Possible relation between maternal consumption of added sugar and sugar-sweetened beverages and birth weight--time trends in a population

Birthweight trends and their explanatory factors in Hungary between 1999 and 2018: an analysis of the Hungarian Tauffer registry

BACKGROUND

The increasing birthweight trend stopped and even reversed in several high income countries in the last 20 years, however the reason for these changes is not well characterized. We aimed to describe birthweight trends of term deliveries in Hungary between 1999 and 2018 and to investigate potential maternal and foetal variables that could drive these changes.

METHODS

We analysed data from the Hungarian Tauffer registry, a compulsory anonymized data collection of each delivery. We included all singleton term deliveries in 1999-2018 (n = 1,591,932). We modelled birthweight trends separately in 1999-2008 and 2008-2018 in hierarchical multiple linear regression models adjusted for calendar year, newborn sex, maternal age, gestational age at delivery, and other important determinants.

RESULTS

Median birthweights increased from 3250/3400 g (girl/boy) to 3300/3440 g from 1999 to 2008 and decreased to 3260/3400 g in 2018. When we adjusted for gestational age at delivery the increase in the first period became more pronounced (5.4 g/year). During the second period, similar adjustment substantially decreased the rate of decline from 2.5 to 1.4 g/year. Further adjustment for maternal age halved the rate of increase to 2.4 g/year in the first period. During the second period, adjustment for maternal age had little effect on the estimate.

CONCLUSIONS

Our findings of an increasing birthweight trend (mostly related to the aging of the mothers) in 1999-2008 may forecast an increased risk of cardiometabolic diseases in offsprings born in this period. In contrast, the decreasing birthweight trends after 2008 may reflect some beneficial effects on perinatal morbidity. However, the long-term effect cannot be predicted, as the trend is mostly explained by the shorter pregnancies.

An animal model of gestational obesity and prediabetes: HISS-dependent insulin resistance induced by a high-sucrose diet in Sprague Dawley rats

This study developed an animal model of gestational obesity and prediabetes in Sprague Dawley rats using 35% sucrose supplementation (SS). Postprandially, insulin stimulates glucose uptake and nutrient partitioning via insulin-dependent action as well as hepatic insulin sensitizing substance (HISS) - dependent action. HISS is glycogenic in heart, kidney, and skeletal muscle (contrasting insulin's lipogenic actions in liver and adipose tissue) and is responsible for the vasodilatory action of insulin. Postprandial insulin sensitivity was quantified using the rapid insulin sensitivity test (RIST). Animals at 15-day gestation and virgin animals received SS for 8 weeks (with a 2-week recovery), 10 weeks, or 22 weeks. SS in pregnant and virgin rats eliminated HISS-dependent glucose uptake, resulting in compensatory hyperinsulinemia and resultant hypertriglyceridemia and obesity. In groups with SS for 8 weeks followed by a 2-week recovery, there was spontaneous partial recovery of HISS-dependent glucose uptake in virgins and complete recovery in pregnancy. The 10-week SS resulted in complete absence of HISS-dependent glucose uptake and produced a model of gestational obesity and prediabetes. The 22-week SS did not produce hyperglycemia or worsen hyperinsulinemia but did increase hypertriglyceridemia above 10-week SS. This substantiates the use of 10-week SS as a model of gestational obesity and (or) prediabetes, allowing further studies into treatments of gestational obesity and insulin resistance.

Evaluation of incomplete maternal smoking data using machine learning algorithms: a study from the Medical Birth Registry of Norway

Background

The Medical Birth Registry of Norway (MBRN) provides national coverage of all births. While retrieval of most of the information in the birth records is mandatory, mothers may refrain to provide information on her smoking status. The proportion of women with unknown smoking status varied greatly over time, between hospitals, and by demographic groups. We investigated if incomplete data on smoking in the MBRN may have contributed to a biased smoking prevalence.

Methods

In a study population of all 904,982 viable and singleton births during 1999–2014, we investigated main predictor variables influencing the unknown smoking status of the mothers’ using linear multivariable regression. Thereafter, we applied machine learning to predict annual smoking prevalence (95% CI) in the same group of unknown smoking status, assuming missing-not-at-random.

Results

Overall, the proportion of women with unknown smoking status was 14.4%. Compared to the Nordic country region of origin, women from Europe outside the Nordic region had 15% (95% CI 12–17%) increased adjusted risk to have unknown smoking status. Correspondingly, the increased risks for women from Asia was 17% (95% CI 15–19%) and Africa 26% (95% CI 23–29%). The most important machine learning prediction variables regarding maternal smoking were education, ethnic background, marital status and birth weight. We estimated a change from the annual observed smoking prevalence among the women with known smoking status in the range of − 5.5 to 1.1% when combining observed and predicted smoking prevalence.

Conclusion

The predicted total smoking prevalence was only marginally modified compared to the observed prevalence in the group with known smoking status. This implies that MBRN-data may be trusted for health surveillance and research.

Supplementary Information

Supplementary information accompanies this paper at 10.1186/s12884-020-03384-y.

Diet quality among pregnant women in the Navajo Birth Cohort Study

Proper nutrition during pregnancy is vital to maternal health and fetal development and may be challenging for Navajo Nation residents because access to affordable and healthy foods is limited. It has been several decades since reported diet quality during pregnancy was examined on Navajo Nation. We present the first study to estimate iodine intake and use the Healthy Eating Index (HEI-2015) to assess maternal diet quality among pregnant women in the Navajo Birth Cohort Study (NBCS). Based on dietary intake data derived from food frequency questionnaires, overall estimated micronutrient intake has remained similar since the last assessment in 1981, with potential improvements evident for folate and niacin. A high proportion of women (>50%) had micronutrient intakes from dietary sources below the Estimated Average Requirements during pregnancy. The median urinary iodine concentration for NBCS women (90.8 μg/L; 95% CI [80, 103.5]) was less than adequate and lower than concentrations reported for pregnant women that participated in the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2014. Overall, average diet quality of NBCS women estimated using the HEI-2015 (62.4; 95% CI [60.7, 64.0]) was similar to that reported for women of child-bearing age and pregnant women in NHANES. Although, NBCS women had diets high in added sugar, with sugar-sweetened beverages as the primary contributors. Our study provides updated insights on maternal diet quality that can inform health and nutrition initiatives in Navajo communities emphasizing nutrition education and access to prenatal vitamins and calcium, iodine, and vitamin E dense foods.

Stumped by the Hump: The Curious Rise and Fall of Norwegian Birthweights, 1991-2007

BACKGROUND

There was a distinct rise in mean birthweights in Norway starting in 1991 that plateaued in 1996-2002 and then declined to previous levels. We investigated whether these changes corresponded to trends in neonatal mortality or other birthweight-associated pregnancy outcomes. We also explored known predictors of birthweight and examined whether these could explain the birthweight trends.

METHODS

We calculated mean birthweight for all live births in Norway in each year from 1982 to 2016, together with annual neonatal mortality and proportion of infants born preterm, or with low Apgar score. We stratified mean birthweight over time by factors including parity, gestational age, and Scandinavian versus non-Scandinavian origin of mother, to test robustness of the pattern. In addition, we used multivariable linear regression to obtain adjusted estimates for mean birthweight per year.

RESULTS

A 50-g rise and fall of mean birthweights during a 25-year period was not accompanied by corresponding changes in neonatal mortality, preterm births, or Apgar scores. The distinct hump pattern was restricted to term births and was not apparent among infants of mothers born outside Scandinavia. We saw a similar pattern for Sweden but not Finland. Known predictors of birthweight (such as parity, mode of onset of delivery, and marital status) did not explain the hump.

CONCLUSIONS

A distinct temporal hump in mean birthweight among Norwegian term births had no obvious explanations. Furthermore, these fluctuations in birthweight were not associated indirectly with adverse outcomes in measures of infant health.

Sex-related change in BMI of 15- to 16-year-old Norwegian girls in cross-sectional studies in 2002 and 2017

Background

The prevalence of overweight and obesity (OWOB) has stabilized in some countries, but a portion of children with high body mass index (BMI) may have become heavier. This study aimed to describe the distributions of BMI and the point prevalence of OWOB in Norwegian adolescents in 2002 and 2017.

Methods

A cross-sectional study involving 15- to 16-year-old adolescents in Oppland, Norway, was undertaken in 2002 and 2017. We calculated their BMI, BMI z-scores (BMIz), and the prevalence of OWOB.

Results

The mean BMI increased from 20.7 to 21.4 (p < 0.001) for girls but remained unchanged at 21.5 vs 21.4 (p = 0.80) for boys. The prevalence of OWOB increased from 9 to 14% among girls (difference 5, 95% CI: 2, 8) and from 17 to 20% among boys (difference 3, 95% CI: − 1, 6%). The BMI density plots revealed similar shapes at both time points for both sexes, but the distribution for girls shifted to the right from 2002 to 2017.

Conclusion

Contrary to previous knowledge, we found that the increase in OWOB presented a uniform shift in the entire BMI distribution for 15–16-year-old Norwegian girls and was not due to a larger shift in a specific subpopulation in the upper percentiles.

Is consumption of sugar-sweetened soft drinks during pregnancy associated with birth weight?

In Norway, there were parallel increases and subsequent decreases in birth weight (BW) and consumption of sugar‐sweetened carbonated soft drinks (SSC) during the period 1990–2010, and by an ecological approach, we have suggested that the relationship was causal. The objective of this study was to examine if such a relationship was present in a prospectively followed cohort of pregnant women. The study population included 62,494 term singleton mother–infant dyads in the Norwegian Mother and Child Cohort Study (MoBa), a national prospective cohort study in Norway from 1999 to 2008. The association between SSC consumption and BW was assessed using multiple regression analyses with adjustment for potential confounders. Each 100 ml intake of SSC was associated with a 7.8 g (95% confidence interval [CI]: −10.3 to −5.3) decrease in BW, a decreased risk of BW > 4,500 g (odds ratio [OR]: 0.94, 95% CI: 0.90 to 0.97) and a near significantly increased risk of BW < 2,500 g (OR: 1.05, 95% CI: 0.99 to 1.10). The negative association with SSC consumption was aggravated by smoking, lack of exercise, and obesity. For mothers with gestational diabetes mellitus, we observed an increased risk of BW > 4,500 g (OR: 1.18, 95% CI: 1.00 to 1.39) and a trend towards significant increase in mean BW (25.1 g, 95% CI: −2.0 to 52.2) per 100 ml SSC. Our findings suggest that increasing consumption of rapidly absorbed sugar from SSC had opposite associations with BW in normal pregnancies and pregnancies complicated by gestational diabetes mellitus.

Use of a web-based dietary assessment tool in early pregnancy

BACKGROUND

Maternal diet is critical to fetal development and lifelong health outcomes. In this context, dietary quality indices in pregnancy should be explicitly underpinned by data correlating food intake patterns with nutrient intakes known to be important for gestation.

AIMS

Our aim was to assess the correlation between dietary quality scores derived from a novel online dietary assessment tool (DAT) and nutrient intake data derived from the previously validated Willett Food Frequency Questionnaire (WFFQ).

METHODS

524 women completed the validated semi-quantitive WFFQ and online DAT questionnaire in their first trimester. Spearman correlation and Kruskal-Wallis tests were used to test associations between energy-adjusted and energy-unadjusted nutrient intakes derived from the WFFQ, and diet and nutrition scores obtained from the DAT.

RESULTS

Positive correlations were observed between respondents' diet and nutrition scores derived from the online DAT, and their folate, vitamin B12, iron, calcium, zinc and iodine intakes/MJ of energy consumed derived from the WFFQ (all P < 0.001). Negative correlations were observed between participants' diet and nutrition scores and their total energy intake (P = 0.02), and their percentage energy from fat, saturated fat, and non-milk extrinsic sugars (NMES) (all P ≤ 0.001). Median dietary fibre, beta carotene, folate, vitamin C and vitamin D intakes derived from the WFFQ, generally increased across quartiles of diet and nutrition score (all P < 0.001).

CONCLUSIONS

Scores generated by this web-based DAT correlate with important nutrient intakes in pregnancy, supporting its use in estimating overall dietary quality among obstetric populations.

Ptyalism in pregnancy - a review of epidemiology and practices

Ptyalism gravidarum is an oral pathological condition specific to gravidity. We present a review of the literature regarding epidemiology internationally, and then highlight therapies reported by patients and caregivers. This often distressing repeated filling of the mouth with watery saliva in a pregnant patient was previously exclusively associated with hyperemesis gravidarum, and the consequent maternal-fetal risk. Our dissertation includes reference to a rare case of isolated sialorrhoea of pregnancy, without nausea or emesis. Both pharmacological and homoeopathic therapies are discussed, and inherent risks to mother and infant are highlighted. It is strongly recommended that this condition be given attention in antenatal care settings, to optimize short, middle and long term pregnancy outcomes.

Serum MicroRNAs as Diagnostic Biomarkers for Macrosomia

BACKGROUND

Macrosomia is defined as an infant's birth weight of more than 4000 g. Although microRNAs (miRNAs) have been implicated in the pathogenesis of various diseases, the associations between serum miRNAs and macrosomia have been rarely reported.

METHODOLOGY

We used the Taqman Low Density Array followed by quantitative reverse transcriptase polymerase chain reaction assays to screen for miRNAs associated with macrosomia using serum samples collected 1 week before delivery.

RESULTS

Profiling results showed that 1 miRNA was significantly upregulated and 10 miRNAs were significantly downregulated in serum samples of macrosomia (ΔΔCt > 3-fold). The expression levels of miR-21 were significantly decreased in macrosomia as compared to the controls in the third trimester. Receiver operating characteristic (ROC) curve analyses showed that the area under the ROC curve for miR-21 was 67.7% (sensitivity = 66.7% and specificity = 70.0%).

CONCLUSIONS

miR-21 in maternal serum is differentially expressed between macrosomia and controls, and miR-21 could be used as a candidate biomarker to predict macrosomia.

Body size at birth and psychiatric disorders among adolescents: a clinical study of 310 under-age inpatient adolescents in Northern Finland

BACKGROUND

Deviant birth measure is a risk factor for later somatic illness but also for later psychiatric disorders of the offspring. Only a few studies have examined the association of birth measures to later psychiatric disorders among adolescents. Studies on sex differences in these associations are scarce as well.

METHODS

The cases consisted of 508 adolescents (208 boys and 300 girls) aged 12-17 years, who were admitted to inpatient psychiatric hospitalization between 2001 and 2006. In addition, 478 healthy controls were derived from the Northern Finnish Birth Cohort 1986, born in approximately the same period and same area as the cases. Data of birth measures were collected from the National Birth Register for cases and from antenatal clinics for controls. Both cases and controls were interviewed using the Schedule for Affective Disorder and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL) to assess psychiatric disorders.

RESULTS

The adolescent patients were statistically significantly shorter and had higher ponderal index at birth compared to healthy controls. In addition, the age of the mothers at adolescent's birth was significantly younger in the patients than the controls. After controlling for various covariates, a 2.4-fold increased likelihood for internalizing disorders was seen among male adolescents with high ponderal index.

CONCLUSIONS

The association of birth measures to psychiatric disorders was confirmed in our study, particularly among male adolescents suffering from internalizing disorders. Further studies in larger adolescent samples are needed to confirm our findings and clear up the association of high ponderal index to specific psychiatric disorders.

2-Hour postload serum glucose levels and maternal blood pressure as independent predictors of birth weight in "appropriate for gestational age" neonates in healthy nondiabetic pregnancies

INTRODUCTION

Increased neonatal birth weight (NBW), often associated with diabetic pregnancies, is a recognized indicator of childhood obesity and future metabolic risk. Predictors of NBW in healthy non-diabetic pregnancies are not yet established. Here, we investigated the association of maternal parameters of healthy non-diabetic mothers with NBW of their "appropriate-for-gestational age" neonates.

METHODS

The study involved 36 healthy mother/infant pairs. Examined parameters included NBW, maternal age, first and last trimester (BMI), weight gain, fasting serum lipids and glucose, 2-hour postload glucose levels and blood pressure.

RESULTS

Postload-glucose levels were significantly higher in mothers of heavier neonates. ANOVA results indicated that 15% increase in postload-glucose levels corresponded to more than 0.5 Kg increase in NBW in the third tertile. NBW correlated positively with postload glucose levels, and negatively with systolic blood pressure. Regression analysis showed that the main predictors of NBW were postload-glucose levels (B = 0.455, P = 0.003), followed by systolic blood pressure (B = -0.447, P = 0.004), together predicting 31.7% NBW variation.

CONCLUSION

This study highlights that increased maternal postload sugar levels and blood pressure, within the normal range, highly predicts NBW of healthy mothers. These findings may provide focus for early dietary intervention measures to avoid future risks to the mother and baby.