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Joint Effects of Prenatal Folic Acid Supplement with Prenatal Multivitamin and Iron Supplement on Obesity in Preschoolers Born SGA: Sex Specific Difference. Nutrients 2023; 15:nu15020380. [PMID: 36678251 PMCID: PMC9863758 DOI: 10.3390/nu15020380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Prenatal maternal nutrient supplementation has been reported to be associated with offspring obesity, but the reports are inconsistent and have mainly ignored the differences between the total children population and children born small for gestational age (SGA). This study aimed to examine the joint effects of folic acid, iron, and multivitamin supplementation during pregnancy on the risk of obesity in preschoolers born SGA. A total of 8918 children aged 3-6.5 years born SGA were recruited from Longhua District in Shenzhen of China in 2021. Their mothers completed a structured questionnaire about the child's and parents' socio-demographic characteristics, maternal prepregnant obesity, and mothers' prenatal supplementation of folic acid, iron, and multivitamin. In addition, the children's current weight and height were measured by trained nurses. Logistic regression models were used to analyze the associations between prenatal supplementations and the current presence of childhood obesity. After controlling for potential confounders, the results of the logistic regression analysis showed that prenatal supplement of folic acid (OR = 0.72, 95% CI = 0.55~0.93) was associated with a lower likelihood of being an obese preschooler born SGA. In contrast, the ingestion of multivitamin or iron supplements during pregnancy did not seem to be related to the likelihood of childhood obesity in preschoolers born SGA. Moreover, cross-over analysis of prenatal folic acid and multivitamin obtained significant negative associations of prenatal folic acid supplement only (OR = 0.73, 95% CI = 0.55~0.97) and combination supplement of folic acid and multivitamin (OR = 0.67, 95% CI = 0.50~0.90) with obesity of preschoolers born SGA; while the cross-over analysis of prenatal folic acid and iron observed significant negative associations between obesity of preschoolers born SGA and a combination supplement of folic acid and iron (OR = 0.70, 95% CI = 0.52~0.96). Furthermore, the aforementioned significant associations were only found in girls and not in boys when the analyses were stratified by sex. Our findings suggest that the prenatal folic acid supplementation may decrease the risk of obesity in preschool girls born SGA, and that this effect may be modified by prenatal multivitamin or iron supplementation.
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Hoyt AT, Wilkinson AV, Langlois PH, Galeener CE, Ranjit N, Sauder KA, Dabelea DM, Moore BF. Prenatal exposure to tobacco and adverse birth outcomes: effect modification by folate intake during pregnancy. Matern Health Neonatol Perinatol 2022; 8:6. [PMID: 36096906 PMCID: PMC9465971 DOI: 10.1186/s40748-022-00141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/01/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Fetal exposure to tobacco increases the risk for many adverse birth outcomes, but whether diet mitigates these risks has yet to be explored. Here, we examined whether maternal folate intake (from foods and supplements) during pregnancy modified the association between prenatal exposure to tobacco and with preterm delivery, small-for-gestational age (SGA) births, or neonatal adiposity. METHODS Mother-child pairs (n = 701) from Healthy Start were included in this analysis. Urinary cotinine was measured at ~ 27 weeks gestation. Diet was assessed using repeated 24-h dietary recalls. Neonatal adiposity (fat mass percentage) was measured via air displacement plethysmography. Interaction was assessed by including a product term between cotinine (< / ≥ limit of detection [LOD]) and folate (< / ≥ 25th percentile [1077 µg/day]) in separate logistic or linear regression models, adjusting for maternal age, race, ethnicity, education, pre-pregnancy body mass index, and infant sex. RESULTS Approximately 26% of women had detectable levels of cotinine. Folate intake was significantly lower among women with cotinine ≥ LOD as compared to those with cotinine < LOD (1293 µg/day vs. 1418 µg/day; p = 0.01). Folate modified the association between fetal exposure to tobacco with neonatal adiposity (p for interaction = 0.07) and SGA (p for interaction = 0.07). Among those with lower folate intake, fetal exposure to tobacco was associated with lower neonatal adiposity (mean difference: -2.09%; 95% CI: -3.44, -0.74) and increased SGA risk (OR: 4.99; 95% CI: 1.55, 16.14). Conversely, among those with higher folate intake, there was no difference in neonatal adiposity (mean difference: -0.17%; 95% CI: -1.13, 0.79) or SGA risk (OR: 1.15; 95% CI: 0.57, 2.31). CONCLUSIONS Increased folate intake during pregnancy (from foods and/or supplements) may mitigate the risk of fetal growth restriction among those who are unable to quit smoking or cannot avoid secondhand smoke during pregnancy.
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Affiliation(s)
- Adrienne T Hoyt
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health - Austin Regional Campus, Austin, TX, USA
| | - Anna V Wilkinson
- Department of Epidemiology, UTHealth School of Public Health - Austin Regional Campus, Human Genetics, and Environmental Sciences, Austin, TX, USA
| | - Peter H Langlois
- Department of Epidemiology, UTHealth School of Public Health - Austin Regional Campus, Human Genetics, and Environmental Sciences, Austin, TX, USA
| | - Carol E Galeener
- Department of Management, Policy and Community Health, UTHealth School of Public Health- Houston Regional Campus, Fleming Center Health for Care Management, Houston, TX, USA
| | - Nalini Ranjit
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health - Austin Regional Campus, Austin, TX, USA
| | - Katherine A Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) CenterDepartment of PediatricsSchool of Medicine, Colorado School of Public Health, University of Colorado, Denver, USA
| | - Dana M Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Department of Pediatrics, Department of Epidemiology, University of Colorado School of Medicine, Colorado School of Public Health, Aurora, CO, USA
| | - Brianna F Moore
- Department of Epidemiology, UTHealth School of Public Health - Austin Regional Campus, Human Genetics, and Environmental Sciences, Austin, TX, USA.
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Herath MP, Ahuja KDK, Beckett JM, Jayasinghe S, Byrne NM, Hills AP. Determinants of Infant Adiposity across the First 6 Months of Life: Evidence from the Baby-bod study. J Clin Med 2021; 10:jcm10081770. [PMID: 33921680 PMCID: PMC8073882 DOI: 10.3390/jcm10081770] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/06/2021] [Accepted: 04/15/2021] [Indexed: 12/16/2022] Open
Abstract
Excess adiposity in infancy may predispose individuals to obesity later in life. The literature on determinants of adiposity in infants is equivocal. In this longitudinal cohort study, we investigated pre-pregnancy, prenatal and postnatal determinants of different adiposity indices in infants, i.e., fat mass (FM), percent FM (%FM), fat mass index (FMI) and log-log index (FM/FFMp), from birth to 6 months, using linear mixed-effects regression. Body composition was measured in 322, 174 and 109 infants at birth and 3 and 6 months afterwards, respectively, utilising air displacement plethysmography. Positive associations were observed between gestation length and infant FM, maternal self-reported pre-pregnancy body mass index and infant %FM, and parity and infant %FM and FMI at birth. Surprisingly, maternal intake of iron supplements during pregnancy was associated with infant FM, %FM and FMI at 3 months and FM/FFMp at 6 months. Male infant sex and formula feeding were negatively associated with all adiposity indices at 6 months. In conclusion, pre-pregnancy and pregnancy factors influence adiposity during early life, and any unfavourable impacts may be modulated postnatally via infant feeding practices. Moreover, as these associations are dependent on the adiposity indices used, it is crucial that researchers use conceptually and statistically robust approaches such as FM/FFMp.
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4
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Venter C, Palumbo MP, Sauder KA, Glueck DH, Liu AH, Yang IV, Ben-Abdallah M, Fleischer DM, Dabelea D. Incidence and timing of offspring asthma, wheeze, allergic rhinitis, atopic dermatitis, and food allergy and association with maternal history of asthma and allergic rhinitis. World Allergy Organ J 2021; 14:100526. [PMID: 33767802 PMCID: PMC7957150 DOI: 10.1016/j.waojou.2021.100526] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/22/2021] [Accepted: 02/05/2021] [Indexed: 02/06/2023] Open
Abstract
Background Studying the developmental precursors of allergy may help explain the mechanisms (or etiology) of allergic disease. We studied childhood respiratory and allergic diseases in a pre-birth cohort from the United States. Objective We assessed the associations between maternal history of asthma and the development of respiratory and allergic diseases in offspring. We also assessed associations with maternal history of allergic rhinitis. Methods Maternal history of asthma and allergic rhinitis was self-reported during early pregnancy. Offspring respiratory and allergy information was obtained from electronic medical records. Adjusted Cox proportional hazard models assessed the associations between maternal history of asthma and development of respiratory and allergic diseases in the offspring up to 8 years. A similar approach was used for maternal history of allergic rhinitis. Results Children born to women with a history of asthma had a 77% greater risk of developing asthma, a 45% greater risk of atopic dermatitis/eczema, and a 65% greater risk of wheeze (all p < 0.01), but no significantly increased risk of allergic rhinitis or food allergies, compared to children born to women with no history of asthma. Maternal history of allergic rhinitis was not associated with any child allergy outcome, and maternal history of both asthma and allergic rhinitis was associated with child atopic dermatitis/eczema only. Conclusions Maternal history of asthma was significantly associated with offspring respiratory and allergic diagnoses. The association between maternal history of asthma and offspring asthma and atopic dermatitis is a novel finding. Our findings may guide physicians who counsel families with a history of maternal asthma and allergic rhinitis about their child's risk of developing respiratory and allergic diseases.
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Affiliation(s)
- Carina Venter
- Section of Allergy and Immunology, University of Colorado School of Medicine, Children's Hospital Colorado, Children's Hospital Colorado, 13123 East 16th Avenue, B518, Aurora, 80045, Colorado, USA.,Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado
- 13123 East 16th Avenue, Box B518
- Anschutz Medical Campus
- Aurora, 80045, Colorado, USA
| | - Michaela P Palumbo
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 12474 E. 19th Avenue, Mail Stop F426, Aurora, 80045, Colorado, USA
| | - Katherine A Sauder
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado
- 13123 East 16th Avenue, Box B518
- Anschutz Medical Campus
- Aurora, 80045, Colorado, USA.,Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 12474 E. 19th Avenue, Mail Stop F426, Aurora, 80045, Colorado, USA.,Department of Epidemiology, Colorado School of Public Health, Medicine-Bioinformatics, University of Colorado, 12605 E. 16th Ave, Aurora, 80045, Colorado, USA
| | - Deborah H Glueck
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado
- 13123 East 16th Avenue, Box B518
- Anschutz Medical Campus
- Aurora, 80045, Colorado, USA.,Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 12474 E. 19th Avenue, Mail Stop F426, Aurora, 80045, Colorado, USA
| | - Andrew H Liu
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado
- 13123 East 16th Avenue, Box B518
- Anschutz Medical Campus
- Aurora, 80045, Colorado, USA
| | - Ivana V Yang
- Department of Epidemiology, Colorado School of Public Health, Medicine-Bioinformatics, University of Colorado, 12605 E. 16th Ave, Aurora, 80045, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, University of Colorado, 12605 E. 16th Ave, Aurora, 80045, Colorado, USA
| | - Miriam Ben-Abdallah
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado
- 13123 East 16th Avenue, Box B518
- Anschutz Medical Campus
- Aurora, 80045, Colorado, USA
| | - David M Fleischer
- Section of Allergy and Immunology, University of Colorado School of Medicine, Children's Hospital Colorado, Children's Hospital Colorado, 13123 East 16th Avenue, B518, Aurora, 80045, Colorado, USA.,Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado
- 13123 East 16th Avenue, Box B518
- Anschutz Medical Campus
- Aurora, 80045, Colorado, USA
| | - Dana Dabelea
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado
- 13123 East 16th Avenue, Box B518
- Anschutz Medical Campus
- Aurora, 80045, Colorado, USA.,Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 12474 E. 19th Avenue, Mail Stop F426, Aurora, 80045, Colorado, USA.,Department of Epidemiology, Colorado School of Public Health, Medicine-Bioinformatics, University of Colorado, 12605 E. 16th Ave, Aurora, 80045, Colorado, USA
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Young MF, Ramakrishnan U. Maternal Undernutrition before and during Pregnancy and Offspring Health and Development. ANNALS OF NUTRITION & METABOLISM 2021; 76:1-13. [PMID: 33524980 DOI: 10.1159/000510595] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/31/2020] [Indexed: 11/19/2022]
Abstract
Maternal undernutrition remains a critical public health problem. There are large regional and within-country disparities in the burden of underweight, anemia, and micronutrient deficiencies across the globe. Driving these disparities are complex and multifactorial causes, including access to health services, water and sanitation, women's status, and food insecurity as well as the underlying social, economic, and political context. Women's health, nutrition, and wellbeing across the continuum of preconception to pregnancy are critical for ensuring positive pregnancy and long-term outcomes for both the mother and child. In this review, we summarize the evidence base for nutrition interventions before and during pregnancy that will help guide programs targeted towards women's nutrition. Growing evidence from preconception nutrition trials demonstrates an impact on offspring size at birth. Preconception anemia and low preconception weight are associated with an increased risk of low birth weight and small for gestational age births. During pregnancy, several evidence-based strategies exist, including balanced-energy protein supplements, multiple micronutrient supplements, and small-quantity lipid nutrient supplements for improving birth outcomes. There, however, remain several important priority areas and research gaps for improving women's nutrition before and during pregnancy. Further progress is needed to prioritize preconception nutrition and access to health and family planning resources. Additional research is required to understand the long-term effects of preconception and pregnancy interventions particularly on offspring development. Furthermore, while there is a strong evidence base for maternal nutrition interventions, the next frontier requires a greater focus on implementation science and equity to decrease global maternal undernutrition disparities.
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Affiliation(s)
- Melissa F Young
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA,
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Abstract
Almost 2 billion adults in the world are overweight, and more than half of them are classified as obese, while nearly one-third of children globally experience poor growth and development. Given the vast amount of knowledge that has been gleaned from decades of research on growth and development, a number of questions remain as to why the world is now in the midst of a global epidemic of obesity accompanied by the "double burden of malnutrition," where overweight coexists with underweight and micronutrient deficiencies. This challenge to the human condition can be attributed to nutritional and environmental exposures during pregnancy that may program a fetus to have a higher risk of chronic diseases in adulthood. To explore this concept, frequently called the developmental origins of health and disease (DOHaD), this review considers a host of factors and physiological mechanisms that drive a fetus or child toward a higher risk of obesity, fatty liver disease, hypertension, and/or type 2 diabetes (T2D). To that end, this review explores the epidemiology of DOHaD with discussions focused on adaptations to human energetics, placental development, dysmetabolism, and key environmental exposures that act to promote chronic diseases in adulthood. These areas are complementary and additive in understanding how providing the best conditions for optimal growth can create the best possible conditions for lifelong health. Moreover, understanding both physiological as well as epigenetic and molecular mechanisms for DOHaD is vital to most fully address the global issues of obesity and other chronic diseases.
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Affiliation(s)
- Daniel J Hoffman
- Department of Nutritional Sciences, Program in International Nutrition, and Center for Childhood Nutrition Research, New Jersey Institute for Food, Nutrition, and Health, Rutgers, the State University of New Jersey, New Brunswick, New Jersey
| | - Theresa L Powell
- Department of Pediatrics and Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Emily S Barrett
- Department of Biostatistics and Epidemiology, School of Public Health and Division of Exposure Science and Epidemiology, Rutgers Environmental and Occupational Health Sciences Institute, Rutgers, the State University of New Jersey, New Brunswick, New Jersey
| | - Daniel B Hardy
- Department of Biostatistics and Epidemiology, School of Public Health and Division of Exposure Science and Epidemiology, Rutgers Environmental and Occupational Health Sciences Institute, Rutgers, the State University of New Jersey, New Brunswick, New Jersey
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7
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Petry CJ, Ong KK, Hughes IA, Dunger DB. Multiple Micronutrient Supplementation during Pregnancy and Increased Birth Weight and Skinfold Thicknesses in the Offspring: The Cambridge Baby Growth Study. Nutrients 2020; 12:nu12113466. [PMID: 33198145 PMCID: PMC7697774 DOI: 10.3390/nu12113466] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 01/08/2023] Open
Abstract
Multiple micronutrient supplementation (MMS) in pregnancy has previously been associated with positive effects on fetal growth, but its value in high-income countries remains controversial. In this study, we investigated effects of pregnancy MMS on offspring size at birth and adiposity, along with risks of various maternal outcomes of pregnancy, using the prospective Cambridge Baby Growth Study. Maternal MMS was reported in 528 out of 970 women who completed pregnancy questionnaires. Gestational diabetes (GDM) was assessed using results from 75 g oral glucose tolerance tests at week 28 of pregnancy. Offspring size at birth was assessed using standard anthropometric measurements and adiposity using skinfold calipers. MMS was associated with increased risk of developing GDM (risk ratio = 1.86 (1.13–3.08), p = 0.02), as well as increased offspring size at birth in terms of weight (p = 0.03), head circumference (p = 0.04), and flank, and subscapular and triceps skinfold thicknesses (p = 0.04, 0.03, and 0.003, respectively). There was no association with quadriceps skinfold thickness (p = 0.2), suggesting that the increased adiposity was partially regionalized. In women who underwent oral glucose tolerance testing, nearly all of these associations were attenuated by adjusting for GDM. These results suggest that the increased offspring size at birth, including (regionalized) adiposity associated with pregnancy, and MMS may be partially related to the development of GDM.
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Affiliation(s)
- Clive J. Petry
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
- Correspondence: ; Tel.: +44-(0)1223-762945
| | - Ken K. Ong
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
- MRC Department of Epidemiology, University of Cambridge, Cambridge CB2 0SL, UK
- Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Ieuan A. Hughes
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
| | - David B. Dunger
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
- Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
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8
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Jalali LM, Koski KG. Amniotic fluid minerals, trace elements, and prenatal supplement use in humans emerge as determinants of fetal growth. J Trace Elem Med Biol 2018; 50:139-145. [PMID: 30262271 DOI: 10.1016/j.jtemb.2018.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/04/2018] [Accepted: 06/15/2018] [Indexed: 01/23/2023]
Abstract
Amniotic fluid (AF), which is swallowed by the developing fetus, contains minerals and trace elements, but their association with fetal growth has not been explored. Our objectives were to assess (1) whether concentrations of AF minerals and trace elements were associated with changes in 5 fetal ultrasound measurements (estimated weight, bi-parietal diameter, head circumference, abdominal circumference, femur length) between 16-20 and 32-36 wks gestation and (2) whether a prenatal supplement was associated with concentrations of AF minerals and trace elements or the 5 fetal ultrasound measurements. We measured, using inductively coupled plasma-mass spectrometry (ICP-MS), 15 minerals and trace elements (aluminum, arsenic, calcium, chromium, copper, iron, lead, magnesium, nickel, potassium, rubidium, selenium, silver strontium, zinc) in amniotic fluid collected from 176 pregnant women undergoing age-related amniocentesis for genetic testing (15.7 ± 1.1 wks). AF mineral concentrations, prenatal supplement use, and determinants of ultrasound measurements during early and late pregnancy were used in models to assess their impact on change in fetal ultrasound measurements. Positive associations were identified for change in bi-parietal diameter with AF calcium, for change in head circumference with AF copper and nickel, and for change in femur length with AF selenium. Arsenic was negatively associated with estimated fetal weight, and this relationship was modified by prenatal supplement use. Additionally, AF chromium concentrations were lower in women taking prenatal supplements. In conclusion, AF minerals were associated with fetal ultrasound indices, supporting a biological role for calcium, copper, nickel and selenium in promoting in-utero fetal growth. Evidence of a mineral-vitamin interaction between arsenic and folic acid in prenatal supplements and mineral-mineral interaction between iron and chromium would suggest that attention be paid to mineral and trace element formulation of prenatal supplements.
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Affiliation(s)
- Lauren M Jalali
- School of Human Nutrition, Macdonald Stewart Building, McGill University, 21111 Lakeshore Road, Ste-Anne de Bellevue, QC, H9X 3V9, Canada.
| | - Kristine G Koski
- School of Human Nutrition, Macdonald Stewart Building, McGill University, 21111 Lakeshore Road, Ste-Anne de Bellevue, QC, H9X 3V9, Canada.
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Polinski KJ, Dabelea D, Hamman RF, Adgate JL, Calafat AM, Ye X, Starling AP. Distribution and predictors of urinary concentrations of phthalate metabolites and phenols among pregnant women in the Healthy Start Study. ENVIRONMENTAL RESEARCH 2018; 162:308-317. [PMID: 29407762 PMCID: PMC5811372 DOI: 10.1016/j.envres.2018.01.025] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 05/17/2023]
Abstract
BACKGROUND Phthalates and phenols are suspected endocrine disrupting chemicals that may adversely impact fetal outcomes following in utero exposure. Understanding predictors of exposure to phthalates and phenols during the prenatal period is important. METHODS We measured urinary concentrations of 15 phthalate metabolites and 11 phenols in 446 pregnant women enrolled in the Healthy Start pre-birth cohort. Creatinine-adjusted geometric means (GM) for each urinary biomarker were compared across categories of potential sociodemographic and dietary predictors. To assess the independent relationship between each significant food group predictor and biomarker we used multivariable models, adjusted for sociodemographic predictors. RESULTS The phthalate metabolites with the highest concentrations were monoethyl phthalate (GM: 41.1µg/g creatinine) and monocarboxyisooctyl phthalate (GM: 20.5µg/g creatinine). Benzophenone-3 (GM: 124.6µg/g creatinine) and methyl paraben (GM: 119.9µg/g creatinine) were the phenols with the highest concentrations. Concentrations of the metabolites of di-n-butyl phthalate and di(2-ethylhexyl) phthalate were significantly higher in younger, unmarried or unemployed mothers, those who were overweight or obese, those with lower educational attainment, or those of minority race/ethnicity (p-values < 0.05). Metabolites of di-n-butyl phthalate concentrations were 18% lower in those who consumed milk ≥ 7 times per week (95% CI: 30-4%). Benzophenone-3 and triclosan concentrations were significantly higher in older, married, or employed mothers, those with normal body mass index, higher educational attainment, higher household income, or who were non-Hispanic white (p-values < 0.05). Benzophenone-3 concentrations were 62% higher in those who consumed seafood ≥ 5 times per month (95% CI: 16-127%). CONCLUSIONS We observed differences in urinary concentrations of phthalates and phenol biomarkers by sociodemographic predictors in an ethnically diverse cohort of pregnant women. These results and future analyses from this prospective cohort will help inform targeted interventions to reduce exposure to these potential endocrine disrupting chemicals during pregnancy.
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Affiliation(s)
- Kristen J Polinski
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Richard F Hamman
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - John L Adgate
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Xiaoyun Ye
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Anne P Starling
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
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10
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Perng W, Ringham BM, Glueck DH, Sauder KA, Starling AP, Belfort MB, Dabelea D. An observational cohort study of weight- and length-derived anthropometric indicators with body composition at birth and 5 mo: the Healthy Start study. Am J Clin Nutr 2017; 106:559-567. [PMID: 28659296 PMCID: PMC5525117 DOI: 10.3945/ajcn.116.149617] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 05/24/2017] [Indexed: 12/30/2022] Open
Abstract
Background: Despite widespread use of weight- and length-based anthropometric indexes as proxies for adiposity, little is known regarding the extent to which they correspond with fat mass (FM) or fat-free mass (FFM) during infancy.Objective: This study aimed to examine associations of 3 derived indicators-weight-for-age z score (WFAZ), weight-for-length score (WFLZ), and body mass index z score (BMIZ)-with FM, percentage of FM, and FFM measured by air-displacement plethysmography during the first 5 mo of life.Design: Applying prospectively collected data from 1027 infants in a Colorado prebirth cohort, we used multivariate regression to evaluate associations between the derived indicators and body composition at birth and at 5 mo, and with change (Δ) during follow-up.Results: At birth, all 3 derived indicators were more strongly associated with FFM than with FM. Each unit of WFAZ corresponded with 0.342 kg FFM (95% CI: 0.331, 0.351 kg FFM), compared with 0.121 kg FM (95% CI: 0.114, 0.128 kg FM) (P < 0.0001); similar trends were observed for WFLZ and BMIZ. By 5 mo, WFLZ and BMIZ were more strongly associated with FM than with FFM, whereas WFAZ correlated similarly with the 2 components of body composition. ΔWFLZ and ΔBMIZ were both more strongly related to ΔFM than to ΔFFM; however, a direct comparison of the 2 indexes with respect to change in the percentage of FM indicated that ΔBMIZ was the optimal proxy of adiposity gain (P < 0.0001, pairwise difference).Conclusions: Weight- and length-based indexes are poor surrogates for newborn adiposity. However, at 5 mo, WFLZ and BMIZ are suitable proxies of FM. When assessing adiposity gain, ΔBMIZ is the best indicator of fat accrual during the first 5 postnatal months. This trial was registered at clinicaltrials.gov as NCT02273297.
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Affiliation(s)
- Wei Perng
- Departments of Nutritional Sciences and dana.dabelea@ucdenver
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Brandy M Ringham
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, CO
| | - Deborah H Glueck
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, CO
| | - Katherine A Sauder
- Department of Pediatrics, School of Medicine, University of Colorado Denver - Anschutz Medical Campus, Denver, CO
| | - Anne P Starling
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO; and
| | - Mandy B Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA
| | - Dana Dabelea
- Department of Pediatrics, School of Medicine, University of Colorado Denver - Anschutz Medical Campus, Denver, CO
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO; and
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Sauder KA, Koeppen HJ, Shapiro ALB, Kalata KE, Stamatoiu AV, Ringham BM, Glueck DH, Norris JM, Dabelea D. Prenatal Vitamin D Intake, Cord Blood 25-Hydroxyvitamin D, and Offspring Body Composition: The Healthy Start Study. Nutrients 2017; 9:E790. [PMID: 28737667 PMCID: PMC5537904 DOI: 10.3390/nu9070790] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/12/2017] [Accepted: 07/18/2017] [Indexed: 12/15/2022] Open
Abstract
Vitamin D deficiency in pregnancy may be associated with increased offspring adiposity, but evidence from human studies is inconclusive. We examined associations between prenatal vitamin D intake, 25-hydroxyvitamin D (25(OH)D) in cord blood, and offspring size and body composition at birth and 5 months. Participants included 605 mother-offspring dyads from the Healthy Start study, an ongoing, pre-birth prospective cohort study in Denver, Colorado, USA. Prenatal vitamin D intake was assessed with diet recalls and questionnaires, and offspring body composition was measured via air displacement plethysmography at birth and 5 months. General linear univariate models were used for analysis, adjusting for maternal age, race/ethnicity, pre-pregnancy body mass index (BMI), offspring sex, and gestational age at birth. Non-Hispanic white race, lower pre-pregnancy BMI, higher prenatal vitamin D intake, and summer births were associated with higher cord blood 25(OH)D. Higher 25(OH)D was associated with lower birthweight (β = -6.22, p = 0.02), but as maternal BMI increased, this association became increasingly positive in direction and magnitude (β = 1.05, p = 0.04). Higher 25(OH)D was also associated with lower neonatal adiposity (β = -0.02, p < 0.05) but not after adjustment for maternal BMI (β = -0.01, p = 0.25). Cord blood 25(OH)D was not associated with offspring size or body composition at 5 months. Our data confirm the hypothesis that vitamin D exposure in early life is associated with neonatal body size and composition. Future research is needed to understand the implications of these associations as infants grow.
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Affiliation(s)
- Katherine A Sauder
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA.
| | - Hallie J Koeppen
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA.
| | - Allison L B Shapiro
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA.
| | - Kathryn E Kalata
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA.
| | - Alexandra V Stamatoiu
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA.
| | - Brandy M Ringham
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO 80045, USA.
| | - Deborah H Glueck
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO 80045, USA.
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA.
| | - Dana Dabelea
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA.
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA.
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