Perinatal Factors Associated with Cardiovascular Disease Risk among Preschool-Age Children in the United States: An Analysis of 1999-2008 NHANES Data

Towards optimum smoking cessation interventions during pregnancy: a household model to explore cost-effectiveness

BACKGROUND AND AIMS

Previous economic evaluations of smoking cessation interventions for pregnant women are limited to single components, which do not in isolation offer sufficient potential impact to address smoking cessation targets. To inform the development of more appropriate complex interventions, we (1) describe the development of the Economics of Smoking in Pregnancy: Household (ESIP.H) model for estimating the life-time cost-effectiveness of smoking cessation interventions aimed at pregnant women and (2) use a hypothetical case study to demonstrate how ESIP.H can be used to identify the characteristics of optimum smoking cessation interventions.

METHODS

The hypothetical intervention was based on current evidence relating to component elements, including financial incentives, partner smoking, intensive behaviour change support, cigarettes consumption and duration of support to 12 months post-partum. ESIP.H was developed to assess the life-time health and cost impacts of multi-component interventions compared with standard National Health Service (NHS) care in England. ESIP.H considers cigarette consumption, partner smoking and some health conditions (e.g. obesity) that were not included in previous models. The Markov model's parameters were estimated based on published literature, expert judgement and evidence-based assumptions. The hypothetical intervention was evaluated from an NHS perspective.

RESULTS

The hypothetical intervention was associated with an incremental gain in quitters (mother and partner) at 12 months postpartum of 249 [95% confidence interval (CI) = 195-304] per 1000 pregnant smokers. Over the long-term, it had an incremental negative cost of £193 (CI = -£779 to 344) and it improved health, with a 0.50 (CI = 0.36-0.69) increase in quality-adjusted life years (QALYs) for mothers, partners and offspring, with a 100% probability of being cost-effective.

CONCLUSIONS

The Economics of Smoking in Pregnancy: Household model for estimating cost-effectiveness of smoking cessation interventions aimed at pregnant women found that a hypothetical smoking cessation intervention would greatly extend reach, reduce smoking and be cost-effective.

Early nutritional influences of cardiovascular health

INTRODUCTION

Increasing evidence shows that nutritional choices during children's formative years, including prenatally, impacts the development of adult onset cardiovascular diseases (CVDs), such as hypertension, myocardial infarction, or stroke.

AREAS COVERED

This literature review aims to synthesize the current body of evidence on nutritional factors, from conception through adolescence, which may influence a person's risk factors for future development of CVD.

EXPERT OPINION

Given the escalating healthcare costs associated with CVD, it is imperative that medical professionals and scientists remain steadfast in prioritizing and promoting early CVD prevention, even within the first few years of life. Though not the only contributing risk factor, diet is a modifiable risk factor and has been shown to have a profound impact on the reduction of cardiovascular morbidity and mortality in adult literature. Nutritional choices should be targeted on multiple levels: prenatally with the mother, individually with the patient, in conjunction with their family unit, and also within the broader community wherein they reside. Healthcare providers can play a key advocacy role for local and national food environment policy changes.

Association between maternal smoking during pregnancy and offspring overweight in U.S.-born children

BACKGROUND

The criticism of the literature on smoking during pregnancy and offspring overweight was the confounding from postnatal factors. Interaction between gestational age and prenatal maternal smoking has not yet assessed.

METHODS

We used the Third National Health and Nutrition Examination Survey (1988-1994), linked with natality files of US-born singletons aged 2 to 6 years. A body mass index in the 85th percentile or higher were considered overweight, including obesity. Gestational age was dichotomized as preterm (<37 weeks, n = 240) or full-term (n = 2125). Smoking status during pregnancy was ascertained by a questionnaire-based interview during National Health and Nutrition Examination Survey.

RESULTS

The prevalence of offspring overweight and obesity combined was 17.3% (SE = 1.3%). And 24.0% (1.3%) of mothers smoked while pregnant. A significant interaction was observed between maternal smoking and gestational age. In preterm children, a higher prevalence of overweight (34.3% [6.7%]) was found among the offspring of smoking mothers compared to non-smoking mothers (15.8% [3.6%]). After adjustment for socio-demographics, prenatal and postnatal factors, in preterm born offspring, the odds ratio of being born to smoking mothers was 2.46 (95% confidence intervals: 1.13-5.37) among children with overweight/obesity compared to children with healthy weight born to non-smoking mothers. In full-term children, the OR of being born to smoking mothers was 0.72 (0.50-1.03) among offspring with overweight/obesity relative to offspring with healthy weight born to non-smoking mothers.

CONCLUSIONS

Maternal smoking during pregnancy was strongly associated with offspring overweight and obesity in preterm births after control for postnatal factors. Preterm children of smoking mothers should be prioritized for obesity prevention.

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.

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.

Breastfeeding is associated with waist-to-height ratio in young adults

Background

The current study investigated the association between breastfeeding and adult weight distribution using an emerging indicator of weight distribution, the waist-to-height ratio (WHtR).

Methods

The study sample consisted of two subsamples of individuals that were part of the National Longitudinal Study of Adolescent Health. One sample (n = 1 179) consisted of individuals from the sibling pair data. A second sample (n = 4 648) consisted of individuals that were not part of the paired data. Regression models were constructed to establish if there was a relationship between breastfeeding and two measures of weight distribution: WHtR and body mass index (BMI). Controls for parental socioeconomic status, maternal smoking, race, sex, age, birth weight, maternal BMI, genetic ancestry, and a genetic risk score (GRS) for obesity were included. In addition, a behavioral risk score (BRS) was constructed to control for other residual confounding factors.

Results

A significant, inverse relationship between breastfeeding and adult WHtR persisted in models constructed from the sibling pair sample (P = 0.002) and unrelated sample (P <0.0001). This association remained significant with the inclusion of ancestry principal components, GRS, and a measure of maternal obesity.

Conclusions

The moderate association between breastfeeding and weight distribution persists into adulthood while controlling for potential confounders. This paper also provides evidence that the WHtR may be a superior outcome measure to BMI in studies investigating breastfeeding and obesity.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2611-7) contains supplementary material, which is available to authorized users.

Low Birth Weight as a Predictor of Cardiovascular Risk Factors in Childhood and Adolescence? The PEP Family Heart Study

BACKGROUND

Low birth weight is considered a risk factor for cardiovascular disease (CVD) in later life. Because data in children and adolescents are sparse and controversial, we assessed the association of birth weight with CVD risk factors in German youths.

METHODS

We categorized 843 urban children and adolescents aged 3-18 years by quintiles of birth weight and measured nine traditional risk factors in terms of body mass index (BMI), waist circumference (WC), systolic (SBP) and diastolic (DBP) blood pressure, total cholesterol (TC), LDL-C, HDL-C, Non HDL-C and triglycerides (TG). SPSS 21 was used for statistical analysis.

RESULTS

Mean values and prevalence of nine anthropometric and lipid risk variables were equally distributed over the five birth weight groups. Though risk factors clustered between 3.0 kg and 4.0 kg of birth weight in both genders we found only one significant correlation of birth weight with TG for males and females and another one for HDL-C in males. The strongest clustering of significant regression coefficients occurred in the 2(nd) birth weight quintile for SBP (ß 0.018), TC (ß -0.050), LDL-C (ß -0.039), non LDL-C (ß -0.049) and log TG (ß -0.001) in males and females.

CONCLUSIONS

Overall we did not find significant associations between birth weight and nine traditional cardiovascular risk factors in children and adolescents. However, the 2(nd) quintile of birth weight might suggest clustering of risk factors.

Age of introduction of first complementary feeding for infants: a systematic review

Background

Despite a World Health Organization recommendation for exclusive breastfeeding of all full-term infants to 6 months of age, it is not clear what the health implications may be. Breast milk alone may not meet the nutrition needs for all growing infants, leaving them at risk for deficiencies. The objective of this study was to investigate the relationship between moderate (4 months) versus late (6 months) introduction of complementary foods to the full-term breastfed infant on iron status and growth.

Methods

An electronic search of peer-reviewed and gray-literature was conducted for randomized control trials (RCTs) and observational studies related to the timing of introduction of complementary foods. Iron status and growth data from the relevant RCTs were analyzed using RevMan 5.2.11.

Results

Three RCTs and one observational study met the inclusion criteria. Meta-analysis showed significantly higher hemoglobin levels in infants fed solids at 4 months versus those fed solids at 6 months in developing countries [mean difference [MD]: 5.0 g/L; 95 % CI: 1.5, 8.5 g/L; P = 0.005]. Meta-anaysis also showed higher serum ferritin levels in the 4-month group in both developed and developing countries [MD: 26.0 μg/L; 95 % CI: -0.1, 52.1 μg/L, P = 0.050], [MD: 18.9 μg/L; 95 % CI: 0.7, 37.1 μg/L, P = 0.040]. Short follow-up periods and small sample sizes of the included studies were the major limitations.

Conclusions

RCT evidence suggests the rate of iron deficiency anemia in breastfed infants could be positively altered by introduction of solids at 4 months.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-015-0409-5) contains supplementary material, which is available to authorized users.

Breastfeeding offers protection against obesity in children of recently immigrated Latina women

Breastfeeding has been found to have a protective effect on subsequent development of obesity in childhood, particularly in white, non-Hispanic populations. The protective effect of nursing for more than 12 months in children of Latina women is less clear, which may be due to differences in levels of acculturation in previously studied populations. We evaluated the association between breastfeeding for 12 months or more and risk for obesity in a cohort of children of recently immigrated relatively unacculturated Latina mothers. Maternal characteristics at birth, including length of stay in the United States, breastfeeding habits at 4-6 weeks of age, 6 months, and 1 year, and anthropometric measurements were obtained for a cohort of 196 children participating in a prospective study. At 1 year of age 39.0% of infants were being breastfed. Being breastfed at 1 year of age was associated with a decreased risk of obesity in both univariate (odds ratio (OR) 0.49, 95% confidence interval (CI) 0.21-0.83) and multivariate models (OR 0.39, 95% CI 0.02-0.93) adjusting for maternal BMI, marital status, education level, country of origin, age, years of living in the United States, and child's birth weight at 3 years of age, regardless of mother's acculturation status using length of stay in the United States as a proxy for acculturation. The association with breastfeeding persisted at 4 years of age as a protective factor for obesity (OR 0.29, 95% CI 0.11-0.80). Breastfeeding for longer than 12 months provides a significant protective effect on the development of obesity in early childhood in a cohort of children of high-risk recently immigrated Latina women in San Francisco who were relatively unacculturated to the United States.

The imperative to prevent and treat childhood obesity: why the world cannot afford to wait

In the past 20 years, the prevalence of obesity in the United States increased almost 50% among adults and by 300% in children. Today, 9.7% of all U.S. infants up to 2 years old have abnormally high weight-for-recumbent length; 25% of children under age 5 are either overweight or obese; and 17% of adolescents are obese. Ethnic disparities in the rates of obesity are also large and apparent in childhood. Further, 44% of obese adolescents have metabolic syndrome. Obese children tend to become obese adults; thus, in a decade, young adults will likely have much higher risks of chronic disease, which has tremendous implications for the healthcare system. However, early childhood may be the best time to prevent obesity. Teachers' healthy eating choices are positively associated with changes in body mass index percentiles for children, for example. In addition, 8 million children attend afterschool programs, which can successfully promote health and wellness and successfully treat obesity. This childhood epidemic of obesity and its health-related consequences in adolescents should be a clinical and public health priority. However, this major public health problem cannot be managed solely in clinical settings. Rather, public health strategies must be integrated into home and family, school and community-based settings.