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Beumer WY, Koot MH, Vrijkotte T, Roseboom TJ, van Ditzhuijzen J. Long-term effects of unintended pregnancy on children: Findings from the Dutch prospective birth-cohort Amsterdam born children and their development study. Soc Sci Med 2024; 357:117200. [PMID: 39142143 DOI: 10.1016/j.socscimed.2024.117200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 07/25/2024] [Accepted: 08/06/2024] [Indexed: 08/16/2024]
Abstract
Several studies investigated short-term risks of children born from unintended pregnancies, however evidence about long-term risks is lacking. We aimed to examine whether children born from unintended pregnancies experience psychosocial problems up into adolescence. This study is based on the longitudinal birth cohort study 'Amsterdam Born Children and their Development' (n = 7784). Unintended pregnancy was measured as a multidimensional construct, based on self-reports on the extent of pregnancy mistiming ('This pregnancy happened too soon'), unwantedness ('I did not want to be pregnant (anymore)') and unhappiness ('I am happy to be pregnant'; recoded). Further, children's psychosocial problems were measured with the Strengths and Difficulties Questionnaire, at 5-6, 11-12 and 15-16 years old. Multiple over-time associations between unintended pregnancy and children's psychosocial problems were analysed using Structural Equation Modelling, while controlling for confounders. Results showed that pregnancy mistiming was a significant predictor of internalizing (β = 0.10, p < 0.001) and externalizing problems (β = 0.07, p = 0.006) and unwanted pregnancy of internalizing problems (β = 0.13, p < 0.001) at 5-6 years. These associations were substantially mediated by maternal mental health and poorer maternal bonding. Associations were no longer present at 11-12 and 15-16 years. Thus, we conclude that children born from unintended pregnancies experience more psychosocial problems at 5-6 years, but no longer at 11-12 and 15-16 years. Unintended pregnancies often coincide with maternal mental health problems and socioeconomic factors. Most importantly, the associations between unintended pregnancy and children's psychosocial problems are influenced by maternal mental health and poorer bonding. Therefore it is important to improve maternal mental health and bonding for the benefit of both mother and child, rather than on the isolated effect of unintended pregnancy per se.
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Affiliation(s)
- Wieke Y Beumer
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gyneacology, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands; Amsterdam Public Health, Amsterdam, the Netherlands.
| | - Marjette H Koot
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gyneacology, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Meibergdreef 9, Amsterdam, Netherlands
| | - Tanja Vrijkotte
- Amsterdam UMC location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands; Amsterdam Public Health, Amsterdam, the Netherlands
| | - Tessa J Roseboom
- Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| | - Jenneke van Ditzhuijzen
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gyneacology, Meibergdreef 9, Amsterdam, Netherlands; Utrecht University, Interdisciplinary Social Science, Social Policy and Public Health, Heidelberglaan 1, Utrecht, Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands
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2
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Beumer WY, Roseboom TJ, Koot MH, Vrijkotte T, van Ditzhuijzen J. Carrying an unintended pregnancy to term and long-term maternal psychological distress: Findings from the Dutch prospective Amsterdam Born Children and their Development study. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231213737. [PMID: 38062674 PMCID: PMC10704944 DOI: 10.1177/17455057231213737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Given the estimated high rate of unintended pregnancies, it is important to investigate long-term effects on psychological distress in women carrying an unintended pregnancy to term. However, research into associations between unintended pregnancies carried to term and psychological distress postpartum is mixed, and especially, evidence on long-term associations is scarce. OBJECTIVE To examine whether carrying an unintended pregnancy to term is associated with maternal psychological distress later in life, up to 12 years postpartum. DESIGN This study is based on the population-based birth cohort study 'Amsterdam Born Children and their Development' study, which included pregnant people in 2003 (n = 7784) and followed them up until 12 years postpartum. METHODS Unintended pregnancy was measured as a multidimensional construct, based on self-reported data around 16 weeks gestation on pregnancy mistiming, unwantedness and unhappiness. Symptoms of maternal psychological distress were assessed around 3 months, 5 years and 12 years postpartum using multiple questionnaires measuring symptoms of depression, anxiety and stress. Multiple structural equation modelling models were analysed, examining the associations between dimensions of unintended pregnancy and maternal psychological distress per time point, while controlling for important co-occurring risks. RESULTS Pregnancy mistiming and unhappiness were significant predictors of more maternal psychological distress around 3 months postpartum. Around 5 years postpartum, only pregnancy mistiming was positively associated with maternal psychological distress. Dimensions of unintended pregnancy were no longer associated with maternal psychological distress around 12 years postpartum. Strikingly, antenatal psychological distress was a much stronger predictor of maternal psychological distress than pregnancy intention dimensions. CONCLUSION Those who carried a more unintended pregnancy to term reported more symptoms of psychological distress at 3 months and 5 years postpartum. People carrying an unintended pregnancy to term may benefit from extra support, not because of the pregnancy intentions per se, but because they may be related to antenatal psychological distress.
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Affiliation(s)
- Wieke Y Beumer
- Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| | - Tessa J Roseboom
- Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| | - Marjette H Koot
- Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, Netherlands
| | - Tanja Vrijkotte
- Amsterdam UMC location Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, Netherlands
| | - Jenneke van Ditzhuijzen
- Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, Netherlands
- Social Policy and Public Health, Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
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3
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Haque S, Mengersen K. Assessing the accuracy of individual link with varying block sizes and cutoff values using MaCSim approach. COMMUN STAT-THEOR M 2022. [DOI: 10.1080/03610926.2020.1857771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Shovanur Haque
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Kerrie Mengersen
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia
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4
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Walker AL, de Rooij SR, Dimitrova MV, Witteveen AB, Verhoeven CJ, de Jonge A, Vrijkotte TGM, Henrichs J. Psychosocial and peripartum determinants of postpartum depression: Findings from a prospective population-based cohort. The ABCD study. Compr Psychiatry 2021; 108:152239. [PMID: 33905988 DOI: 10.1016/j.comppsych.2021.152239] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/07/2021] [Accepted: 03/13/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Postpartum depression is prevalent and concerns a serious health problem for women and their families. The current large-scale birth cohort study investigated: (1) the associations of various potential determinants of postpartum depression using a multidimensional approach, and (2) the individual contribution of obstetric and perinatal determinants and pregnancy-specific anxiety to the risk of postpartum depression. METHODS This study was based on a large-scale birth cohort study in Amsterdam, the Netherlands (ABCD-study). In 5109 women depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (cut-off ≥16 indicating high risk of postpartum depression). Determinants were assessed using self-report or perinatal registries. RESULTS In the final multivariable model, other-Western and non-Western ethnic background, increased antepartum depressive symptoms, increased antepartum anxiety, increased pregnancy-specific anxiety, being unemployed, poor sleep quality, unwanted pregnancy, abuse, multiparity, and congenital abnormality were all independently related to an increased risk of postpartum depression. The strongest risk factors for postpartum depression were antepartum depressive symptoms (adjusted odds ratio (AOR) = 3.86, 95% confidence interval (CI) 3.02-4.92), having a baby with a congenital abnormality (AOR = 2.33, 95% CI 1.46-3.73), and abuse (AOR = 1.95, 95% CI 1.02-3.73). The final model accounted for 24.5% of the variance. LIMITATIONS Our dataset did not provide information on social support or maternal and family history of depression. Next to these determinants, future research should include biological factors. CONCLUSIONS The determinants identified provide opportunities for the development of multidimensional early screening and early intervention strategies for women with an increased risk of postpartum depression.
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Affiliation(s)
- Annika L Walker
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG - Amsterdam Public Health, De Boelelaan 1117, Amsterdam, Netherlands.
| | - Susanne R de Rooij
- Amsterdam University Medical Center, University of Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam University Medical Center, University of Amsterdam, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Academic UMC, Meibergdreef 9, Amsterdam, Netherlands; Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
| | - Marta V Dimitrova
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG - Amsterdam Public Health, De Boelelaan 1117, Amsterdam, Netherlands
| | - Anke B Witteveen
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG - Amsterdam Public Health, De Boelelaan 1117, Amsterdam, Netherlands
| | - Corine J Verhoeven
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG - Amsterdam Public Health, De Boelelaan 1117, Amsterdam, Netherlands; Department of Obstetrics and Gynecology, Maxima Medical Centre, Veldhoven, Netherlands; Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Ank de Jonge
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG - Amsterdam Public Health, De Boelelaan 1117, Amsterdam, Netherlands
| | - Tanja G M Vrijkotte
- Amsterdam University Medical Center, University of Amsterdam, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Academic UMC, Meibergdreef 9, Amsterdam, Netherlands
| | - Jens Henrichs
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG - Amsterdam Public Health, De Boelelaan 1117, Amsterdam, Netherlands
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5
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Vrijkotte T, Brand T, Bonsel G. First trimester employment, working conditions and preterm birth: a prospective population-based cohort study. Occup Environ Med 2021; 78:654-660. [PMID: 33627481 PMCID: PMC8380879 DOI: 10.1136/oemed-2020-107072] [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: 09/20/2020] [Revised: 12/14/2020] [Accepted: 01/05/2021] [Indexed: 11/24/2022]
Abstract
Objectives To explore the association between working conditions during first trimester and total preterm birth (PTB), and subtypes: spontaneous PTB and iatrogenic PTB, additionally to explore the role of hypertension. Methods Pregnant women from the Amsterdam Born Children and their Development study, filled out a questionnaire between January 2003 and March 2004, two weeks after first prenatal screening (singleton liveborn, n=7561). Working conditions were working hours/week, standing/walking hours/week, physical work load and job strain. Results Prolonged standing/walking during first trimester was associated with an increased risk for total PTB (OR=1.5; 95% CI 1.0–2.3, after adjustments). Other working conditions were not related to total PTB. The separation into spontaneous and iatrogenic PTB revealed that standing/walking was associated with iatrogenic PTB only (OR=2.09; 95% CI 1.00–4.97). The highest risk was found for the combination of a long workweek with high physical work load (OR=3.42; 95% CI 1.04–8.21). Hypertension did not mediate these associations; however, stratified analysis revealed that high physical work load was only related to iatrogenic PTB when pregnancy-induced hypertension was present (OR=6.44; 95% CI 1.21–29.76). Conclusion This study provides evidence that high physically demanding work is associated with an increased risk for iatrogenic PTB and not with spontaneous PTB. Pregnancy-induced hypertension may play a role: when present, high physical work load leads to a more severe outcome.
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Affiliation(s)
- Tanja Vrijkotte
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Teus Brand
- Netherlands Center for Occupational Diseases, Coronel Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Gouke Bonsel
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands.,EuroQol Research Foundation, Rotterdam, Netherlands
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6
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Vrijkotte TGM, Smeets J, de Rooij SR, Bosch JA. Maternal long-chain polyunsaturated fatty acid status during early pregnancy: Association with child behavioral problems and the role of autonomic nervous system activity. Clin Nutr 2020; 40:3338-3345. [PMID: 33218766 DOI: 10.1016/j.clnu.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 10/06/2020] [Accepted: 11/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND & AIMS The prenatal environment, including availability of critical nutrients, has a profound impact on offspring development. The present study examined the association between maternal long-chain polyunsaturated fatty acid (LC-PUFA) status during pregnancy and later child behavioral problems at the age of 5-6 years. In light of evidence of autonomic nervous system (ANS) dysregulation in some behavioral problems, study further tested if the above association is statistically mediated by cardiac ANS activity. METHODS Data was collected as part of the Amsterdam Born Children and their Development-study and complete data were available for 1717 mothers and their offspring. Maternal LC-PUFA status was assessed during early pregnancy (mean gestation = 12.7, SD = 2.5 weeks) and quantified as levels of docosahexenoic acid (DHA), arachidonic acid (AA), eicosapentaenoic acid (EPA), as well as the ratio of n-6:n-3 fatty acids. Child emotional problems and peer problems (internalizing problems), as well as conduct problems and inattention/hyperactivity (externalizing problems), were assessed using the Strengths and Difficulties Questionnaire as rated by the mother and teacher at 5-6 years. Child cardiac respiratory sinus arrhythmia (RSA), pre-ejection period (PEP), and heart rate (HR) were utilized as measures of ANS activity at 5-6 years. RESULTS The results confirmed an association between maternal LC-PUFA status and internalizing behavioral problems as rated by the mother, as shown for DHA (β = -0.11;p < 0.01), EPA (β = -0.22;p < 0.05), and n-6:n-3 LC-PUFA (β = 0.17;p < 0.01). Statistical mediation was only demonstrated for HR. No associations were observed between LC-PUFA status and externalizing behavioral problems. CONCLUSIONS The present results are consistent with a role of maternal LC-PUFA status in internalizing behavioral problems as rated by the mother. These results were not observed when problem behavior was rated by the teacher. Analyses did not yield strong evidence supporting ANS activity as a possible mediator in this relationship.
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Affiliation(s)
- T G M Vrijkotte
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - J Smeets
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - S R de Rooij
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - J A Bosch
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
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7
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Beyond maternal education: Socio-economic inequalities in children's diet in the ABCD cohort. PLoS One 2020; 15:e0240423. [PMID: 33048970 PMCID: PMC7553270 DOI: 10.1371/journal.pone.0240423] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 09/27/2020] [Indexed: 11/26/2022] Open
Abstract
Objective We examined whether the role of maternal education in children’s unhealthy snacking diet is moderated by other socio-economic indicators. Methods Participants were selected from the Amsterdam Born Children and their Development cohort, a large ongoing community-based birth cohort. Validated Food Frequency Questionnaires (FFQ) (n = 2782) were filled in by mothers of children aged 5.7±0.5yrs. Based on these FFQs, a snacking dietary pattern was derived using Principal Component Analysis. Socio-economic indicators were: maternal and paternal education (low, middle, high; based on the highest education completed) household finance (low, high; based on ability to save money) and neighbourhood SES (composite score including educational level, household income and employment status of residents per postal code). Cross-sectional multivariable linear regression analysis was used to assess the association and possible moderation of maternal education and other socio-economic indicators on the snacking pattern score. Analyses were adjusted for children’s age, sex and ethnicity. Results Low maternal education (B 0.95, 95% CI 0.83;1.06), low paternal education (B 0.36, 95% CI 0.20;0.52), lower household finance (B 0.18, 95% CI 0.11;0.26) and neighbourhood SES (B -0.09, 95% CI -0.11;-0.06) were independently associated with higher snacking pattern scores (p<0.001). The association between maternal education and the snacking pattern score was somewhat moderated by household finance (p = 0.089) but remained strong. Children from middle-high educated mothers (B 0.44, 95% CI 0.35;0.52) had higher snacking pattern scores when household finance was low (B 0.49, 95% CI 0.33;0.65). Conclusions All socio-economic indicators were associated with increased risk of unhealthy dietary patterns in young children, with low maternal education conferring the highest risk. Yet, within the group of middle-high educated mothers, lower household finance was an extra risk factor for unhealthy dietary patterns. Intervention strategies should therefore focus on lower educated mothers and middle-high educated mothers with insufficient levels of household finance.
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8
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Weight development between age 5 and 10 years and its associations with dietary patterns at age 5 in the ABCD cohort. BMC Public Health 2020; 20:427. [PMID: 32238152 PMCID: PMC7110614 DOI: 10.1186/s12889-020-08559-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 03/19/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Social inequalities in bodyweight start early in life and track into adulthood. Dietary patterns are an important determinant of weight development in children, towards both overweight and underweight. Therefore, we aimed to examine weight development between age 5 and 10 years by ethnicity, SES and thereafter by BMI category at age 5, to explore its association with dietary patterns at age 5. METHODS Participants were 1765 children from the Amsterdam Born Children and their Development (ABCD) cohort that had valid data on BMI at age 5 and 10 and diet at age 5. Linear mixed model analysis was used to examine weight development between age 5 and 10 years and to assess if four previously identified dietary patterns at age 5 (snacking, full-fat, meat and healthy) were associated with weight development. Analyses were adjusted for relevant confounders, stratified by ethnicity and SES and thereafter stratified per BMI category at age 5. RESULTS Overall, weight decreased in Dutch and high SES children and increased in non-Dutch and low/middle SES children. Across the range of bodyweight categories at age 5, we observed a conversion to normal weight, which was stronger in Dutch and high SES children but less pronounced in non-Dutch and low/middle SES children. Overall, the observed associations between weight development and dietary patterns were mixed with some unexpected findings: a healthy dietary pattern was positively associated with weight development in most groups, regardless of ethnicity and SES (e.g. Dutch B 0.084, 95% CI 0.038;0.130 and high SES B 0.096, 95% CI 0.047;0.143) whereas the full-fat pattern was negatively associated with weight development (e.g. Dutch B -0.069, 95% CI -0.114;-0.024 and high SES B -0.072, 95% CI -0.119;-0.026). CONCLUSIONS We observed differential weight development per ethnic and SES group. Our results indicate that each ethnic and SES group follows its own path of weight development. Associations between dietary patterns and weight development showed some unexpected findings; follow-up research is needed to understand the association between dietary patterns and weight development.
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9
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Zafarmand MH, Spanjer M, Nicolaou M, Wijnhoven HAH, van Schaik BD, Uitterlinden AG, Snieder H, Vrijkotte TG. Influence of Dietary Approaches to Stop Hypertension-Type Diet, Known Genetic Variants and Their Interplay on Blood Pressure in Early Childhood. Hypertension 2020; 75:59-70. [DOI: 10.1161/hypertensionaha.118.12292] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
There is limited evidence on association between adherence to the Dietary Approaches to Stop Hypertension (DASH diet) and a lower blood pressure (BP) in children. In a population-based cohort study, among 1068 Dutch children aged 5 to 7, we evaluated the association between a DASH-type diet, 29 known genetic variants incorporated in a genetic risk score, and their interaction on BP. We calculated DASH score based on the food intake data measured through a validated 71-item food frequency questionnaire. In our sample, DASH score ranged from 9 (low adherence to the DASH diet) to 33 (median=21), and genetic score ranged from 18 (low genetic risk on high BP) to 41 (median=29). After adjustment for covariates, each 10 unit increase in DASH score was associated with a lower systolic BP of 0.7 mm Hg (
P
=0.033). DASH score was negatively associated with hypertension (odds ratio=0.96 [0.92–0.99],
P
=0.044). Similarly, each SD increment in genetic score was associated with 0.5 mm Hg higher diastolic BP (
P
=0.002). We found a positive interaction between low DASH score and high genetic score on diastolic BP adjusted for BP risk factors (β=1.52,
P
interaction
=0.019 in additive scale and β=0.03,
P
interaction
=0.021 in multiplicative scale). Our findings show that adherence to the DASH-type diet, as well as a low (adult-derived) genetic risk profile for BP, is associated with lower BP in children and that the genetic basis of BP phenotypes at least partly overlaps between adults and children. In addition, we found evidence of a gene-diet interaction on BP in children.
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Affiliation(s)
- Mohammad Hadi Zafarmand
- From the Department of Public Health (M.H.Z., M.S., M.N., T.G.M.V.), Amsterdam UMC, University of Amsterdam, the Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics (M.H.Z.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Marit Spanjer
- From the Department of Public Health (M.H.Z., M.S., M.N., T.G.M.V.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Mary Nicolaou
- From the Department of Public Health (M.H.Z., M.S., M.N., T.G.M.V.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Hanneke A. H. Wijnhoven
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, the Netherlands (H.A.H.W.)
| | - Barbera D.C. van Schaik
- Amsterdam Public Health Research Institute and Bioinformatics Laboratory, Department of Clinical Epidemiology, Biostatistics and Bioinformatics (B.D.C.v.S.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Andre G. Uitterlinden
- Department of Epidemiology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands (A.G.U.)
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (A.G.U.)
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, the Netherlands (H.S.)
| | - Tanja G.M. Vrijkotte
- From the Department of Public Health (M.H.Z., M.S., M.N., T.G.M.V.), Amsterdam UMC, University of Amsterdam, the Netherlands
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10
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Walker AL, Peters PH, de Rooij SR, Henrichs J, Witteveen AB, Verhoeven CJM, Vrijkotte TGM, de Jonge A. The Long-Term Impact of Maternal Anxiety and Depression Postpartum and in Early Childhood on Child and Paternal Mental Health at 11-12 Years Follow-Up. Front Psychiatry 2020; 11:562237. [PMID: 33192681 PMCID: PMC7531027 DOI: 10.3389/fpsyt.2020.562237] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/18/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Postpartum maternal anxiety and depression can affect child development and family functioning. However, the long-term impact of postpartum maternal anxiety and depression on child and paternal mental health is understudied. The present large-scale prospective cohort study is one of the first to investigate whether maternal anxiety and depressive symptoms postpartum and at child age 5-6 years separately and synergistically increase paternal anxiety and depressive symptoms and child emotional problems in early adolescence at age 11-12 years. Secondly, we investigated whether concurrent paternal anxiety and depressive symptoms at child age 11-12 years moderated the association between maternal anxiety and depressive symptoms in the postpartum period and at child age 5-6 years with child emotional problems at age 11-12 years. METHODS This study is part of the Amsterdam Born Children and Development (ABCD) cohort study, the Netherlands (N = 2.298). Maternal postpartum anxiety and depressive symptoms were assessed using the State-Trait Anxiety Inventory (STAI) and the Center for Epidemiologic Studies Depression Scale (CES-D) at 13 weeks postpartum. Maternal anxiety and depressive symptoms at child age 5-6 years and parental anxiety and depressive symptoms at 11-12 years were assessed using the Depression Anxiety Stress Scale (DASS-21). Child emotional problems were reported by the child and a teacher using the Strengths and Difficulties Questionnaire (SDQ). Multivariable linear regression was conducted, adjusted for demographic, perinatal/obstetric confounders, and affective symptoms of the other family members at 11-12 years. RESULTS Neither maternal anxiety nor depressive symptoms were related to paternal depressive symptoms at child age 11-12 years, while maternal postpartum depressive symptoms, depressive symptoms at 5-6 years and maternal anxiety at 5-6 years were positively related to paternal anxiety at 11-12 years. However, effect sizes were small. Only maternal postpartum depression was positively but weakly associated with more child emotional problems at 11-12 years. Although paternal concurrent affective symptoms were positively related to more child emotional problems in early adolescence, they did not moderate the association between maternal symptoms and child emotional problems. CONCLUSIONS Our results indicate that fathers and children seem to be affected only to a small extent by maternal postpartum anxiety or depression.
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Affiliation(s)
- Annika L Walker
- Department of Midwifery Science, Amsterdam UMC, Vrije Universiteit Amsterdam, AVAG-Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Priya H Peters
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
| | - Susanne R de Rooij
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands.,Department of Clinical Epidemiology, Amsterdam UMC, University of Amsterdam, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jens Henrichs
- Department of Midwifery Science, Amsterdam UMC, Vrije Universiteit Amsterdam, AVAG-Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Anke B Witteveen
- Department of Midwifery Science, Amsterdam UMC, Vrije Universiteit Amsterdam, AVAG-Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Corine J M Verhoeven
- Department of Midwifery Science, Amsterdam UMC, Vrije Universiteit Amsterdam, AVAG-Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Tanja G M Vrijkotte
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, Amsterdam UMC, Vrije Universiteit Amsterdam, AVAG-Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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12
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Effect of excessive infant crying on resting BP, HRV and cardiac autonomic control in childhood. PLoS One 2018; 13:e0197508. [PMID: 29851997 PMCID: PMC5979019 DOI: 10.1371/journal.pone.0197508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/03/2018] [Indexed: 11/19/2022] Open
Abstract
Objective Early life stress has been shown to influence the developing autonomic nervous system. Stressors in infancy may program the autonomic nervous system resting state set point, affecting cardiovascular function in later life. Excessive crying may be an indicator of increased stress arousal in infancy. We hypothesized that excessive infant crying is related to altered cardiac autonomic nervous system activity and increased blood pressure at age 5–6 years. Methods In the Amsterdam Born Children and their Development study, excessive crying, maternal burden of infant care and maternal aggressive behavior in the 13th week after birth (range 11–16 weeks) were reported using questionnaires. Blood pressure, heart rate, heart rate variability and indicators of cardiac autonomic nervous system activity (sympathetic drive by pre-ejection period, parasympathetic drive by respiratory sinus arrhythmia) were measured at age 5–6 years during rest. Inclusion criteria were singleton birth, term-born, and no reported congenital or cardiovascular problems (N = 2153 included). Results Excessive crying (2.8%) was not associated with resting heart rate, heart rate variability, pre-ejection period, respiratory sinus arrhythmia nor with blood pressure at age 5–6 years. Conclusions Excessive infant crying as an indicator of increased stress arousal does not seem to be related to resting activity of the autonomic nervous system or blood pressure at age 5–6. Potential associations may become visible under stressed conditions.
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Rashid V, Engberink MF, van Eijsden M, Nicolaou M, Dekker LH, Verhoeff AP, Weijs PJM. Ethnicity and socioeconomic status are related to dietary patterns at age 5 in the Amsterdam born children and their development (ABCD) cohort. BMC Public Health 2018; 18:115. [PMID: 29310648 PMCID: PMC5759294 DOI: 10.1186/s12889-017-5014-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 12/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health inequalities are already present at young age and tend to vary with ethnicity and socioeconomic status (SES). Diet is a major determinant of overweight, and studying dietary patterns as a whole in relation to overweight rather than single nutrients or foods has been suggested. We derived dietary patterns at age 5 and determined whether ethnicity and SES were both related to these dietary patterns. METHODS We analysed 2769 validated Food Frequency Questionnaires filled in by mothers of children (5.7 ± 0.5y) in the Amsterdam Born Children and their Development (ABCD) cohort. Food items were reduced to 41 food groups. Energy adjusted intake per food group (g/d) was used to derive dietary patterns using Principal Component Analysis and children were given a pattern score for each dietary pattern. We defined 5 ethnic groups (Dutch, Surinamese, Turkish, Moroccan, other ethnicities) and 3 SES groups (low, middle, high, based on maternal education). Multivariate ANOVA, with adjustment for age, gender and maternal age, was used to test potential associations between ethnicity or SES and dietary pattern scores. Post-hoc analyses with Bonferroni adjustment were used to examine differences between groups. RESULTS Principal Component Analysis identified 4 dietary patterns: a snacking, full-fat, meat and healthy dietary pattern, explaining 21% of the variation in dietary intake. Ethnicity was related to the dietary pattern scores (p < 0.01): non-Dutch children scored high on snacking and healthy pattern, whereas Turkish children scored high on full-fat and Surinamese children on the meat pattern. SES was related to the snacking, full-fat and meat patterns (p < 0.01): low SES children scored high on the snacking and meat pattern and low on the full-fat pattern. CONCLUSIONS This study indicates that both ethnicity and SES are relevant for dietary patterns at age 5 and may enable more specific nutrition education to specific ethnic and low socioeconomic status target groups.
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Affiliation(s)
- Viyan Rashid
- Department of Nutrition and Dietetics, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Dr. Meurerlaan 8, 1067, SM, Amsterdam, The Netherlands.
| | - Marielle F Engberink
- Department of Nutrition and Dietetics, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Dr. Meurerlaan 8, 1067, SM, Amsterdam, The Netherlands
| | - Manon van Eijsden
- Department of Epidemiology, Health Promotion and Health Care Innovation, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Mary Nicolaou
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Institute, The Netherlands
| | - Louise H Dekker
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Institute, The Netherlands
| | - Arnoud P Verhoeff
- Department of Epidemiology, Health Promotion and Health Care Innovation, Public Health Service Amsterdam, Amsterdam, The Netherlands.,Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter J M Weijs
- Department of Nutrition and Dietetics, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Dr. Meurerlaan 8, 1067, SM, Amsterdam, The Netherlands.,Nutrition and Dietetics, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
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Oostenbroek MHW, Kersten RHJ, Tros B, Kunst AE, Vrijkotte TGM, Finken MJJ. Maternal hypothyroxinaemia in early pregnancy and problem behavior in 5-year-old offspring. Psychoneuroendocrinology 2017; 81:29-35. [PMID: 28411411 DOI: 10.1016/j.psyneuen.2017.03.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/04/2017] [Accepted: 03/22/2017] [Indexed: 12/25/2022]
Abstract
INTRODUCTION There is evidence, though not consistent, that offspring born to mothers with subtle decreases in thyroid function early in their pregnancies may be at risk of cognitive impairments and attention problems. However, other types of problem behavior have not been addressed thus far. We tested whether maternal thyroid function in early pregnancy is associated with several types of problem behavior in offspring at age 5-6 years. METHODS This was a longitudinal study that included the data of 2000 mother-child pairs from the Amsterdam Born Children and their Development study. At a median gestational age of 12.9 (interquartile range: 11.9-14.1) weeks, maternal blood was sampled for assessment of free T4 and TSH. Overall problem behavior, hyperactivity/inattention, conduct problems, emotional problems, peer relationship problems and prosocial behavior were measured at age 5-6 years using the Strengths and Difficulties Questionnaire, which was filled out by both parents and teachers. RESULTS Maternal hypothyroxinaemia <5th percentile was associated with a 1.70 (95% confidence interval (CI): 1.01-2.86) increased odds of teacher-reported hyperactivity/inattention after adjustment for confounders. By increasing the cut-off level to <10th percentile, the odds ratio became 1.47 (95% CI: 0.99-2.20). There were no associations between maternal thyroid function parameters and hyperactivity/inattention as reported by parents, nor with teacher or parent reports of other types of problem behavior. CONCLUSIONS Our results partially confirm previous observations, showing that early disruptions in the maternal thyroid hormone supply may be associated with ADHD symptoms in offspring. Our study adds that there is no evidence for an effect on other types of problem behavior.
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Affiliation(s)
- Maurits H W Oostenbroek
- Department of Public Health, Academic Medical Centre, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
| | - Remco H J Kersten
- Department of Public Health, Academic Medical Centre, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
| | - Benjamin Tros
- Department of Public Health, Academic Medical Centre, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
| | - Anton E Kunst
- Department of Public Health, Academic Medical Centre, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
| | - Tanja G M Vrijkotte
- Department of Public Health, Academic Medical Centre, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
| | - Martijn J J Finken
- Department of Pediatric Endocrinology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
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Koelewijn JM, Sluijs AM, Vrijkotte TGM. Possible relationship between general and pregnancy-related anxiety during the first half of pregnancy and the birth process: a prospective cohort study. BMJ Open 2017; 7:e013413. [PMID: 28490549 PMCID: PMC5623367 DOI: 10.1136/bmjopen-2016-013413] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The rate of interventions during childbirth has increased dramatically during the last decades. Maternal anxiety might play a role in the progress of the labour process and interventions during labour. This study aimed to identify associations between anxiety in the first half of pregnancy and the birth process, including any interventions required during labour. In addition, differences in the associations by parity and ethnicity were explored. DESIGN Prospective cohort study. SETTING Primary care midwifery practices and secondary/tertiary care obstetric practices in Amsterdam, participating in the multiethnic ABCD (Amsterdam Born Children and their Development) study (participation rate 96%; response 8266/12 373 (67%)). PARTICIPANTS Included were women with singletons, alive at labour start, with a gestational age ≥24 weeks (n=6443). INDEPENDENT VARIABLE General anxiety (State-Trait Anxiety Inventory state) and pregnancy-related anxiety (Pregnancy-Related Anxieties Questionnaire (PRAQ)) were self-reported in the first half of pregnancy. OUTCOMES Associations between both forms of anxiety and several indicators of the birth process were analysed. Subgroup analyses were performed for parity and ethnicity. RESULTS The prevalence of high general anxiety (State-Trait Anxiety Inventory score ≥43) and pregnancy-related anxiety (PRAQ score ≥P90) were 30.9% and 11.0%, respectively. After adjustment, in nulliparae, both general anxiety and pregnancy-related anxiety were associated with pain relief and/or sedation (OR for general anxiety 1.23; 95% CI 1.02 to 1.48; OR for pregnancy-related anxiety 1.45; 95% CI 1.14 to 1.85). In multiparae, general anxiety was associated with induction of labour (OR 1.53; 95% CI 1.16 to 2.03) and pregnancy-related anxiety was associated with primary caesarean section (OR 1.66; 95% CI 1.02 to 2.70). Associations were largely similar for all ethnicities. CONCLUSIONS High levels of general and pregnancy-related anxiety in early pregnancy contribute modestly to more interventions during the birth process with similar associations between ethnic groups, but with some differences between nulliparae and multiparae.
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Affiliation(s)
- Johanna Maria Koelewijn
- Sanquin Research and Landsteiner Laboratory, Department of Experimental Immunohematology, University of Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne Marie Sluijs
- Department of Obstetrics and Gynecology, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands
| | - Tanja G M Vrijkotte
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Vrijkotte TGM, Hrudey EJ, Twickler MB. Early Maternal Thyroid Function During Gestation Is Associated With Fetal Growth, Particularly in Male Newborns. J Clin Endocrinol Metab 2017; 102:1059-1066. [PMID: 28359096 DOI: 10.1210/jc.2016-3452] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/11/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intrauterine growth patterns are influenced by maternal thyroid function during gestation and by fetal sex. It is unknown, however, whether the relationships between maternal thyrotropin (TSH) and free thyroxine (fT4) levels in early pregnancy and fetal growth outcomes are modified by fetal sex. DESIGN Data were obtained from a community-based cohort study of pregnant women living in Amsterdam (Amsterdam Born Children and Their Development study). TSH and fT4 levels were determined during the first prenatal screening at median 13 weeks (interquartile range, 12 to 14). Women with live-born singletons and no overt thyroid dysfunction were included (N = 3988). Associations between these maternal hormones and birth weight, small for gestational age (SGA), and large for gestational age (LGA) were analyzed separately for each sex. RESULTS After adjustments, 1 pmol/L increase in maternal fT4 levels was associated with a reduction in birth weight of 33.7 g (P < 0.001) in male newborns and 16.1 g (P < 0.05) in female newborns. Increased maternal fT4 was not associated with increased odds for SGA, but was associated with a decreased odds for LGA in boys [per 1 pmol/L; odds ratio (OR), 0.79; 95% confidence interval (CI), 0.69 to 0.90]. Maternal subclinical hypothyroidism in early pregnancy (TSH > 2.5 mU/L, 7.3%) was associated with increased odds for LGA in male newborns (OR, 1.95; 95% CI, 1.22 to 3.11). CONCLUSION Maternal fT4 in early pregnancy was observed to be inversely associated with birth weight, with a stronger relationship in males. Male infants also had increased odds for LGA in mothers with subclinical hypothyroidism. Sexual dimorphism appears to be present in the relationship between maternal thyroid metabolism and fetal intrauterine growth, with stronger associations in male infants.
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Affiliation(s)
- Tanja G M Vrijkotte
- Department of Public Health, Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands; and
| | - E Jessica Hrudey
- Department of Public Health, Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands; and
| | - Marcel B Twickler
- Department of Endocrinology, Diabetology, and Metabolic Diseases, Antwerp University Hospital, 2650 Edegem, Belgium
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Smarius LJCA, Strieder TGA, Loomans EM, Doreleijers TAH, Vrijkotte TGM, Gemke RJ, van Eijsden M. Excessive infant crying doubles the risk of mood and behavioral problems at age 5: evidence for mediation by maternal characteristics. Eur Child Adolesc Psychiatry 2017; 26:293-302. [PMID: 27422707 PMCID: PMC5323467 DOI: 10.1007/s00787-016-0888-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 07/06/2016] [Indexed: 02/07/2023]
Abstract
The onset of behavioral problems starts in early life. This study examined whether excessive infant crying (maternal ratings) is a determinant of emotional and behavioral problems at age 5-6 years. In the Amsterdam Born Children and their Development (ABCD) study, a large prospective, observational, population-based multiethnic birth cohort, excessive infant crying (crying for three or more hours per 24 h day over the past week) during the 13th week after birth (range 11-25 weeks, SD 2 weeks), maternal burden of infant care and maternal aggressive behavior (either angry speaking, or physical aggression) was assessed using a questionnaire. Children's behavioral and emotional problems at the age of 5-6 were assessed by Goodman's Strengths and Difficulties Questionnaire (SDQ), by the subscale of generalized anxiety of the preschool anxiety scale (PAS), and by the Short Mood and Feelings Questionnaire (SMFQ). Inclusion criterion was singleton birth. Exclusion criteria were preterm born babies or congenital disorders. Among 3389 children, excessive infant crying (n = 102) was associated with a twofold increased risk of the overall problem behavior, conduct problems, hyperactivity, and mood problems at the age of 5-6 [ORs between 1.75 (95 % CI 1.09-2.81) and 2.12 (95 % CI 1.30-3.46)]. This association was mediated by maternal burden of infant care (change in odds' ratio 1-17 %) and maternal aggressive behavior (change in odds' ratio 4-10 %). There was no effect modification by the child's gender or maternal parity. Excessive infant crying was not associated with general anxiety problems. Excessive infant crying doubles the risk of behavioral, hyperactivity, and mood problems at the age of 5-6, as reported by their mother. Maternal burden of infant care partially mediates the association between excessive crying and behavioral and mood problems. Special care for mothers with a high burden of care for their excessive crying infant, notwithstanding their own good health, can be a feasible strategy for possible prevention of mood and behavioral problems in their children later in life.
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Affiliation(s)
| | - Thea G A Strieder
- Academic Center for Child and Adolescent Psychiatry de Bascule, Meibergdreef 5, 1105AZ, Amsterdam, The Netherlands
| | - Eva M Loomans
- Department of Epidemiology, Health Promotion and Health Care Innovation Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Theo A H Doreleijers
- Department of Child and Adolescent Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Tanja G M Vrijkotte
- Department of Social Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Reinoud J Gemke
- Department of Pediatrics and EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, 1007 MB, The Netherlands
| | - Manon van Eijsden
- Department of Epidemiology, Health Promotion and Health Care Innovation Public Health Service Amsterdam, Amsterdam, The Netherlands
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Vissenberg R, Vrijkotte TGM, van der Post JAM, Fliers E, Goddijn M, Bisschop PH. Abnormal thyroid function parameters in the second trimester of pregnancy are associated with breech presentation at term: a nested cohort study. Eur J Obstet Gynecol Reprod Biol 2016; 199:169-74. [PMID: 26930045 DOI: 10.1016/j.ejogrb.2016.02.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 02/07/2016] [Accepted: 02/11/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Thyroid dysfunction has been described as a possible risk factor for having an abnormal fetal position at birth. In this study we aim to determine the association between thyroid function in early pregnancy and breech presentation at term. STUDY DESIGN We used data from the Amsterdam Born Children and their Development (ABCD) cohort. 3347 pregnant women were included between January 2003 and March 2004 in Amsterdam, the Netherlands. Thyroid function tests were performed between 5 and 37 weeks gestational age (median 12.9 weeks). The main outcome measure was the association between thyroid function in early pregnancy and breech presentation at term. Univariate and multivariate analysis were performed to determine the association between thyroid function and breech presentation. RESULTS Increased TSH in pregnancy, defined as thyroid stimulating hormone (TSH) >97.5th percentile (>3.53mIU/L), was associated with a higher risk for breech presentation at term (aOR 2.32, CI 1.1-4.8, p=0.02) compared to euthyroidism (TSH between 2.5th and 97.5th percentile). After exclusion of overt hypothyroidism and hyperthyroidism the aOR was 2.34 (CI 1.1-5.0, p=0.03). Trimester specific analysis showed a significant association of increased TSH levels (>3.68mIU/L) in the second trimester with breech presentation (aOR 3.7, CI 1.7-7.8, p=0.001). In the second trimester low free thyroxine (FT4) <2.5th percentile (<6.7pmol/L) was also associated with breech presentation (aOR 2.5, CI 1.0-6.3, p=0.04). CONCLUSIONS Increased TSH and decreased FT4 in the second trimester of pregnancy are associated with an increased risk for breech presentation at term. The association of abnormal thyroid parameters in the first of third trimester is still unclear.
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Affiliation(s)
- Rosa Vissenberg
- Academic Medical Centre, Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands.
| | - Tanja G M Vrijkotte
- Academic Medical Centre, Department of Public Health, Amsterdam, The Netherlands
| | - Joris A M van der Post
- Academic Medical Centre, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands
| | - Eric Fliers
- Academic Medical Centre, Department of Endocrinology and Metabolism, Amsterdam, The Netherlands
| | - Mariette Goddijn
- Academic Medical Centre, Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands
| | - Peter H Bisschop
- Academic Medical Centre, Department of Endocrinology and Metabolism, Amsterdam, The Netherlands
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Temel S, Erdem Ö, Voorham TAJJ, Bonsel GJ, Steegers EAP, Denktaş S. Knowledge on preconceptional folic acid supplementation and intention to seek for preconception care among men and women in an urban city: a population-based cross-sectional study. BMC Pregnancy Childbirth 2015; 15:340. [PMID: 26684337 PMCID: PMC4684618 DOI: 10.1186/s12884-015-0774-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 12/04/2015] [Indexed: 11/29/2022] Open
Abstract
Background To study the knowledge of a large city population on preconception folic acid supplementation and intention to seek for preconception care within an urban perinatal health program. Methods Cross-sectional surveys run in Rotterdam, the Netherlands, in 2007 and annually from 2009 to 2014. A random sample of residents aged between 16 and 85 years was taken each year from the municipal population register. Bivariate analysis, interaction analysis, trend analysis and logistic regression were performed. Results Knowledge on preconceptional folic acid supplementation significantly improved (+20 %) between 2007 and 2009, and the intention to consult a GP or midwife in the preconception period significantly increased (+53 %) from 2007 to 2012. Logistic regression analyses showed that low socio-economic status was significantly associated with low preconceptional folic acid knowledge, but with higher intention to seek out preconception care. An interaction effect was found between educational level and ethnicity, showing that the higher the educational level the lower the gap of level of knowledge between the different ethnic groups. Conclusion Despite campaigns about folic acid supplementation knowledge on this supplement remains low. The intention amongst men and women to seek out preconception care is still insufficient. Structural interventions to increase and maintain awareness on folic acid supplementation, especially among high-risk groups, are needed.
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Affiliation(s)
- Sevilay Temel
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Westzeedijk 118, Room Wk-221, 3016 AH, Rotterdam, The Netherlands.
| | - Özcan Erdem
- Municipal Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.
| | - Toon A J J Voorham
- Municipal Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.
| | - Gouke J Bonsel
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Westzeedijk 118, Room Wk-221, 3016 AH, Rotterdam, The Netherlands.
| | - Semiha Denktaş
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Westzeedijk 118, Room Wk-221, 3016 AH, Rotterdam, The Netherlands.
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20
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Noten AME, Loomans EM, Vrijkotte TGM, van de Ven PM, van Trotsenburg ASP, Rotteveel J, van Eijsden M, Finken MJJ. Maternal hypothyroxinaemia in early pregnancy and school performance in 5-year-old offspring. Eur J Endocrinol 2015; 173:563-71. [PMID: 26306579 DOI: 10.1530/eje-15-0397] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/05/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Overt hypothyroidism in pregnant women is associated with a lower intelligence quotient in their children. More recently, subtle decreases in maternal thyroid function have also been associated with neurodevelopmental impairment in offspring. We tested the effect of hypothyroxinaemia during early pregnancy on school performance. DESIGN This was a longitudinal study that included the data of 1196 mother-child pairs from the Amsterdam Born Children and Their Development study. METHODS Maternal serum free thyroxine (T4) and TSH were obtained at a median gestational age of 12.9 (interquartile range: 11.9-14.3) weeks. School performance was assessed at age 5 years and based on scores obtained in arithmetic and language tests from the national monitoring and evaluation system. Poor school performance was defined as a test result <25th percentile and subnormal school performance as a result <50th percentile of the norm population. To estimate the impact of possible non-response bias, we conducted inverse-probability weighted analyses. RESULTS Maternal hypothyroxinaemia (i.e., a maternal free T4 in the lowest 10% of distribution) was associated with a 1.61 (95% CI: 1.05-2.47) -fold increased odds of subnormal arithmetic performance after adjustment for confounders (P=0.03). However, the odds ratio dropped to 1.48 (95% CI: 0.94-2.32) after inverse-probability weighting (P=0.09). No such relations were found with TSH. CONCLUSIONS Maternal hypothyroxinaemia at the end of the first trimester was associated with reduced performance in an arithmetic test, but not in a language test, in 5-year-old offspring. However, our results should be interpreted carefully because of possible non-response bias.
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Affiliation(s)
- Anna M E Noten
- Department of PediatricsVU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The NetherlandsDepartment of EpidemiologyDocumentation and Health Promotion, Public Health Service Amsterdam, Amsterdam, The NetherlandsDepartment of Developmental PsychologyTilburg University, Tilburg, The NetherlandsDepartment of Public HealthAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Epidemiology and BiostatisticsVU University Medical Center, Amsterdam, The NetherlandsDepartment of Pediatric EndocrinologyAcademic Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Health SciencesVU University, Amsterdam, The Netherlands
| | - Eva M Loomans
- Department of PediatricsVU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The NetherlandsDepartment of EpidemiologyDocumentation and Health Promotion, Public Health Service Amsterdam, Amsterdam, The NetherlandsDepartment of Developmental PsychologyTilburg University, Tilburg, The NetherlandsDepartment of Public HealthAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Epidemiology and BiostatisticsVU University Medical Center, Amsterdam, The NetherlandsDepartment of Pediatric EndocrinologyAcademic Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Health SciencesVU University, Amsterdam, The Netherlands Department of PediatricsVU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The NetherlandsDepartment of EpidemiologyDocumentation and Health Promotion, Public Health Service Amsterdam, Amsterdam, The NetherlandsDepartment of Developmental PsychologyTilburg University, Tilburg, The NetherlandsDepartment of Public HealthAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Epidemiology and BiostatisticsVU University Medical Center, Amsterdam, The NetherlandsDepartment of Pediatric EndocrinologyAcademic Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Health SciencesVU University, Amsterdam, The Netherlands
| | - Tanja G M Vrijkotte
- Department of PediatricsVU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The NetherlandsDepartment of EpidemiologyDocumentation and Health Promotion, Public Health Service Amsterdam, Amsterdam, The NetherlandsDepartment of Developmental PsychologyTilburg University, Tilburg, The NetherlandsDepartment of Public HealthAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Epidemiology and BiostatisticsVU University Medical Center, Amsterdam, The NetherlandsDepartment of Pediatric EndocrinologyAcademic Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Health SciencesVU University, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of PediatricsVU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The NetherlandsDepartment of EpidemiologyDocumentation and Health Promotion, Public Health Service Amsterdam, Amsterdam, The NetherlandsDepartment of Developmental PsychologyTilburg University, Tilburg, The NetherlandsDepartment of Public HealthAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Epidemiology and BiostatisticsVU University Medical Center, Amsterdam, The NetherlandsDepartment of Pediatric EndocrinologyAcademic Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Health SciencesVU University, Amsterdam, The Netherlands
| | - A S Paul van Trotsenburg
- Department of PediatricsVU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The NetherlandsDepartment of EpidemiologyDocumentation and Health Promotion, Public Health Service Amsterdam, Amsterdam, The NetherlandsDepartment of Developmental PsychologyTilburg University, Tilburg, The NetherlandsDepartment of Public HealthAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Epidemiology and BiostatisticsVU University Medical Center, Amsterdam, The NetherlandsDepartment of Pediatric EndocrinologyAcademic Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Health SciencesVU University, Amsterdam, The Netherlands
| | - Joost Rotteveel
- Department of PediatricsVU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The NetherlandsDepartment of EpidemiologyDocumentation and Health Promotion, Public Health Service Amsterdam, Amsterdam, The NetherlandsDepartment of Developmental PsychologyTilburg University, Tilburg, The NetherlandsDepartment of Public HealthAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Epidemiology and BiostatisticsVU University Medical Center, Amsterdam, The NetherlandsDepartment of Pediatric EndocrinologyAcademic Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Health SciencesVU University, Amsterdam, The Netherlands
| | - Manon van Eijsden
- Department of PediatricsVU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The NetherlandsDepartment of EpidemiologyDocumentation and Health Promotion, Public Health Service Amsterdam, Amsterdam, The NetherlandsDepartment of Developmental PsychologyTilburg University, Tilburg, The NetherlandsDepartment of Public HealthAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Epidemiology and BiostatisticsVU University Medical Center, Amsterdam, The NetherlandsDepartment of Pediatric EndocrinologyAcademic Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Health SciencesVU University, Amsterdam, The Netherlands Department of PediatricsVU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The NetherlandsDepartment of EpidemiologyDocumentation and Health Promotion, Public Health Service Amsterdam, Amsterdam, The NetherlandsDepartment of Developmental PsychologyTilburg University, Tilburg, The NetherlandsDepartment of Public HealthAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Epidemiology and BiostatisticsVU University Medical Center, Amsterdam, The NetherlandsDepartment of Pediatric EndocrinologyAcademic Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Health SciencesVU University, Amsterdam, The Netherlands
| | - Martijn J J Finken
- Department of PediatricsVU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The NetherlandsDepartment of EpidemiologyDocumentation and Health Promotion, Public Health Service Amsterdam, Amsterdam, The NetherlandsDepartment of Developmental PsychologyTilburg University, Tilburg, The NetherlandsDepartment of Public HealthAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Epidemiology and BiostatisticsVU University Medical Center, Amsterdam, The NetherlandsDepartment of Pediatric EndocrinologyAcademic Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Health SciencesVU University, Amsterdam, The Netherlands
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Harskamp-van Ginkel MW, London SJ, Magnus MC, Gademan MG, Vrijkotte TG. A Study on Mediation by Offspring BMI in the Association between Maternal Obesity and Child Respiratory Outcomes in the Amsterdam Born and Their Development Study Cohort. PLoS One 2015; 10:e0140641. [PMID: 26485533 PMCID: PMC4618476 DOI: 10.1371/journal.pone.0140641] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/28/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND A causal relationship between maternal obesity and offspring asthma is hypothesized to begin during early development, but no underlying mechanism for the found association is identified. We quantitatively examined mediation by offspring body mass index (BMI) in the association of maternal pre-pregnancy BMI on risk of asthma and wheezing during the first 7-8 years of life in a large Amsterdam born birth cohort. METHODS For 3185 mother-child pairs, mothers reported maternal pre-pregnancy BMI and offspring outcomes "ever being diagnosed with asthma" and "wheezing in the past 12 months" on questionnaires. We measured offspring height and weight at age 5-6 years. We performed a multivariate log linear regression comparing outcomes in offspring of mothers with different BMI categories. For each category we quantified and tested mediation by offspring BMI and also investigated interaction by parental asthma. RESULTS At the age of 7-8 years, 8% of the offspring ever had asthma and 7% had current wheezing. Maternal pre-pregnancy obesity was associated with higher risks of asthma (adjusted RR 2.32 (95% CI: 1.49-3.61) and wheezing (adjusted RR 2.16 (95% CI: 1.28-3.64). Offspring BMI was a mediator in the association between maternal BMI and offspring wheezing, but not for asthma. There was no interaction by parental asthma. CONCLUSIONS Maternal pre-pregnancy obesity was associated with higher risks of offspring asthma and wheezing. The association between maternal obesity and offspring wheezing was both direct and indirect (mediated) through the child's own BMI.
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Affiliation(s)
| | - Stephanie J. London
- Epidemiology Branch and Laboratory of Respiratory Biology, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, Durham, North Carolina, United States of America
| | - Maria C. Magnus
- Department of Chronic Diseases, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Maaike G. Gademan
- Department of Public Health, Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Tanja G. Vrijkotte
- Department of Public Health, Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
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Do neighborhood characteristics in Amsterdam influence adiposity at preschool age? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:5561-80. [PMID: 26006128 PMCID: PMC4454985 DOI: 10.3390/ijerph120505561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/05/2015] [Accepted: 05/14/2015] [Indexed: 11/30/2022]
Abstract
Background: Neighborhood characteristics may contribute to adiposity in young children, but results in the current literature are inconsistent. This study aimed to investigate whether objective (socioeconomic status (SES)) and subjective (perceived safety, satisfaction with green spaces and perceived physical disorder) neighborhood characteristics directly influence child adiposity (as measured by BMI, percent body fat (%BF) and waist-to-height ratio (WHtR)). Methods: Data on child BMI, %BF and WHtR were obtained from the Amsterdam Born Children and their Development cohort at 5–6 years of age. Three thousand four hundred and sixty nine (3469) children were included in the analyses. Mixed models, using random intercepts for postal code area to account for neighborhood clustering effects, were used to analyze the relationships of interest. Results: Associations were observed for both perceived safety and neighborhood SES with %BF after adjustment for maternal education and ethnicity. All relationships were eliminated with the inclusion of individual covariates and parental BMI into the models. Conclusions: In general, child adiposity at age 5–6 years was not independently associated with neighborhood characteristics, although a small relationship between child %BF and both neighborhood SES and perceived safety cannot be ruled out. At this young age, familial and individual factors probably play a more important role in influencing child adiposity than neighborhood characteristics.
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de Beer M, Vrijkotte TGM, Fall CHD, van Eijsden M, Osmond C, Gemke RJBJ. Associations of infant feeding and timing of linear growth and relative weight gain during early life with childhood body composition. Int J Obes (Lond) 2014; 39:586-92. [PMID: 25435256 DOI: 10.1038/ijo.2014.200] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 08/05/2014] [Accepted: 10/14/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Growth and feeding during infancy have been associated with later life body mass index. However, the associations of infant feeding, linear growth and weight gain relative to linear growth with separate components of body composition remain unclear. METHODS Of 5551 children with collected growth and infant-feeding data in a prospective cohort study (Amsterdam Born Children and their Development), body composition measured using bioelectrical impedance analysis at the age of 5-6 years was available for 2227 children. We assessed how feeding (duration of full breastfeeding and timing of introduction of complementary feeding) and conditional variables representing linear growth and relative weight gain were associated with childhood fat-free mass (FFM) and fat mass (FM). RESULTS Birth weight was positively associated with both FFM and FM in childhood, and more strongly with FFM than FM. Faster linear growth and faster relative weight gain at all ages in infancy were positively associated with childhood FFM and FM. The associations with FM were stronger for relative weight gain than for linear growth (FM z score: β coefficient 0.23 (95% con 0.19 to 0.26), P<0.001 and 0.14 (0.11 to 0.17), P<0.001 per s.d. change in relative weight gain and linear growth between 1 and 3 months, respectively). Compared with full breastfeeding <1 month, full breastfeeding >6 months was associated with lower FM (FM z score: -0.17 (-0.28 to -0.05), P=0.005) and lower FFM (FFM z score: -0.13 (-0.23 to -0.03), P=0.015), as was the introduction of complementary feeding >6 months (FM z score: -0.22 (-0.38 to -0.07), P=0.004), compared with <4 months. CONCLUSIONS Faster infant weight gain is associated with a healthier childhood body composition when it is caused by faster linear growth. Full breastfeeding >6 months and introduction of complementary feeding >6 months are associated with lower childhood FM.
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Affiliation(s)
- M de Beer
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - T G M Vrijkotte
- Department of Social Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - C H D Fall
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - M van Eijsden
- Department of Epidemiology, Documentation and Health Promotion, Public Health Service, Amsterdam, The Netherlands
| | - C Osmond
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - R J B J Gemke
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
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Increased maternal BMI is associated with infant wheezing in early life: a prospective cohort study. J Dev Orig Health Dis 2014; 5:351-60. [PMID: 25081820 DOI: 10.1017/s2040174414000312] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Rates of obesity are increasing in women of child bearing age with negative impacts on maternal and offspring health. Emerging evidence suggests in utero origins of respiratory health in offspring of obese mothers but mechanisms are unknown. Changes in maternal cortisol levels are one potential factor as cortisol levels are altered in obesity and cortisol is separately implicated in development of offspring wheeze. We aimed to assess whether increased pre-pregnancy maternal body mass index (BMI) was associated with offspring early life wheezing, and whether this was mediated by altered cortisol levels in the mother. In a prospective community-based cohort (Amsterdam Born Children and their Development cohort), women completed questionnaires during pregnancy and at 3-5 months post-delivery regarding self-history of asthma and atopy, and of wheezing of their offspring (n=4860). Pre-pregnancy BMI was recorded and serum total cortisol levels were measured in a subset of women (n=2227) at their first antenatal visit. A total of 20.2% (n=984) women were overweight or obese and 10.3% reported wheezing in their offspring. Maternal BMI was associated with offspring wheezing (1 unit (kg/m2) increase, OR: 1.03; 95% CI: 1.00-1.05), after correction for confounders. Although maternal cortisol levels were lower in overweight mothers and those with a history of asthma, maternal cortisol levels did not mediate the increased offspring wheezing. Pre-pregnancy BMI impacts on baby wheezing, which is not mediated by lower cortisol levels. As the prevalence of obesity in women of child-bearing age is increasing, further studies are needed to investigate modifiable maternal factors to avoid risk of wheezing in young children.
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No associations of prenatal maternal psychosocial stress with fasting glucose metabolism in offspring at 5-6 years of age. J Dev Orig Health Dis 2014; 5:361-9. [PMID: 25081574 DOI: 10.1017/s2040174414000300] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Highly prevalent maternal psychosocial complaints are accompanied by increases in glucocorticoid stress hormones, which may predispose the offspring for type 2 diabetes and cardiovascular disease later in adulthood. The aim of the current research is to study whether prenatal maternal psychosocial stress is associated with parameters of blood glucose metabolism in their children aged 5-6 years. The study design was a prospective birth cohort (the Amsterdam Born Children and their Development study, the Netherlands). Depressive symptoms, pregnancy-related anxiety, parenting daily hassles and job strain were recorded by questionnaire (gestational week 16). A cumulative score was also calculated. Possible sex differences in the associations were considered. The subjects were 1952 mother-child pairs. Outcome measures were fasting glucose (n=1952), C-peptide and insulin resistance (HOMA2-IR) (n=1478) in the children at the age of 5-6 years. The stress scales, single and cumulative, were not associated with glucose/C-peptide/insulin resistance (all P>0.05). We did not find evidence for sex differences. In conclusion, we did not find evidence for an association between psychosocial stress during early pregnancy and parameters of glucose metabolism in offspring at the age of 5-6 years. Differences emerging later in life or in response to a metabolic challenge should not be ruled out.
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Finken MJJ, van Eijsden M, Loomans EM, Vrijkotte TGM, Rotteveel J. Maternal hypothyroxinemia in early pregnancy predicts reduced performance in reaction time tests in 5- to 6-year-old offspring. J Clin Endocrinol Metab 2013; 98:1417-26. [PMID: 23408575 DOI: 10.1210/jc.2012-3389] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Overt hypothyroidism in pregnant women is associated with poorer neurodevelopment in their children. Findings from studies investigating the effect of less severe impairments in the maternal thyroid function on cognitive functioning in offspring are difficult to interpret for a number of reasons, including lack of objective cognitive tests, preschool age at assessment, and small sample sizes. OBJECTIVE We aimed to assess the effect of the maternal thyroid status in early pregnancy on their offspring's cognitive performance at 5 to 6 years of age. DESIGN AND PARTICIPANTS This was a prospective study that included the data of 1765 healthy 5- to 6-year-old children from the Amsterdam Born Children and their Development study. Maternal serum free T4 and TSH were obtained at a median gestational age of 90 (interquartile range, 83 to 100) days. MAIN OUTCOME MEASURES Cognitive performance was tested using a computerized assessment program that measured response speed, response speed stability, visuomotor skills, response selection, and response inhibition. RESULTS Maternal hypothyroxinemia (ie, maternal free T4 in the lowest 10% of distribution) was associated with a 41.3 (95% confidence interval, 20.3-62.4) ms slower response speed in a simple reaction time task. In this test, it was also associated with a decreased stability in response speed. The relations found persisted after adjustment for family background and perinatal conditions. The effect of hypothyroxinemia on these outcomes was dependent on its interaction with TSH level. CONCLUSIONS Lower maternal free T4 concentration at the end of the first trimester predicted slower response speed and decreased stability in response speed in offspring at 5 to 6 years of age.
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Affiliation(s)
- Martijn J J Finken
- Department of Pediatric Endocrinology, VU University Medical Center, Amsterdam, The Netherlands.
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de Graaf JP, Ravelli ACJ, de Haan MAM, Steegers EAP, Bonsel GJ. Living in deprived urban districts increases perinatal health inequalities. J Matern Fetal Neonatal Med 2012; 26:473-81. [DOI: 10.3109/14767058.2012.735722] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Temel S, Birnie E, Sonneveld HM, Voorham AJJ, Bonsel GJ, Steegers EAP, Denktaş S. Determinants of the intention of preconception care use: lessons from a multi-ethnic urban population in the Netherlands. Int J Public Health 2012; 58:295-304. [PMID: 22871983 DOI: 10.1007/s00038-012-0396-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 07/06/2012] [Accepted: 07/12/2012] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To investigate the determinants of the intention of preconception care use of women in a multi-ethnic urban population. METHODS The ASE-model-a health behaviour model-was used as an explanatory framework. A representative sample was taken from the municipal population registers of two districts in Rotterdam, the Netherlands, 2009-2010. 3,225 women (aged 15-60 years) received a questionnaire, which was returned by 631: 133 Dutch, 157 Turkish and Moroccan, and 341 Surinamese and Antillean. Descriptive, univariate and multivariate analyses were performed. RESULTS The multiple logistic analyses showed that intention to attend preconception care was significantly higher in women with a Turkish and Moroccan background (β 1.02, P = 0.006), a higher maternal age (β 0.04, P = 0.008) and a positive attitude (β 0.50, P < 0.001). Having no relationship (β -1.16, P = 0.004), multiparity with previous adverse perinatal outcome (β -1.32, P = 0.001), a high educational level (β -1.23, P = 0.03), having paid work (β -0.72, P = 0.01) and experienced barriers level (β -0.15, P = 0.003) were associated with less intention to use preconception care. CONCLUSIONS Modifiable determinants as attitude and barriers can be addressed to enhance preconception care attendance.
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Affiliation(s)
- S Temel
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, Room Wk-221, Westzeedijk 118, 3016 AH, Rotterdam, The Netherlands.
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Loomans EM, van Dijk AE, Vrijkotte TGM, van Eijsden M, Stronks K, Gemke RJBJ, Van den Bergh BRH. Psychosocial stress during pregnancy is related to adverse birth outcomes: results from a large multi-ethnic community-based birth cohort. Eur J Public Health 2012; 23:485-91. [PMID: 22850187 DOI: 10.1093/eurpub/cks097] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Prevalence rates of psychosocial stress during pregnancy are substantial. Evidence for associations between psychosocial stress and birth outcomes is inconsistent. This study aims to identify and characterize different clusters of pregnant women, each with a distinct pattern of psychosocial stress, and investigate whether birth outcomes differ between these clusters. METHODS Latent class analysis was performed on data of 7740 pregnant women (Amsterdam Born Children and their Development study). Included constructs were depressive symptoms, state anxiety, job strain, pregnancy-related anxiety and parenting stress. RESULTS Five clusters of women with distinct patterns of psychosocial stress were objectively identified. Babies born from women in the cluster characterized as 'high depression and high anxiety, moderate job strain' (12%) had a lower birth weight, and those in the 'high depression and high anxiety, not employed' cluster (15%) had an increased risk of pre-term birth. CONCLUSIONS Babies from pregnant women reporting both high levels of anxiety and depressive symptoms are at highest risk for adverse birth outcomes.
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Affiliation(s)
- Eva M Loomans
- Department of Psychology, Tilburg University, The Netherlands.
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van den Berg G, van Eijsden M, Vrijkotte TGM, Gemke RJBJ. Educational inequalities in perinatal outcomes: the mediating effect of smoking and environmental tobacco exposure. PLoS One 2012; 7:e37002. [PMID: 22590643 PMCID: PMC3349660 DOI: 10.1371/journal.pone.0037002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 04/11/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Socioeconomic status (SES) is adversely associated with perinatal outcomes. This association is likely to be mediated by tobacco exposure. However, previous studies were limited to single perinatal outcomes and devoted no attention to environmental tobacco exposure. Therefore, this study aimed firstly to explain the role of maternal smoking in the association between maternal education and preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA), and secondly to explain whether environmental tobacco smoke mediates these associations further. STUDY DESIGN This study was nested in a population-based cohort study in the Netherlands, the Amsterdam Born Children and their Development (ABCD) study. Analyses were done in a sample of 3821 pregnant women of Dutch origin, using logistic regression analysis. RESULTS Least educated women, who were more often smoking and exposed to environmental tobacco smoke, had a significantly higher risk of PTB (OR 1.95 [95% CI: 1.19-3.20]), LBW (OR 2.41 [95% CI: 1.36-4.27]) and SGA (OR 1.90 [95% CI 1.32-2.74]) than highly educated women. The mediating effect of smoking in the least educated women was 43% for PTB, 55% for LBW and 66% for SGA. Environmental tobacco smoke did not explain these associations further. After adjustment for maternal smoking, the association between lower maternal education and pregnancy outcomes was no longer significant. CONCLUSIONS Smoking explains to a considerable extent the association between lower maternal education and adverse perinatal outcomes. Therefore, tobacco-interventions in lower educated women should be primarily focussed on maternal smoking to reduce PTB, LBW, and SGA. Additional attention to environmental tobacco exposure does not seem to reduce educational inequalities in perinatal outcomes.
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Affiliation(s)
- Gerrit van den Berg
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands.
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Djelantik AAAMJ, Kunst AE, van der Wal MF, Smit HA, Vrijkotte TGM. Contribution of overweight and obesity to the occurrence of adverse pregnancy outcomes in a multi-ethnic cohort: population attributive fractions for Amsterdam. BJOG 2011; 119:283-90. [PMID: 22168897 DOI: 10.1111/j.1471-0528.2011.03205.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To estimate the contribution of pre-pregnancy excessive weight to the occurrence of adverse pregnancy outcomes and to detect the differences in these contributions between different ethnic groups. DESIGN Prospective multi-ethnic community-based cohort study. SETTING The prevalence of excessive weight is increasing and in general higher in immigrant groups in many industrialised countries. Maternal excessive weight, like smoking during pregnancy, is an important risk factor for adverse pregnancy outcomes. POPULATION A total of 8266 pregnant women, living in the Netherlands, were included in the ABCD study between January 2003 and March 2004. METHODS After applying the exclusion criteria, the analysis included 7871 pregnancies. Binomial log-linear regression analyses were performed to estimate relative risks (RRs) expressing the association between overweight/obesity and small-for-gestational-age (SGA), large-for-gestational-age (LGA), preterm birth (PTB; <37 weeks of gestation) and extreme PTB (<32 weeks of gestation), controlling for parity, maternal age, education level and smoking. Next, the RRs were used to estimate population attributive fractions (PAF) for Amsterdam and separately for several ethnic groups. MAIN OUTCOME MEASURES The RRs and PAFs. RESULTS The PAFs for overweight/obesity were: SGA -4.9%, LGA 15.3%, PTB 6.6% and extreme PTB 22.0%. In absolute terms, this corresponds to -47 SGA infants, 126 LGA infants, 35 PTB and 20 extreme PTB per year in Amsterdam. Except for SGA, these PAFs were higher than those for smoking (6.2%, -3.9%, 5.5% and 10.6%, respectively). The contribution of overweight/obesity to LGA and PTB was higher in non-Western immigrant groups. CONCLUSIONS Overweight/obesity has become an important contributor to the occurrence of adverse pregnancy outcomes in Amsterdam. For most outcomes, these contributions are larger than those for smoking. Development of special obesity prevention programmes for young women is required, especially focused on immigrant groups.
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Affiliation(s)
- A A A M J Djelantik
- Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands
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Abstract
BACKGROUND Psychiatric epidemiology is an important cornerstone of research in psychiatry and integral for the treatment and care of people suffering from psychiatric disorders. However, psychiatric epidemiology is a difficult science, which is often beset with methodological problems. AIMS In light of this, the current review sought to explore 13 of the common methodological issues in psychiatric epidemiology. METHODS Many methodological problems result from misunderstandings. As such, we sought to highlight these problems, provide evidence to counteract the myths surrounding these problems and subsequently provide recommendations to overcome these problems. To highlight and clarify these issues, examples are provided from current psychiatric literature. RESULTS Areas discussed in the review include problems with: taxonometry of disorders, sole reliance on self-reports, single-question diagnoses, baseline participation rates, measurement of lifetime prevalence, inconsistency of multiple informants, selection of covariates, testing of interactions, correction for multiple testing, the intermittent measurement of disorders during follow-up, evaluation of causal associations, data invalidation related to loss from follow-up and the publication of negative findings. CONCLUSION Many methodological myths prevail in the area of epidemiology and this review endeavoured to elucidate and clarify these. This review was developed as a teaching tool for students, clinicians and researchers.
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Affiliation(s)
- Rachel S Newson
- Department of Epidemiology, Erasmus University Medical Centre, The Netherlands
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Timmermans S, Bonsel GJ, Steegers-Theunissen RPM, Mackenbach JP, Steyerberg EW, Raat H, Verbrugh HA, Tiemeier HW, Hofman A, Birnie E, Looman CWN, Jaddoe VWV, Steegers EAP. Individual accumulation of heterogeneous risks explains perinatal inequalities within deprived neighbourhoods. Eur J Epidemiol 2011; 26:165-80. [PMID: 21203801 PMCID: PMC3043261 DOI: 10.1007/s10654-010-9542-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 12/20/2010] [Indexed: 11/04/2022]
Abstract
Dutch’ figures on perinatal mortality and morbidity are poor compared to EU-standards. Considerable within-country differences have been reported too, with decreased perinatal health in deprived urban areas. We investigated associations between perinatal risk factors and adverse perinatal outcomes in 7,359 pregnant women participating in population-based prospective cohort study, to establish the independent role, if any, for living within a deprived urban neighbourhood. Main outcome measures included perinatal death, intrauterine growth restriction (IUGR), prematurity, congenital malformations, Apgar at 5 min < 7, and pre-eclampsia. Information regarding individual risk factors was obtained from questionnaires, physical examinations, ultrasounds, biological samples, and medical records. The dichotomous Dutch deprivation indicator was additionally used to test for unexplained deprived urban area effects. Pregnancies from a deprived neighbourhood had an increased risk for perinatal death (RR 1.8, 95% CI [1.1; 3.1]). IUGR, prematurity, Apgar at 5 min < 7, and pre-eclampsia also showed higher prevalences (P < 0.05). Residing within a deprived neighbourhood was associated with increased prevalence of all measured risk factors. Regression analysis showed that the observed neighbourhood related differences in perinatal outcomes could be attributed to the increased risk factor prevalence only, without a separated role for living within a deprived neighbourhood. Women from a deprived neighbourhood had significantly more ‘possibly avoidable’ risk factors. To conclude, women from a socioeconomically deprived neighbourhood are at an increased risk for adverse pregnancy outcomes. Differences regarding possibly avoidable risk factors imply that preventive strategies may prove effective.
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Affiliation(s)
- Sarah Timmermans
- The Generation R Study Group, Erasmus MC Rotterdam, POB 2040, 3000 CA Rotterdam, The Netherlands.
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Maternal depressive symptoms in relation to perinatal mortality and morbidity: results from a large multiethnic cohort study. Psychosom Med 2010; 72:769-76. [PMID: 20668282 DOI: 10.1097/psy.0b013e3181ee4a62] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To explore whether 1) maternal depressive symptoms during pregnancy are associated with preterm birth (PTB), small for gestational age (SGA), a low Apgar score and child loss; 2) maternal smoking mediates the associations; and 3) the associations differ by ethnic background. METHODS Pregnant women in Amsterdam were approached during their first prenatal visit to participate in the Amsterdam Born Children and their Development study. They filled out a questionnaire covering sociodemographic data, life-style, and (psychosocial) health. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression scale. The baseline sample consisted of 8,052 women; the main ethnic groups were: Dutch, Creole, Turkish, and Moroccan. RESULTS The prevalence of perinatal outcomes was: 5.4% (PTB); 12.3% (SGA); l 1.5% (low Apgar score); and 1.4% (child loss). The prevalence of high depressive symptomatology was 30.6%. After adjustment for maternal age, parity, education, ethnicity, prepregnancy body mass index, hypertension, alcohol and drug use, and a small mediation effect of maternal smoking, high versus low levels of depressive symptoms were associated with SGA (odds ratio [OR], 1.19; p = .02) and a low Apgar score (OR, 1.74; p = .01), but not with PTB (OR, 1.16; p = .18) and child loss (OR, 1.28; p = .24). Stratified analyses by ethnic background showed a tendency toward higher risks, although insignificant, among Creole women. CONCLUSIONS Several pathways may explain the detrimental effects of maternal depressive symptomatology on perinatal health outcomes, including a psychoendocrinological pathway involving the hormone cortisol or mediation effects by maternal risk behaviors. Further research should explore the underlying pathways, in particular among ethnic subgroups.
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van Eijsden M, Vrijkotte TGM, Gemke RJBJ, van der Wal MF. Cohort profile: the Amsterdam Born Children and their Development (ABCD) study. Int J Epidemiol 2010; 40:1176-86. [PMID: 20813863 DOI: 10.1093/ije/dyq128] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Manon van Eijsden
- Department of Epidemiology, Documentation and Health Promotion, Public Health Service of Amsterdam, Amsterdam, The Netherlands
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Denktaş S, Koopmans G, Birnie E, Foets M, Bonsel G. Underutilization of prescribed drugs use among first generation elderly immigrants in the Netherlands. BMC Health Serv Res 2010; 10:176. [PMID: 20569456 PMCID: PMC2901342 DOI: 10.1186/1472-6963-10-176] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 06/22/2010] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In developed countries, health care utilization among immigrant groups differs where the dominant interpretation is unjustified overutilization due to lack of acculturation. We investigated utilization of prescribed drugs in native Dutch and various groups of immigrant elderly. METHODS Cross-sectional study using data from the survey "Social Position, Health and Well-being of Elderly Immigrants" (the Netherlands, 2003). Ethnicity-matched interviewers conducted the survey among first generation immigrants aged 55 years and older. Outcome measure is self-reported use of prescribed drugs. Utilization is explained by need, and by enabling and predisposing factors, in particular acculturation; analysis is conducted by multiple logistic regression. RESULTS The study population consisted of immigrants from Turkey (n = 307), Morocco (n = 284), Surinam (n = 308) and the Netherlands Antilles (n = 300), and a native Dutch reference group (n = 304). Prevalence of diabetes mellitus (DM), COPD and musculoskeletal disorders was relatively high among immigrant elderly. Drug utilization in especially Turkish and Moroccan elderly with DM and COPD was relatively low. Drugs use for non-mental chronic diseases was explained by more chronic conditions (OR 2.64), higher age (OR 1.03), and modern attitudes on male-female roles (OR 0.74) and religiosity (OR 0.89). Ethnicity specific effects remained only among Turkish elderly (OR 0.42). Drugs use for mental health problems was explained by more chronic conditions (OR 1.43), better mental health (OR 0.95) and modern attitudes on family values (OR 0.59). Ethnicity specific effects remained only among Moroccan (OR 0.19) and Antillean elderly (OR 0.31). Explanation of underutilization of drugs among diseased with diabetes and musculoskeletal disorders are found in number of chronic diseases (OR 0.74 and OR 0.78) and regarding diabetes also in language proficiency (OR 0.66) and modern attitudes on male-female roles (OR 1.69). CONCLUSIONS Need and predisposing factors (acculturation) are the strongest determinants for drugs utilization among elderly immigrants. Significant drugs underutilization exists among migrants with diabetes and musculoskeletal disorders.
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Affiliation(s)
- Semiha Denktaş
- Department of Health Policy and Management, Erasmus University Rotterdam, the Netherlands.
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Denktaş S, Koopmans G, Birnie E, Foets M, Bonsel G. Ethnic background and differences in health care use: a national cross-sectional study of native Dutch and immigrant elderly in the Netherlands. Int J Equity Health 2009; 8:35. [PMID: 19814786 PMCID: PMC2768713 DOI: 10.1186/1475-9276-8-35] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 10/08/2009] [Indexed: 11/17/2022] Open
Abstract
Background Immigrant elderly are a rapidly growing group in Dutch society; little is known about their health care use. This study assesses whether ethnic disparities in health care use exist and how they can be explained. Applying an established health care access model as explanatory factors, we tested health and socio-economic status, and in view of our research population we added an acculturation variable, elaborated into several sub-domains. Methods Cross-sectional study using data from the "Social Position, Health and Well-being of Elderly Immigrants" survey, conducted in 2003 in the Netherlands. The study population consisted of first generation immigrants aged 55 years and older from the four major immigrant populations in the Netherlands and a native Dutch reference group. The average response rate to the survey was 46% (1503/3284; country of origin: Turkey n = 307, Morocco n = 284, Surinam n = 308, the Netherlands Antilles n = 300, the Netherlands n = 304). Results High ethnic disparities exist in health and health care utilisation. Immigrant elderly show a higher use of GP services and lower use of physical therapy and home care. Both self-reported health status (need factor) and language competence (part of acculturation) have high explanatory power for all types of health services utilisation; the additional impact of socio-economic status and education is low. Conclusion For all health services, health disparities among all four major immigrant groups in the Netherlands translate into utilisation disparities, aggravated by lack of language competence. The resulting pattern of systematic lower health services utilisation of elderly immigrants is a challenge for health care providers and policy makers.
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Affiliation(s)
- Semiha Denktaş
- Department of Health Policy and Management, Erasmus Medical Centre, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
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