A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention

This systematic review focuses on outcomes of gestational weight gain, specifically birthweight, fetal growth, and postpartum weight retention, for singleton pregnancies with respect to the 1990 Institute of Medicine weight gain recommendations. A total of 35 studies met the inclusion criteria and were reviewed. There was strong evidence to support associations between excessive gestational weight gain and increased birthweight and fetal growth (large for gestational age) as well as inadequate gestational weight gain and decreased birthweight and fetal growth (small for gestational age). There was moderate evidence to support the association between excessive gestational weight gain and postpartum weight retention. Clear clinical recommendations based on this review are challenging because of several limitations in the literature. Improvements in future research include the use of consistent definitions of gestational weight gain and outcomes of interest, assessment of confounders, and better collection of weight and weight gain data.

Sociodemographic, perinatal, behavioral, and psychosocial predictors of weight retention at 3 and 12 months postpartum

Postpartum weight retention plays an important role in the pathway leading to obesity among women of childbearing age. The objective of this study was to examine predictors of moderate (1-10 pounds) and high (>10 pounds) postpartum weight retention using data from a prospective pregnancy cohort that followed women into the postpartum period; n = 688 and 550 women at 3 and 12 months, respectively. Analysis included descriptive statistics and predictive modeling using log-binomial techniques. The average weight retained at 3 and 12 months postpartum in this population was 9.4 lb (s.d. = 11.4) and 5.7 lb (s.d. = 13.2), respectively. At 3 months postpartum, prepregnancy weight, gestational weight gain, and hours slept during the night were associated with moderate or high weight retention, whereas having an infant hospitalized after going home and scoring in the upper 75th percentile of the Eating Attitudes Test (EAT) were associated only with high weight retention. At 12 months postpartum, prepregnancy weight, gestational weight gain, and maternal education were associated with moderate weight retention; and gestational weight gain, maternal age, race, employment status, and having an infant hospitalized at birth were associated with high weight retention. The results of this study illustrate the importance of prepregnancy weight and gestational weight gain in predicting postpartum weight retention. Furthermore, given the lack of successful intervention studies that exist to date to help women lose weight in the postpartum period, the results of this study may help to inform future interventions that focus on such aspects as hours of sleep, dealing with stress associated with a hospitalized infant, and nonclinical eating disorder symptomatology.

Childhood hair product use and earlier age at menarche in a racially diverse study population: a pilot study

PURPOSE

Previous studies suggest that hair products containing endocrine disrupting chemicals could alter puberty. We evaluated the association between childhood hair product use and age at menarche in a racially diverse study population.

METHODS

We recruited 300 African-American, African-Caribbean, Hispanic, and white women from the New York City metropolitan area who were between 18-77 years of age. Data were collected retrospectively on hair oil, lotion, leave-in conditioner, perm, and other types of hair products used before age 13. Recalled age at menarche ranged from 8 to 19 years. We used multivariable binomial regression to evaluate the association between hair product use and age at menarche (<12 vs. ≥12), adjusting for potential confounders.

RESULTS

African-Americans were more likely to use hair products and reached menarche earlier than other racial/ethnic groups. Women reporting childhood hair oil use had a risk ratio of 1.4 (95% confidence interval [CI]: 1.1-1.9) for earlier menarche, adjusting for race/ethnicity and year of birth. Hair perm users had an increased risk for earlier menarche (adjusted risk ratio = 1.4, 95% CI: 1.1-1.8). Other types of hair products assessed in this study were not associated with earlier menarche.

CONCLUSIONS

Childhood hair oil and perm use were associated with earlier menarche. If replicated, these results suggest that hair product use may be important to measure in evaluating earlier age at menarche.

Implementation of the new institute of medicine gestational weight gain guidelines

In May 2009, the Institute of Medicine (IOM) introduced revised gestational weight gain guidelines that were based on balancing the benefits and risks of weight gain for both the mother and child's health. This article provides an overview of these new recommendations, explaining the key changes made from the previous 1990 IOM recommendations. The important role of health care providers of pregnant women in the implementation of the new recommendations is detailed, and specific guidance for troubleshooting issues that may be encountered when helping women achieve appropriate gestational weight gains is provided.

Is Meeting the Recommended Dietary Allowance (RDA) for Protein Related to Body Composition among Older Adults?: Results from the Cardiovascular Health of Seniors and Built Environment Study

OBJECTIVE

Studies suggest protein intake may be associated with lower body weight, but protein has also been associated with preservation of lean body mass. Understanding the role of protein in maintaining health for older adults is important for disease prevention among this population.

DESIGN

Cross-sectional study of the relationship of dietary protein on body composition.

SETTING

New York City community centers.

PARTICIPANTS

1,011 Black, White, and Latino urban men and women 60-99 years of age.

MEASUREMENTS

Protein intake was assessed using two interviewer-administered 24-hour recalls, and body composition was assessed using bioelectrical impedance analysis (BIA) of fat mass (kg) (FM), fat free mass (kg) (FFM), and impedance resistance (Ohms).

STATISTICAL ANALYSIS

Indices of FM and FFM were calculated by dividing BIA measurements by height squared (m2), and percent FFM was calculated by dividing FFM by the sum of FM and FFM. Log linear models adjusting for age (continuous), race/ethnicity, education, physical activity (dichotomized at the median), hypertension, diabetes, and total calories (continuous).

RESULTS

Just 33% of women and 50% of men reported meeting the RDA for protein. Both fat free mass index (FFMI) and fat mass index (FMI) were negatively associated with meeting the RDA for protein (Women: FFMI -1.78 95%CI [-2.24, -1.33], FMI -4.12 95% CI [-4.82, -3.42]; Men: FFMI -1.62 95% CI [-2.32, -0.93] FMI -1.80 95% CI [-2.70, -0.89]). After accounting for confounders, women and men consuming at least 0.8 g/kg/day had a 6.2% (95% CI: 5.0%, 7.4%) and a 3.2% (95% CI 1.1%, 5.3%) higher percent fat free mass, respectively.

CONCLUSIONS

FFM, FFMI, FM, and FMI were inversely related to meeting the RDA for protein. Meeting the RDA for protein of at least 0.8g/kg/day was associated with a higher percentage of fat free mass among older adults. These results suggest meeting the protein recommendations of at least 0.8 g/kg/day may help to promote lower overall body mass, primarily through loss of fat mass rather than lean mass.

Correlates of Prenatal Diet Quality in Low-Income Hispanic Women

BACKGROUND

Low-income Hispanic women are at-risk of poor prenatal diet quality. Correlates associated with prenatal diet quality in this group of women are understudied.

OBJECTIVE

The objective of this study was to examine the associations between financial, cultural, psychosocial, and lifestyle correlates and prenatal diet quality in low-income Hispanic women.

DESIGN

This cross-sectional analysis used data from pregnant women enrolled in the Starting Early Trial, a randomized-controlled trial of a primary-care based child obesity prevention program beginning in pregnancy. The trial enrolled women from clinics affiliated with a large urban medical center in New York City from 2012 to 2014. Financial, cultural, psychosocial, and lifestyle variables were collected using a comprehensive baseline questionnaire. Usual dietary intakes over the past year were assessed using the Block Food Frequency Questionnaire 2005 bilingual version.

PARTICIPANTS

The study enrolled low-income Hispanic women between 28 and 32 gestational weeks (N=519).

MAIN OUTCOME MEASURES

Prenatal diet quality was measured by the Healthy Eating Index 2015.

STATISTICAL ANALYSES PERFORMED

Unadjusted and adjusted multivariable linear regression analyses were performed to determine independent associations between financial, cultural, psychosocial, and lifestyle correlates and Healthy Eating Index 2015 total score.

RESULTS

Overall prenatal diet quality was poor (mean Healthy Eating Index 2015 total score=69.0±9.4). Most women did not meet the maximum score for total vegetables (65.3%), whole grains (97.1%), dairy (74.8%), fatty acids (84.4%), refined grains (79.8%), sodium (97.5%), saturated fats (92.9%), and added sugars (66.5%). Women who reported screen time ≤2 hours/day, physical activity before and/or during pregnancy, and being born outside the United States had higher mean Healthy Eating Index 2015 total score than women with screen time >2 hours/day, no physical activity, and those born in the United States.

CONCLUSIONS

Prenatal diet quality of low-income pregnant Hispanic women was suboptimal. This cross-sectional study revealed associations between cultural and lifestyle factors and prenatal diet quality in low-income Hispanic women. Longitudinal studies are needed to determine long-term influences and specific behaviors to target for effective intervention studies.

Food assistance programs and income are associated with the diet quality of grocery purchases for households consisting of women of reproductive age or young children

Women's diet quality during reproductive years and children's diet quality during early life influence long term health. Few studies have evaluated the impact of food assistance programs and income on the diet quality of grocery purchases made by households consisting of women of reproductive age and young children. We used data from the Food Acquisition and Purchase Survey 2012-2013 (FoodAPS) to evaluate how household income, Special Supplemental Nutrition Assistance Program for Women, Infants and Children (WIC) participation, and Supplemental Nutrition Assistance Program (SNAP) participation are related to the diet quality of grocery purchases made by households that include women of reproductive age or young children (n = 2436). The diet quality of household grocery purchases was assessed with the Healthy Eating Index (HEI) 2015. HEI-2015 total score (0-100) and component scores were evaluated according to household income (eligible for WIC: income-to-poverty ratio ≤ 185%; ineligible for WIC: income-to-poverty ratio > 185%) and WIC, SNAP, and WIC + SNAP participation. Median HEI-2015 total score was lowest among SNAP households and highest among income ineligible for WIC and WIC households (47.2 and 54.1, respectively). Compared to income ineligible for WIC households, WIC + SNAP and SNAP households had lower HEI-2015 whole fruit (β = -0.30, 95% CI: -0.59, -0.01 and β = -0.41, 95% CI: -0.63, -0.20, respectively) and total vegetable scores (β = -0.58, 95% CI: -0.83, -0.32 and β = -0.27, 95% CI: -0.45, -0.08, respectively). The diet quality of grocery purchases in this population varies according to household income and food assistance participation.

Prenatal dietary exposures and offspring body size from 6 months to 18 years: A systematic review

BACKGROUND

In utero dietary exposures may influence childhood obesity.

OBJECTIVES

To evaluate the relationship between prenatal dietary exposures and offspring body size from 6 months to 18 years.

DATA SOURCES

Articles were identified in PubMed and Web of Science (January 2010-March 2018) using the PRISMA guidelines. Additional studies were identified through a reference review of articles that met the inclusion criteria and related reviews.

STUDY SELECTION

Prospective cohort studies that assessed dietary patterns, foods, macronutrients, or beverages during healthy pregnancy and offspring body size. The extraction of articles was done using predefined data fields.

SYNTHESIS

One author extracted all information and evaluated bias with the NHLBI's Quality Assessment Tool.

RESULTS

A total of 851 research articles were evaluated. Twenty-one studies assessing dietary patterns, macronutrients, foods, and beverages met inclusion criteria. Consumption of a Mediterranean dietary pattern during pregnancy was associated with reduced body size, while refined carbohydrates were associated with offspring obesity. No association was observed between data-driven dietary patterns and offspring body size, as well as a pro-inflammatory diet pattern and offspring body size. Mixed and null findings were observed for the relationship between total carbohydrates, n-3 polyunsaturated fatty acids, protein, sugar-sweetened beverages, and artificially sweetened beverages and offspring body size.

CONCLUSIONS

Adhering to a Mediterranean diet and limiting refined carbohydrates during pregnancy may influence offspring body size between 6 months and 18 years. The diverging results that exist between studies highlight the complexity of this topic.

Exposures to phthalates and bisphenols in pregnancy and postpartum weight gain in a population-based longitudinal birth cohort

BACKGROUND

Experimental evidence suggests that exposures to phthalates and bisphenols may interfere with processes related to glucose and lipid metabolism, insulin sensitivity, and body weight. Few studies have considered the possible influence of chemical exposures during pregnancy on maternal weight gain or metabolic health outcomes postpartum.

OBJECTIVE

To examine the associations of early and mid-pregnancy bisphenol and phthalate urine concentrations with maternal weight gain 6 years postpartum.

METHODS

We analyzed urine samples for bisphenol, phthalate and creatinine concentrations from early and mid-pregnancy in 1192 women in a large, population-based birth cohort in Rotterdam, the Netherlands, and examined postpartum weight gain using maternal anthropometrics before pregnancy and 6 years postpartum. We have used covariate-adjusted linear regressions to evaluate associations of early and mid-pregnancy bisphenols and phthalate metabolites with weight change. Mediator and interaction models have been used to assess the role of gestational weight gain and breastfeeding, respectively. Sensitivity analysis is performed among women without subsequent pregnancies.

RESULTS

Among all 1192 mothers included in the analysis, each log unit increase in the average bisphenol A and all assessed phthalate groupings were associated with increased maternal weight gain. As a proxy for phthalate exposure, each log unit increase in averaged phthalic acid was associated with 734 g weight gain (95% CI 273-1196 g) between pre-pregnancy and 6 years postpartum. Mediation by gestational weight gain was not present. Breastfeeding and ethnicity did not modify the effects. Stratification revealed these associations to be strongest among overweight and obese women. Among women without subsequent pregnancies (n = 373) associations of bisphenols, HMW phthalate metabolites and di-2-ethylhexylphthalate metabolites attenuated. For phthalic acid, LMW phthalate metabolites and di-n-octylphthalate metabolites associations increased. Similarly to the whole group, stratification yielded significant results among overweight and obese women.

DISCUSSION

In a large population-based birth cohort, early and mid-pregnancy phthalate exposures are associated with weight gain 6 years postpartum, particularly among overweight and obese women. These data support ongoing action to replace phthalates with safer alternatives.

Outcomes of maternal weight gain

OBJECTIVES

The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC) systematically reviewed evidence on outcomes of gestational weight gain and their confounders and effect modifiers, outcomes of weight gain within or outside the 1990 Institute of Medicine (IOM) guidelines, risks and benefits of weight gain recommendations, and anthropometric measures of weight gain.

DATA SOURCES

We searched MEDLINE Cochrane Collaboration resources, Cumulative Index to Nursing & Allied Health Literature, and Embase.

REVIEW METHODS

We included studies published in English from 1990 through October 2007. We excluded studies with low sample size (based on study design: case series <100 subjects and cohorts <40 subjects).

RESULTS

Overall, strong evidence supported an association between gestational weight gains and the following outcomes: preterm birth, total birthweight, low birthweight (<2,500 g), macrosomia, large-for-gestational-age (LGA) infants, and small-for-gestational-age (SGA) infants; moderate evidence supported an association for cesarean delivery and intermediate-term weight retention (3 months to 3 years postpartum). The studies reviewed provided strong evidence for the independent association of pregravid weight status and outcomes, moderate evidence for age and parity, and weak evidence for race. Regarding outcomes of weight gain within or outside 1990 IOM guidelines, moderate to strong evidence suggests an association between weight gain below IOM recommendations and preterm birth, low birthweight, SGA birthweights, and failure to initiate breastfeeding, and strong evidence for the association between weight gain above IOM recommendations and high birthweight, macrosomia, and LGA birthweights. Moderate evidence supports an association between weight gain above IOM guidelines and cesarean delivery and postpartum weight retention in the short, intermediate, and long term. Included research is inadequate for objective assessments of the range of harms and benefits of providing all women, irrespective of age, race or ethnicity, or pregravid body mass index (BMI), with the same recommendation for weight gain in pregnancy.

CONCLUSIONS

Gestational weight gain is associated with some infant and maternal outcomes. One weight gain recommendation for all women is not supported by the evidence identified in this review. To understand fully the impact of gestational weight gain on short- and long-term outcomes for women and their offspring will require that researchers use consistent definitions of weight gain during pregnancy, better address confounders in their analyses, improve study designs and statistical models, and conduct studies with longer followup.

Prenatal Dietary Exposures and Offspring Body Size from 6 Months to 18 Years: A Systematic Review (P11-019-19)

Objectives

In utero dietary exposures may influence childhood obesity. Current research on the relationship between prenatal food and beverage intakes and offspring obesity has yielded mixed results. The purpose of this review is to evaluate the relationship between prenatal dietary exposures and offspring body size from 6 months to 18 years.

Methods

A systematic review of English articles using PubMed and Web of Science (January 2010- March 2018) was conducted using the PRISMA guidelines. Additional studies were identified through a reference review of articles that met the inclusion criteria and related review articles. Longitudinal observational studies that assessed dietary patterns, food(s) and/or macronutrients(s), or beverage(s) consumption during healthy pregnancy and evaluated offspring body size between the ages of 6 months and 18 years were included in the review.

Results

Twenty studies evaluating dietary patterns (n = 6), macronutrient(s) and/or food(s) (n = 11), and beverages (n = 3) met inclusion criteria. Consumption of a Mediterranean dietary pattern during pregnancy was associated with lower anthropometric measures in offspring, while sugars and refined carbohydrates were associated with offspring obesity. Mixed results were observed for n-3 polyunsaturated fatty acids, protein, sugar-sweetened beverages, and artificially sweetened beverages.

Conclusions

These findings suggest that following a Mediterranean diet and limiting sugar intake during pregnancy may make small but significant contributions to preventing childhood overweight and obesity. Future research should focus on prenatal diet quality to better communicate the information to health practitioners.

Funding Sources

None.

Long-Term Trends in Ultra-Processed Food Consumption by Cardiometabolic Disease Status in the Framingham Offspring Study

Objectives

Ultra-processed foods currently provide the majority of calories in the U.S. and are closely linked with cardiometabolic diseases. Yet, little is known regarding consumption trends among individuals with and without cardiometabolic diseases. The current analyses examined longitudinal trends in diet processing level from 1991–2008 within the Framingham Heart Study Offspring Cohort by disease status.

Methods

Analyses were conducted using dietary data serially collected by a food frequency questionnaire at study exams every 4 years between 1991–2008. The analytical sample included 2893 adults with valid dietary data for ≥3 exams (mean age: 54.0 y). Based on the NOVA framework, foods were classified as unprocessed/minimally processed foods, processed culinary ingredients (salt, sugar, fats and oils), culinary preparations (homemade baked goods and dishes), processed foods and ultra-processed foods. Consumption of each processing level (servings/d) were examined by calculating means, standard deviations and p-values for trends over the 4 exams. Mixed effects models with subject-specific random intercepts were used to account for within-subject correlation. Trends were stratified by prevalent cardiometabolic disease (CVD, diabetes, hypertension).

Results

Among individuals with cardiometabolic diseases, over 17 years of follow-up, consumption of ultra-processed foods (7.9–6.1 servings/d) and minimally processed foods (11.2–10.6 servings/d) decreased (p-trend &lt; 0.001). Intakes of processed foods, culinary ingredients and culinary preparations changed minimally during the study period. Trends were similar among individuals without cardiometabolic diseases (ultra-processed foods 7.3 to 5.8 servings/d) and minimally processed foods (11.3–11.0 servings/d) (p-trend &lt; 0.001).

Conclusions

Consumption of ultra-processed foods, a putative cardiovascular risk factor, remained high throughout the 1990s and 2000s, among aging adults, regardless of the cardiometabolic disease status. Yet, processing level has not been addressed in federal or clinical dietary guidelines. Future investigations should determine if dietary recommendations distinguishing ultra-processed from moderately and minimally processed foods facilitate healthier food choices.

Funding Sources

None.

DASH Diet Concordance Among Adults in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study (2010–2013)

Objectives

South Asian Americans have a disproportionately higher risk of atherosclerotic cardiovascular disease (ASCVD) and risk factors, such as hypertension compared to non-Hispanic whites and other Asian American groups. Our objective was to investigate adherence to Dietary Approaches to Stop Hypertension (DASH), an established dietary pattern to reduce blood pressure, and association with sociodemographic, body composition, and ASCVD risk factors.

Methods

Baseline data from 893 adults (40–83y, 47% female) recruited between 2010–2013 for the MASALA Study were used in these analyses. We computed a DASH concordance score from the validated 163-item Study of Health Assessment and Risk in Ethnic groups food frequency questionnaire (FFQ), using an established method. We scored concordance based on 8 components: high intake of 1) fruit, 2) vegetables, 3) nuts/legumes, 4) low-fat dairy products, and 5) whole grains, and low intake of 6) sodium, 7) sugar-sweetened beverages, and 8) red/processed meats. The theoretical DASH score may range from 8 (low concordance) to 40 (high concordance).

Results

The DASH score in MASALA participants ranged 12–35 (mean ± SD, 24.4 ± 4.4). The average score was higher among women (25.4 ± 4.1) than men (23.6 ± 4.5; P &lt; 0.001), higher among adults 65 and older than those ≤50 (24.9 ± 4.3 vs. 23.9 ± 4.6, P = 0.015), and higher among participants who had lived less than 50% of their life in the U.S. (24.9 ± 4.4 vs. 23.9 ± 4.4, p-0.0014). The score was also higher among participants who had a Bachelor's degree or greater (P = 0.0064), but there was no difference in the score based on annual family income (P = 0.07). The score was higher among vegetarians than non-vegetarians (26.7 ± 3.5 vs. 23 ± 4.4; P &lt; 0.001). It was also inversely associated with indicators of central adiposity including waist circumference (P = 0.001) and waist-to-hip ratio (P &lt; 0.001).

Conclusions

Our results indicate that adherence to the DASH dietary pattern is associated with select sociodemographic factors and body composition among South Asians in the U.S. The computed DASH score will be utilized in forthcoming analyses to determine its associations with risk factors for hypertension, central adiposity, and ASCVD among participants in the MASALA cohort.

Funding Sources

NHLBI, National Center for Research Resources, National Center for Advancing Translational Sciences, NIH, via UCSF-CTSI.

Clinical interventions to increase vegetable intake in children

PURPOSE OF REVIEW

Eating behaviors and dietary patterns begin in early childhood and persist into adolescence and adulthood, affecting lifelong acute and chronic disease risk. Vegetables provide a high density of necessary vitamins, minerals, and fiber. Dietary intake data show that children of all ages consume below the recommended range for vegetables. Pediatric providers are optimally positioned to promote vegetable intake in childhood. This review seeks to summarize lessons learned from behavioral interventions useful in the pediatric primary care setting to improve vegetable intake.

RECENT FINDINGS

Ten published studies tested behavioral interventions in primary care to increase child vegetable intake. Strategies tested include teaching healthy eating behaviors and role modeling to parents of infants, and motivational interviewing paired with frequent office visits and reminders for families of older children and adolescents. Some strategies suggested positive change, despite study quality being limited by underpowered samples, heterogeneity of outcome measures, and statistical analytic approach.

SUMMARY

Increased vegetable intake was achieved in infants through parental role-modeling when providers emphasized healthy dietary choices in parents. Older children increased their vegetable intake with motivational interviewing and frequent reminders from providers. Despite the high prevalence of inadequate vegetable intake among children, at present, there is only a modest body of literature to help guide pediatric providers in implementing practice-based interventions to improve vegetable intake in childhood, highlighting a need for high-quality research in this area.

Metabolism-Disrupting Chemical Mixtures during Pregnancy, Folic Acid Supplementation, and Liver Injury in Mother-Child Pairs

Background and Aims

Scarce knowledge about the impact of metabolism-disrupting chemicals (MDCs) on liver injury limits opportunities for intervention. We evaluated pregnancy MDC-mixture associations with liver injury and effect modification by folic acid (FA) supplementation in mother-child pairs.

Methods

We studied ∼200 mother-child pairs from the Mexican PROGRESS cohort, with measured 43 MDCs during pregnancy (estimated air pollutants, blood/urine metals or metalloids, urine high- and low-molecular-weight phthalate [HMWPs, LMWPs] and organophosphate-pesticide [OP] metabolites), and serum liver enzymes (ALT, AST) at ∼9 years post-parturition. We defined liver injury as elevated liver enzymes in children, and using established clinical scores for steatosis and fibrosis in mothers (i.e., AST:ALT, FLI, HSI, FIB-4). Bayesian Weighted Quantile Sum regression assessed MDC-mixture associations with liver injury outcomes. We further examined chemical-chemical interactions and effect modification by self-reported FA supplementation.

Results

In children, many MDC-mixtures were associated with liver injury outcomes. Per quartile HMWP-mixture increase, ALT increased by 10.1% (95%CI: 1.67%, 19.4%) and AST by 5.27% (95% CI: 0.80%, 10.1%). LMWP-mixtures and air pollutant-mixtures were associated with higher AST and ALT, respectively. Air pollutant and non-essential metal/element associations with liver enzymes were attenuated by maternal cobalt blood concentrations ( p -interactions<0.05). In mothers, only the LMWP-mixture was associated with liver injury [OR=1.53 (95%CI: 1.01, 2.28) for HSI>36, and OR=1.62 (95%CI: 1.05, 2.49) for AST:ALT<1]. In mothers and children, most associations were attenuated (null) at FA supplementation≥600mcg/day ( p -interactions<0.05).

Conclusions

Pregnancy MDC exposures may increase liver injury risk, particularly in children. These associations may be attenuated by higher FA supplementation and maternal cobalt levels.

Impact of metabolism-disrupting chemicals and folic acid supplementation on liver injury and steatosis in mother-child pairs

BACKGROUND & AIMS

Scarce knowledge about the impact of metabolism-disrupting chemicals (MDCs) on steatotic liver disease limits opportunities for intervention. We evaluated pregnancy MDC-mixture associations with liver outcomes, and effect modification by folic acid (FA) supplementation in mother-child pairs.

METHODS

We studied ∼200 mother-child pairs from the Mexican PROGRESS cohort, with 43 MDCs measured during pregnancy (estimated air pollutants, blood/urine metals or metalloids, urine high- and low-molecular-weight phthalate [HMWPs, LMWPs] and organophosphate-pesticide metabolites), and serum liver enzymes (ALT, AST) at ∼9 years post-parturition. Outcomes included elevated liver enzymes in children and established clinical scores for steatosis and fibrosis in mothers (i.e.

, AST

ALT, FLI, HSI, FIB-4). Bayesian-weighted quantile sum regression assessed MDC-mixture associations with liver outcomes. We further examined chemical-chemical interactions and effect modification by self-reported FA supplementation.

RESULTS

In children, many MDC-mixtures were associated with liver injury. Per quartile HMWP-mixture increase, ALT increased by 10.1% (95% CI 1.67%, 19.4%) and AST by 5.27% (95% CI 0.80%, 10.1%). LMWP-mixtures and air pollutant-mixtures were associated with higher AST and ALT, respectively. Air pollutant and non-essential metal/element associations with liver enzymes were attenuated by maternal cobalt blood concentrations (p-interactions <0.05). In mothers, only the LMWP-mixture was associated with odds for steatosis (odds ratio = 1.53, 95% CI 1.01-2.28 for HSI >36, and odds ratio 1.62, 95% CI 1.05-2.49 for AST:ALT <1). In mothers and children, most associations were attenuated (null) at FA supplementation ≥600 μg/day (p-interactions <0.05).

CONCLUSIONS

Pregnancy MDC exposures may increase risk of liver injury and steatosis, particularly in children. Adequate FA supplementation and maternal cobalt levels may attenuate these associations.

IMPACT AND IMPLICATIONS

The effects of environmental chemical exposures on steatotic liver diseases are not well understood. In a parallel investigation of mothers and children, we found that pregnancy exposures to metabolism-disrupting chemicals may increase the risk of liver injury and steatosis, especially in the child, and that these associations could be attenuated by higher folic acid and/or cobalt levels. These findings can inform policies to decrease environmental chemical pollution and contribute to the design of clinical interventions addressing the metabolic dysfunction-associated steatotic liver disease epidemic.

Abstract P614: The Association Between Dietary Patterns and Coronary Artery Calcium Score: A Systematic Review

Background and Objective: Coronary artery calcium (CAC) score is an early indicator of CVD. Diet is an established primary prevention strategy for CVD, but limited research has systematically evaluated the relationship between diet and CAC. The current study sought to review longitudinal studies evaluating the association between dietary intake and CAC score.

Methods: Five databases were searched from inception to October 2022. We included prospective studies that included terms to capture food, diet, and nutrient intake in disease-free adults with CAC score measured by computed tomography. Two authors developed the search strategies and screened articles for inclusion.

Results: Of 58 articles on dietary intake and CAC score, nine assessed the relationship between dietary intake at baseline and CAC score at follow up. Sample size was moderate to large across the nine studies, ranging from 861 to 15,368 participants. Seven studies used a food frequency questionnaire, one used a semi-quantitative interview, and one used a single-item question to assess diet intake. One study was conducted in Germany, while eight were conducted in the US. Three studies derived data from the CARDIA study, a cohort of young adults aged 18-30 at baseline. Two studies used the MESA study, a prospective study of adults aged 45-84 at baseline. Four studies found an association between dietary pattern intake and CAC score, with studies finding that higher fruit and vegetable intake and Mediterranean-like diet associated with lower risk of CAC progression, and low carbohydrate diet and starchy vegetable, meat and alcohol intake associated with increased risk of CAC presence.

Conclusions: Studies suggested that there is a relationship between diet intake and CAC presence and progression, with research reflecting positive effects associated with patterns rich in fruits and vegetables alongside deleterious effects associated with high saturated fat and low dietary fiber intake. Finding reflect the strong influence of diet on clinical indicators of CVD.

Mental health outcomes across the reproductive life course among women with disabilities: a systematic review

PURPOSE

This systematic review examined literature on mental health outcomes among women with disabilities living in high-income countries within the context of reproductive health, spanning menstruation through menopause.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched MEDLINE, CINAHL, and PsycINFO databases for studies published through June 2023. Eligible studies were observational, quantitative, and included a comparison group without disabilities.

RESULTS

A total of 2,520 studies were evaluated and 27 studies met inclusion criteria. These studies assessed mental health during prepregnancy, pregnancy, postpartum, and parenting among women with and without disabilities. None of the studies examined reproductive health time periods related to menstruation, fertility, or menopause. Women of reproductive age with disabilities were more likely to have poor mental health outcomes compared to women without disabilities. During pregnancy and the postpartum, women with disabilities were at greater risk of diagnosed perinatal mental disorders and psychiatric-related healthcare visits. Findings also suggested mental distress and inadequate emotional and social support related to parenting among women with disabilities. The greatest risks of poor mental health outcomes were often observed among women with intellectual and developmental disabilities and among women with multiple types of disabilities, compared to women without disabilities.

CONCLUSIONS

Routine reproductive healthcare visits provide significant prevention and treatment opportunities for poor mental health among women with disabilities. Further research examining mental health outcomes within the context of reproductive health, especially understudied areas of menstruation, fertility, parenting, and menopause, among women with disabilities is needed.