Maternal Smoking Research Articles

Prenatal and childhood lead exposure is prospectively associated with biological markers of aging in adolescence

Few studies have related early life lead exposure to adolescent biological aging, a period characterized by marked increases in maturational tempo. We examined associations between prenatal and childhood lead exposure and adolescent biological age (mean 14.5 years) utilizing multiple epigenetic clocks including: intrinsic (IEAA), extrinsic (EEAA), Horvath, Hannum, PhenoAge, GrimAge, Skin-Blood, Wu, PedBE, as well as DNA methylation derived telomere length (DNAmTL). Epigenetic clocks and DNAmTL were calculated via adolescent blood DNA methylation measured by Infinium MethylationEPIC BeadChips. We constructed general linear models (GLMs) with individual lead measures predicting biological age. We additionally examined sex-stratified models and lead by sex interactions, adjusting for adolescent age and lead levels, maternal smoking and education, and proportion of cell types. We also estimated effects of lead exposure on biological age using generalized estimating equations (GEE). First trimester blood lead was positively associated with a 0.14 increase in EEAA age in the GLMs though not the GEE models (95%CI 0.03, 0.25). First and 2nd trimester blood lead levels were associated with a 0.02 year increase in PedBE age in GLM and GEE models (1st trimester, 95%CI 0.004, 0.03; 2nd trimester, 95%CI 0.01, 0.03). Third trimester and 24 month blood lead levels were associated with a −0.06 and −0.05 decrease in Skin-Blood age, respectively, in GLM models. Additionally, 3rd trimester blood lead levels were associated with a 0.08 year decrease in Hannum age in GLM and GEE models (95%CI -0.15, −0.01). There were multiple significant results in sex-stratified models and significant lead by sex interactions, where males experienced accelerated biological age, compared to females who saw a decelerated biological age, with respect to IEAA, EEAA, Horvath, Hannum, and PedBE clocks. Further research is needed to understand sex-specific relationships between lead exposure and measures of biological aging in adolescence and the trajectory of biological aging into young adulthood.

Maternal Smoking during Pregnancy and its effects on Neural Tube Defects.

Maternal smoking is a potent teratogen among congenital malformations, however its role in the development of Neural Tube Defects (NTDs) is still unclear. In this systematic review, we intend to further investigate the interaction of smoking during pregnancy and the incidence of NTDs. This article was written according to PRISMA criteria from February 2015 and August 2022. After examining the four stages of PRISMA criteria, we selected clinical articles. These articles were selected from PubMed, Scopus and Google scholar (for results follow-up) databases. We gathered NTDs effect and types, smoking type and habit of parents, from neonates. Eventually, 8 articles were included by two separated authors, Smoking was associated with an increase NTDs in the population of pregnant mothers and also among children whose fathers smoked. The main side effects that were considered to be the cause of NTDs besides smoking were alcohol and BMI (18.5-24.9). Smoking also affects the level of folic acid as a substance with an essential role that affects the closure of the neural tube. folic acid available to infants changing along with the level of other blood elements such as zinc, that necessary prevent for NTDs condition. Parental smoking can be considered as one of the strong teratogens in the occurrence of NTDs. Smoking, whether active or passive by the mother, or by the father, is associated with the occurrence of NTDs, In order to reduce the prevalence this disorder, we advise pregnant mothers and neonate's fathers to quit smoking.

Transtorno do espectro do autismo e o uso materno e paterno de medicamentos, tabaco, álcool e drogas ilícitas

Abstract The aim of this study was to investigate the association between maternal and paternal licit and illicit drug use, smoking and drinking and autism spectrum disorder (ASD). We conducted a case-control study with children and adolescents diagnosed with ASD and neurotypical individuals. The data were collected using a semi-structured questionnaire administered during interviews with the children’s mothers or guardians. The following variables were analyzed: child sex and age; maternal and parental age; use of medicines before and during pregnancy; classes of medicines used during pregnancy; maternal and paternal smoking; maternal and paternal drinking; maternal and paternal illicit drug use. The data were analyzed using logistic regression and crude and adjusted odds ratios (OR). After adjustment, the results showed an association between maternal use of antipyretics/pain killers during pregnancy (OR = 2.26; 95%CI 1.29-3.95; p < 0.040) and ASD. No association was found between maternal and paternal smoking, drinking and illicit drug use before and during pregnancy and ASD. The findings suggest that the development of ASD is influenced by environmental factors.

Maternal and paternal licit and illicit drug use, smoking and drinking and autism spectrum disorder.

The aim of this study was to investigate the association between maternal and paternal licit and illicit drug use, smoking and drinking and autism spectrum disorder (ASD). We conducted a case-control study with children and adolescents diagnosed with ASD and neurotypical individuals. The data were collected using a semi-structured questionnaire administered during interviews with the children's mothers or guardians. The following variables were analyzed: child sex and age; maternal and parental age; use of medicines before and during pregnancy; classes of medicines used during pregnancy; maternal and paternal smoking; maternal and paternal drinking; maternal and paternal illicit drug use. The data were analyzed using logistic regression and crude and adjusted odds ratios (OR). After adjustment, the results showed an association between maternal use of antipyretics/pain killers during pregnancy (OR = 2.26; 95%CI 1.29-3.95; p < 0.040) and ASD. No association was found between maternal and paternal smoking, drinking and illicit drug use before and during pregnancy and ASD. The findings suggest that the development of ASD is influenced by environmental factors.

Systemic and Environmental Risk Factors Associated with Molar Incisor Hypomineralisation.

The etiology of molar incisor hypomineralisation (MIH) has been attributed to systemic and environmental factors since 2001. The identification of MIH etiology is fundamental to better understand this condition, for differential diagnosis, and to identify the patient group at risk of MIH. Although the etiology of MIH is still unclear, it is stated as a multifactorial origin, with an overlap of systemic and genetic risk factors. The aim of this chapter was to discuss the systemic and environmental factors associated with MIH according to scientific evidence in the literature, relating it to the basic knowledge of amelogenesis and tooth development chronology. In this chapter, amelogenesis is described and illustrated in detail. Some characteristics of the amelogenesis process could explain some clinical features of the developmental defect of enamel, especially MIH. The chronology of tooth development was also referred to as a characteristic for the occurrence of MIH. Finally, the literature about systemic and environmental risk factors was revised, and the prenatal, perinatal, and postnatal factors associated with MIH were discussed. During the prenatal period, maternal health status, including illnesses during pregnancy and maternal smoking, are the main investigated factors associated with MIH. Prematurity (<37 weeks), low birth weight, and cesarean delivery are the factors associated with MIH during the perinatal period. Moreover, postnatal factors, such as common childhood illnesses, respiratory disease, infections, and antibiotic use, have been associated with MIH. New longitudinal studies that consider the synergy between exposure to environmental factors and biological susceptibility are likely to provide a new understanding of the etiology of MIH.

Association between birth conditions and bone mineral density in adults from the 1982 and 1993 birth cohorts in Pelotas, Rio Grande do Sul State, Brazil

This study assessed the association of birth weight, gestational age, and intrauterine growth with bone mineral density (BMD) at 22 and 30 years of age in the 1982 and 1993 birth cohorts in Pelotas, Rio Grande do Sul State, Brazil. BMD was measured by dual-energy X-ray absorptiometry (DXA) and the association was assessed using analysis of variance. Multiple linear regression was used to control for confounding factors: sex; household income at birth; maternal smoking during pregnancy; maternal schooling; maternal ethnicity/skin color; and pre-pregnancy body mass index. The study tested whether body fat in adulthood was a mediator of the association analyzed, using the G-computation Formula. A total of 6,803 participants from the 1982 and 1993 cohorts were evaluated at 30 and 22 years of age, respectively. Birth weight was associated with BMD at all sites, with a greater difference at the femoral neck. Individuals born weighing less than 2,000g had on average -0.036g/cm2 (95%CI: -0.064; -0.008) of BMD in the femoral neck than individuals weighing more than 3,500g. Individuals with an intrauterine growth z-score at least 1.28 standard deviation below the mean had an average of -0.013g/cm2 (95%CI: -0.024; -0.002) of BMD in the lumbar spine compared with individuals with an above-average z-score. The mediation analysis showed that body fat in adulthood did not mediate the association. Birth conditions have been associated with BMD in adulthood and the identification of early factors related to bone loss is essential due to the demographic inversion that has been taking place in low- and middle-income countries.

Factors influencing maternal death in Cambodia, Laos, Myanmar, and Vietnam countries: A systematic review.

A maternal mortality ratio is a sensitive indicator when comparing the overall maternal health between countries and its very high figure indicates the failure of maternal healthcare efforts. Cambodia, Laos, Myanmar, and Vietnam-CLMV countries are the low-income countries of the South-East Asia region where their maternal mortality ratios are disproportionately high. This systematic review aimed to summarize all possible factors influencing maternal mortality in CLMV countries. This systematic review applied "The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist (2020)", Three key phrases: "Maternal Mortality and Health Outcome", "Maternal Healthcare Interventions" and "CLMV Countries" were used for the literature search. 75 full-text papers were systematically selected from three databases (PubMed, Google Scholar and Hinari). Two stages of data analysis were descriptive analysis of the general information of the included papers and qualitative analysis of key findings. Poor family income, illiteracy, low education levels, living in poor households, and agricultural and unskilled manual job types of mothers contributed to insufficient antenatal care. Maternal factors like non-marital status and sex-associated work were highly associated with induced abortions while being rural women, ethnic minorities, poor maternal knowledge and attitudes, certain social and cultural beliefs and husbands' influences directly contributed to the limitations of maternal healthcare services. Maternal factors that made more contributions to poor maternal healthcare outcomes included lower quintiles of wealth index, maternal smoking and drinking behaviours, early and elderly age at marriage, over 35 years pregnancies, unfavourable birth history, gender-based violence experiences, multigravida and higher parity. Higher unmet needs and lower demands for maternal healthcare services occurred among women living far from healthcare facilities. Regarding the maternal healthcare workforce, the quality and number of healthcare providers, the development of healthcare infrastructures and human resource management policy appeared to be arguable. Concerning maternal healthcare service use, the provisions of mobile and outreach maternal healthcare services were inconvenient and limited. Low utilization rates were due to several supply-side constraints. The results will advance knowledge about maternal healthcare and mortality and provide a valuable summary to policymakers for developing policies and strategies promoting high-quality maternal healthcare.

Perinatal risk factors for the onset of bipolar disorder in young adulthood: a 22-year birth cohort.

Bipolar disorder (BD) is a major cause of disability-adjusted life years in young adults. Pregnancy complications have previously been associated with BD. The current study aimed to examine the association between perinatal factors and BD. We included 3,794 subjects from the 1993 Pelotas population-based birth cohort study. We assessed 27 variables at birth and modeled BD onset at 18 and 22 years. Bivariate analysis was performed by means of binomial logistic regression models. The variables with p-values less than 0.05 were included in a multiple regression with confounders. Maternal smoking was associated with a 1.42-fold increased risk of BD at 18 or 22 years old (95%CI 1.091-1.841), and maternal passive exposure to tobacco with a 1.43-fold increased risk (95%CI 1.086-1.875). No association was found between other perinatal factors and BD after controlling for confounders. The results of the present cohort study corroborate previous reports in the literature indicating a negative effects of maternal smoking during pregnancy. These findings can be further tested and support the development of strategies to prevent the onset development of BD.

Clinical Profile and Outcomes of Respiratory Distress in Neonates- A Cross Sectional Study

Background: Respiratory distress in neonates is a significant cause of morbidity and mortality worldwide. Understanding its prevalence and associated factors is crucial for effective management and preventive strategies. This cross-sectional study aimed to assess the prevalence and clinical profile and outcomes associated with respiratory distress in neonates admitted to the neonatal unit. Methods: Data were collected from neonates admitted to Miracle hospitals, medipally, Hyderabad, Paramitha hospitals, medipally, Hyderabad over period of 6 months. Clinical signs and symptoms of respiratory distress, demographic details, maternal history, and neonatal characteristics were recorded. Descriptive statistics were used to summarize the data, and multivariable logistic regression analysis was performed to identify independent predictors of respiratory distress. Results: 150 neonates included in the study those were diagnosed with respiratory distress. Preterm birth, low birth weight, maternal complications during pregnancy, and perinatal asphyxia were significantly associated with an increased risk of respiratory distress. Neonates born via cesarean section had a higher likelihood of respiratory distress compared to those born via vaginal delivery. Additionally, male gender and maternal smoking during pregnancy were identified as significant risk factors. The prevalence of Respiratory distress observed in males (60%) and in females (40%). Higher percentage of our study population belonged to the preterm babies (&lt;38weeks). In the sample size of 150 patients, we observed 60 cases with TTNB, 40 Cases with HMD, 30 cases with MAS, 15 cases with congenital pneumonia &amp; 5 cases with birth asphyxia. Conclusion: This study provides insights into the prevalence and associated factors of respiratory distress in neonates, highlighting the importance of early recognition and targeted interventions. Strategies targeting modifiable risk factors such as maternal smoking cessation and optimizing prenatal care may help reduce the burden of respiratory distress in neonates. Further research is warranted to explore additional factors and validate these findings in diverse settings.

From womb to wellness: early environmental exposures, cord blood DNA methylation and disease origins.

Fetal exposures can induce epigenetic modifications, particularly DNA methylation, potentially predisposing individuals to later health issues. Cord blood (CB) DNA methylation provides a unique window into the fetal epigenome, reflecting the intrauterine environment's impact. Maternal factors, including nutrition, smoking and toxin exposure, can alter CB DNA methylation patterns, associated with conditions from obesity to neurodevelopmental disorders. These epigenetic changes underscore prenatal exposures' enduring effects on health trajectories. Technical challenges include tissue specificity issues, limited coverage of current methylation arrays and confounding factors like cell composition variability. Emerging technologies, such as single-cell sequencing, promise to overcome some of these limitations. Longitudinal studies are crucial to elucidate exposure-epigenome interactions and develop prevention strategies. Future research should address these challenges, advance public health initiatives to reduce teratogen exposure and consider ethical implications of epigenetic profiling. Progress in CB epigenetics research promises personalized medicine approaches, potentially transforming our understanding of developmental programming and offering novel interventions to promote lifelong health from the earliest stages of life.

Learning Non-monotone Optimal Individualized Treatment Regimes

We propose a new modeling and estimation approach to select the optimal treatment regime from different options through constructing a robust estimating equation. The method is protected against misspecification of the propensity score model, the outcome regression model for the non-treated group, or the potential non-monotonic treatment difference model. Our method also allows residual errors to depend on covariates. A single index structure is incorporated to facilitate the nonparametric estimation of the treatment difference. We then identify the optimal treatment through maximizing the value function. Theoretical properties of the treatment assignment strategy are established. We illustrate the performance and effectiveness of our proposed estimators through extensive simulation studies and a real dataset on the effect of maternal smoking on baby birth weight.

An Overview of Environmental Tobacco Smoke Exposure During Pregnancy: Lower Birth Weight and Height as the Main Health Effect on Human Fetus

Background: Exposure to environmental tobacco smoke (ETS) during pregnancy also poses serious health risks for mother and baby. No study has comprehensively compiled these health effects. In this review, we conducted a narrative scientific review to investigate the results of studies conducted on the effect of mothers’ exposure to ETS on the weight and height of infants and fetuses during pregnancy. Materials and Methods: The literature search was conducted in March 2024 in Web of Science, Scopus, PubMed, and Google Scholar databases. After considering the criteria of the study, 29 papers were included in this overview. Results: ETS exposure is associated with different adverse fetal outcomes. Most studies that examine the effects of passive maternal smoking on fetal growth show that ETS increases the risk of lower mean birth weight and or length. Conclusion: Pregnant women exposed to ETS and their fetuses are as susceptible groups against ETS exposure. Other health consequences on babies due to involuntary exposure of pregnant mothers to ETS should be investigated in future studies.

The Effect of Maternal Smoking During Pregnancy on the Neonatal Weight of the Newborn

Background: According to the World Health Organization, smoking is the most significant risk factor for adverse pregnancy outcomes in industrialized countries. A potential mediator of the impact of smoking on fetal growth is the placenta, which provides the transport of oxygen and nutrients between the mother and the fetus. Nicotine causes a reduction in uteroplacental circulation, leading to negative fetal outcomes such as small size for gestational age, low birth weight, poor growth, and compromised neurological development of the fetus. Many studies have documented a strong association between active smoking during pregnancy and fetal growth restriction. Objective: The aim of this study was to investigate the impact of smoking during pregnancy on newborn birth weight. Methods: In a retrospective study, we analyzed 659 pregnancies with recorded data on smoking during pregnancy and newborn birth weights from the pregnancy database at the Obstetrics Department of the Health Center in Velika Kladuša, Bosnia and Herzegovina, for the period from 2009 to 2010. Results and Discussion: Data analysis revealed that 19.8% of women smoked during pregnancy. The mean birth weight of newborns born to non-smoking mothers was 3446 g, while the mean birth weight of newborns born to smoking mothers was 3287 g. Newborns of smoking mothers had a birth weight that was 159 g lower than those of non-smoking mothers. Conclusion: Smoking during pregnancy significantly affects birth weight and, consequently, pregnancy outcomes.

Heavy metals and trace elements in maternal blood and prevalence of congenital limb abnormalities among newborns: the Japan Environment and Children's Study.

Heavy metals such as lead (Pb) and cadmium (Cd) have been associated with adverse pregnancy and developmental outcomes, including congenital abnormalities. This study investigated the association between exposure to heavy metals and trace elements during fetal life and congenital limb abnormalities in infants. This study is based on a prospective ongoing nationwide birth cohort from the Japan Environment and Children's Study (JECS). The concentrations of Cd, Pb, mercury (Hg), selenium (Se), and manganese (Mn) were measured in maternal blood collected during the mid-late trimesters. Inclusion criteria were available from questionnaires filled in during pregnancy, including information about congenital limb abnormalities at birth or at one month. To examine the associations with limb anomalies and individual chemicals, logistic regression models were applied following log-transformation or division into quartiles of Cd, Pb, Hg, Se, and Mn concentrations. To assess the associations with the heavy metals and trace elements mixture, quantile g-computation was employed. All models were adjusted for age, maternal smoking history, maternal alcohol intake, history of smoking, and infant sex. Data from 90,163 participants were included in the analysis, of whom 369 had congenital limb abnormalities in any of the collected information, and 89,794 had none. Among the 369 cases of congenital limb abnormalities, there were 185 and 142 cases of polydactyly and syndactyly, respectively. The median concentrations of Pb, Cd, Hg, Se, and Mn were 5.85, 0.66, 3.64, 168, and 15.3 ng/g, respectively. There were no associations between maternal blood concentrations of Pb [adjusted odd ratio = 0.83; 95% confidence interval = 0.61, 1.11], Cd [0.87; 0.68, 1.10], Hg [0.88; 0.73, 1.07], Se [1.07; 0.44, 2.59], and Mn [0.91; 0.64, 1.30] with congenital limb abnormalities. No significant association was observed between the mixture of heavy metals and trace elements [0.85; 0.72, 1.02] and any congenital limb abnormalities. Moreover, there was no association with all polydactylies and all syndactylies, or any type of abnormality as a subdivision. At the maternal exposure levels of Cd, Pb, Hg, Se, and Mn assessed in the present study, no association was identified with the risk of developing congenital limb abnormalities in children.

Adolescent smoking patterns: Associations with sociodemographic factors, cyberbullying, and psychiatric diagnoses in an outpatient clinical sample

There is a scarcity of research on smoking in adolescents within a clinical (outpatient) sample, and there is no existing knowledge on the relationship between cyberbullying and smoking in this population. The primary aim of this study is to determine the prevalence of smoking among adolescents in a clinical sample. Additionally, it aims to examine the potential associations between smoking status and factors such as socioeconomic characteristics, psychiatric diagnoses, and cyberbullying levels. A cross-sectional study was performed on 200 adolescents who visited a tertiary child and adolescent psychiatry outpatient clinic. Participants were assessed using the DSM-5 based psychiatric evaluation, the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version-DSM-5 Turkish Adaptation (K-SADS-PL-DSM-5-T), the Revised Cyber Bullying Inventory-II, and the Fagerström Test for Nicotine Dependence. The study found that 21% of the sample consisted of regular smokers, with a higher prevalence observed among older adolescents. The prevalence of depression and disruptive behavior disorders was significantly greater in the smoking group compared to other groups (p:0.043, p < 0.001, respectively). There was a significant difference in the scores for the cyberbullying bully subdimension among smokers (p = 0.013). The results of the multinomial logistic regression analysis indicated significant associations between smoking and age, maternal smoking status, friends smoking status, and a diagnosis of disruptive behavior disorder (p < 0.05 for all variables). This study reveals a significant prevalence of adolescent smoking in an outpatient clinic. These findings highlight the necessity of implementing focused smoking cessation interventions for this specific population.

Nurturing Infants to Prevent Atopic Dermatitis and Food Allergies: A Longitudinal Study.

Atopic dermatitis (AD) at a young age often precedes the development of food allergies. Although AD affects millions of infants worldwide, prenatal and postnatal risk factors, and their association with the development of food allergies later on, are not fully elucidated. This study seeks to investigate AD epidemiology in infancy and its risk factors, examining early-life factors (both prenatal and postnatal) that could contribute to the later development of food allergies. Between January 2019 and December 2019, 501 infants were included in this prospective cohort study. Longitudinal data collection was performed through maternal interviews, the first one conducted within three days after the delivery and the second within 24 to 36 months after the delivery, encompassing variables such as demographics, family history of atopy, maternal smoking, antibiotic use during pregnancy, the mode of delivery, breastfeeding history, food practices, and greenness exposure within 3 days from delivery, while they were still in the hospital. Maternal smoking during pregnancy (p = 0.001) and an older sibling atopy history (p = 0.03) was significantly linked to AD incidence. Cesarean section delivery (p = 0.04) was associated with a higher risk of food allergies in infants with AD. Having a garden at home correlated with a higher likelihood of AD (p = 0.01), and food elimination without medical guidance (p = 0.02) due to AD correlated with an elevated risk of food allergies. Encouraging timely allergenic food introduction while promoting dietary diversity, rich in plant-based foods, maternal smoking cessation, and professional dietary guidance may help minimize AD and food allergy risk. Future studies should address the role of greenness in the development of AD and food allergies.

Predicting child development and school readiness, at age 5, for Aboriginal and non-Aboriginal children in Australia's Northern Territory.

Positive early development is critical in shaping children's lifelong health and wellbeing. Identifying children at risk of poor development is important in targeting early interventions to children and families most in need of support. We aimed to develop a predictive model that could inform early support for vulnerable children. We analysed linked administrative records for a birth cohort of 2,380 Northern Territory children (including 1,222 Aboriginal children) who were in their first year of school in 2015 and had a completed record from the Australian Early Development Census (AEDC). The AEDC measures early child development (school readiness) across five domains of development. We fitted prediction models, for AEDC weighted summary scores, using a Partial Least Square Structural Equation Model (PLS-SEM) considering four groups of factors-pre-pregnancy, pregnancy, known at birth, and child-related factors. We first assessed the models' internal validity and then the out-of-sample predictive power (external validity) using the PLSpredict procedure. We identified separate predictive models, with a good fit, for Aboriginal and non-Aboriginal children. For Aboriginal children, a significant pre-pregnancy predictor of better outcomes was higher socioeconomic status (direct, β = 0.22 and indirect, β = 0.16). Pregnancy factors (gestational diabetes and maternal smoking (indirect, β = -0.09) and child-related factors (English as a second language and not attending preschool (direct, β = -0.28) predicted poorer outcomes. Further, pregnancy and child-related factors partially mediated the effects of pre-pregnancy factors; and child-related factors fully mediated the effects of pregnancy factors on AEDC weighted scores. For non-Aboriginal children, pre-pregnancy factors (increasing maternal age, socioeconomic status, parity, and occupation of the primary carer) directly predicted better outcomes (β = 0.29). A technical observation was that variance in AEDC weighted scores was not equally captured across all five AEDC domains; for Aboriginal children results were based on only three domains (emotional maturity; social competence, and language and cognitive skills (school-based)) and for non-Aboriginal children, on a single domain (language and cognitive skills (school-based)). The models give insight into the interplay of multiple factors at different stages of a child's development and inform service and policy responses. Recruiting children and their families for early support programs should consider both the direct effects of the predictors and their interactions. The content and application of the AEDC measurement need to be strengthened to ensure all domains of a child's development are captured equally.

Maternal determinants of dietary patterns in infancy and early childhood in the Growing up in New Zealand cohort

Given the importance of diet in early life, assessing children’s diet is crucial to guide interventions. Using data from a nationally generalizable New Zealand (NZ) birth cohort we examined children’s dietary patterns at 9- (n = 6259), 24- (n = 6292), and 54-months (n = 6131), and their association with maternal sociodemographic and health behaviours. At each time-point, children's dietary patterns were identified using principal components analysis. We then used multivariate linear regression to examine associations between each pattern and maternal variables. At 9-, 24- and 54-months, two dietary patterns were identified, explaining 36.4%, 35.3% and 33.6% of children's intake variability, respectively. Refined high in sugar, salt and fat dietary pattern, at all time-points, was characterized by high positive loadings in white/refined breads and cereals, and items with high sugar, sodium, and fat content. At 24-months, Refined high in sugar, salt and fat also included a high positive loading with protein food groups. Fruit and vegetables dietary pattern, at all time-points, had high positive loadings for fruits and vegetables (with type varying across time-points). Fruit and vegetables also included high loading in whole grain options of breads and cereals at 24-months and the protein food group was part of this dietary pattern at 9- and 54-months. Children’s scores on the Refined high in sugar, salt and fat pattern had strong associations with maternal smoking habits, education level, ethnicity, and maternal scores in the “Junk” and “Traditional/White bread” dietary patterns (constructed from an antenatal interview). Children’s scores on the Fruit and vegetables pattern had strong associations with the maternal scores in the dietary pattern “Health Conscious”. Interventions to improve diet in early life in NZ need to be responsive to ethnicity and suitable for people of all education levels. Interventions that improve maternal health behaviours may also improve children’s diet.

Impact of maternal age and body mass index on the structure and function of the heart in newborns: a Copenhagen Baby Heart Study

BackgroundMaternal obesity and advanced age have been associated with an increased risk of structural congenital heart defects in the offspring. Whether these factors may also cause abnormalities in infant cardiac dimension and function is unknown. This study investigates whether maternal body mass index (BMI) and maternal age are associated with changes in left ventricular (LV) dimensions and function in the newborn.MethodsInfants enrolled in the Copenhagen Baby Heart Study (CBHS), who were born at term, and contributed with a transthoracic echocardiography (TTE) within 60 days of birth were included. The exposure variables were prepregnancy maternal BMI (kg/m2) < 18.5; 18.5–24.9 (reference); 25–29.9; 30–34.9 and ≥ 35 and maternal age (years) < 25; 25–29; 30–34 (reference); 35–39 and ≥ 40. Outcomes were LV parameters ascertained by 2D-echocardiography. Associations between each maternal factor and infant LV parameters were analysed with either a linear model adjusted for the child’s weight and length at birth, gestational age, sex, age at TTE, and maternal smoking, or a linear mixed model, further adjusted for random effects of analyst and month of analysis. Analyses investigating impact of maternal BMI were adjusted for maternal age, and vice versa.ResultsThe study cohort included 24,294 infants. Compared with infants in the BMI reference group, infants born to women with a BMI ≥ 25 kg/m2 generally had smaller measures of LV internal diameters in end-diastole, reaching statistical significance for BMI 30–34.9 kg/m2 [-0.11 ± 0.04 mm, p = 0.01]. All groups of infants born to women with a BMI ≥ 25 kg/m2 had significantly smaller LV internal diameters in end-systole: BMI 25–29.9 kg/m2 [-0.04 ± 0.02 mm, p = 0.04], BMI 30–34.9 kg/m2 [-0.12 ± 0.03 mm, p = 0.001] and BMI ≥ 35 kg/m2 [-0.11 ± 0.05 mm, p = 0.03].Compared with infants in the age reference group, infants born to women ≥ 40 years had significantly smaller LV internal diameters in end-diastole [-0.15 ± 0.04 mm, p = 0.001] and end-systole [-0.09 ± 0.04 mm, p = 0.009].ConclusionsSystematic population-based echocardiography of infants showed that a maternal prepregnancy BMI ≥ 25 kg/m2 and maternal age ≥ 40 years were associated with smaller systolic and diastolic LV diameters. The long-term effects are unknown.Clinical trial registrationApril 2016, Copenhagen Baby Heart, NCT02753348.

Intergenerational transmission of tobacco smoking: The role of the child’s behavioral difficulties. Data from the Danish National Birth cohort (DNBC)

AimsThis study explores the role of offspring behavioral difficulties in the intergeneration transmission of tobacco smoking. MethodsThis longitudinal cohort study is based on children born in Denmark in 1996–2003 participating in the Danish National Birth Cohort (DNBC), followed-up until 18years of age. We included mother-child pairs with complete data regarding the exposure (4 trajectories of maternal daily smoking quantity during pregnancy: low, intermediate/stable, intermediate/decreasing and high), outcome (offspring daily smoking status at 18 years) and mediator (offspring symptoms of hyperactivity-inattention at 11 years), that is 24,588 mother-child pairs. ResultsIn our study population, during pregnancy respectively 86.2%, 6.80%, 4.08% and 2.97% mothers belonged to the low, intermediate/stable, intermediate/decreasing and high smoking trajectory groups. After controlling for covariates using propensity scores, the direct effect of maternal smoking in pregnancy on offspring smoking in adolescence was statistically significant, especially when the mother belonged to the intermediate/stable smoking trajectory group (ORIPW = 2.09, 95% CI: 1.70 – 2.61) or to the high smoking trajectory group (ORIPW = 2.08, 95% CI: 1.52 – 3.11) compared to the low smoking trajectory group. None of the indirect effects of maternal smoking in pregnancy were statistically significant, and neither were the proportions mediated. ConclusionMaternal pregnancy smoking seems to have an influence on offspring smoking in early adulthood, which does not appear to be mediated by offspring behavioral difficulties. Women should be strongly encouraged to quit smoking in pregnancy to reduce both short and long-term health risks among their offspring.