Maternal Blood Pressure Rise During Pregnancy and Offspring Obesity Risk at 4 to 7 Years Old: The Jiaxing Birth Cohort

Associations of prenatal blood pressure trajectory and variability with child neurodevelopment at 2 years old

BACKGROUND

The patterns of blood pressure (BP) change throughout the pregnancy were related to adverse birth outcomes. However, little is known about the long-term effect of BP change patterns on child neurodevelopment. This study aimed to explore the relationship between the BP trajectory and BP variability during pregnancy and early childhood neurodevelopment.

METHOD

A total of 2797 mother-newborn pairs were derived from the Wuhan Healthy Baby Cohort Study. BP was measured during each antenatal visit, and Mental and Psychomotor Development Indexes (MDI and PDI) were assessed using the Bayley Scales of Infant Development (BSID) when the children were 2 years old. Delayed neurodevelopment was defined as scores of PDI or MDI less than - 1SD relative to the mean score of the study population. A group-based multi-trajectory model was adopted to identify multi-trajectories of systolic blood pressure (SBP) and diastolic blood pressure (DBP). Visit-to-visit BP variability was assessed by the coefficient of variation (CV), standard deviation (SD), and average real variability (ARV). Generalized linear models and multivariate logistic regressions were used to assess the associations of BP trajectories and variability with BSID scores and delayed neurodevelopment, respectively.

RESULTS

Five distinct trajectories for SBP and DBP were identified, namely, "Low-increasing," "Low-stable," "Moderate-decreasing," "Moderate-increasing," and "High-stable" groups. Compared with the "Low-stable" group, the children whose mothers' BP fell into the other four groups had lower PDI scores, and mothers in the "Low-increasing," "Moderate-increasing," and "Moderate-decreasing" groups had 43% (OR: 1.43, 95% CI: 1.01, 2.03), 48% (OR: 1.48, 95% CI: 1.05, 2.08) and 45% (OR:1.45, 95% CI: 1.03, 2.04) higher risk of having offspring with delayed psychomotor neurodevelopment, respectively. High DBP variability was associated with lower BSID scores, and delayed psychomotor neurodevelopment (OR = 1.46, 95% CI: 1.10, 1.92 for DBP-SD; OR = 1.53, 95% CI: 1.16, 2.02 for DBP-CV).

CONCLUSION

Our findings suggest that BP change patterns assessed by multi-trajectory and visit-to-visit variability were associated with lower BSID scores and delayed neurodevelopment. Health professionals should be aware of the influence of BP level and its oscillations during pregnancy on the risk of delayed neurodevelopment.

Association between maternal hypertension and infant neurodevelopment in extremely preterm infants

OBJECTIVE

To examine the association between maternal hypertension during pregnancy and neurodevelopmental impairment (NDI) at 24 months post-menstrual age in extremely preterm infants.

STUDY DESIGN

Using data from two tertiary neonatal units (2011-2017) for infants born at 23 + 0 to 28 + 6 weeks, we investigated outcomes of NDI related to maternal hypertension and small-for-gestational-age (SGA) status.

RESULTS

Of 1019 pre-term infants, 647 had complete data and were included in the analysis. Ninety-six (15%) had maternal hypertension exposure; 25 (4%) were also SGA. Infants with maternal hypertension showed a higher odds of any NDI (aOR: 2.29, 95% CI = 1.36-3.87) and significant NDI (aOR: 2.01, 95% CI = 1.02-3.95). The combination of hypertension and SGA further elevated this risk (aOR for any NDI: 4.88, 95% CI = 1.80-13.22; significant NDI: 6.91, 95% CI = 2.50-19.12).

CONCLUSION

Maternal hypertension during pregnancy elevates the risk of NDI in extremely preterm infants, more so when combined with SGA.

The risk prediction of intergenerational transmission of overweight and obesity between mothers and infants during pregnancy

BACKGROUND

Overweight and obesity in mothers before pregnancy lead to overweight and obesity in their offspring, which is the main form of intergenerational transmission of overweight and obesity in early life. Many factors, especially non-genetic factors, may influence intergenerational transmission, but little prediction research has been conducted. Therefore, we analyzed the status of intergenerational transmission in maternal and infant overweight and obesity. Second, we explored the factors during the pregnancy that might affect the the intergenerational transmission; According to the two application scenarios of pregnancy screen and self-management, risk prediction models for pregnant women were carried out.

METHODS

Based on a prospective birth cohort, a total of 908 mothers and offspring were followed up during early life. Follow-up visits were performed at the first trimester, second trimester, third trimester, delivery, 42 days after delivery, and 6 months and 12 months of age. The investigation methods included questionnaire survey, physical examination, biological sample collection and clinical data collection. In terms of risk prediction, univariate analysis was used to screen candidate predictors. Second, multivariable Cox proportional hazard regression models were used to determine the final selected predictors. Third, the corresponding histogram models were drawn, and then the 10-fold cross-validation methods were used for internal verification.

RESULTS

Regarding intergenerational transmission of overweight and obesity between mothers and infants during pregnancy, the risk prediction model for pregnancy screen was constructed. The model established: h(t|X) = h0(t)exp.(- 0.95 × (Bachelor Degree or above) + 0.75 × (Fasting blood glucose in the second trimester) + 0.89 × (Blood pressure in the third trimester) + 0.80 × (Cholesterol in third trimester) + 0.55 × (Abdominal circumference in third trimester))., with good discrimination (AUC = 0.82) and calibration (Hosmer-Lemeshow2 = 4.17). The risk prediction model for self-management was constructed. The model established: h(t|X) = h0(t)exp. (0.98 × (Sedentary >18METs) + 0.88 × (Sleep index≥8) + 0.81 × (Unhealthy eating patterns Q3/Q4) + 0.90 × (Unhealthy eating patterns Q4/Q4) + 0.85 × (Depression)), with good discrimination (AUC = 0.75) and calibration (Hosmer-Lemeshow2 = 3.81).

CONCLUSIONS

The risk predictions of intergenerational transmission of overweight and obesity between mothers and infants were performed for two populations and two application scenarios (pregnancy screening and home self-management). Further research needs to focus on infants and long-term risk prediction models.

Study protocol for the sheMATTERS study (iMproving cArdiovascular healTh in new moThERS): a randomized behavioral trial assessing the effect of a self-efficacy enhancing breastfeeding intervention on postpartum blood pressure and breastfeeding continuation in women with hypertensive disorders of pregnancy

BACKGROUND

Individuals with hypertensive disorders of pregnancy (HDP) have an elevated lifetime risk of chronic hypertension, metabolic syndrome, and premature cardiovascular disease. Because breastfeeding duration and exclusivity have been associated in observational studies with improved cardiovascular health, optimizing breastfeeding in those with HDP might be an unrealized cardio-prevention approach, in particular because individuals with HDP have more breastfeeding challenges. Breastfeeding supportive interventions targeting one's breastfeeding self-efficacy have been shown to improve breastfeeding rates.

METHODS

We designed an open-label, multi-center 1:1 randomized behavioral trial to test whether a previously validated self-efficacy enhancing breastfeeding intervention can improve breastfeeding duration and/or exclusivity, and lower postpartum blood pressure at 12 months. Randomization is computer-generated and stratified by site (four hospitals in Montreal, Quebec and one hospital in Kingston, Ontario; all in Canada). Included are breastfeeding participants with HDP (chronic/gestational hypertension or preeclampsia) who delivered a live singleton infant at > 34 weeks, speak English or French, and have no contraindications to breastfeeding. Informed and written consent is obtained at hospitalization for delivery or a re-admission with hypertension within 1 week of discharge. Participants assigned to the intervention group receive a breastfeeding self-efficacy-based intervention delivered by a trained lactation consultant in hospital, with continued reactive/proactive support by phone or text message for up to 6 months postpartum. Regardless of group assignment, participants are followed for self-reported outcomes, automated office blood pressure, and home blood pressure at several time points with end of follow-up at 12 months.

DISCUSSION

This study will assess whether an intensive nurse-led behavioral intervention can improve breastfeeding rates and, in turn, postpartum blood pressure - an early marker for atherosclerotic cardiovascular disease. If effective, this form of enhanced breastfeeding support, along with closer BP and metabolic surveillance, can be implemented broadly in individuals lactating after HDP.

TRIAL REGISTRATION

ClinicalTrials.gov, # NCT04580927 , registered on Oct 9, 2020.

Associations of maternal gestational hypertension with high blood pressure and overweight/obesity in their adolescent offspring: a retrospective cohort study

Maternal hypertensive disorders during pregnancy may have an impact on fetal development and the health of the offspring in later life. The aim of the study was to evaluate the associations of maternal gestational hypertension (GH) with high blood pressure (HBP) (prehypertension/hypertension) and overweight/obesity in their adolescent offspring at the age of 12 to 15 years. We analyzed data of 4819 participants born in Kaunas city during 1995-1998 who were included in the study "Prevalence and Risk Factors of HBP in 12-15-Year-Old Lithuanian Children and Adolescents". The diagnosis of maternal gestational hypertension was obtained from medical records. Associations of maternal GH with their offspring's HBP and overweight/obesity in adolescence were assessed by multivariate logistic regression analysis. Among 4819 adolescents of 12-15 years of age, 25.7% had HBP, 12% had overweight, and 2.5% had obesity. Of 4819 mothers, 92.3% were normotensive during pregnancy, and 7.7% had GH. In the multivariate analysis after adjustment for age, sex, birth weight, adolescent BMI, and maternal pre/early pregnancy BMI, adolescent offspring born to mothers with GH had higher odds of prehypertension, hypertension, and prehypertension/hypertension (aOR 1.58; 95% CI 1.13-2.22; aOR 1.87; 95% CI 1.41-2.47; and aOR 1.76, 95% CI 1.39-2.24; respectively), compared to the offspring of normotensive mothers. After adjustment for age, sex, birth weight, and maternal pre/early pregnancy BMI, a significant association was found between maternal GH and the offspring's overweight/obesity in adolescence (aOR 1.41; 95% CI 1.04-1.91). The findings of this study suggest that maternal GH is associated with an increased odds of HBP (prehypertension and hypertension, both separately and combined) and overweight/obesity in their offspring during adolescence.

Hypertensive disorders in pregnancy and risk of asthma in offspring: a systematic review and meta-analysis

OBJECTIVES

The association between hypertensive disorders in pregnancy (HDP) and an increased risk of asthma in offspring remains controversial. No systematic review of this topic has been performed. The aim of this systematic review was to summarise the available evidence regarding the association between HDP and the risk of asthma in offspring.

DESIGN

Systematic review and meta-analysis.

METHODS

On the basis of a prepared protocol, a systematic search of PubMed, EMBASE, the Cochrane Library and Web of Science was performed using a detailed search strategy from the database inception to 17 January 2020. Cohort, case-control and cross-sectional studies published in English reporting the diagnoses of maternal HDP and asthma in offspring were included. The Meta-analysis of Observational Studies in Epidemiology guidelines were followed throughout the study. The estimated pooled ORs of HDP and asthma in offspring were calculated from the studies, and the meta-analysis was performed using random-effects models.

RESULTS

Ten cohort studies involving a total of 6 270 430 participants were included. According to the Newcastle-Ottawa Scale, the overall methodological quality was good since 8 studies were of high quality and 2 studies were of moderate quality. After controlling for potential confounders, HDP was associated with a possible increased risk of asthma in offspring, with a pooled adjusted OR (aOR) of 1.19 (95% CI 1.12 to 1.26). The subgroup analyses according to HDP subgroups, sibling design, study quality, study location, offspring ages, singleton status, exposure assessment, outcome assessment and adjusted factors showed similar results.

CONCLUSIONS

Exposure to HDP may be associated with an increased risk of asthma in offspring. Further research is needed to verify the results and determine whether the observed relationship is causal.

PROSPERO REGISTRATION NUMBER

CRD42020148250.

Exposure to heavy metals and trace minerals in first trimester and maternal blood pressure change over gestation

BACKGROUND

While several heavy metals and trace minerals have been linked with hypertensive disorders during pregnancy (HDP) in women, no studies have estimated the relationship of exposure to these chemicals, both independently and as a mixture, with systolic blood pressure (SBP) or diastolic blood pressure (DBP) over gestation.

OBJECTIVES

We examined individual and joint effects of 1^st trimester chemicals with SBP and DBP over gestation, and whether those chemicals were associated with HDP.

METHODS

We used data from 1832 non-obese pregnant women with low-risk antenatal profiles from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies - Singleton cohort (2009-2013). In plasma collected from women at 8-13 weeks' gestation (baseline enrollment), we measured heavy metals, barium (Ba), cesium (Cs), antimony (Sb), as well as trace minerals, cobalt (Co), copper (Cu), molybdenum (Mo), selenium (Se), and zinc (Zn). We obtained BP at baseline and throughout gestation until delivery and diagnosis of HDP from medical records. We used Bayesian Kernel Machine Regression (BKMR) as well as traditional linear and logistic regressions to examine the cross-sectional associations of chemicals with baseline BP and HDP. We used linear mixed effect regression to examine longitudinal associations between chemicals and rate of weekly change in BP in each trimester. We adjusted for sociodemographic and lifestyle factors and pre-pregnancy body mass index in all models.

RESULTS

BKMR revealed that comparing the entire chemical mixture at the 90^th percentile vs. the 50^th percentile was associated with a 1.61 mmHg (95% CI: 0.41, 2.81) higher SBP and a 1.09 mmHg (0.10, 2.09) higher DBP. No interactions were observed between chemicals. Accounting for chemical co-exposure in BKMR, each interquartile range (IQR) increment in Cu was associated with a 0.67 mmHg (0.02, 1.32) higher SBP and a 0.60 mmHg (0.08, 1.12) higher DBP at baseline; each IQR increment in Se was associated with a 0.67 mmHg (0.05, 1.29) higher SBP but not DBP. In longitudinal analyses, women with higher (i.e., above median concentration) baseline Cu had a 0.09 mmHg (0.01, 0.17) and 0.06 mmHg (0.001, 0.12) larger weekly decrease in SBP and DBP in 2^nd trimester, respectively. Women with higher baseline Ba had a 0.12 mmHg (0.04, 0.20) larger weekly increase in SBP in 2^nd trimester, while women with higher Cs had a 0.05 mmHg (0.01, 0.10) larger weekly increase in DBP in 3^rd trimester. None of the chemicals examined were significantly associated with HDP.

CONCLUSIONS

In this multi-ethnic cohort of women with low antenatal risk, plasma metals and trace minerals in early pregnancy, both individually and as a mixture, were statistically significantly associated with BP during gestation in small magnitude and in different directions, but not with HDP. The implications of these findings for women's postpartum BP and future cardiovascular health remains to be investigated.

Hypertensive Disorders of Pregnancy and Behavioural Outcomes in the Offspring: Findings from the Millennium Cohort Study

BACKGROUND

The aim of this study was to examine the association between hypertensive disorders of pregnancy (HDP) and behavioural outcomes in offspring at five time-points.

METHODS

We used maternal-reported data from the Millennium Cohort Study. Data on HDP were collected when children were 9-months. Data on behavioural outcomes were collected at age 3, 5, 7, 11 and 14years using the Strengths and Difficulties Questionnaire (SDQ). Multivariate logistic regression analysis examined a HDP-behavioural difficulties relationship, using validated SDQ cut-off points. Multilevel models with linear splines examined the association between HDP and repeated measures of SDQ.

RESULTS

18,274 singleton children were included in the study at baseline, Multivariate logistic regression suggested HDP was not significantly associated with SDQ domain cut-off points at ages 3, 7 and 11years. At age 5years, HDP was associated with a 40% increased odds of behavioural difficulties based on total SDQ(≥17) (OR:1.40, 95% CI:1.03,1.91). HDP was associated with a 43% increased odds of Peer Problem difficulties at age 5 (OR:1.43, 95% CI:1.10,1.86), and a 28% increased odds of Peer Problem difficulties(≥4) at age 14 (OR:1.28, 95% CI:1.02,1.61). In the linear spline model, mean SDQ score was higher at each time-point in those exposed to HDP, although did not always reach statistical significance.

LIMITATIONS

Data on different classifications of HDP were unavailable; therefore, we could not examine the effect of gestational hypertension and preeclampsia separately.

CONCLUSIONS

While we did not find strong evidence of associations between HDP and behavioural outcomes overall, some associations between HDP and behavioural difficulties did persist at age 5 and 14years.

Comparison between type A and type B early adiposity rebound in predicting overweight and obesity in children: a longitudinal study

Early adiposity rebound (EAR) predicts paediatric overweight/obesity, but current approaches do not consider both the starting point of EAR and the BMI trajectory. We compared the clinical characteristics at birth, age 3-5 and 6-8 years of children, according to the EAR and to its type (type A/type B-EAR). We assessed the children's odds of being classified as overweight/obese at age 6-8 years, according to the type of EAR as defined at age 3-5 years. As part of this two-wave observational study, 1055 children were recruited and examined at age 3-5 years. Antenatal and postnatal information was collected through interviews with parents, and weight and height from the health records. Type A and type B-EAR were defined in wave 1 according to the BMI nadir and the variation of BMI z-score between the starting point of the adiposity rebound and the last point on the curve. At 6-8 years (wave 2), 867 children were followed up; 426 (40·4 %) children demonstrated EAR. Among them, 172 had type A-EAR, higher rates of parental obesity (P < 0·05) and greater birth weight compared with other children (P < 0·001). Odds for overweight/obesity at 6-8 years, when adjusting for antenatal and postnatal factors, was 21·35 (95 % CI 10·94, 41·66) in type A-EAR children and not significant in type B-EAR children (OR 1·76; 95 % CI 0·84, 3·68) compared with children without EAR. Classification of EAR into two subtypes provides physicians with a reliable approach to identify children at risk for overweight/obesity before the age of 5 years.

Preventing Premature Atherosclerotic Disease

PURPOSE OF REVIEW

Cardiovascular disease (CVD) can begin in youth. Prevention is essential to reducing the burden of CVD-related risk factors in childhood and disease development in adulthood. This review addresses the clinical scope of CVD prevention, including a review of conditions encountered, proposed diagnostic criteria, and management strategies. We also highlight the impact of the intrauterine environment on the development of CVD risk. Finally, we highlight the potential role of telehealth in the management of pediatric patients with risk factors for premature CVD.

RECENT FINDINGS

Growing evidence suggests that maternal obesity, diabetes, and preeclampsia may play an important role in the development of CVD risk among offspring contributing to the development of known traditional CVD risk factors among offspring. As the prevalence of CVD continues to rise, knowledge as well as appropriate diagnosis and management of primordial and traditional risk factors for CVD is needed. The diagnosis and management of CVD risk factors is a central role of the preventive pediatric cardiologist, but it is imperative that the general physician and other pediatric subspecialists be aware of these risk factors, diagnoses, and management strategies. Finally, telehealth may offer an additional method for providing preventive care, including screening and counseling of at risk children and adolescents for traditional risk factors and for providing education regarding risk factors in cases of long distance care and/or during periods of social distancing.

Predictive value of ophthalmic artery Doppler velocimetry in relation to hypertensive disorders of pregnancy

PURPOSE

To test the predictive value of ophthalmic artery (OA) Doppler velocimetry in relation to the occurrence of hypertensive disorders of pregnancy (HDP).

METHODS

We compared, by analysis of variance, the values of seven OA Doppler variables (peak systolic velocity, second systolic peak velocity [P2], mean velocity, end diastolic velocity, resistance index [RI], pulsatility index [PI], and peak ratio) of 31 women with preeclampsia and 33 women with gestational hypertension vs those of 227 women without HDP. The prognostic value of these variables in relation to the occurrence of HDP was evaluated by the area under the curve (AUC) receiver operating characteristic curve.

RESULTS

All OA Doppler variables except RI and PI showed significant (P < .5) differences between groups. After adjustment for confounders, only P2 was an independent predictor of HDP (P < .001), with an AUC of 0.76. The best cut-off point for predicting HDP was P2 ≥ 21.4 cm/s, with sensitivity 69%, specificity 78%, positive likelihood ratio 3.1, negative likelihood ratio 0.4, positive predictive value 47%, and negative predictive value 90%. P2 improved the predictive ability of a model based on clinical variables, incrementing AUC from 0.77 to 0.84 in the final model containing clinical and Doppler variables.

CONCLUSION

The elevation of OA P2 in the second trimester of pregnancy is an independent predictor of hypertensive disorders, and improves the discriminatory ability of clinical markers.

Mild maternal sleep-disordered breathing during pregnancy and offspring growth and adiposity in the first 3 years of life

Sleep-disordered breathing (SDB) during pregnancy has been linked to adverse fetal outcomes. Since the intrauterine milieu plays a critical role in childhood growth, we explored the interactions between maternal SDB and offspring growth and adiposity patterns during infancy. Fifty-eight healthy women with uncomplicated pregnancies underwent an objective sleep study and laboratory evaluation during the third trimester, their offspring underwent a 3-year growth surveillance. The 14 (24.1%) women with SDB had a higher body mass index (BMI) (P = 0.003), elevated C-reactive protein levels (P = 0.003), and decreased HDL-cholesterol levels (P = 0.009) than the women without SDB. A general linear model evaluated the interactions between maternal SDB and offspring growth and adiposity measurements after controlling for gestational age and maternal and paternal BMIs. The offspring of mothers with SDB had a significantly smaller head circumference at birth (P = 0.004), with a distinctive pattern of catchup growth by the end of the first year of life (P = 0.018). Their growth pattern was distinguished by compromised birth weight-to-length, rapid catch-up growth, and an increase in both weight-to-length and triceps thickness by the age of three (P < 0.001 and P = 0.001, respectively). Our findings suggest that maternal SDB during pregnancy affects head circumference growth and adiposity acquisition from birth through infancy.

Integration of an interpretable machine learning algorithm to identify early life risk factors of childhood obesity among preterm infants: a prospective birth cohort

BACKGROUND

The early life risk factors of childhood obesity among preterm infants are unclear and little is known about the influence of the feeding practices. We aimed to identify early life risk factors for childhood overweight/obesity among preterm infants and to determine feeding practices that could modify the identified risk factors.

METHODS

A total of 338,413 mother-child pairs were enrolled in the Jiaxing Birth Cohort (1999 to 2013), and 2125 eligible singleton preterm born children were included for analyses. We obtained data on health examination, anthropometric measurement, lifestyle, and dietary habits of each participant at their visits to clinics. An interpretable machine learning-based analytic framework was used to identify early life predictors for childhood overweight/obesity, and Poisson regression was used to examine the associations between feeding practices and the identified leading predictor.

RESULTS

Of the eligible 2125 preterm infants (863 [40.6%] girls), 274 (12.9%) developed overweight/obesity at age 4-7 years. We summarized early life variables into 25 features and identified two most important features as predictors for childhood overweight/obesity: trajectory of infant BMI (body mass index) Z-score change during the first year of corrected age and maternal BMI at enrollment. According to the impacts of different BMI Z-score trajectories on the outcome, we classified this feature into the favored and unfavored trajectories. Compared with early introduction of solid foods (≤ 3 months of corrected age), introducing solid foods after 6 months of corrected age was significantly associated with 11% lower risk (risk ratio, 0.89; 95% CI, 0.82 to 0.97) of being in the unfavored trajectory.

CONCLUSIONS

The trajectory of BMI Z-score change within the first year of life is the most important predictor for childhood overweight/obesity among preterm infants. Introducing solid foods after 6 months of corrected age is a recommended feeding practice for mitigating the risk of being in the unfavored trajectory.

Hypertensive disorders of pregnancy and risk of asthma in offspring: protocol for a systematic review and meta-analysis

INTRODUCTION

Hypertensive disorders of pregnancy (HDP), one of the most common obstetrical complications, has been reported to have a controversial relationship with the increased risk of asthma in offspring. No systematic review of this topic has been performed. The aim of this systematic review will be to summarise the available evidence examining the association between HDP and the risk of asthma in offspring.

METHODS AND ANALYSIS

We will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines. A systematic search of the PubMed, Embase, Cochrane and Web of Science databases will be performed using a detailed search strategy from database inception through 31 December 2019. Cohort, case-control and cross-sectional studies that report a diagnosis of maternal HDP and asthma in offspring will be included. Studies will be limited to the English language and include only human participants. Two independent reviewers will conduct the study selection, data extraction and risk of bias assessments using a standardised data extraction form. A meta-analysis will be performed to calculate overall pooled estimates using the generic inverse variance method. The data will be synthesised by either fixed-effect or random effects models according to heterogeneity tests. All analyses will be performed in Stata 14 and RevMan 5.3. High-quality evidence of the relationship between HDP and the risk of asthma in exposed offspring will be identified through the synthesis of current studies. In addition, the results of subgroup analyses and related secondary outcomes will be reported. The following will be concluded: (i) whether HDP increases the risk of asthma in offspring, (ii) whether HDP affects the severity of asthma in exposed offspring and (iii) whether possible differences in the risk of asthma among different HDP subgroups exist.

ETHICS AND DISSEMINATION

There is no requirement for ethics approval because the meta-analysis and systematic review will be based on published data. It is anticipated that the dissemination of results will take place at conferences and through publication in a peer-reviewed journal.

Childhood dietary patterns and body composition at age 6 years: the Children of SCOPE study

Dietary patterns describe the quantity, variety, or combination of different foods and beverages in a diet and the frequency of habitual consumption. Better understanding of childhood dietary patterns and antenatal influences could inform intervention strategies to prevent childhood obesity. We derived empirical dietary patterns in 1142 children (average age 6.0 (0.2) years) in Auckland, New Zealand whose mothers had participated in the Screening for Pregnancy Endpoints (SCOPE) cohort study and explored associations with measures of body composition. Participants (Children of SCOPE) had their diet assessed by food frequency questionnaire (FFQ) and empirical dietary patterns were extracted using factor analysis. Three distinct dietary patterns were identified; 'Healthy', 'Traditional' and 'Junk'. Associations between dietary patterns and measures of childhood body composition (waist, hip, arm circumferences, body mass index (BMI), bioelectrical impedance analysis (BIA) derived body fat percentage, and sum of skinfold thicknesses (SST)) were assessed by linear regression, with adjustment for maternal influences. Children who had higher 'Junk' dietary pattern scores had 0.24cm greater arm (0.08 SD (95%CI 0.04, 0.13)) and 0.44cm hip (0.05 SD (95% CI 0.01, 0.10)) circumferences, 1.13cm greater SST (0.07 SD (95%CI 0.03, 0.12)) and were more likely to be obese (OR=1.74 (95%CI 1.07, 2.82)); those with higher 'Healthy' pattern scores were less likely to be obese (OR=0.62 (95%CI 0.39, 1.00)). In a large mother-child cohort, a dietary pattern characterised by high sugar and fat foods was associated with greater adiposity and obesity risk in children aged 6 years, while a 'Healthy' dietary pattern offered some protection against obesity. Targeting unhealthy dietary patterns could inform public health strategies to reduce the prevalence of childhood obesity.

Association between phthalate exposure and blood pressure during pregnancy

BACKGROUND

Phthalates are endocrine disrupting chemicals (EDCs) that pose a serious hazard to the human health. Many epidemiological studies revealed a relationship between phthalates exposure and blood pressure in general population, while the relationship in pregnant women remains unknown.

OBJECTIVES

Aimed to elucidate whether phthalate exposure is associated with blood pressure among pregnant women.

METHODS

This study included 636 participants from Wuhan, China. Urine samples were conducted repeatedly in three trimesters, and 9 phthalates were measured in these samples. After each urine was sampled, all the participants completed blood pressure measurements. Associations between repeated measurements of phthalate concentration and blood pressure were evaluated by using generalized estimating equations. Stratified analysis by fetus gender was conducted.

RESULTS

Among the pregnant women with male fetuses, mono-i-butyl phthalate (MiBP) exposed in the 1st trimester was associated with the increased diastolic blood pressure (DBP) measured in the 2nd trimester, while the environmental risk score (ERS) measured in the 1st and 2nd trimester was positively associated with systolic blood pressure (SBP) and DBP in the 2nd trimester. No significant relationships were observed among all the population or pregnant women with female fetuses.

CONCLUSIONS

Exposure to higher levels of MiBP may be related to increased blood pressure during pregnancy in pregnant women with male fetuses.

The interactive effect of pre-pregnancy overweight and obesity and hypertensive disorders of pregnancy on the weight status in infancy

We aimed to assess whether hypertensive disorders of pregnancy (HDP) could modify the effect of pre-pregnancy overweight or obesity (OWO) on the risk of offspring high body mass index (BMI) in infancy. A total of 3,765 mother-child pairs were recruited from two Chinese birth cohorts. BMI ≥ 85th percentile, based on World Health Organization criteria, was defined as a high BMI for the risk of developing severe obesity in later life. Logistic regression analysis was used to assess the combined effects and multiplicative interactions of pre-pregnancy OWO + HDP on offspring high BMI. Relative excess risk due to interaction (RERI) or attributable proportion (AP) was used to estimate additive interactions. RERI > 0 or AP > 0 indicates a significant additive interaction. Compared with the non-OWO and normal blood pressure group, the combination of OWO + HDP was positively associated with offspring high BMI at 12 months of age [OR 3.10 (95%CI 1.59, 6.04)], with 51% of the effects attributed to an additive interaction [AP 0.51 (95%CI 0.13, 0.89)]. An interactive effect was found between the pre-pregnancy OWO + HDP and offspring high BMI in infancy. Interventions to control pre-pregnancy OWO and HDP are important to prevent obesity and associated adverse outcomes in offspring.

Maternal blood pressure mediates the association between maternal obesity and infant weight gain in early postpartum

BACKGROUND

It is unknown to what extent higher maternal blood pressure (BP) in early postpartum impacts the relationship between higher maternal weight status and greater infant weight gain in early postpartum.

OBJECTIVE

To evaluate the mediating role of higher maternal BP at 1 month postpartum on the association between higher maternal weight status at 1 month postpartum and greater infant weight gain over 6 months postpartum.

METHODS

Participants were 169 Hispanic mother-infant pairs. Maternal body mass index (BMI) and BP were assessed at 1 month postpartum. Infant weight was measured at 1 and 6 months postpartum to calculate weight-for-age z scores (WAZ). Multiple linear regression models were used for prediction, and Sobel test was used to determine mediation.

RESULTS

Controlling for maternal pre-pregnancy BMI, age, delivery mode, infant sex, and infant birth weight revealed that both maternal BMI (β = .29) and BP (β = .32) predicted infant WAZ gain (both P ≤ .03). However, the relationship between infant WAZ gain and maternal BMI was no longer significant after further adjustment for maternal BP, which remained significant (P < .05). Maternal BP explained 23.6% (Sobel T = 2.01) of the association between maternal BMI at 1 month and infant WAZ gain over 6 months.

CONCLUSION

Our data suggest that higher maternal weight status at 1 month postpartum is related to greater infant weight gain over 6 months postpartum, and this relationship is mediated by higher maternal BP at 1 month postpartum.

Maternal Blood Pressure, Cord Glucocorticoids, and Child Neurodevelopment at 2 Years of Age: A Birth Cohort Study

BACKGROUND

Pregnancy hypertensive disorders have impaired neurodevelopment in offspring. We aimed to explore the association of normal range maternal blood pressure (BP) with child neurodevelopment, as well as the possible role of placental 11-beta-hydroxysteroid dehydrogenase type 2 (11β-HSD2) therein.

METHODS

Among 1,008 mother-child pairs recruited in Wuhan, China, in 2013-2015, we measured maternal third-trimester BP (systolic BP (SBP) and diastolic BP (DBP)) and cord glucocorticoids (cortisol and cortisone), a marker reflecting placental 11β-HSD2 activity. We evaluated child neurodevelopment using the Bayley Scales of Infant Development (BSID) with obtaining the Mental and Psychomotor Development Index (MDI and PDI). Multiple regression and mediation analysis were performed to estimate the effect.

RESULTS

Each 5 mm Hg increase in maternal third-trimester SBP was associated with 1.54 points decrease in MDI (95% confidence interval (CI) = -2.60, -0.48) and 1.23 points decrease in PDI (95% CI = -2.14, -0.31); similar association was observed between DBP and BSID (adjusted β = -1.32; 95% CI = -2.53, -0.10 for MDI and -1.37; 95% CI = -2.42, -0.33 for PDI). Also, we found significant associations between cord cortisol/cortisone ratio and PDI (adjusted β = 2.95; 95% CI = 0.91, 4.99), as well as between maternal BP and cord cortisol/cortisone ratio (adjusted β = -0.03; 95% CI = -0.06, -0.01 for both SBP and DBP). Mediation analysis revealed that cord cortisol/cortisone ratio explained 6.29% of the association between SBP and PDI, and 6.85% between DBP and PDI.

CONCLUSIONS

Increased maternal normal range BP may affect child neurodevelopment. Furthermore, placental 11β-HSD2 activity might be involved in the process.