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Akagi T, Saijo Y, Yoshioka E, Sato Y, Nakanishi K, Kato Y, Nagaya K, Takahashi S, Ito Y, Iwata H, Yamaguchi T, Miyashita C, Ito S, Kishi R, Kamijima M, Yamazaki S, Ohya Y, Kishi R, Yaegashi N, Hashimoto K, Mori C, Ito S, Yamagata Z, Inadera H, Nakayama T, Sobue T, Shima M, Kageyama S, Suganuma N, Ohga S, Katoh T. Association between maternal multimorbidity and neurodevelopment of offspring: a prospective birth cohort study from the Japan Environment and Children's Study. BMJ Open 2024; 14:e082585. [PMID: 39097305 PMCID: PMC11345530 DOI: 10.1136/bmjopen-2023-082585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 07/22/2024] [Indexed: 08/05/2024] Open
Abstract
OBJECTIVES To investigate the association between multimorbidity during pregnancy and neurodevelopmental delay in offspring using data from a Japanese nationwide birth cohort study. DESIGN This study was a prospective birth cohort study. SETTING This study population included 104 059 fetal records who participated in The Japan Environment and Children's Study from 2011 to 2014. PARTICIPANTS Pregnant women whose children had undergone developmental testing were included in this analysis. PRIMARY AND SECONDARY OUTCOME MEASURES Neurodevelopment of offspring was assessed using the Japanese version of the Ages and Stages Questionnaire, third edition, comprising five developmental domains. The number of comorbidities among the pregnant women was categorised as zero, single disease or multimorbidity (two or more diseases). Maternal chronic conditions included in multimorbidity were defined as conditions with high prevalence among women of reproductive age. A multivariate logistic regression analysis was conducted to examine the association between multimorbidity in pregnant women and offspring development. RESULTS Pregnant women with multimorbidity, single disease and no disease accounted for 3.6%, 30.6% and 65.8%, respectively. The ORs for neurodevelopmental impairment during the follow-up period were similar for infants of mothers with no disease comorbidity and those with a single disease comorbidity. However, the ORs for neurodevelopmental impairment were significantly higher for children born to mothers with multimorbidity compared with those born to healthy mothers. CONCLUSION An association was observed between the number of comorbidities in pregnant women and developmental delay in offspring. Multimorbidity in pregnant women may be associated with neurodevelopmental delay in their offspring. Further research is required in this regard in many other regions of the world.
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Affiliation(s)
- Takanobu Akagi
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Yasuaki Saijo
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Eiji Yoshioka
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Yukihiro Sato
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Kentaro Nakanishi
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
| | - Yasuhito Kato
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
| | - Ken Nagaya
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Satoru Takahashi
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
| | - Yoshiya Ito
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
| | - Hiroyoshi Iwata
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Takeshi Yamaguchi
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Chihiro Miyashita
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Sachiko Ito
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Reiko Kishi
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - The Japan Environment and Children's Study group
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, Asahikawa, Japan
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Michihiro Kamijima
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, Asahikawa, Japan
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Shin Yamazaki
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, Asahikawa, Japan
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Yukihiro Ohya
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, Asahikawa, Japan
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Reiko Kishi
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, Asahikawa, Japan
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Nobuo Yaegashi
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, Asahikawa, Japan
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Koichi Hashimoto
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, Asahikawa, Japan
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Chisato Mori
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, Asahikawa, Japan
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Shuichi Ito
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, Asahikawa, Japan
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Zentaro Yamagata
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, Asahikawa, Japan
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Hidekuni Inadera
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, Asahikawa, Japan
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Takeo Nakayama
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, Asahikawa, Japan
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Tomotaka Sobue
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, Asahikawa, Japan
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Masayuki Shima
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, Asahikawa, Japan
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Seiji Kageyama
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, Asahikawa, Japan
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Narufumi Suganuma
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, Asahikawa, Japan
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Shoichi Ohga
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, Asahikawa, Japan
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Takahiko Katoh
- Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, Asahikawa, Japan
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
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Qin X, Li P, Wu Y, Wang X, Yan S, Xu Y, Zhu P, Hao J, Tao F, Huang K. Impact of caesarean delivery on children's autism-like behaviours: the mediation of exclusive breastfeeding. Int Breastfeed J 2022; 17:53. [PMID: 35841102 PMCID: PMC9284736 DOI: 10.1186/s13006-022-00493-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 06/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background The rate of autism spectrum disorder (ASD) has been rising worldwide, and therefore it is important to identify potential causes of ASD to facilitate early prevention. This study examined the role of breastfeeding and the association between caesarean delivery (CD) and children’s autism spectrum disorder. Methods The data were from the Ma’anshan birth cohort (MABC) in China, that was set up between May 2013 and September 2014. Women within 14 gestational weeks were recruited. The delivery mode was extracted from medical notes and infant feeding was obtained from questionnaire surveys. Autism-like behaviour was assessed using the Checklist for Autism in Toddlers (CHAT-23) when children were 18 months old, and 3 years of age. At 5 years of age, autism-like behaviour was assessed using the Clancy Autism Behavior Scale behavior. Structural equation models tested the mediation effects of breastfeeding between CD and children’s autism spectrum disorder. Results In all, 1520 (48.89%) women gave birth via CD, and 406 (13.86%) children were identified with autism-like behaviours at 18 months. Compared with women giving birth via vaginal delivery, those giving birth via CD were more likely to experience a higher proportion of delayed initiation of breastfeeding (p < 0.01), and delayed onset of lactogenesis (p < 0.01). CD was associated with a lower proportion of exclusive breastfeeding at 4 months after delivery (p = 0.02). Autism-like behaviour was less likely amongst infants with exclusively breastfeeding at 4 months than amongst those not exclusively breastfeeding at 4 months (p < 0.01). SEM indicated that women who gave birth by CD were more likely to stop exclusive breastfeeding in the first 4 months (standard estimations = − 0.04, p = 0.02), and those children who were not exclusively breastfed at 4 months were more likely to have autism-like behaviours (standard estimations = − 0.05, p < 0.01). The associations persisted at 3 years, but not at 5 years. Conclusions Exclusive breastfeeding at 4 months of age mediated the association between caesarean delivery and children’s autism-like behaviours. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-022-00493-6.
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Affiliation(s)
- Xiaoyun Qin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China.,Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China.,NHC Key Laboratory of study on abnormal gametes and reproductive tract, Hefei, 230032, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, China
| | - Peixuan Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China.,Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China.,NHC Key Laboratory of study on abnormal gametes and reproductive tract, Hefei, 230032, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, China
| | - Ya Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China.,Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China.,NHC Key Laboratory of study on abnormal gametes and reproductive tract, Hefei, 230032, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, China
| | - Xiaoxu Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China.,Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China.,NHC Key Laboratory of study on abnormal gametes and reproductive tract, Hefei, 230032, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, China
| | - Shuangqin Yan
- Ma'anshan Maternal and Child Health Care Hospital, Ma'anshan, 243000, China
| | - Yeqing Xu
- Ma'anshan Maternal and Child Health Care Hospital, Ma'anshan, 243000, China
| | - Peng Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China.,Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China.,NHC Key Laboratory of study on abnormal gametes and reproductive tract, Hefei, 230032, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, China
| | - Jiahu Hao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China.,Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China.,NHC Key Laboratory of study on abnormal gametes and reproductive tract, Hefei, 230032, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China.,Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China.,NHC Key Laboratory of study on abnormal gametes and reproductive tract, Hefei, 230032, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, China
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China. .,Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China. .,NHC Key Laboratory of study on abnormal gametes and reproductive tract, Hefei, 230032, China. .,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, China. .,Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Hefei, 230032, China.
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