considered EPDS score ≥10 indicative of postnatal psychological distress (PPD) and EPDS ≥12 for postnatal depressive symptoms (PNDS). After data imputation, multivariate logistic regression analysis was performed. ResultsAmong the 16,411 mothers included in our sample, 26% benefited both from EPI and ANC, 31.1 % of ANC, 7.7% of an EPI and 35% of neither; 20,1% presented PPD and 12,1% PNDS. The likelihood of presenting PPD was significantly higher in mothers who had neither had EPI nor ANC (OR = 1.15 (95% CI : 1.01–1.30). There was no association between receiving or not an EPI and/or ANC and presenting PNDS. ConclusionsAntenatal preventive measures may be helpful to prevent PPD at 2 months’ post- partum, while PNDS do not seem to be influenced by these actions.

Miswriting (Especially Mirror Writing) of the Digits: An Ecological Assessment Using ELFE Data

The French National Cohort of Children Study (Etude Longitudinale Française depuis l'Enfance—ELFE) tested the literacy and numeracy skills of 4- to 5-year-old typically developing children in the second year of école maternelle. Tasks were administered by more than 4,000 teachers at schools across France. One of the study's numeracy tasks required participants to write the number of ducks (up to 5) they had counted. Analyzing the digits written by 14,904 children showed that miswritings were much more common for the digit 3 than for the digit 4. This result is consistent with the right-orienting rule, which young children in Western cultures apply when they do not know a digit's orientation, and which leads them to write, for example, ε instead of 3.The nature and frequency of miswritten digits did not differ significantly between the 466 children presumed to have written with their left hand and the 3,531 children presumed to have written with their right hand. However, a logistic mixed-effects regression showed that two other factors—age of entry to école maternelle and very early smartphone use—had a (modest) influence on the percentage of digits that were miswritten.

Early growth according to protein content of infant formula: Results from the EDEN and ELFE birth cohorts.

In several systematic reviews, rapid weight gain in early life has been related to increased risk of later obesity. In line with this finding, the "early protein hypothesis" suggests that reducing early protein intake is a potential lever for obesity prevention. To determine whether the variability of protein content of infant formula used in France over the period 2003-2012 is significantly associated with early growth in children. A pooled sample of infants from the EDEN (Etude des Déterminants pré et postnatals de la santé et du développement de l'Enfant) mother-child cohort (born in 2003-2006) and the ELFE (Etude Longitudinale Française depuis l'Enfance) birth cohort (born in 2011) (ntotal =5846) was used. Protein content of the infant formula received at 4months was classified into five groups. Associations between protein content (or breastfed status) at 4 months and weight-, length- and BMI-for-age z-scores at 6, 12 and 18 months were analysed by multivariable linear regression. This analysis showed a positive association between protein content and weight-, length- and BMI-for-age z-scores at 6months and only for weight-for-age at 12 months. At 6months, as compared with the intermediate protein-content group (2.1-2.5g/100 kcal), infants receiving very-high protein content (>2.8g/100 kcal) had higher BMI-for-age z-score and those from the very-low protein-content group (<2.0g/100 kcal) had lower BMI-for-age z-score. Exclusively breastfed infants had lower length and weight z-scores than formula-fed infants at any age. Our findings show a positive association, under real conditions of use, between protein contents in infant formula still on the market and weight-, length- and BMI-for-age z-scores from 6 to 18 months.

Parental migrant status and health inequalities at birth: The role of immigrant educational selectivity

Immigrants tend to exhibit better health than natives despite immigrants' more disadvantaged socioeconomic status. This paradox has often been attributed to immigrants' pre-migration selectivity. However, most empirical studies investigating the role of selectivity have focused on adult health; less attention has been paid to children's birth outcomes outside the U.S. context. Using data from the Etude Longitudinale Française depuis l’Enfance (ELFE), a nationally representative sample of over 18000 births in France in 2011, we investigate the role of immigrant parents' educational selectivity in shaping four birth outcomes: birthweight, low birthweight, prematurity, and being born small for gestational age. Results from linear and logistic regressions confirm a health advantage for children of immigrants compared to natives despite lower parental socioeconomic status, mainly among children of Middle Eastern and North African parents. Immigrant parents' positive pre-migration educational selectivity explains most of this health advantage, predominantly among children with two immigrant parents. Further, mediation analyses indicate that the effect of educational selectivity is partially mediated by parental health behaviors, particularly smoking during pregnancy. Furthermore, analyses suggest that selectivity improves birth outcomes only for children of recent arrivals, with less than five years of residence in France. The beneficial effect of selectivity declines with length of residence, suggesting that a process of “unhealthy assimilation,” coupled with the cumulative exposure to health risks and disadvantaged living conditions, may lead to the erosion of the protective effect of immigrant selectivity.

Characterization of Infant Feeding Practices and Related-Family Characteristics in the French Nationwide ELFE Birth Cohort.

Family characteristics such as education level or income are related to infant feeding practices. This study aimed to characterize infant feeding practices and investigate their associations with family characteristics. Analyses were performed with data from a French nationwide cohort, Etude Longitudinale Française depuis l’Enfance (ELFE). Feeding practices were characterized by two methods, a principal component analysis and a hierarchical ascendant classification (n = 8922). This characterization was conducted in three steps: considering firstly only introduction of main food groups, then also food pieces and finally adding the type of complementary food. The associations between family characteristics and the infant feeding patterns or clusters were tested by linear or multinomial regressions (n = 7556). Besides breastfeeding duration and age of first introduction of complementary foods, it appeared also important to consider specific food groups such as sweetened beverages and cow’s milk, and the introduction of food pieces, to describe feeding practices. Recommended feeding practices (longer breastfeeding, complementary food in the right period) were related to higher maternal age and education level, so was migration status, the presence of older children, low income or the mothers’ attendance to pre-birth preparation classes. The interrelations between feeding practices and family characteristics must be considered when examining the influence of feeding practices on child’s health.

Informal and formal social support during pregnancy and joint maternal and paternal postnatal depression: Data from the French representative ELFE cohort study.

Insufficient social support has been intensively studied as a risk factor of postpartum depression (PPD) among mothers. However, to date, no study has examined the role of informal and formal dimensions of social support during pregnancy with regard to joint maternal and paternal depression after birth. Study associations between insufficient informal and formal support during pregnancy and joint parental PPD. Using data from the nationally representative French ELFE (Etude Longitudinale Française depuis l'Enfance) cohort study (N = 12,350), we estimated associations between insufficient informal and formal support received by the mother during pregnancy and joint parental PPD in multi-imputed multivariate multinomial regression models. In 166 couples (1.3%), both parents were depressed. The likelihood of joint parental PPD was increased in case of insufficient informal support (insufficient partner support: odds ratio (OR) = 1.68 (95% confidence interval (CI): 1.57-1.80); frequent quarrels: OR = 1.38 (95% CI: 1.19-1.60)). We also observed associations between formal support during pregnancy and joint parental PPD (early prenatal psychosocial risk assessment: OR = 1.13 (95% CI: 1.05-1.22); antenatal education: OR = 1.13 (95% CI: 1.05-1.23)), which disappeared when analyses were restricted to women with no psychological difficulties during pregnancy. Insufficient informal social support during pregnancy appears to predict risk of joint PPD in mothers and fathers and should be identified early on to limit complications and the impact on children.

Sleep habits and sleep characteristics at age one year in the ELFE birth cohort study

ObjectiveInfant sleep plays a critical role in normal development. Sleep problems, including sleep onset difficulties (SODs) and night waking (NW), range from 20% to 30% in infants and young children and can be persistent over time up to adulthood. Young French children seem to have longer sleep durations and less sleep troubles than their counterparts worldwide. Here, we aimed at describing infant sleep characteristics (total sleep time (TST)/24 h, NW, and SODs) and associated sleep habits in infants at age one year from the French nationwide birth cohort Etude Longitudinale Française depuis l’Enfance (ELFE). MethodsThis study included 11,783 infants with information on both sleep characteristics and sleep habits (parental presence when falling asleep, eating to fall asleep, sucking a pacifier or finger to sleep and sleep arrangement and location). Associations were studied by multinomial logistic regression analyses adjusted for familial and infant characteristics. ResultsMean TST was 13 h36 min including 2 h54 min of naps; 20% of the infants had TST ≤12 h/24 h. About 46% did not present SOD or NW, 16% had frequent SODs and 22% had NW > 1 night in 2. Parental presence, feeding to fall asleep and infant sleep arrangements were frequent in infants with short sleep duration (≤12 h/24 h), NW and SODs. Non-nutritive sucking was associated with risk of NW, SOD and TST >14 h/24 h. Parental room sharing was associated with NW. ConclusionThis work provides new information on infant sleep arrangements and non-nutritive sucking that should be accounted for when considering sleep behaviors. In addition, most identified sleep habits associated with poor sleep characteristics may be amenable to change.

Breastfeeding Status and Duration and Infections, Hospitalizations for Infections, and Antibiotic Use in the First Two Years of Life in the ELFE Cohort.

In low- and middle-income countries, the protective effect of breastfeeding against infections is well established, but in high-income countries, the effect could be weakened by higher hygienic conditions. We aimed to examine the association between breastfeeding and infections in the first 2 years of life, in a high-income country with relatively short breastfeeding duration. Among 10,349 young children from the nationwide Etude Longitudinale Française depuis l’Enfance (ELFE) birth cohort, breastfeeding and parent-reported hospitalizations, bronchiolitis and otitis events, and antibiotic use were prospectively collected up to 2 years. Never-breastfed infants were used as reference group. Any breastfeeding for <3 months was associated with higher risks of hospitalizations from gastrointestinal infections or fever. Predominant breastfeeding for <1 month was associated with higher risk of a single hospital admission while predominant breastfeeding for ≥3 months was associated with a lower risk of long duration (≥4 nights) of hospitalization. Ever breastfeeding was associated with lower risk of antibiotic use. This study confirmed the well-known associations between breastfeeding and hospitalizations but also highlighted a strong inverse association between breastfeeding and antibiotic use. Although we cannot infer causality from this observational study, this finding is worth highlighting in a context of rising concern regarding antibiotic resistance.

Social Inequalities in Prenatal Folic Acid Supplementation: Results from the ELFE Cohort

Most professional and international organizations recommend folic acid supplementation for women planning pregnancy. Various studies have shown high levels of non-compliance with this recommendation. This study aimed to identify sociodemographic characteristics related to this compliance. The analyses were based on 16,809 women from the French nationwide ELFE cohort (Etude Longitudinale Française depuis l’Enfance). Folic acid supplementation was assessed at delivery, and sociodemographic characteristics were collected at two months postpartum. The association between sociodemographic characteristics and compliance with recommendations on folic acid supplementation (no supplementation, periconceptional supplementation, and supplementation only after the periconceptional period) was examined using multivariate multinomial logistic regression. Only 26% of French women received folic acid supplementation during the periconceptional period, 10% of women received supplementation after the periconceptional period, and 64% received no supplementation. Young maternal age, low education level, low family income, multiparity, single parenthood, maternal unemployment, maternal overweight, and smoking during pregnancy were related to lower likelihood of folic acid supplementation during the periconceptional period compared to no supplementation. These associations were not explained by unplanned pregnancy. Immigrant and underweight women were more likely to receive folic acid supplementation after the periconceptional period. Our study confirms great social disparities in France regarding the compliance with the recommendations on folic acid supplementation.

Frequency of Use of Added Sugar, Salt, and Fat in Infant Foods up to 10 Months in the Nationwide ELFE Cohort Study: Associated Infant Feeding and Caregiving Practices.

The consumption of sugar, salt, and fat in infancy may influence later health. The objective of this study was to describe the frequency of use of added sugar, salt, and fat during the complementary feeding period and the associated infant caregiving practices. Data were obtained from a monthly questionnaire filled by parents for 10,907 infants from the French Etude Longitudinale Française depuis l’Enfance (ELFE) cohort. A score of frequency of use (SU) for added sugar, salt, and fat (oil, margarine, butter, and/or cream) was calculated from the age at complementary feeding introduction (CFI) to the 10th month. Associations between the SU of each added ingredient with infant feeding and caregiving practices were studied with multivariable linear regressions adjusted for familial characteristics. Only 28% of the parents followed the recommendation of adding fat and simultaneously not adding sugar or salt. Breastfeeding mothers were more prone to add sugar, salt, and fat than non-breastfeeding mothers. CFI before four months was positively associated with the SU of added sugar and salt and negatively associated with the SU of added fat. The use of commercial baby food was negatively related to the SU of added salt and fat. The use of these added ingredients was mainly related to breastfeeding, age at CFI, and use of commercial food, and it was independent of the household socioeconomic characteristics.

Women's mental health in the perinatal period according to migrant status: the French representative ELFE birth cohort.

Mental health problems in the perinatal period are common. We examined associations between different categories of migrant status and region of origin in relation to mental health during pregnancy and at 2 months post-partum. We analyzed data from the French nationally representative Etude Longitudinale Française depuis l'Enfance birth cohort (n = 17 988). Migrant status was divided into five categories: 'majority population', 'descendants with one migrant parent', 'descendants with two migrant parents', 'naturalized migrant' and 'non-naturalized migrant women'. Multivariate logistic regression models were implemented to examine associations between migrant status and mental health outcomes: persistent psychological difficulties during pregnancy as well as mother's depression and poor self-reported health at 2 months post-partum. After adjusting for covariates, migrant status was not associated with psychological difficulties during pregnancy. Descendants of migrants had comparable mental health to the majority population. Non-naturalized migrant women were more likely to experience depression (odd's ratio (OR)= 1.66, 95%confidence interval (CI): 1.27, 2.20) and poor self-reported health (OR = 1.45, 95%CI: 1.06, 1.98) during the post-partum period. The region of origin was associated with post-partum health independently of migrant status, such that women from Africa and Turkey were most likely to have depression or poor self-rated health. First, but not second, generation migrant women appear to have high levels of mental health difficulties during the post-partum period. Women from North Africa, Sub-Saharan Africa, and Turkey have higher levels of distress than those from other regions. In particular, non-naturalized migrant appear to be a vulnerable group; they may disproportionately face stressors that increase their risk for post-partum depressive symptoms.