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Zhang L, Yin W, Yu W, Wang P, Wang H, Zhang X, Zhu P. Environmental exposure to outdoor artificial light at night during pregnancy and fetal size: A prospective cohort study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 883:163521. [PMID: 37062314 DOI: 10.1016/j.scitotenv.2023.163521] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Previous studies suggested outdoor artificial light at night (ALAN) exposure may contribute to children and adult obesity, but less is known about the associations of outdoor ALAN exposure during pregnancy with fetal size. METHODS From 2015 to 2021, 6210 mother-child pairs were included. Average outdoor ALAN levels during pregnancy were measured using satellite imaging data. Fetal biparietal diameter, head circumference, abdominal circumference (AC), and femur length were measured before delivery with ultrasonography. We also collected anthropometric birth outcomes, including birth length, birth weight, macrosomia, low birth weight, small for gestational age, and large for gestational age at delivery. Multivariable linear regression models and binary logistic regression models were used to examine the potential associations of outdoor ALAN with fetal size adjusting for a broad set of potential confounds. RESULTS An IQR (14.87 nW/cm2/sr) increase in outdoor ALAN during pregnancy was associated with 1.30 (β = 1.30, 95 % CI: 0.31,2.29) higher AC percentiles and 13 % (OR = 1.13, 95 % CI: 1.00,1.27) higher odds of macrosomia after adjusting confounders. In sex stratification analysis, an IQR (14.87 nW/cm2/sr) increase in outdoor ALAN during pregnancy was associated with 1.65 (β = 1.65, 95 % CI: 0.24,3.06) higher fetal AC percentiles and 27 % (OR = 1.27, 95 % CI: 1.06,1.53) higher odds of macrosomia in females. CONCLUSIONS Our findings suggest that higher outdoor ALAN exposure during pregnancy is associated with larger fetal AC and a higher risk of macrosomia, particularly in the female fetus. Future studies are needed to verify these preliminary findings and identify potential mechanisms for the association.
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Affiliation(s)
- Lei Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Wanjun Yin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Wenjie Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, China
| | - Peng Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Haixia Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Xiujun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, China
| | - Peng Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China.
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Erzse A, Rwafa-Ponela T, Goldstein S, Motlhatlhedi M, Watson D, Hofman KJ, Danis M, Norris SA, Ward KA, Tugendhaft A. What values drive communities' nutrition priorities in a resource constrained urban area in South Africa? BMC Public Health 2023; 23:873. [PMID: 37170249 PMCID: PMC10175056 DOI: 10.1186/s12889-023-15761-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 04/26/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Voices of under-resourced communities are recognised as important yet are often unheard in decisions about healthcare resource allocation. Deliberative public engagement can serve as an effective mechanism for involving communities in establishing nutrition priorities. This study sought to identify the priorities of community members of a South African township, Soweto, and describe the underlying values driving their prioritisation process, to improve nutrition in the first 1000 days of life. METHODS We engaged 54 community members (28 men and 26 women aged > 18 years) from Soweto. We conducted seven group discussions to determine how to allocate limited resources for prioritising nutrition interventions. We used a modified public engagement tool: CHAT (Choosing All Together) which presented 14 nutrition intervention options and their respective costs. Participants deliberated and collectively determined their nutritional priorities. Choices were captured quantitatively, while group discussions were audio-recorded. A thematic analysis was undertaken to identify the reasons and values associated with the selected priorities. RESULTS All groups demonstrated a preference to allocate scarce resources towards three priority interventions-school breakfast provisioning, six-months paid maternity leave, and improved food safety. All but one group selected community gardens and clubs, and five groups prioritised decreasing the price of healthy food and receiving job search assistance. Participants' allocative decisions were guided by several values implicit in their choices, such as fairness and equity, efficiency, social justice, financial resilience, relational solidarity, and human development, with a strong focus on children. Priority interventions were deemed critical to supporting children's optimal development and well-being, interrupting the intergenerational cycle of poverty and poor human development in the community. CONCLUSION Our study demonstrates how public engagement can facilitate the incorporation of community values and programmatic preferences into nutrition priority setting, enabling a responsive approach to local community needs, especially in resource constrained contexts. Findings could guide policy makers to facilitate more appropriate decisions and to improve nutrition in the first 1000 days of life.
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Affiliation(s)
- Agnes Erzse
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
| | - Teurai Rwafa-Ponela
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Susan Goldstein
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Molebogeng Motlhatlhedi
- SAMRC/ Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniella Watson
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Karen J Hofman
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Marion Danis
- Department of Bioethics, National Institutes of Health, Bethesda, MD, USA
| | - Shane A Norris
- SAMRC/ Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Kate A Ward
- SAMRC/ Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Aviva Tugendhaft
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Norris SA, Draper CE, Prioreschi A, Smuts CM, Ware LJ, Dennis C, Awadalla P, Bassani D, Bhutta Z, Briollais L, Cameron DW, Chirwa T, Fallon B, Gray CM, Hamilton J, Jamison J, Jaspan H, Jenkins J, Kahn K, Kengne AP, Lambert EV, Levitt N, Martin MC, Ramsay M, Roth D, Scherer S, Sellen D, Slemming W, Sloboda D, Szyf M, Tollman S, Tomlinson M, Tough S, Matthews SG, Richter L, Lye S. Building knowledge, optimising physical and mental health and setting up healthier life trajectories in South African women ( Bukhali): a preconception randomised control trial part of the Healthy Life Trajectories Initiative (HeLTI). BMJ Open 2022; 12:e059914. [PMID: 35450913 PMCID: PMC9024255 DOI: 10.1136/bmjopen-2021-059914] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION South Africa's evolving burden of disease is challenging due to a persistent infectious disease, burgeoning obesity, most notably among women and rising rates of non-communicable diseases (NCDs). With two thirds of women presenting at their first antenatal visit either overweight or obese in urban South Africa (SA), the preconception period is an opportunity to optimise health and offset transgenerational risk of both obesity and NCDs. METHODS AND ANALYSIS Bukhali is the first individual randomised controlled trial in Africa to test the efficacy of a complex continuum of care intervention and forms part of the Healthy Life Trajectories Initiative (HeLTI) consortium implementing harmonised trials in Canada, China, India and SA. Starting preconception and continuing through pregnancy, infancy and childhood, the intervention is designed to improve nutrition, physical and mental health and health behaviours of South African women to offset obesity-risk (adiposity) in their offspring. Women aged 18-28 years (n=6800) will be recruited from Soweto, an urban-poor area of Johannesburg. The primary outcome is dual-energy X-ray absorptiometry derived fat mass index (fat mass divided by height2) in the offspring at age 5 years. Community health workers will deliver the intervention randomly to half the cohort by providing health literacy material, dispensing a multimicronutrient supplement, providing health services and feedback, and facilitating behaviour change support sessions to optimise: (1) nutrition, (2) physical and mental health and (3) lay the foundations for healthier pregnancies and early child development. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Human Ethics Research Committee University of the Witwatersrand, Johannesburg, South Africa (M1811111), the University of Toronto, Canada (19-0066-E) and the WHO Ethics Committee (ERC.0003328). Data and biological sample sharing policies are consistent with the governance policy of the HeLTI Consortium (https://helti.org) and South African government legislation (POPIA). The recruitment and research team will obtain informed consent. TRIAL REGISTRATION This trial is registered with the Pan African Clinical Trials Registry (https://pactr.samrc.ac.za) on 25 March 2019 (identifier: PACTR201903750173871). PROTOCOL VERSION 20 March 2022 (version #4). Any protocol amendments will be communicated to investigators, Institutional Review Board (IRB)s, trial participants and trial registries.
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Affiliation(s)
- Shane A Norris
- SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
- Global Health Research Institute, School of Human Development and Health, University of Southampton, Southampton, UK
| | - Catherine E Draper
- SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Alessandra Prioreschi
- SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - C M Smuts
- Centre of Excellence of Nutrition, North-West University, Potchefstroom, South Africa
| | - Lisa Jayne Ware
- SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - CindyLee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronton, Ontario, Canada
| | - Philip Awadalla
- Department of Molecular Genetics, Ontario Institute for Cancer Research, University of Toronto, Toronto, Ontario, Canada
| | - D Bassani
- Centre for Global Child Health, SickKids Research Institute, Toronto, Ontario, Canada
| | - Zulfiqar Bhutta
- Centre for Global Child Health, SickKids Research Institute, Toronto, Ontario, Canada
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | | | - D William Cameron
- Medicine, Division of Infectious Diseases, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Tobias Chirwa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - B Fallon
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - C M Gray
- Division of Molecular Biology and Human Genetics, University of Stellenbosch, Stellenbosch, South Africa
- Division of Immunology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Rondebosch, South Africa
| | - Jill Hamilton
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - J Jamison
- Community Services, Red River College, Winnipeg, Manitoba, Canada
| | - Heather Jaspan
- Division of Immunology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Rondebosch, South Africa
| | - Jennifer Jenkins
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen Kahn
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- SAMRC Rural Public Health and Health Transitions Research Unit (Agincourt), Uinversity of the Witwatersrand, Johannesburg, South Africa
| | - A P Kengne
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Estelle V Lambert
- Division of Exercise Science and Sports Medicine, University of Cape Town, Rondebosch, South Africa
| | - Naomi Levitt
- Chronic Diseases Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | | | - Michele Ramsay
- Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel Roth
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephen Scherer
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Sellen
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Wiedaad Slemming
- Department of Paediatrics, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Deborah Sloboda
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - M Szyf
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
| | - Stephen Tollman
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- SAMRC Rural Public Health and Health Transitions Research Unit (Agincourt), Uinversity of the Witwatersrand, Johannesburg, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, University of Stellenbosch, Cape Town, South Africa
| | - Suzanne Tough
- Department of Paediatrics, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Stephen G Matthews
- Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
- Department of Physiology, Obstetrics & Gynaecology and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Linda Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Lye
- SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
- Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
- Department of Physiology, Obstetrics & Gynaecology and Medicine, University of Toronto, Toronto, Ontario, Canada
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