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Jia Y, Cheng S, Liu L, Cheng B, Liang C, Ye J, Chu X, Yao Y, Wen Y, Kafle OP, Zhang F. Association between birth by caesarian section and anxiety, self-harm: a gene-environment interaction study using UK Biobank data. BMC Psychiatry 2023; 23:237. [PMID: 37029353 PMCID: PMC10080817 DOI: 10.1186/s12888-023-04720-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 03/27/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Limited efforts have been paid to explore the underlying genetic mechanisms of birth by caesarian section (CS) affecting the risks of adult anxiety and self-harm. METHODS Using UK Biobank cohort, the logistic regression model was first applied to evaluate the associations of adult anxiety and self-harm with birth by CS. Using birth by CS as exposure variables, genome-wide by environment interaction study (GWEIS) was then applied by PLINK2.0 to identify associated genes interacting with birth by CS for anxiety and self-harm. RESULTS In the observational study, significant associations were observed between birth by CS and anxiety (odds ratio (OR) = 1.24; 95% confidence interval (CI), 1.12-1.38; P = 4.86 × 10- 5), and self-harm (OR = 1.12; 95% CI, 1.01-1.24; P = 2.90 × 10- 2). GWEIS revealed multiple suggestive genes interacted with birth by CS for anxiety, such as DKK2 (rs13137764, P = 1.24 × 10- 9, adjusted P = 2.68 × 10- 7) and ATXN1 (rs62389045, P = 4.38 × 10- 8, adjusted P = 3.55 × 10- 6). For self-harm, significant gene-environment interactions of birth by CS on self-harm were detected, such as ALDH1A2 (rs77828167, P = 1.62 × 10- 8; rs116899929, P = 1.92 × 10- 8) and DAB1 (rs116124269, P = 3.20 × 10- 8; rs191070006, P = 3.63 × 10- 8). CONCLUSIONS Our results suggested that birth by CS was associated with the risk of adult anxiety and self-harm. We also discovered some genes interacted with birth by CS might influence the risk of anxiety and self-harm, which may provide novel clues for the pathogenesis of those mental disorders.
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Affiliation(s)
- Yumeng Jia
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Shiqiang Cheng
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Li Liu
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Bolun Cheng
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Chujun Liang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Jing Ye
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Xiaomeng Chu
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yao Yao
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yan Wen
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Om Prakash Kafle
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Feng Zhang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China.
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Zhou Y, Li Q, Wang P, Li J, Zhao W, Zhang L, Wang H, Cheng Y, Shi H, Li J, Zhang Y. Associations of prenatal PFAS exposure and early childhood neurodevelopment: Evidence from the Shanghai Maternal-Child Pairs Cohort. ENVIRONMENT INTERNATIONAL 2023; 173:107850. [PMID: 36857906 DOI: 10.1016/j.envint.2023.107850] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 01/22/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Epidemiological data on the effects of perfluoroalkyl and polyfluoroalkyl substances (PFAS) on infant neurodevelopment trajectories are far from being sufficiently addressed. In this study, 1285 mother-child pairs were recruited during 2016-2017. A high-performance liquid chromatography-triple quadrupole mass spectrometer was used to measure 16 PFAS levels in cord serum. Ages and Stages Questionnaires were used to examine children's neurodevelopment at 2, 6, 12, and 24 months of age. Group-based trajectory models were applied to derive the neurodevelopmental trajectories. Children with relatively low scores from 2 to 24 months were classified into a low-score group and were used as a risk group in each domain. Multiple linear regression, logistic regression, and quantile-based g-computation were performed to assess associations of single or mixture PFAS exposures with neurodevelopment and trajectories. Perfluorooctane sulphonate (PFOS), perfluorooctanoic acid (PFOA), perfluorohexanesulfonic acid (PFHxS), and 6:2 chlorinated polyfluorooctane ether sulfonate (6:2Cl-PFESA) were detected in over 90 % samples. PFOA had the highest concentration (median: 4.61 μg/L). Each ln-unit (μg/L) increase of PFAS (e.g., PFOA, PFOS, PFHxS, 6:2Cl-PFESA) was associated with poor scores of communication domain at 6 months, with the effect size ranging from -0.69 to -0.44. PFOS (OR: 1.14, (1.03, 1.26), PFDA (OR:1.08, (1.02, 1.15)), PFHxS (OR:1.31, (1.12, 1.56)), and 6:2Cl-PFESA (OR:1.08, (1.00, 1.16)) were associated with an increased risk of being in the low-score group in the early childhood communication domain's trajectory. Each mixture quartile increment was associated with a 1.60 (-2.76, -0.45) decrease in communication domain scores of 6-month-old infants, and the mixture effect was mainly attributed to PFOS. Each mixture quartile increase was associated with a 1.23-fold (1.03, 1.46) risk of being in the low-score group of the communication domain, and the mixture effect was mainly attributed to PFOS. In conclusion, PFAS and their mixtures might adversely affect childhood neurodevelopment. The gender-specific associations existed in the above associations.
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Affiliation(s)
- Yuhan Zhou
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai 200032, China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Qiang Li
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai 200032, China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China; Putuo District Center for Disease Control & Prevention, Shanghai 200333, China
| | - Pengpeng Wang
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai 200032, China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Jinhong Li
- Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Wenxuan Zhao
- Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Liyi Zhang
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai 200032, China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Hang Wang
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai 200032, China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Yukai Cheng
- Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Huijing Shi
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
| | - Jiufeng Li
- Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Yunhui Zhang
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai 200032, China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China.
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Begum T, Anuradha S, Fatima Y, Mamun AA. Epidemiology of Caesarean section on maternal request in Australia: A population-based study. Midwifery 2023; 117:103578. [PMID: 36535176 DOI: 10.1016/j.midw.2022.103578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 09/08/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To explore the trends, determinants, and short-term maternal and neonatal health outcomes of Caesarean section on maternal request (CSMR). DESIGN Population-based record linkage study. SETTING Birth registry data for all births in Queensland, Australia, from 2008 to 2017. PARTICIPANTS Pregnancies resulting in live or intrapartum stillbirth with >=20 gestational weeks and/or >=400 gm birth weight were the study population. The analytic sample was restricted to low-risk pregnancies by excluding preterm, non-cephalic pregnancies with medical risk factors. MEASUREMENTS CSMR was defined as a first-time C-section in singleton, term pregnancies with an ICD-10-AM code of O-82/O-47. CSMR trend was reported in age-standardised rate using a join-point regression model. The determinants and perinatal outcomes of CSMR were tested against Spontaneous vaginal births (VBs) and planned VBs including assisted VBs and emergency C-sections in this group. The generalised estimating equation technique was used for regression analysis and reported in the odds ratio (OR) at a 95% Confidence Interval (CI). FINDINGS Of total C-sections (n = 204,863), the average annual change in CSMR rate was 4.4% (95% CI: 2.1-6.7%, p<0.01) for the total pregnancies (N=613,375) Of the analytic sample (N=365568), nulliparous women with age ≥35 years (OR: 2.32,95% CI: 2.09-2.57), delivered at private hospitals (OR:4.90; 95% CI: 4.65-5.18); with mood disorders (OR: 2.15; 95% CI: 1.88-2.43) were positive and midwives birth attendant (OR 0.28; 95% CI: 0.26 to 0.30) was negative influencing factors for CSMR. In a propensity score matched sample; CSMR observed an increasedrisk of anaesthetic complications (OR: 8.00; 95% CI:1.95-32.82) and slightly reduced odds of birth asphyxia (OR:0.20;95%CI:0.06-0.60)against planned VBs while the overall incidence of birth-asphyxia was low (1.29%) However, neonatal morbidities (OR:1.61; 95% CI:1-2.59) and special care admission (OR:2.15; 95% CI:1.03-4.5) were higher after CSMR in comparison to SVBs CONCLUSION: Despite being linked with adverse perinatal health outcomes, the incidence of CSMR increased 1.75-fold during the past 10 years. Maternal educational interventions to provide adequate information, including the long-term risks and benefits of C-sections, can help reduce the growing rates of CSMR.
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Affiliation(s)
- Tahmina Begum
- Institute for Social Science Research, The University of Queensland (UQ), Australia; ARC Centre of Excellence for Children and Families Over the Life Course Centre, UQ, Australia; Poche Centre for Indigenous Health, UQ, Australia; Health System and Population Studies Division, icddr,b, Bangladesh.
| | | | - Yaqoot Fatima
- Institute for Social Science Research, The University of Queensland (UQ), Australia; ARC Centre of Excellence for Children and Families Over the Life Course Centre, UQ, Australia; Murtupuni Centre for Rural and Remote Health, James Cook University, Mount Isa, Australia
| | - Abdullah Al Mamun
- Institute for Social Science Research, The University of Queensland (UQ), Australia; ARC Centre of Excellence for Children and Families Over the Life Course Centre, UQ, Australia; Metro South Public Health Unit, Queensland Health, Australia
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Huang Z, Fu W, Dou L, Bao H, Wu W, Su P, Huang K, Zhu P, Sheng J, Xu Y, Tao F, Hao J. Prenatal Bisphenol A Exposure and Early Childhood Behavior and Cognitive Function: A Chinese Birth Cohort Study. Neuroendocrinology 2022; 112:311-323. [PMID: 33910209 DOI: 10.1159/000516881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/28/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Biomonitoring of bisphenol A (BPA) in human blood is still scarce, although already noticeable. We aimed to examine the associations between prenatal serum BPA concentrations and behavior and cognitive function in preschool children. METHODS A total of 1,782 mother-child pairs with complete demographic information, blood samples, and psychological measurements were included from the China-Anhui Birth Cohort (C-ABCS). We detected serum BPA concentrations and assessed children's neurodevelopment using a set of psychometric scales. RESULTS The median prenatal maternal serum BPA concentration was 0.23 (P25, P75: 0.07, 0.52) ng/mL, with a detection frequency of 85.19%. Compared with the girls with the lowest concentrations, those with highest BPA concentrations had increased risks of inhibitory self-control impairment [relative risk (RR) = 3.66, 95% confidence interval (CI): 1.53, 7.58], emergent metacognition impairment (RR = 1.70, 95% CI: 1.07, 2.78), conduct problem (RR = 1.68, 95% CI: 1.12, 2.39), peer relationship problem (RR = 2.57, 95% CI: 1.33, 4.47), higher total difficulties score (RR = 1.76, 95% CI: 1.12, 2.67), and higher impact factor score (RR = 1.52, 95% CI: 1.11, 2.05), while the boys with the highest prenatal BPA concentrations had an increased risk of conduct problem compared with those with the lowest concentrations (RR = 1.59, 95% CI: 1.09, 2.24) (P-interaction = 0.011). After stratification by age, high prenatal BPA concentrations were associated with increased ADHD (RR = 4.44, 95% CI: 1.54, 10.85) among children aged 3 years, not among children aged 4 years. CONCLUSION Our study revealed the sex-specific and age-specific impacts of prenatal BPA exposure on preschool children's cognitive and behavioral development.
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Affiliation(s)
- Zhaohui Huang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics/Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
- Anhui Provincial Center for Women and Child Health, Hefei, China
| | - Weinan Fu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Lianjie Dou
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China
| | - Huihui Bao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics/Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Wanke Wu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics/Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Puyu Su
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics/Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Kun Huang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics/Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Peng Zhu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics/Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Jie Sheng
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics/Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Yuanyuan Xu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics/Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Fangbiao Tao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics/Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Jiahu Hao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics/Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
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Maher GM, Khashan AS, McCarthy FP. Obstetrical mode of delivery and behavioural outcomes in childhood and adolescence: findings from the Millennium Cohort Study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1697-1709. [PMID: 35032173 PMCID: PMC9288955 DOI: 10.1007/s00127-022-02233-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/06/2022] [Indexed: 12/20/2022]
Abstract
PURPOSE To examine the association between mode of delivery (in particular caesarean section) and behavioural outcomes in offspring at six time-points between age 3 and 17 years. METHODS Similar to previous work examining the association between mode of delivery and behavioural outcomes in offspring at age 7, we used maternal-reported data from the Millennium Cohort Study. Data on mode of delivery were collected when children were 9 months and categorised as spontaneous vaginal delivery, assisted vaginal delivery, induced vaginal delivery, emergency caesarean section, planned caesarean section and caesarean section after induction of labor. Data on behavioural outcomes were collected at ages 3, 5, 7, 11, 14 and 17 years using the Strengths and Difficulties Questionnaire (SDQ). Crude and adjusted logistic regression examined mode of delivery-behavioural difficulties relationship, using validated SDQ cut-off points (total SDQ ≥ 17, emotional ≥ 5, conduct ≥ 4, hyperactivity ≥ 7, peer problems ≥ 4 and prosocial behaviour ≤ 4). Multilevel models with linear splines examined the association between mode of delivery and repeated measures of SDQ. RESULTS There were 18,213 singleton mother-child pairs included at baseline, 13,600 at age 3; 13,831 at age 5; 12,687 at age 7; 11,055 at age 11; 10,745 at age 14 and 8839 at age 17. Adjusted logistic regression suggested few associations between mode of delivery and behavioural outcomes at ages 3, 5, 11, 14 and 17 years using validated SDQ cut-off points. After correction for multiple testing, only the protective association between planned caesarean section-Conduct difficulties at age 5 years (OR 0.63, 95% CI 0.46, 0.85) and positive association between caesarean section after induction-Emotional difficulties at age 11 years (OR 1.57, 95% CI 1.19, 2.07) remained statistically significant. Multilevel modelling suggested mean SDQ scores were similar in each mode of delivery group at each time point. CONCLUSIONS Results of this study indicate that mode of delivery is unlikely to have a major impact on behavioural outcomes.
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Affiliation(s)
- Gillian M Maher
- INFANT Research Centre, Cork, Ireland.
- School of Public Health, University College Cork, Cork, Ireland.
| | - Ali S Khashan
- INFANT Research Centre, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- INFANT Research Centre, Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
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de Dios-Aguado M, Agulló-Ortuño MT, Ugarte-Gurrutxaga MI, Yañez-Araque B, Molina-Gallego B, Gómez-Cantarino S. Nutritional Health Education in Pregnant Women in a Rural Health Centre: Results in Spanish and Foreign Women. Healthcare (Basel) 2021; 9:1293. [PMID: 34682974 PMCID: PMC8544496 DOI: 10.3390/healthcare9101293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 12/03/2022] Open
Abstract
The dietary behaviour of pregnant women, as well as the socio-cultural conditions in which pregnancy takes place, influence obstetric outcomes. To analyse the influence of socioeconomic factors and dietary habits on obstetric outcomes in Spanish and foreign pregnant women living in a rural environment, a population-based, prospective-observational study in a cohort of Spanish and foreign pregnant women in the town of Yepes, in the province of Toledo, Spain was conducted. Foreign pregnant women are ecodependent on their partners, have secondary education and low socioeconomic level. Spanish pregnant women have secondary education, a medium socio-economic level, live with their partners and are economically independent. Moreover, 85% of Spanish pregnant women gave birth at term and reached a gestational age of 40 ± 1.83 weeks. However, only 55% of foreign pregnant women reached a gestational age of 39.72 ± 2.28 weeks. Through health education, pregnant women in this geographical area of Castilla la Mancha, Spain, adopted bicultural dietary patterns, thus reaching the prescribed diet of 2000 Kcal. Through this diet, both Spanish and foreign pregnant women maintained albumin and plasma protein levels within the established range, with no significant differences in obstetric outcomes among pregnant women in the study.
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Affiliation(s)
- Mercedes de Dios-Aguado
- Primary Health Care No.1. Health Centre, Yepes, Castilla-La Mancha Public Health Service (SESCAM), 45005 Toledo, Spain;
- Research Group Nursing, Pain and Care (ENDOCU), UCLM, Av. Carlos III s/n, 45071 Toledo, Spain; (M.I.U.-G.); (B.M.-G.)
| | - María Teresa Agulló-Ortuño
- Faculty of Physiotherapy and Nursing of the Toledo Campus, University of Castilla-La Mancha (UCLM), 45071 Toledo, Spain;
| | - María Idoia Ugarte-Gurrutxaga
- Research Group Nursing, Pain and Care (ENDOCU), UCLM, Av. Carlos III s/n, 45071 Toledo, Spain; (M.I.U.-G.); (B.M.-G.)
- Faculty of Physiotherapy and Nursing of the Toledo Campus, University of Castilla-La Mancha (UCLM), 45071 Toledo, Spain;
| | - Benito Yañez-Araque
- Department of Physical Activity and Sports Sciences, Campus Toledo, University of Castilla-La Mancha, 45071 Toledo, Spain;
| | - Brígida Molina-Gallego
- Research Group Nursing, Pain and Care (ENDOCU), UCLM, Av. Carlos III s/n, 45071 Toledo, Spain; (M.I.U.-G.); (B.M.-G.)
- Faculty of Physiotherapy and Nursing of the Toledo Campus, University of Castilla-La Mancha (UCLM), 45071 Toledo, Spain;
| | - Sagrario Gómez-Cantarino
- Research Group Nursing, Pain and Care (ENDOCU), UCLM, Av. Carlos III s/n, 45071 Toledo, Spain; (M.I.U.-G.); (B.M.-G.)
- Faculty of Physiotherapy and Nursing of the Toledo Campus, University of Castilla-La Mancha (UCLM), 45071 Toledo, Spain;
- Health Sciences Research Unit: Nursing (UICISA: E), Coimbra School of Nursing (ESEnfC), 3004-011 Coimbra, Portugal
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Deng R, Tang X, Liu J, Gao Y, Zhong X. Cesarean delivery on maternal request and its influencing factors in Chongqing, China. BMC Pregnancy Childbirth 2021; 21:384. [PMID: 34011289 PMCID: PMC8132350 DOI: 10.1186/s12884-021-03866-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 05/10/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A high rate of cesarean delivery has become a cause of global concern. Although the rate of cesarean delivery has declined over recent years, it remains at a high level largely because of cesarean delivery on maternal request (CDMR). Unnecessary cesarean delivery has limited significance in benefiting maternal and infant physical health; in some ways, it might pose potential risks instead. With the implementation of the "Two-child Policy" in China, an increasing number of women plan to have a second child. Accordingly, how to handle the CDMR rate in China remains an important issue. METHODS Data were collected from a longitudinal follow-up study conducted in Chongqing, China, from 2018 to 2019. A structured questionnaire was administered to subjects for data collection. Basic information, including demographic characteristics, living habits, medical history, and follow-up data of pregnant women, as well as their families and society, was collected. Additionally, delivery outcomes were recorded. Logistic regression was performed to analyze the factors influencing CDMR. RESULTS The rate of cesarean delivery in Chongqing, China was 36.01 %, and the CDMR rate was 8.42 %. Maternal request (23.38 %), fetal distress (22.73 %), and pregnancy complications (9.96 %) were the top three indications for cesarean delivery. Logistic regression analysis showed that older age (OR = 4.292, 95 % CI: 1.984-9.283) and being a primiparous woman (OR = 6.792, 95 % CI: 3.230-14.281) were risk factors for CDMR. In addition, CDMR was also associated with factors such as the tendency to choose cesarean delivery during late pregnancy (OR = 5.525, 95 % CI: 2.116-14.431), frequent contact with mothers who had undergone vaginal deliveries (OR = 0.547, 95 % CI: 0.311-0.961), and the recommendation of cesarean delivery by doctors (OR = 4.071, 95 % CI: 1.007-16.455). CONCLUSIONS "Maternal request" has become the primary indication for cesarean delivery. The occurrence of CDMR is related to both the personal factors of women during pregnancy and others. Medical institutions and obstetricians should continue popularizing delivery knowledge among pregnant women, enhancing their own professional knowledge about delivery, adhering to the standard indications for cesarean delivery, and providing pregnant women with adequate opportunities for attempting vaginal delivery.
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Affiliation(s)
- Ruibin Deng
- School of Public Health and Management, Chongqing Medical University, #1 Yixue Rd, 400016 Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Innovation Center for Social Risk Governance in Health, Chongqing Medical University, 400016 Chongqing, China
| | - Xian Tang
- School of Public Health and Management, Chongqing Medical University, #1 Yixue Rd, 400016 Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Innovation Center for Social Risk Governance in Health, Chongqing Medical University, 400016 Chongqing, China
| | - Jiaxiu Liu
- School of Public Health and Management, Chongqing Medical University, #1 Yixue Rd, 400016 Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Innovation Center for Social Risk Governance in Health, Chongqing Medical University, 400016 Chongqing, China
| | - Yuwen Gao
- School of Public Health and Management, Chongqing Medical University, #1 Yixue Rd, 400016 Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Innovation Center for Social Risk Governance in Health, Chongqing Medical University, 400016 Chongqing, China
| | - Xiaoni Zhong
- School of Public Health and Management, Chongqing Medical University, #1 Yixue Rd, 400016 Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Innovation Center for Social Risk Governance in Health, Chongqing Medical University, 400016 Chongqing, China
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Chen Q, Ming Y, Gan Y, Huang L, Zhao Y, Wang X, Liu Y, Zhang J. The impact of cesarean delivery on infant DNA methylation. BMC Pregnancy Childbirth 2021; 21:265. [PMID: 33785011 PMCID: PMC8011183 DOI: 10.1186/s12884-021-03748-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mounting evidence suggests that cesarean delivery may have a long-lasting effect on infant health. But the underlying mechanisms remain unclear. This study aims to examine whether cesarean delivery on maternal request without any medical indications (CDMR) impacts DNA methylation status in the umbilical cord blood of the infant. METHODS A cross-sectional study was conducted in Shanghai, China. A total of 70 CDMR and 70 vaginal deliveries (VD) were recruited in 2012. The cord blood DNA methylation status was measured in 30 CDMR and 30 VD newborns using Illumina Infinium Human Methylation 450 K BeadChip. To validate the results, the cord blood DNA methylation status was measured in another 40 CDMR and 40 VD newborns using targeted bisulfite sequencing assay. A total of 497 CpG sites from 40 genes were included in the analysis. RESULTS A total of 165 differentially methylated positions (DMPs) exhibited differences in DNA methylation by 10% or more between the CDMR and VD groups, many of which were related to the development of the immune system. Based on the targeted bisulfite sequencing assay, 16 genes (16/22, 72.7%) had higher methylation level in the CDMR group than the VD group. Among them, 5 genes were related to the immune system. After considering the estimation of cell type proportions, there was few significant differences in DNA methylation between CDMR and VD groups. CONCLUSIONS The DMPs identified between CDMR and VD groups might be largely explained by the cell type proportions. Further studies are needed to examine DNA methylation in each cell type separately.
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Affiliation(s)
- Qian Chen
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Yanhong Ming
- Department of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, 200011, China
| | - Yuexin Gan
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Lisu Huang
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Yanjun Zhao
- Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, China
| | - Xia Wang
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Yongjie Liu
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
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Takács L, Putnam SP, Monk C, Dahlen HG, Thornton C, Bartoš F, Topalidou A, Peters LL. Associations Between Mode of Birth and Neuropsychological Development in Children Aged 4 Years: Results from a Birth Cohort Study. Child Psychiatry Hum Dev 2021; 52:1094-1105. [PMID: 33128716 PMCID: PMC8528797 DOI: 10.1007/s10578-020-01084-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/19/2020] [Accepted: 10/13/2020] [Indexed: 01/18/2023]
Abstract
The aim of this prospective longitudinal study was to examine the association between Cesarean section (CS) and child development and behavior. The sample consisted of 256 children who were born at term without serious perinatal pathologies. Their development and behavior was assessed at the age of four using Ages and Stages Questionnaire (ASQ-3), Children's Behavior Questionnaire and Strength and Difficulties Questionnaire. Multivariate linear regression analyses were conducted to assess the association between CS and child outcomes. CS was associated with better scores in the Problem Solving domain of the ASQ in the whole sample. After stratifying by child sex, the positive association between CS and the Problem Solving domain was significant in boys, while no association was found in girls. Girls were rated less optimally in the Gross Motor domain of the ASQ when born via CS. Mode of birth was not associated with behavioral outcomes.
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Affiliation(s)
- Lea Takács
- Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic. .,Department of Obstetrics & Gynecology, Columbia University, New York, NY, USA.
| | - Samuel P. Putnam
- grid.253245.70000 0004 1936 7654Department of Psychology, Bowdoin College, Brunswick, ME USA
| | - Catherine Monk
- grid.21729.3f0000000419368729Department of Obstetrics & Gynecology, and Psychiatry, Columbia University, New York, NY USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York, NY USA
| | - Hannah G. Dahlen
- grid.1029.a0000 0000 9939 5719School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - Charlene Thornton
- grid.1029.a0000 0000 9939 5719School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - František Bartoš
- grid.4491.80000 0004 1937 116XDepartment of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
| | - Anastasia Topalidou
- grid.7943.90000 0001 2167 3843Research in Childbirth and Health Unit, School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Lilian L. Peters
- grid.4830.f0000 0004 0407 1981Department of General Practice & Elderly Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands ,grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science AVAG, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.1029.a0000 0000 9939 5719School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
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Zhang S, Qin X, Li P, Huang K. Effect of Elective Cesarean Section on Children's Obesity From Birth to Adolescence: A Systematic Review and Meta-Analysis. Front Pediatr 2021; 9:793400. [PMID: 35155315 PMCID: PMC8829565 DOI: 10.3389/fped.2021.793400] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/13/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Elective cesarean section (ECS) is the most common reason for the increasing cesarean section rate worldwide, and it is reported to be related to adverse short-term and long-term outcomes in both mothers and infants. Findings on the association between ECS and overweight and obesity in children are controversial in recent studies. Therefore, we conducted a systematic review and meta-analysis to examine the effect of ECS on offspring's overweight and obesity. METHODS PubMed, Science Direct, Web of Science, CNKI (China National Knowledge Infrastructure), Wanfang Database (in Chinese), and China Biology Medicine disc databases were searched using different combinations of three groups of keywords: "elective cesarean section," "overweight/obesity," and "children." Nine cohort studies and 11 independent risk estimates were finally identified. RESULTS We have observed significant association between ECS and children's obesity, the total pooled risk ratio (RR) being 1.10 (95% CI: 1.01-1.18; I 2 = 32.4%). In subgroup analysis, ECS was found to be associated with the occurrence of obesity in preschoolers (RR = 1.12, 95% CI: 1.02-1.22; I 2 = 16.8%). Furthermore, it revealed that ECS was related with the high risk of children's obesity where the rate of ECS exceeded 10%. No significant association was observed between ECS and children's overweight, and the RR was 1.12 (95% CI: 0.94-1.30; I 2 = 55.6%). CONCLUSIONS Overall, it indicated that children born via ECS had an increased risk of later-life obesity. Given the global increase in childhood obesity, our findings would provide evidence-based reference for early life intervention on children's obesity. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021267211, identifier: CRD42021267211.
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Affiliation(s)
- Shanshan Zhang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China.,National Health Commission (NHC) Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Xiaoyun Qin
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China.,National Health Commission (NHC) Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Peixuan Li
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China.,National Health Commission (NHC) Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Kun Huang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China.,National Health Commission (NHC) Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China.,Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Hefei, China
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Mu W, Huang YH, Chaumont A, Létourneau I, El-Chaar D, Xia T, Wu Wen S. Breast feeding after caesarean delivery on maternal request: protocol of a systematic review and meta-analysis. BMJ Open 2020; 10:e038309. [PMID: 32792447 PMCID: PMC7430420 DOI: 10.1136/bmjopen-2020-038309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/09/2020] [Accepted: 06/25/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Caesarean delivery under maternal request (CDMR) is a major factor contributing to the rising global rates of caesarean section (CS) procedure. The choice of CDMR without medical indications could provide a sense of assured safety by avoiding the experiences and complications of vaginal birth, and the risks related to an emergency CS. However, it might adversely influence women's breast feeding patterns and produce a long-lasting impact on maternal and neonatal health. This study aims to systematically review the current evidence relating to the effects of intentions of performing CDMR on breast feeding. METHODS AND ANALYSIS A comprehensive literature search will be performed in three English-language electronic databases, major clinical study registries and other sources for original studies reporting the breast feeding outcomes after a planned CDMR or vaginal delivery. The three databases Medline, Embase and the Cochrane Central Register of Controlled Trials will be searched via Ovid from inception to February 2020. Randomised controlled trials (RCTs), pseudo-RCTs, cohort studies and case-control studies on this topic will be included. Participants in the experimental or case group should meet the Robson criteria of classes 2B or 4B and have experienced planned CS undertaken for no maternal or foetal indication, whereas participants in the control group have undergone scheduled vaginal delivery. All kinds of breast feeding outcomes will be included. Meta-analyses will be attempted to provide an estimate of the pooled effect and will be stratified by different study designs. A qualitative description will be provided if quantitative synthesis proves to be fruitless. ETHICS AND DISSEMINATION This study is a secondary literature review that does not need ethical approval. No primary data will be collected from the participants. Findings of this study will be presented at scientific conferences and be published in scientific journals. PROSPERO REGISTRATION NUMBER CRD42020160303.
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Affiliation(s)
- Wei Mu
- Department of Clinical Pharmacology, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Yu Hong Huang
- Department of Clinical Pharmacology, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Andréanne Chaumont
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Isabelle Létourneau
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Darine El-Chaar
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Obstetrics & Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Tian Xia
- Reproductive Center, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shi Wu Wen
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Obstetrics & Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
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Guo L, Wang T, Wang W, Fan B, Xie B, Zhang H, Liao Y, Lu C. Association between habitual weekday sleep duration and depressive symptoms among Chinese adolescents:The role of mode of birth delivery. J Affect Disord 2020; 265:583-589. [PMID: 31759667 DOI: 10.1016/j.jad.2019.11.095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/04/2019] [Accepted: 11/13/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Depressive symptoms among adolescents are common. This study aimed to assess, among Chinese adolescents, the associations of habitual weekday sleep duration with depressive symptoms and whether these associations varied with the mode of birth delivery. METHODS Data were from the 2015 School-based Chinese Adolescents Health Survey, and 150,053 students' questionnaires were qualified for analysis. Multi-level logistic regression models were performed. RESULTS A weekday sleep duration of ≤5 h/night was associated with depressive symptoms (adjusted odds ratio [aOR]=2.98, 95% CI=2.75-3.24), and adolescents who reported a weekday sleep duration of 5-7 h/night (aOR=1.69, 95% CI=1.60-1.79) and >9 h/night (aOR=1.28, 95% CI=1.11-1.45) were also at a higher risk of depressive symptoms. Stratification analyses showed that in both adolescents delivered by vaginal birth and cesarean section (CS), a weekday sleep duration of ≤5 h/night, 5-7 h/night, and >9 h/night were associated with the increased risk of depressive symptoms in the adjusted models, and the magnitudes of the aORs in adolescents delivered by CS were slightly higher than those in adolescents delivered by vaginal birth. LIMITATIONS The cross-sectional study design and self-reported sleep duration and depressive symptoms. CONCLUSION This study demonstrates a significant U-shaped association between weekday sleep duration and depressive symptoms among Chinese adolescents. In both adolescents delivered by vaginal birth and CS, those who reported having abnormal sleep duration were at a high risk of depressive symptoms. Based on the findings of this study, we suggest sleep duration and mode of delivery should be a matter of concern for public health authorities.
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Affiliation(s)
- Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, China
| | - Tian Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, China
| | - Beifang Fan
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Bo Xie
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Huimin Zhang
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Yuhua Liao
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, China.
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