Maternal smoking during pregnancy and childhood overweight and fat distribution: the KOALA Birth Cohort Study

[Factors associated with the development of malnutrition due to excess in children]

INTRODUCTION

malnutrition due to excess is a serious public health problem currently affecting 53 % of children and adolescents in Chile. The early identification of associated factors is key in prevention and necessary to guide interventions from early stages of life.

OBJECTIVE

to identify factors associated with the development of malnutrition due to excess in three-year-old children under control at Ancora Family Health.

METHODS

a case-control study was carried out in three Ancora Family Health Centers located in the communes of La Pintana and Puente Alto; it included 133 children and their mothers. Factors dependent on the child and the mother were analyzed and their importance in the development of malnutrition due to excess was determined.

RESULTS

logistic regression showed maternal smoking during pregnancy as a risk factor (OR = 4.065, 95 % CI: 1.119-14.770, p = 0.033) and as protective factors birth weight < 4,000 g (OR = 0.112, 95 % CI: 0.026-0.483, p = 0.003) and weight gain during the first year of life < 6.4 kg in women and < 6.9 kg in men (OR = 0.060, 95 % CI: 0.017-0.210, p = 0.000).

CONCLUSIONS

the most important risk factor was maternal smoking and the protective factors were birth weight and weight gain in the first year. Health programs and public policies should focus on modifiable factors such as smoking during pregnancy and adequate weight gain in the first year of life.

The Uterine Environment and Childhood Obesity Risk: Mechanisms and Predictions

PURPOSE OF REVIEW

Childhood obesity is a growing health problem in many populations, hence the urgent need to unravel the underlying mechanisms. Some evidence suggests that exposure to suboptimal intrauterine environments can program foetal metabolic health, with adverse consequences in later life, including susceptibility to childhood obesity.

FINDINGS

Factors such as high and low foetal birth weight, excessive gestational-weight-gain, maternal stress and smoking are all associated with increased risk of childhood obesity in observational studies. Animal models, where both genetic background and the postnatal environment can be carefully controlled, suggest that several different mechanisms, including epigenetic changes, dysregulation of adipose tissue development and programming of appetite, may be key drivers of developmental programming of childhood obesity. However, the influence of genetics and the post-natal environment are much more difficult to disentangle as independent effects in human studies, which are also complicated by low follow-up rates. Suboptimal intrauterine environments interact with maternal and foetal genetics and with the postnatal environment to contribute to the risk of childhood obesity. Maternal metabolic challenges, for example obesity and insulin resistance, contribute to the risk of foetal overgrowth and subsequent adiposity in childhood. To protect the long-term health of populations, research focusing on effective means of identifying and intervening in the transgenerational cycle of childhood obesity is required.

Study of the Combined Effect of Maternal Tobacco Smoking and Polygenic Risk Scores on Birth Weight and Body Mass Index in Childhood

Background: Maternal smoking during pregnancy has adverse health effects on the offspring, including lower birth weight and increased risk for obesity. These outcomes are also influenced by common genetic polymorphisms. We aimed to investigate the combined effect of maternal smoking during pregnancy and genetic predisposition on birth weight and body mass index (BMI)-related traits in 1,086 children of the Human Early Life Exposome (HELIX) project.

Methods: Maternal smoking during pregnancy was self-reported. Phenotypic traits were assessed at birth or at the age of 8 years. Ten polygenic risk scores (PRSs) per trait were calculated using the PRSice v2 program. For birth weight, we estimated two sets of PRSs based on two different base GWAS summary statistics: PRS-EGG, which includes HELIX children, and PRS-PanUK, which is completely independent. The best PRS per trait (highest R2) was selected for downstream analyses, and it was treated in continuous or categorized into three groups. Multivariate linear regression models were applied to evaluate the association of the explanatory variables with the traits of interest. The combined effect was evaluated by including an interaction term in the regression models and then running models stratified by the PRS group.

Results: BMI-related traits were correlated among them but not with birth weight. A similar pattern was observed for their PRSs. On average, the PRSs explained ∼4% of the phenotypic variation, with higher PRS values related to higher trait values (p-value &lt;5.55E-08). Sustained maternal smoking was associated with lower birth weight and higher BMI and related traits (p-value &lt;2.99E-02). We identified a gene by environment (GxE) interaction for birth weight between sustained maternal smoking and the PRS-EGG in three groups (p-value interaction = 0.01), which was not replicated with the PRS-PanUK (p-value interaction = 0.341). Finally, we did not find any statistically significant GxE interaction for BMI-related traits (p-value interaction &gt;0.237).

Conclusion: Sustained maternal smoking and the PRSs were independently associated with birth weight and childhood BMI-related traits. There was low evidence of GxE interactions.

An innovative postnatal risk assessment and corresponding care pathways in Preventive Child Healthcare

Aims

This study aims to evaluate the effectiveness of an innovative postnatal risk assessment (the postnatal Rotterdam Reproductive Risk Reduction checklist: R4U) and corresponding care pathways in Preventive Child Healthcare (PCHC), along with PCHC professional satisfaction.

Design

Four PCHC organizations located in three municipalities with a higher adverse perinatal outcome than the national average were selected for participation. The study concerns a historically controlled study design.

Methods

The study enrolled participants from September 2016 until December 2017. The historical cohort existed of children born in previous years from 2008 until 2016. The outcome measure was defined as catch‐up growth: more than 0.67 standard deviation score weight for height increase in the first 6 months of life. PCHC professional opinion was assessed with a digital survey.

Results

After the inclusion period, 1,953 children were included in the intervention cohort and 7,436 children in the historical cohort. Catch‐up growth was significantly less common in the intervention cohort; 14.9% versus 19.5% in the historical cohort (p < 0.001). A regression sensitivity analysis, using matching, showed an odds ratio of 0.957 (95% CI 0.938–0.976) for the intervention cohort. In the survey, 74 PCHC physicians and nurses participated; most of them were neutral concerning the benefits of the postnatal R4U.

Conclusion

This study shows that the implementation of a novel postnatal risk assessment including in PCHC is feasible and effective. Final efforts to ensure a widespread implementation should be taken.

Impact

PCHC offers a unique opportunity to recognize and address risk factors for growth and development in children and to implement care pathways. Effective and widely implemented risk assessments in antenatal and PCHC are scarce. To our knowledge, this kind of evidence‐based postnatal risk assessment has not been implemented in PCHC before and seizes the opportunity to prevent catch‐up growth and its long‐term effects.

The effect of prenatal maternal physical activity and lifestyle in perinatal outcome: results from a Greek study

BACKGROUND

Several maternal characteristics, including lifestyle, have been associated with perinatal outcomes and birth anthropometric characteristics of the offspring. This study aimed to identify whether physical activity (PA) and other lifestyle parameters of the mother are associated with the pregnancy outcomes or with the infant's birth anthropometric characteristics.

METHODS

Participants were recruited in Mitera Maternity Hospital, Athens, Greece. Socio-demographic, medical history and anthropometric assessment took place. PA during pregnancy was assessed with the Pregnancy Physical Activity Questionnaire. Dietary assessment was conducted with the Food Frequency Questionnaire and adherence to the Mediterranean diet was evaluated with the MedDiet score. Birth weight and gestational age data were also collected.

RESULTS

Sedentary-intensity activity scores increased with increased educational level, while moderate-intensity activity scores decreased with increased educational level. Pregnant women who delivered large for gestational age infants had lower sports activity score. Higher vigorous and sports activity score was demonstrated in cases with a vaginal delivery compared with caesarean section. PA score was significantly and positively correlated with several nutrient intakes and PA was higher in women with a healthier nutritional pattern. Increased MedDiet scores were found in mothers with increased educational level.

CONCLUSIONS

Overall, PA was higher in women with a healthier nutritional pattern. An increased vs. a low activity level during pregnancy is positively associated with vaginal delivery and with the size of the offspring.

Maternal plasma choline and betaine in late pregnancy and child growth up to age 8 years in the KOALA Birth Cohort Study

BACKGROUND

Sufficient choline and betaine during pregnancy are needed for fetal growth and development.

OBJECTIVES

We aimed to investigate the associations between maternal plasma choline and betaine in the third trimester of pregnancy and child growth from birth up to 8 years of age.

METHODS

Concentrations of choline and betaine were measured in plasma of 1331 pregnant women from the KOALA (Kind, Ouders en gezondheid: Aandacht voor Leefstijl en Aanleg) Birth Cohort Study in the Netherlands. Child weight and height were measured at birth and at 1 (91% complete), 2 (86%), and 6-8 y (76%). Birth weight, weight gain in the first year, and z scores for weight and height at 1 and 2 y were used as continuous outcome variables. BMI z scores at 1 and 2 y were used as continuous and dichotomous outcomes, and BMI z scores at age 6-8 y were used to study overweight at that age.

RESULTS

Each 1-µmol/L increase of maternal plasma choline was associated with a mean 20-g (95% CI: 1.1, 38.0 g) higher weight gain in the first year of life, and a higher BMI z score (β: 0.02; 95% CI: 0.00, 0.04) and slightly higher odds of BMI z score >85th percentile (OR: 1.08; 95% CI: 1.03, 1.10) at 1-2 y. Each 1-µmol/L increase of plasma betaine was associated with a mean 12-g (95% CI: 0.8, 23.9 g) higher weight gain in the first year of life and higher odds of BMI z score >85th percentile at 1-2 y (OR: 1.03; 95% CI: 1.00, 1.07). Lastly, betaine was associated with overweight at 6-8 y (OR: 1.17; 95% CI: 1.02, 1.34), only in boys.

CONCLUSIONS

Third-trimester pregnancy plasma choline and betaine were positively associated with childhood anthropometric measures. In boys, some of the associations may have persisted up to 8 y of age. Further studies may investigate the validity of maternal plasma choline and betaine concentrations as markers of maternal intake and fetal transfer.

Machine Learning-Based DNA Methylation Score for Fetal Exposure to Maternal Smoking: Development and Validation in Samples Collected from Adolescents and Adults

BACKGROUND

Fetal exposure to maternal smoking during pregnancy is associated with the development of noncommunicable diseases in the offspring. Maternal smoking may induce such long-term effects through persistent changes in the DNA methylome, which therefore hold the potential to be used as a biomarker of this early life exposure. With declining costs for measuring DNA methylation, we aimed to develop a DNA methylation score that can be used on adolescent DNA methylation data and thereby generate a score for in utero cigarette smoke exposure.

METHODS

We used machine learning methods to create a score reflecting exposure to maternal smoking during pregnancy. This score is based on peripheral blood measurements of DNA methylation (Illumina's Infinium HumanMethylation450K BeadChip). The score was developed and tested in the Raine Study with data from 995 white 17-y-old participants using 10-fold cross-validation. The score was further tested and validated in independent data from the Northern Finland Birth Cohort 1986 (NFBC1986) (16-y-olds) and 1966 (NFBC1966) (31-y-olds). Further, three previously proposed DNA methylation scores were applied for comparison. The final score was developed with 204 CpGs using elastic net regression.

RESULTS

Sensitivity and specificity values for the best performing previously developed classifier ("Reese Score") were 88% and 72% for Raine, 87% and 61% for NFBC1986 and 72% and 70% for NFBC1966, respectively; corresponding figures using the elastic net regression approach were 91% and 76% (Raine), 87% and 75% (NFBC1986), and 72% and 78% for NFBC1966.

CONCLUSION

We have developed a DNA methylation score for exposure to maternal smoking during pregnancy, outperforming the three previously developed scores. One possible application of the current score could be for model adjustment purposes or to assess its association with distal health outcomes where part of the effect can be attributed to maternal smoking. Further, it may provide a biomarker for fetal exposure to maternal smoking. https://doi.org/10.1289/EHP6076.

Parents' underestimation of their child's weight status. Moderating factors and change over time: A cross-sectional study

Background

Parents’ underestimation of their child’s weight status can hinder active participation in overweight prevention programs. We examined the level of agreement between the parents’ perception of their child’s weight status and the child’s actual weight status, moderating factors, and change over time.

Methods

This cross-sectional study used data collected in 2009 (n = 8105), 2013 (n = 8844) and 2017 (n = 11,022) from a community-based survey conducted among parents of children age 2–12 years in the Netherlands. Parents classified their perception of their child’s weight status on a 5-point Likert scale. In 2009 and 2013, the child’s BMI was calculated from self-reported data by parents. The level of agreement between the parent’s perception of the weight status and the actual weight status was examined using Cohen’s kappa. The role of demographic factors on parents’ perception were examined using logistic regression.

Results

In 2009, 2013 and 2017, 6%, 6% and 5% of the parents, respectively, classified their child as heavy/extremely heavy. In 2009 and 2013, 64.7% and 61.0% of parents, respectively, underestimated the weight status of their overweight child. This was even higher among parents of obese children. Overall, the agreement between the parents’ perception and the actual weight status improved from 2009 (kappa = 0.38) to 2013 (kappa = 0.43) (p<0.05), but remained unsatisfactory. The parents’ underestimation of their child’s overweight/obesity status was associated with the child’s age in 2009 and 2013 (2–7 years; OR: 0.18), the child’s gender in 2009 (male; OR: 0.55), and the parents’ education level in 2009 (middle and high education; OR: 0.56 and 0.44 respectively).

Conclusions

Parents’ underestimation of their child’s weight status remains alarmingly high, particularly among parents of young, obese children. This underestimation is a barrier to preventing childhood overweight/obesity. Healthcare professionals should take this underestimation into consideration and should actively encourage parents to take steps to prevent overweight/obesity in their children.

Experiences and cessation needs of Indigenous women who smoke during pregnancy: a systematic review of qualitative evidence

OBJECTIVES

The aim of this review was to identify and synthesize the best available evidence to address two questions: i) what is the experience of smoking during pregnancy for Indigenous women? and ii) what are the smoking cessation needs of Indigenous women who smoke during pregnancy?

INTRODUCTION

Smoking during pregnancy not only affects pregnant women's general health but also causes such serious problems as pre-term delivery, low birth weight, and sudden infant death. Rates of smoking during pregnancy are particularly high among Indigenous women. Learning about Indigenous women's experiences of smoking during pregnancy and associated smoking cessation needs is important to providing informed health care to them.

INCLUSION CRITERIA

The participants of interest were Indigenous women who smoked during a current or past pregnancy. The phenomena of interest were the experiences of smoking during pregnancy for Indigenous women and the smoking cessation needs of Indigenous women during pregnancy. The context was any community worldwide where pregnant Indigenous women live. Studies considered for this review were those in which qualitative data were gathered and analysed on the phenomena of interest, including mixed methods research.

METHODS

A comprehensive search was conducted for published studies in academic databases (i.e. PubMed, CINAHL, PsycINFO, Embase, Sociological Abstracts, SocINDEX, and Web of Science), unpublished studies in sources of gray literature (i.e. ProQuest Dissertations and Theses, OAIster, LILACS, MedNar, Google, Google Scholar, OpenGrey and relevant websites), and any additional studies in reference lists. Language and date limiters were not applied. The searches included all studies globally and were carried out on October 31, 2016. Studies that met the inclusion criteria were assessed for methodological quality by two reviewers independently, using the criteria of the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Descriptive details of each study accepted for this review were extracted in accordance with the elements of the JBI Data Extraction Form for Qualitative Research. The research findings that were relevant to the phenomena of interest and had participant voice were extracted from each included study and synthesized using the JBI meta-aggregative approach. The synthesized findings were assigned confidence scores in accordance with the JBI ConQual approach.

RESULTS

Thirteen studies were included in this review following careful consideration of the methodological quality of each study. The studies yielded a total of 116 research findings, which were grouped into 19 categories and then aggregated to form five synthesized findings. Confidence in the findings was determined to be low to very low (see ConQual Summary of Findings).

CONCLUSION

There is a small body of research evidence on Indigenous women's experiences of smoking during pregnancy and their smoking cessation needs. Confidence in the synthesized findings is constrained due to methodological limitations in many of the primary studies included in this review, along with mixed credibility of the research findings from across primary studies.

Weight gain, feeding and eating in the first year of life of babies of smoking and non-smoking mothers

Babies of mothers who smoke during pregnancy tend to be born underweight but are at risk for pediatric obesity. Maternal feeding practices, maternal disordered eating, and child temperament were assessed as potential mediators of early weight gain in babies of smoking and non-smoking mothers. The BMIs of babies of 88 smoking and 107 non-smoking mothers were recorded at birth and reported one year later. Mothers self-reported on disordered eating and child feeding practices, and on their infants' temperament. Babies of smoking mothers had lower BMI at birth but not at age one. For babies of non-smoking but not for those of smoking mothers, BMI at birth predicted BMI at age one. Smoking mothers' disordered eating and pressure for children to eat predicted their babies' BMI at age one. In the non-smoking group only, there were significant correlations between babies' temperamental difficulties and babies' BMI at age one. In contrast to non-smoking mothers, smoking mothers tend to pressure their babies to eat, and not to feed them in response to their distress. This interim picture may provide insight into the transition of the children of smoking mothers from underweight newborns to children classified as overweight.

Smoking and pregnancy: Epigenetics and developmental origins of the metabolic syndrome

Maternal smoking causes lower birth weight, birth defects, and other adverse pregnancy outcomes. Epidemiological evidence over the past four decades has grown stronger and the adverse outcomes attributed to maternal smoking and secondhand smoke exposure have expanded. This review presents findings of latent and persistent metabolic effects in offspring of smoking mothers like those observed in studies of maternal undernutrition during pregnancy. The phenotype of offspring of smoking mothers is like that associated with maternal undernutrition. Born smaller than offspring of nonsmokers, these children have increased risk of being overweight or obese later. Plausible mechanisms include in utero hypoxia, nicotine-induced reductions in uteroplacental blood flow, placental toxicity, or toxic growth restriction from the many toxicants in tobacco smoke. Studies have reported increased risk of insulin resistance, type 2 diabetes and hypertension although the evidence here is weaker than for overweight/obesity. Altered DNA methylation has been consistently documented in smoking mothers' offspring, and these epigenetic alterations are extensive and postnatally durable. A causal link between altered DNA methylation and the phenotypic changes observed in offspring remains to be firmly established, yet the association is strong, and mediation analyses suggest a causal link. Studies examining expression patterns of affected genes during childhood development and associated health outcomes should be instructive in this regard. The adverse effects of exposure to tobacco smoke during pregnancy now clearly include permanent metabolic derangements in offspring that can adversely affect life-long health.

Maternal smoking early in pregnancy is associated with increased risk of short stature and obesity in adult daughters

We assessed anthropometry in 22,421 adult daughters in association with their mothers’ tobacco smoking early in pregnancy (at their first antenatal visit) in Sweden, particularly their risk of short stature and obesity. Adult daughters were grouped by maternal smoking levels during pregnancy: Non-smokers (58.5%), Light smokers (24.1%; smoked 1–9 cigarettes/day), and Heavier smokers (17.4%; smoked ≥10 cigarettes/day). Anthropometry was recorded on the adult daughters at approximately 26.0 years of age. Obesity was defined as BMI ≥30 kg/m², and short stature as height more than two standard deviations below the population mean. Daughters whose mothers were Light and Heavier smokers in early pregnancy were 0.8 cm and 1.0 cm shorter, 2.3 kg and 2.6 kg heavier, and had BMI 0.84 kg/m² and 1.15 kg/m² greater, respectively, than daughters of Non-smokers. The adjusted relative risk of short stature was 55% higher in women born to smokers, irrespectively of smoking levels. Maternal smoking had a dose-dependent association with obesity risk, with offspring of Heavier smokers 61% and of Light smokers 37% more likely to be obese than the daughters of Non-smokers. In conclusion, maternal smoking in pregnancy was associated with an increased risk of short stature and obesity in their adult daughters.

Maternal smoking during pregnancy and offspring body mass index and overweight: a systematic review and meta-analysis

Abstract: The present study aimed to conduct a systematic review and meta-analysis to evaluate the evidence on the association of maternal smoking during pregnancy with offspring body composition in childhood, adolescence and adulthood. MEDLINE, Web of Science and LILACS databases were searched. Reference lists were also screened. We included original studies, conducted in humans, that assessed the association of maternal smoking during pregnancy with offspring body mass index (BMI) and overweight in childhood, adolescence and adulthood, published through May 1st, 2018. A meta-analysis was used to estimate pooled effect sizes. The systematic review included 64 studies, of which 37 evaluated the association of maternal smoking during pregnancy with overweight, 13 with BMI, and 14 evaluated both outcomes. Of these 64 studies, 95 measures of effect were extracted and included in the meta-analysis. We verified that the quality of evidence across studies regarding maternal smoking in pregnancy and overweight and BMI of offspring to be moderate and low, respectively. Most studies (44 studies) were classified as moderate risk bias. Heterogeneity among studies included was high and, in the random-effects pooled analysis, maternal smoking during pregnancy increased the odds of offspring overweight (OR: 1.43, 95%CI: 1.35; 1.52) and mean difference of BMI (β: 0.31, 95%CI: 0.23; 0.39). In conclusion, offspring of mothers who smoked during pregnancy have higher odds of overweight and mean difference of BMI, and these associations persisted into adulthood.

Substance use in pregnancy: The medical challenge

Substance use contributes significantly to the global burden of disease. Growing numbers of women use nicotine, alcohol, and illicit substances. Women are the most vulnerable to problematic substance use in their reproductive years. The first 1000 days of life, starting at conception, have been established as a critical window of time for long-term health and development. Substance use in pregnancy is associated with negative pregnancy and child health outcomes. The impact of antenatal substance use on these outcomes needs to be considered within a challenging and complex context. This review provides an overview of the current literature on the impact of substances on pregnancy and child outcomes as well as the evidence and guidelines on screening and interventions for women using substances during pregnancy.

Maternal smoking during pregnancy and early development of overweight and growth deficit in children: an analysis of survival

Abstract Objectives: to evaluate the association between smoking during pregnancy and nutritional status. Methods: cohort study with a sample of 460 children in the baseline. The children were assessed four times, being measured for weight and length to be converted in indexes length forage (L/A) and body mass index forage (BMI/A) in Z-score. The time until occurrence of growth deficit and overweight was calculated in days and compared to maternal smoking during pregnancy. To assess the association between smoking during pregnancy and the outcomes, a Hazard Ratio by Cox regression was obtained, adjusting by confounding variables selected from Directed Acyclic Graphs (DAG). Results: the time until occurrence of growth deficit and overweight was lower in children whose mothers smoked during pregnancy. Smoking during pregnancy was a risk factor for length deficit (HR = 2.84; CI95% = 1.42 to 5.70) and for overweight (HR = 1.96; CI95% = 1, 09 to 3.53), even after the adjustment. Conclusions: maternal smoking was a changeable factor associated with anthropometric outcomes, which demonstrates the need for actions to combat smoking during pregnancy in order to prevent early nutritional deviations.

Maternal smoking and risk of obesity in school children: Investigating early life theory from the GRECO study

Based on the Early Life Theory, maternal smoking may be a factor affecting child weight status, adiposity level and blood pressure later in life. The purpose of this study was primarily to examine the risk of maternal smoking during pregnancy with overweight and obesity, central and total adiposity in school children. Secondarily, to assess the effect of maternal smoking, with children's blood pressure (BP). Data from the Greek Childhood Obesity cross sectional study (GRECO), conducted from October 2008 to May 2009, were used. A total of 2400 questionnaires gathered from children and their parents were analysed. Maternal and gestational data were gathered by a self-administered questionnaire. Women were categorized as non-smokers or smokers if they smoked ≥ 1 cigarettes/day during pregnancy. Children's body weight, height, waist circumference and BP were measured. Multiple logistic and linear regression analysis was conducted, adjusting for covariates. Four models were used in the process. The study found that children of maternal-smokers were more likely to be overweight or obese (OR: 1.6 to 1.82) and to have a larger waist circumference (OR: 1.73 to 1.85), compared to children of non-smokers in all models used. Total fat percentage was not significantly associated with maternal smoking when adjusted. Systolic and diastolic BP was not associated with maternal smoking. Results of this study strengthen the need for smoking cessation during pregnancy in order to possibly reduce the childhood obesity epidemic. Creating public health awareness of the potential risk of maternal-smoking on children's weight status later in life is warranted.

Perinatal, sociodemographic and lifestyle correlates of increased total and visceral fat mass levels in schoolchildren in Greece: the Healthy Growth Study

Objective

To identify possibly independent associations of perinatal, sociodemographic and lifestyle factors with childhood total and visceral body fat.

Design

A representative sample of 2655 schoolchildren (9–13 years) participated in the Healthy Growth Study, a cross-sectional epidemiological study.

Setting

Seventy-seven primary schools in four large regions in Greece.

Subjects

A sample of 1228 children having full data on total and visceral fat mass levels, as well as on anthropometric, dietary, physical activity, physical examination, socio-economic and perinatal indices, was examined.

Results

Maternal (OR=3·03 and 1·77) and paternal obesity (OR=1·62 and 1·78), maternal smoking during pregnancy (OR=1·72 and 1·93) and rapid infant weight gain (OR=1·42 and 1·96) were significantly and positively associated with children’s increased total and visceral fat mass levels, respectively. Children’s television watching for >2 h/d (OR=1·40) and maternal pre-pregnancy obesity (OR=2·46) were associated with children’s increased total and visceral fat mass level, respectively. Furthermore, increased children’s physical activity (OR=0·66 and 0·47) were significantly and negatively associated with children’s total and visceral fat mass levels, respectively. Lastly, both father’s age >46 years (OR=0·57) and higher maternal educational level (OR=0·45) were associated with children’s increased total visceral fat mass level.

Conclusions

Parental sociodemographic characteristics, perinatal indices and pre-adolescent lifestyle behaviours were associated with children’s abnormal levels of total and visceral fat mass. Any future programme for childhood prevention either from the perinatal age or at late childhood should take these indices into consideration.

Early Life Antibiotic Exposure and Weight Development in Children

OBJECTIVE

To examine the timing, frequency, and type of antibiotic exposure during the first 10 years of life in association with (over)weight across this period in a cohort of 979 children.

STUDY DESIGN

Within the Child, Parents and Health: Lifestyle and Genetic Constitution Birth Cohort Study, antibiotic exposure record was obtained from general practitioners. Anthropometric outcomes (age- and sex-standardized body mass index, weight and height z-scores, and overweight) were measured repeatedly at 7 time points during the first 10 years of life. Generalized estimating equations method was used for statistical analysis.

RESULTS

After adjusting for confounding factors, children exposed to one course of antibiotics compared with none in the first 6 months of life had increased weight- (adjusted generalized estimating equations estimates [adjβ] 0.24; 95% CI 0.03-0.44) and height (adjβ 0.23; 95% CI 0.0002-0.46) z-scores; exposure to ≥2 courses during the second year of life was associated with both increased weight (adjβ 0.34; 95% CI 0.07-0.60), and height z-scores (adjβ 0.29; 95% CI -0.003 to 0.59). Exposure later in life was not associated with anthropometric outcomes. Associations with weight z-scores were mainly driven by exposure to broad- (≥2 courses: adjβ 0.11; 95% CI 0.003-0.22) and narrow-spectrum β-lactams (1 course: adjβ 0.18; 95% CI 0.005-0.35) during the follow-up period. Specific antibiotic used was not associated with body mass index z-scores and overweight.

CONCLUSIONS

Repeated exposure to antibiotics early in life, especially β-lactam agents, is associated with increased weight and height. If causality of obesity can be established in future studies, this further highlights the need for restrictive antibiotic use and avoidance of prescriptions when there is minimal clinical benefit.

Systematic review and meta-analysis of the association between maternal smoking in pregnancy and childhood overweight and obesity

BACKGROUND

By 2020, it is predicted that 60 million children worldwide will be overweight. Maternal smoking in pregnancy has been suggested as a contributing factor. Our objective was to systematically review studies on this, thereby expanding the evidence base for this association.

METHODS

Systematic review with meta-analysis, Prospero Registration number CRD42012002859. We searched PubMed, Embase, Global Health, Web of Science and the Grey literature. We included prevalence, cohort and cross-sectional studies involving full-term, singleton pregnancies. Published and unpublished studies through to 1 January 2015 in all languages, demonstrating an objective overweight outcome up until 18 years of age and data presented as an OR, were included. Quality assessment was undertaken using an adaption of the Newcastle-Ottawa scale. Statistical analysis was performed using Review Manager V.5.3.

FINDINGS

The meta-analysis included 39 studies of 236 687 children from Europe, Australia, North America and South America and Asia. Maternal smoking in pregnancy ranged from 5.5% to 38.7%, with the prevalence of overweight from 6.3% to 32.1% and obesity from 2.6% to 17%. Pooled adjusted ORs demonstrated an elevated odds of maternal smoking in pregnancy for childhood overweight (OR 1.37, 95% CI 1.28 to 1.46, I₂ 45%) and childhood obesity (OR 1.55, 95% CI 1.40 to 1.73, I₂ 24%).

INTERPRETATION

Our results demonstrate an association between maternal prenatal smoking and childhood overweight. This contributes to the growing evidence for the aetiology of childhood overweight, providing important information for policymakers and health professionals alike in planning cessation programmes or antismoking interventions for pregnant female smokers.

A Novel Method to Describe Early Offspring Body Mass Index (BMI) Trajectories and to Study Its Determinants

Background

Accurately characterizing children’s body mass index (BMI) trajectories and studying their determinants is a statistical challenge. There is a need to identify early public health measures for obesity prevention. We describe a method that allows studies of the determinants of height, weight and BMI growth up to five years of age. We illustrated this method using maternal smoking during pregnancy as one of the early-life factors that is potentially involved in prenatal programming of obesity.

Methods

Individual height and weight trajectories were fitted using the Jenss-Bayley model on 28,381 and 30,515 measurements, respectively, from 1,666 children to deduce BMI trajectories. We assessed global associations between smoking and growth trajectories and cross-sectional associations at specific ages.

Results

Children exposed in late pregnancy had a 0.24 kg/m² (95% confidence interval: 0.07, 0.41) higher BMI at 5 years of age compared with non-exposed children. Although the BMIs of children exposed during late pregnancy became significantly higher compared with those of non-exposed children from 2 years onwards, the trajectories began to diverge during the first weeks of life.

Conclusion

Our method is relevant for studies on the relationships between individual-level exposures and the dynamics and shapes of BMI growth during childhood, including key features such as instantaneous growth velocities and the age or BMI value at the BMI infancy peak that benefit from the monotonic pattern of height and weight growth.

Risk Factors for Childhood Obesity in the First 1,000 Days: A Systematic Review

CONTEXT

Mounting evidence suggests that the origins of childhood obesity and related disparities can be found as early as the "first 1,000 days"-the period from conception to age 2 years. The main goal of this study is to systematically review existing evidence for modifiable childhood obesity risk factors present from conception to age 2 years.

EVIDENCE ACQUISITION

PubMed, Embase, and Web of Science were searched for studies published between January 1, 1980, and December 12, 2014, of childhood obesity risk factors present during the first 1,000 days. Prospective, original human subject, English-language research with exposure occurrence during the first 1,000 days and with the outcome of childhood overweight or obesity (BMI ≥85th percentile for age and sex) collected between age 6 months and 18 years were analyzed between December 13, 2014, and March 15, 2015.

EVIDENCE SYNTHESIS

Of 5,952 identified citations, 282 studies met inclusion criteria. Several risk factors during the first 1,000 days were consistently associated with later childhood obesity. These included higher maternal pre-pregnancy BMI, prenatal tobacco exposure, maternal excess gestational weight gain, high infant birth weight, and accelerated infant weight gain. Fewer studies also supported gestational diabetes, child care attendance, low strength of maternal-infant relationship, low SES, curtailed infant sleep, inappropriate bottle use, introduction of solid food intake before age 4 months, and infant antibiotic exposure as risk factors for childhood obesity.

CONCLUSIONS

Modifiable risk factors in the first 1,000 days can inform future research and policy priorities and intervention efforts to prevent childhood obesity.

Maternal smoking in pregnancy association with childhood adiposity and blood pressure

BACKGROUND

Maternal smoking during pregnancy has been associated with increased risk of childhood overweight/obesity defined by body mass index (BMI). We examined its association with a range of adiposity measures and cardiovascular indicators in children aged 3-10 years.

METHODS

We used data from a cross-sectional study of schoolchildren across mainland Portuguese districts (2009-2010). We applied quantile regressions to examine maternal smoking associations with adiposity (n = 17 286), blood pressure (BP) and resting pulse rate (RPR) (n ≈ 2500) measures across the age range, adjusting for prenatal and early life factors.

RESULTS

Maternal smoking during pregnancy was associated with increases in offspring adiposity levels. The difference in median BMI between children of smokers and non-smokers was 0.39 kg m(-2) (95% confidence interval: 0.25, 0.53) in boys and 0.46 kg m(-2) (0.31, 0.62) in girls; 0.55 cm (0.24, 0.87) and 0.82 cm (0.45, 1.19), respectively, in median waist circumference; and 0.94 mm (0.49, 1.40) and 1.47 mm (0.87, 2.07) in median sum of (triceps, subscapular, suprailiac) skin-folds. The associations appeared to be stronger with increasing age. The differences in the 90th centile tended to be greater than those in median. There was no consistent association of maternal smoking with BP and RPR.

CONCLUSIONS

Children whose mother smoked during pregnancy had higher adiposity levels than children of non-smokers, across several measures, particularly among older children. Although there was no consistent association with cardiovascular indicators, maternal smoking association with childhood obesity may have implications for cardiovascular risk factors over the life course.

Leisure time physical activity before and during mid-pregnancy and offspring adiposity in mid-childhood

BACKGROUND

Effects of maternal leisure time physical activity (LTPA) on paediatric obesity are unknown. The objective of this study was to examine associations of maternal LTPA with offspring overall and central adiposity in mid-childhood.

METHODS

We analysed data from 802 mother-child dyads from Project Viva, a prospective pre-birth cohort study. Women reported average weekly LTPA before and during mid-pregnancy. At age 7-10 years, we measured fat, truncal fat and lean mass with dual-energy X-ray absorptiometry. Using multivariable linear regression, we examined associations of maternal LTPA with offspring adiposity, adjusting for child age and sex, maternal race/ethnicity, education, age, pre-pregnancy body mass index, marital status and smoking status.

RESULTS

Mean (standard deviation) of LTPA before and during mid-pregnancy were 9.5 (8.1) and 7.1 (7.0) h week(-1) . At mean age 7.8 (0.8) years, childhood fat, truncal fat and lean mass indices were 4.3 (1.8), 1.4 (0.8) and 12.9 (1.4) kg m(-2) . We did not find that higher maternal LTPA was associated with lower child adiposity outcomes. For example, compared with 0-3 h week(-1) of LTPA during mid-pregnancy, children of mothers with +8 h week(-1) had fat mass index 0.07 kg m(-2) (95% confidence interval: -0.22, 0.36). In analyses of within-person LTPA change from before to mid-pregnancy, compared with +2 h week(-1) decrease in LTPA, increased LTPA (2 ± h week(-1) ) was associated with a 0.09 kg m(-2) fat mass index (-0.25, 0.43).

CONCLUSIONS

Contrary to our hypothesis, higher LTPA before and during mid-pregnancy, and the change between them, were not associated with lower adiposity in mid-childhood.

Parental pre-pregnancy BMI is a dominant early-life risk factor influencing BMI of offspring in adulthood

Objective

We examined parental and early‐life variables in order to identify risk factors for adulthood overweight and obesity in offspring. We report here on the longitudinal prevalence of overweight and obesity in Australian children born between 1989 and 1991 and followed from birth to age 22.

Methods

Data were analysed on 1355 participants from the Western Australian Pregnancy Cohort (Raine) Study, with anthropometry collected during pregnancy, at birth, one year and at three yearly intervals thereafter. Multivariate analyses and cross‐sectional logistic regression quantified the timing and contribution of early‐life risk factors for overweight and obesity in young‐adulthood.

Results

At five years of age 12.6% of children were overweight and 5.2% were obese. By early adulthood, the prevalence of obesity had increased to 12.8%, whilst overweight remained relatively stable at 14.2% (range from early childhood to adulthood 11–16%). Parental pre‐pregnancy body mass index (BMI) was the strongest determinant of adult offspring BMI. Although rapid first year weight gain was associated with increased offspring BMI, the impact of first year weight‐gain diminished over childhood, whilst the impact of parental BMI increased over time.

Conclusions

Parental pre‐pregnancy BMI and rapid early‐life weight gain predispose offspring to obesity in adulthood.

Differential impact of maternal and paternal ethnicity on the pattern of fat distribution in infants at age 3 months

BACKGROUND

As ethnicity is typically recorded as a single demographic variable in clinical studies, little is known about the relative impact of maternal vs. paternal ethnicity on fat distribution.

OBJECTIVES

The objective of this study was to determine whether there is a differential impact of maternal and paternal ethnicity on infant adiposity.

METHODS

Three hundred fifty-five infants underwent anthropometric assessment at age 3 months, including skin-fold thickness (SFT) measurement at subscapular, suprailiac and triceps. Maternal (M) and paternal (P) ethnicity were classified as white (M = 241, P = 252), Asian (M = 50, P = 42) or other (M = 64, P = 61).

RESULTS

Infants with either Asian mother (compared with white) or Asian father (compared with white) had increased subscapular, suprailiac and triceps SFT (all P < 0.05). On logistic regression analysis, however, only maternal Asian ethnicity (compared with white) independently predicted the likelihood of an infant being in the highest tertile for SFT at subscapular (odds ratio [OR] = 2.72, 95% confidence interval 1.17-6.34, P = 0.02), suprailiac (OR = 3.56, 1.51-8.42, P = 0.004) and triceps (OR = 3.26, 1.40-7.55, P = 0.005). In contrast, paternal Asian ethnicity was independently associated with sum of SFT only (OR = 2.46, 1.02-5.97, P = 0.04).

CONCLUSION

Maternal and paternal Asian ethnicity have differential effects on infant fat distribution. Future clinical studies on obesity and fat composition should consider the distinct contributions of both parents to the ethnic classification of participants.

Gut colonization with methanobrevibacter smithii is associated with childhood weight development

OBJECTIVE

To prospectively investigate the presence and counts of archaea in feces of 472 children in association with weight development from 6 to 10 years of age.

METHODS

Within the KOALA Birth Cohort Study, a single fecal sample from each child was analyzed by quantitative polymerase chain reaction to quantify archaea (Methanobrevibacter smithii, Methanosphera stadtmanae). Anthropometric outcomes (overweight [body mass index {BMI} ≥ 85th percentile], age- and sex-standardized BMI, weight, and height z-scores) were repeatedly measured at ages (mean ± SD) of 6.2 ± 0.5, 6.8 ± 0.5, 7.8 ± 0.5, and 8.8 ± 0.5 years. Generalized estimating equation was used for statistical analysis while controlling for confounders.

RESULTS

Methanobrevibacter smithii colonization was associated with an increased risk of overweight (adjusted odds ratio [OR] = 2.69; 95% confidence interval [CI] 0.96-7.54) from 6 to 10 years of age. Children with high levels (>7 log10 copies/g feces) of this archaeon were at highest risk for overweight (OR = 3.27; 95% CI 1.09-9.83). Moreover, M. smithii colonization was associated with higher weight z-scores (adj. β 0.18; 95% CI 0.00-0.36), but not with height. For BMI z-scores, the interaction (P = 0.008) between M. smithii and age was statistically significant, implying children colonized with M. smithii had increasing BMI z-scores with age.

CONCLUSIONS

Presence and higher counts of M. smithii in the gut of children are associated with higher weight z-scores, higher BMI z-scores, and overweight.

Picky eating and child weight status development: a longitudinal study

BACKGROUND

Children's picky eating behaviour has been linked both to being overweight and underweight. However, the role of parenting practices in this relationship has rarely been investigated. The present study aimed to clarify the direction of the association between picky eating and weight status and to examine the moderating role of food parenting practices.

METHODS

The present study comprised a longitudinal study on the effects of picky eating on child weight status within the KOALA Birth Cohort Study, the Netherlands. Mothers and their children were included in the analyses. Children's picky eating behaviour and food parenting practices were assessed at baseline (child age 5 years). Their weight status was assessed repeatedly until age 9 years. Mixed effects linear and logistic regressions were used to compare picky eaters (n = 403) and non-picky eaters (n = 621) on changes in weight status over the years.

RESULTS

At baseline of age 5 years, picky eaters were slightly shorter, more often underweight and less often overweight than non-picky eaters, whereas energy intake in relation to body weight (kJ kg(-1)) was similar. Picky eaters with a normal weight at baseline had no increased risk of becoming underweight during follow-up until age 9 years, and were less likely to become overweight compared to non-picky eaters. There were no interactions with food parenting practices. The parents of picky eaters more often reported pressuring their child to eat and restrict unhealthy food intake compared to parents of non-picky eaters.

CONCLUSIONS

The association between picky eating and child weight status was not influenced by parenting practices.

The intestinal microbiota composition and weight development in children: the KOALA Birth Cohort Study

OBJECTIVE

To investigate whether the intestinal microbiota composition in early infancy is associated with subsequent weight development in children.

METHODS

Analyses were conducted within the KOALA Birth Cohort Study (n = 2834). This cohort originates from two recruitments groups: pregnant women with a conventional lifestyle (no selection based on lifestyle) and pregnant women recruited through alternative channels (organic shops, anthroposophic clinicians/midwives, Steiner schools and relevant magazines). From 909 one-month-old infants, fecal samples were collected and analyzed by quantitative PCR targeting bifidobacteria, Bacteroides fragilis group, Clostridium difficile, Escherichia coli, Lactobacilli and total bacteria counts. Between the ages of 1 and 10 years, parent-reported weight and height was collected at 7 time points. Age- and gender-standardized body mass index (BMI) z-scores were calculated. Data were analyzed using generalized estimating equation.

RESULTS

Colonization with B. fragilis group was borderline significantly associated with a higher BMI z-score of 0.15 (95% confidence interval (CI): -0.02 to 0.31), in the conventional subcohort. After stratification for fiber intake (P(forinteraction) = 0.003), colonization with B. fragilis group was associated with a 0.34 higher BMI z-score among children with a low-fiber intake in this subcohort (95% CI: 0.17-0.53). Higher counts among colonized children were positively associated with BMI z-score only in children within the conventional subcohort and a high-fiber diet (BMI z-score 0.08; 95% CI: 0.01-0.14), but inversely associated in children with a low-fiber diet (BMI z-score -0.05; 95% CI: -0.10 to 0.00), and in children recruited through alternative channels (BMI z-score -0.10; 95% CI: -0.17 to -0.03). The other bacteria were not associated with BMI z-scores, regardless of subcohort.

CONCLUSION

Using a targeted approach, we conclude that the intestinal microbiota, particularly the B. fragilis group, is associated with childhood weight development. To identify the potential impact of additional bacterial taxa, further prospective studies applying an unconstrained in-depth characterization of the microbiota are needed.

Maternal but not fetal FADS gene variants modify the association between maternal long-chain PUFA intake in pregnancy and birth weight

Several studies have shown a positive association between maternal fish intake in pregnancy and pregnancy duration and child birth weight (BW), probably due to fish n-3 (ω-3) long-chain polyunsaturated fatty acids (LC-PUFAs). n-3 LC-PUFAs can also be synthesized endogenously, and their synthesis depends on single nucleotide polymorphisms (SNPs) in the fatty acid desaturase (FADS) gene encoding for FADS. We assessed the associations of maternal docosahexaenoic acid (DHA) intake in pregnancy with pregnancy duration and BW and investigated whether these associations are modified by maternal or fetal FADS SNP genotypes. We hypothesized that we would find stronger associations in minor allele homozygous mothers or fetuses due to their lower n-3 LC-PUFA endogenous synthesis and hence higher dependence on dietary supply. Data on maternal diet, pregnancy duration, and BW were available for 2622 mother-child pairs from the KOALA (Kind, Ouders en gezondheid: Aandacht voor Leefstijl en Aanleg) Birth Cohort Study. The rs174556 FADS SNP was genotyped in 1516 mothers and 1515 children. Associations and gene-diet interactions were tested with linear regression adjusting for potential confounders, including intake of other PUFAs. Women at the 75th percentile of DHA intake had 0.7-d longer pregnancies (P = 0.016) and 28-g heavier infants (P = 0.039) than did women at the 25th percentile of intake. Associations with arachidonic acid intake were of the same order but in the opposite direction. Mothers who were homozygous for the minor allele had 2-d shorter pregnancies (P = 0.035) and infants who were nearly 140 g lighter (P = 0.006) than did mothers who were major allele homozygotes. Post hoc analyses revealed that they had higher prepregnancy BMI (P = 0.020). Among the women homozygous for the minor allele, those at the 75th percentile of DHA intake had 226-g heavier infants than those at the 25th percentile of intake (P = 0.030), whereas DHA intake was not significantly associated with BW in major allele carriers. These findings suggest that maternal and fetal fatty acid requirements during pregnancy depend on maternal genetic variation in LC-PUFA synthesis.

Parental perception of child's weight status and subsequent BMIz change: the KOALA birth cohort study

Background

Parents often fail to correctly perceive their children’s weight status, but no studies have examined the association between parental weight status perception and longitudinal BMIz change (BMI standardized to a reference population) at various ages. We investigated whether parents are able to accurately perceive their child’s weight status at age 5. We also investigated predictors of accurate weight status perception. Finally, we investigated the predictive value of accurate weight status perception in explaining children’s longitudinal weight development up to the age of 9, in children who were overweight at the age of 5.

Methods

We used longitudinal data from the KOALA Birth Cohort Study. At the child’s age of 5 years, parents filled out a questionnaire regarding child and parent characteristics and their perception of their child’s weight status. We calculated the children’s actual weight status from parental reports of weight and height at ages 2, 5, 6, 7, 8, and 9 years. Regression analyses were used to identify factors predicting which parents accurately perceived their child’s weight status. Finally, regression analyses were used to predict subsequent longitudinal BMIz change in overweight children.

Results

Eighty-five percent of the parents of overweight children underestimated their child’s weight status at age 5. The child’s BMIz at age 2 and 5 were significant positive predictors of accurate weight status perception (vs. underestimation) in normal weight and overweight children. Accurate weight status perception was a predictor of higher future BMI in overweight children, corrected for actual BMI at baseline.

Conclusions

Children of parents who accurately perceived their child’s weight status had a higher BMI over time, probably making it easier for parents to correctly perceive their child’s overweight. Parental awareness of the child’s overweight as such may not be sufficient for subsequent weight management by the parents, implying that parents who recognize their child’s overweight may not be able or willing to adequately manage the overweight.