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Tauriainen A, Harju S, Raitio A, Hyvärinen A, Tauriainen T, Helenius I, Vanamo K, Saari A, Sankilampi U. Longitudinal growth of children born with gastroschisis or omphalocele. Eur J Pediatr 2023; 182:5615-5623. [PMID: 37819418 PMCID: PMC10746581 DOI: 10.1007/s00431-023-05217-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/10/2023] [Accepted: 09/15/2023] [Indexed: 10/13/2023]
Abstract
Normal childhood growth is an indicator of good health, but data addressing the growth of children born with abdominal wall defects (AWDs) are limited. The detailed growth phenotypes of children born with gastroschisis or omphalocele are described and compared to peers without AWDs from birth to adolescence. Data from 183 gastroschisis and 144 omphalocele patients born between 1993 and 2017 were gathered from Finnish nationwide registers and electronic health records. Weight (n = 3033), length/height (n = 2034), weight-for-length (0-24 months, n = 909), and body mass index measures (2-15 years, n = 423) were converted into sex- and age-specific Z-scores. Linear mixed models were used for comparisons. Intrauterine growth failure was common in infants with gastroschisis. Birth weight Z-scores in girls and boys were - 1.2 (0.2) and - 1.3 (0.2) and length Z-scores - 0.7 (0.2) and - 1.0 (0.2), respectively (p < 0.001 for all comparisons to infants without AWDs). During early infancy, growth failure increased in infants with gastroschisis, and thereafter, catch-up growth was prominent and faster in girls than in boys. Gastroschisis children gained weight and reached their peers' weights permanently at 5 to 10 years. By 15 years or older, 30% of gastroschisis patients were overweight. Infants with omphalocele were born with a normal birth size but grew shorter and weighing less than the reference population until the teen-age years. CONCLUSION Children with gastroschisis and omphalocele have distinct growth patterns from fetal life onwards. These growth trajectories may also provide some opportunities to modulate adult health. WHAT IS KNOWN • Intrauterine and postnatal growth failure can be seen frequently in gastroschisis and they often show significant catch-up growth later in infancy. It is assumed that part of the children with gastroschisis will become overweight during later childhood. WHAT IS NEW • The longitudinal growth of girls and boys with gastroschisis or omphalocele is described separately until the teenage years. The risk of gaining excessive weight in puberty was confirmed in girls with gastroschisis.
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Airaksinen M, Taylor E, Gallen A, Ilén E, Saari A, Sankilampi U, Räsänen O, Haataja LM, Vanhatalo S. Charting infants' motor development at home using a wearable system: validation and comparison to physical growth charts. EBioMedicine 2023; 92:104591. [PMID: 37137181 PMCID: PMC10176156 DOI: 10.1016/j.ebiom.2023.104591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Early neurodevelopmental care and research are in urgent need of practical methods for quantitative assessment of early motor development. Here, performance of a wearable system in early motor assessment was validated and compared to developmental tracking of physical growth charts. METHODS Altogether 1358 h of spontaneous movement during 226 recording sessions in 116 infants (age 4-19 months) were analysed using a multisensor wearable system. A deep learning-based automatic pipeline quantified categories of infants' postures and movements at a time scale of seconds. Results from an archived cohort (dataset 1, N = 55 infants) recorded under partial supervision were compared to a validation cohort (dataset 2, N = 61) recorded at infants' homes by the parents. Aggregated recording-level measures including developmental age prediction (DAP) were used for comparison between cohorts. The motor growth was also compared with respective DAP estimates based on physical growth data (length, weight, and head circumference) obtained from a large cohort (N = 17,838 infants; age 4-18 months). FINDINGS Age-specific distributions of posture and movement categories were highly similar between infant cohorts. The DAP scores correlated tightly with age, explaining 97-99% (94-99% CI 95) of the variance at the group average level, and 80-82% (72-88%) of the variance in the individual recordings. Both the average motor and the physical growth measures showed a very strong fit to their respective developmental models (R2 = 0.99). However, single measurements showed more modality-dependent variation that was lowest for motor (σ = 1.4 [1.3-1.5 CI 95] months), length (σ = 1.5 months), and combined physical (σ = 1.5 months) measurements, and it was clearly higher for the weight (σ = 1.9 months) and head circumference (σ = 1.9 months) measurements. Longitudinal tracking showed clear individual trajectories, and its accuracy was comparable between motor and physical measures with longer measurement intervals. INTERPRETATION A quantified, transparent and explainable assessment of infants' motor performance is possible with a fully automated analysis pipeline, and the results replicate across independent cohorts from out-of-hospital recordings. A holistic assessment of motor development provides an accuracy that is comparable with the conventional physical growth measures. A quantitative measure of infants' motor development may directly support individual diagnostics and care, as well as facilitate clinical research as an outcome measure in early intervention trials. FUNDING This work was supported by the Finnish Academy (314602, 335788, 335872, 332017, 343498), Finnish Pediatric Foundation (Lastentautiensäätiö), Aivosäätiö, Sigrid Jusélius Foundation, and HUS Children's Hospital/HUS diagnostic center research funds.
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Harju S, Saari A, Sund R, Sankilampi U. Epidemiology of Disorders Associated with Short Stature in Childhood: A 20-Year Birth Cohort Study in Finland. Clin Epidemiol 2022; 14:1205-1214. [PMID: 36320440 PMCID: PMC9618248 DOI: 10.2147/clep.s372870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background Many primary and secondary disorders disturb growth and cause short stature (height below −2 SDS) in childhood. Growth monitoring programs aim at their early detection but are not evidence-based: epidemiology of childhood growth disorders is poorly characterized, and no consensus exists on priority target conditions. Herein, we describe population-based epidemiological data on several primary and secondary growth disorders associated with short stature in childhood. Materials and Methods This retrospective population-based 20-year birth cohort study examined 1 144 503 children (51% boys) born in Finland between 1998 and 2017, with 16.5 million care notifications including medical diagnoses. The first occurrences of key primary or secondary growth disorders were identified in multiple registers. Median ages at diagnosis (MAD), and age- and sex-specific cumulative incidences (CMI) from birth until 16 years of age were determined. Results Turner syndrome was the most common primary growth disorder (CMI 52 per 100 000 at 16 years, MAD 4.0 years). Most primary growth disorders were diagnosed before the age of 4 years, and thereafter, secondary growth disorders increased in number. MAD of growth hormone deficiency (GHD) was 8.7 (boys) and 7.2 years (girls). At 16 years, the CMI of GHD was higher in boys than in girls (127 versus 93 per 100 000, respectively), whereas the CMI of hypothyroidism was higher in girls (569 versus 306 per 100 000). Celiac disease was the most common secondary growth disorder and more common in girls than in boys (988 versus 546 per 100 000 at 16 years, respectively). Conclusion These population-based epidemiological data indicate that childhood growth monitoring should be age- and sex-specific. In the early childhood, the focus should be on primary growth disorders, and from preschool age also on secondary growth disorders. These results provide evidence for improving growth monitoring programs and diagnostic practices targeting on Turner syndrome, GHD, hypothyroidism, and celiac disease.
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Sarkkola C, Viljakainen J, de Oliveira Figueiredo RA, Saari A, Lommi S, Engberg E, Viljakainen H. Prevalence of Thinness, Overweight, Obesity, and Central Obesity in Finnish School-Aged Children: A Comparison of National and International Reference Values. Obes Facts 2022; 15:240-247. [PMID: 34937040 PMCID: PMC9021618 DOI: 10.1159/000521170] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/23/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The global epidemic of obesity concerns children, and monitoring the prevalence is of highest priority. Body mass index (BMI) with age- and sex-specific cutoff values determines weight status in children, although multiple reference systems exist. Our aim was to compare the prevalence for thinness, normal weight, overweight, and obesity in Finnish school-aged children according to national and international reference values, as well as to determine which cutoff values for overweight agree with the criteria for central obesity. METHODS This study includes 10,646 children aged 9-12 years from the Finnish Health in Teens cohort. Height, weight, and waist circumference were measured in 2011-2014. BMI (weight [kg]/height [m]2) and the waist-to-height ratio (WHtR; waist [cm]/height [cm]) were calculated. The WHtR cutoff of >0.5 indicated central obesity. We compared the sex-specific prevalence of thinness, overweight, and obesity using the International Obesity Task Force (IOTF), World Health Organization (WHO) and Finnish (FIN) BMI-for-age reference values, as well as these three against central obesity based on the WHtR. RESULTS The prevalence of thinness, overweight, and obesity were 11.0%, 12.7%, and 2.6%, respectively, using IOTF; 2.6%, 15.9%, and 5.2% using WHO; and 5.1%, 11.4%, and 2.2% using FIN. Overweight and obesity were more common in boys than girls using WHO and FIN, while thinness was more common in girls using IOTF and FIN. IOTF versus WHO exhibited moderate agreement (κ = 0.59), which improved for IOTF versus FIN (κ = 0.74). Of those classified as overweight by WHO, 37% and 47% were regarded as normal weight according to IOTF and FIN, respectively. The prevalence of central obesity was 8.7%, and it was more common in boys than girls. WHO provided the highest sensitivity: 95% of individuals with central obesity were classified with overweight or obesity. Using FIN provided the highest specificity (93%). CONCLUSION Our findings show that WHO overestimates the prevalence of overweight and obesity, while IOTF overrates thinness. Thus, comparing prevalence rates between studies requires caution. The novelty of this study is the comparison of the cutoff values for overweight with central obesity. The choice of reference system affects the generalizability of the research results.
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Länkimäki S, Spalding M, Saari A, Alahuhta S. Procedural Sedation Intubation in a Paramedic-Staffed Helicopter Emergency Medical System in Northern Finland. Air Med J 2021; 40:385-389. [PMID: 34794775 DOI: 10.1016/j.amj.2021.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/14/2021] [Accepted: 08/26/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Airway management to ensure sufficient gas exchange is of major importance in emergency care. Prehospital endotracheal intubation (ETI) by paramedics is a widely debated method to ensure a patent airway. ETI is performed with procedural sedation in comatose patients because of the regulation. The use of medications increases the rate of successful airway management compared with nonmedication ETI and may also improve outcomes in patients with traumatic brain injury. In the absence of an operative emergency physician and with long distances, paramedic-induced airway management may increase the survival of patients in selected scenarios. A paramedic-staffed helicopter emergency medical system in Northern Finland operates in a rural area without an emergency physician and paralytic medications and treats critically ill patients using basic or advanced life support ground units. The aim of this study was to evaluate the success rates of ETI performed by a small, appropriately trained, and experienced group of 8 nurse paramedics in an out-of-hospital setting. METHODS The inclusion criterion for the study was an attempted intubation in patients with medical or traumatic indication for airway management by nurse paramedic. RESULTS Fifty-one patients were treated with ETI. The first-pass success rate was 72.5%, the second-pass success rate was 94.1%, and the overall success rate was 100% within 4 attempts. The median on-scene time was 54 minutes, and there were no signs of aspiration during laryngoscopy or after successful ETI. The primary mortality rate was 11.7%. CONCLUSION The use of a rigid standard operating procedure for paramedic rapid sequence induction, paralytics, a video laryngoscope, and a gum elastic bougie might positively affect the ETI first-pass success rate. A follow-up study after these future modifications is needed. This small study suggests that intubation might be 1 option for airway management by an experienced nonanesthesiologist in Lapland.
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Karvonen M, Saari A, Sund R, Sankilampi U. Maternal Smoking During Pregnancy and Offspring Head Growth in Comparison to Height and Weight Growth Up to 6 Years of Age: A Longitudinal Study. Clin Epidemiol 2021; 13:959-970. [PMID: 34675684 PMCID: PMC8520481 DOI: 10.2147/clep.s327766] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background Maternal smoking during pregnancy causes fetal growth retardation. Thereafter, it has been associated with excessive childhood weight gain and decreased linear growth in the offspring. However, it is not known whether head circumference (HC), the surrogate of brain size in childhood, is altered after intrauterine tobacco exposure. We assessed the association of maternal smoking during pregnancy with offspring HC growth up to age 6 years in comparison with length/height growth and weight gain. Methods We combined data from Medical Birth Register and longitudinal growth data from primary care of 43,632 children (born 2004–2017). Linear mixed effects models were used for modeling, adjusting for potential perinatal and socioeconomic confounders. Results At birth, maternal smoking during pregnancy was associated with a mean deficit of 0.19 standard deviation score (SDS) (95% CI: −0.25, −0.12) in HC, −0.38 SDS (95% CI: −0.43, −0.32) in length, and −0.08 SDS (95% CI:−0.14, −0.02) in weight-for-length. HC in smokers’ children failed to catch up to that of non-smokers’ children. Height of smokers’ infants reached that of non-smokers’ infants by 12 months but declined thereafter. Weight-for-height of smokers’ infants exceeded the level of non-smokers’ infants at 3 months and remained significantly elevated thereafter. HC in the offspring of mothers who quit smoking in the first trimester was not deficient, but their weight-for-height was elevated. Conclusion HC of smokers’ children is still deficient at age 6 years. Since most of the head growth occurs during the first 2 years of life, the defect may be permanent. In smokers’ children, weight gain was excessive up to 6 years and height was deficient at 6 years consistent with previous literature. Efforts should be made to encourage pregnant women to quit smoking in the beginning of the pregnancy.
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Karvonen M, Saari A, Lamidi M, Selander T, Löppönen T, Lönnqvist T, Dunkel L, Sankilampi U. Screening of hydrocephalus in infants using either WHO or population-based head circumference reference charts. Acta Paediatr 2021; 110:881-888. [PMID: 32794225 DOI: 10.1111/apa.15533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/03/2020] [Accepted: 08/11/2020] [Indexed: 11/28/2022]
Abstract
AIM The aim was to compare the performances of the World Health Organization (WHO) and population-based (PB) references in the screening for hydrocephalus in infants aged <2 years. METHODS We collected 341 longitudinal head circumference (HC) measurements of hydrocephalic infants and 120 181 measurements of 15 145 healthy infants from primary care. The measurements were converted into z-scores, and a new screening parameter, change in HC standard deviation score (SDS) over time (ΔHC SDS), was calculated. Comparisons were made using receiver operating characteristics analysis and linear mixed models. RESULTS The mean HC SDSWHO was 3.5 and the mean HC SDSPB was 2.9 in the hydrocephalic infants, and in healthy children, those numbers were 1.0 SDSWHO and 0 SDSPB , respectively. The best screening accuracy was obtained with the PB reference in combination with the ΔHC SDS parameter (AUC 0.89). The accuracy of the WHO standard could be improved to a similar level by customising the screening cut-offs of HC SDS according to the population and combining screening parameters. CONCLUSIONS Auxology alone was not sufficient for the screening of hydrocephalus. The WHO standard should be validated in the population, and population-specific cut-offs for normality defined before its introduction.
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Saari A, Pokka J, Mäkitie O, Saha MT, Dunkel L, Sankilampi U. Early Detection of Abnormal Growth Associated with Juvenile Acquired Hypothyroidism. J Clin Endocrinol Metab 2021; 106:e739-e748. [PMID: 33245341 DOI: 10.1210/clinem/dgaa869] [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: 08/27/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Development of the typical growth phenotype in juvenile acquired hypothyroidism (JHT), the faltering linear growth with increasing weight, has not been thoroughly characterized. OBJECTIVE To describe longitudinal growth pattern in children developing JHT and investigate how their growth differs from the general population in systematic growth monitoring. DESIGN Retrospective case-control study. SETTING JHT cases from 3 Finnish University Hospitals and healthy matched controls from primary health care. PATIENTS A total of 109 JHT patients aged 1.2 to 15.6 years (born 1983-2010) with 554 height and weight measurements obtained for 5 years preceding JHT diagnosis. Each patient was paired with 100 healthy controls (born 1983-2008) by sex and age. Longitudinal growth pattern was evaluated in mixed linear models. Growth monitoring parameters were evaluated using receiver operating characteristics analysis. RESULTS At diagnosis, JHT patients were heavier (mean adjusted body mass index-for-age [BMISDS] difference, 0.65 [95% CI, 0.46-0.84]) and shorter (mean adjusted height-for-age deviation from the target height [THDEVSDS] difference, -0.34 [95% CI, -0.57 to -0.10]) than healthy controls. However, 5 years before diagnosis, patients were heavier (mean BMISDS difference, 0.33 [95% CI, 0.12-0.54]) and taller (mean THDEVSDS difference, 0.29 [95% CI, 0.06-0.52]) than controls. JHT could be detected with good accuracy when several growth parameters were used simultaneously in screening (area under the curve, 0.83 [95% CI, 0.78-0.89]). CONCLUSIONS Abnormal growth pattern of patients with JHT evolves years before diagnosis. Systematic growth monitoring would detect abnormal growth at an early phase of JHT and facilitate timely diagnosis of JHT.
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Leskinen T, Eloranta AM, Tompuri T, Saari A, Ollila H, Mäkelä J, Niinikoski H, Lagström H. Changes in body composition by age and obesity status in preschool-aged children: the STEPS study. Eur J Clin Nutr 2020; 75:57-65. [PMID: 32647366 DOI: 10.1038/s41430-020-0678-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/02/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Obesity in early childhood is associated with increased risk of chronic diseases, but studies of body composition at preschool ages are sparse. Therefore, we examined differences in body composition by sex and obesity status in Finnish preschool-aged children and within-individual changes in body composition in normal and overweight children. SUBJECT/METHODS Body composition was measured using segmental multifrequency bioimpedance analysis (BIA) in 476 children and in 781 children at age 3 and 5 years, respectively. Of those, 308 had repeated BIA measurements at both ages. BMI-SDS was used for classification of normal weight and overweight children. RESULTS Sex difference in the amount of lean mass (LM) was already seen at 3 years of age (boys 11.7 kg, girls 11.3 kg; p < 0.001). At 5 years of age, boys had lower fat mass (FM; 3.6 kg vs. 3.9 kg, p < 0.001), lower percent fat mass (%FM; 17.2% vs. 19.1%; p < 0.001), and higher LM (16.0 kg vs. 15.2 kg; p < 0.001) than girls. Overweight children had higher values in FM, %FM, and LM compared with normal weight peers at both ages. Among normal weight children, the increase of LM by age was associated with only minor changes in FM, whereas children who were or became overweight both LM and FM was substantially increased between 3 and 5 years of age. CONCLUSIONS BIA-assessed body composition differs by sex and obesity status already at age of 3 years. For children who are or become overweight at very young age, the patterns for the changes in LM and FM by age are different than for normal weight children.
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Riikonen R, Törmänen S, Saari A, Koponen P, Helminen M, Nuolivirta K, Korppi M, Lauhkonen E. Preliminary communication suggests overweight was associated with reduced lung function in adolescence after infant bronchiolitis. Acta Paediatr 2019; 108:1729-1730. [PMID: 31162726 DOI: 10.1111/apa.14886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Saari A, Sankilampi U. Is There a Causal Link Between Antibiotic Exposure During Infancy and Risk for Obesity? Pediatrics 2018; 142:peds.2018-2692. [PMID: 30381475 DOI: 10.1542/peds.2018-2692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2018] [Indexed: 11/24/2022] Open
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Stalman SE, Hellinga I, van Dommelen P, Hennekam RCM, Saari A, Sankilampi U, Dunkel L, Wit JM, Kamp GA, Plötz FB. Application of the Dutch, Finnish and British Screening Guidelines in a Cohort of Children with Growth Failure. Horm Res Paediatr 2016; 84:376-82. [PMID: 26448202 DOI: 10.1159/000440652] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/25/2015] [Indexed: 11/19/2022] Open
Abstract
AIMS To evaluate three guidelines for selecting short children for diagnostic workup in a general pediatric clinic. METHODS All patients (n = 131) aged 3.00-9.99 years who were referred for growth failure to a general pediatric clinic were evaluated for their medical history and growth and examined. All of them underwent the same standardized diagnostic workup. Retrospectively, the criteria for the diagnostic workup from three guidelines (proposed in the Netherlands, Finland and the UK) were applied, and their sensitivity was assessed. A Dutch reference sample (n = 958) was used for calculating population specificity. RESULTS In 23 patients (17.6%), a pathological cause of their growth failure was found. The sensitivity of the original Dutch, Finnish and British guidelines was 73.9, 78.3 and 56.5% and their specificity 98.5, 83.7 and 95.8%, respectively. When adding recent growth deflection to the Dutch guideline, sensitivity increased to 87%, but specificity decreased markedly (to 87%). CONCLUSION The proposed cutoff values for height standard deviation score and distance to target height/mid-parental height, as used in the Netherlands and Finland, are effective for population growth monitoring, and superior to the monitoring algorithm in the UK. Growth deflection irrespective of height is an important sign of acquired growth disorders, but its specificity is too low for population screening.
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Saari A, Schröder T. Pharmacokinetics of Three Contrast Media in Experimental Pancreatography. Acta Radiol 2016. [DOI: 10.1177/028418518903000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Diatrizoate, iohexol and ioxaglate were compared in experimental pancreatography in piglets. Outflow of contrast medium (CM) through the pancreatic papilla was permitted (n=14) or impaired (n=17) during examination. The CM concentrations were measured in portal and systemic plasma and in lymph to study the absorption of CM. Absorption of diatrizoate and iohexol was similar in both types of experiment, but radiographically, diatrizoate escaped significantly earlier from the pancreatic duct when outflow was permitted (p<0.01), suggesting that the CM was absorbed mainly during injection. Ioxaglate concentrations rose more slowly in systemic plasma and lymph, and fell more slowly in the portal plasma than those of diatrizoate and iohexol, which suggests that ioxaglate was absorbed over a longer period. When outflow was impaired, ioxaglate concentrations remained on a lower level, indicating less penetration in the pancreatic parenchyma. CM absorption varied markedly within each group, suggesting that variations in intraductal pressure and flow are more important in absorption than the type of CM used.
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Kivisaari L, Nuutinen P, Lehtola A, Saari A, Pitkäranta P, Standertskjöld-Nordenstam CG, Lempinen M, Schröder T. Ionic and Non-Ionic Contrast Media Used for Contrast-Enhanced Computed Tomography in Experimental Pancreatitis. Acta Radiol 2016. [DOI: 10.1177/028418518802900221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Contrast enhancement of the pancreas was studied in pigs using dynamic computed tomography in experimental oedematous and haemorrhagic/necrotizing pancreatitis during the first two minutes after injection of an intravenous bolus of non-ionic contrast medium (iohexol). The prospects of separating the two forms of the disease, known to be possible with ionic contrast media, were tested with a non-ionic contrast medium. In the oedematous form, contrast enhancement after 5 hours of the disease was significantly higher than in the haemorrhagic/necrotizing form. Contrast enhancement after 30 hours of disease tended to vary with the severity of the disease, showing that the course of oedematous pancreatitis is dynamic. Intermediate forms occur and follow-up studies are needed during the disease. A non-ionic contrast medium proved as good for separating the two forms of the disease in the early phase as were ionic contrast media. In severely ill patients, non-ionic contrast media should therefore be used.
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Kiviranta P, Kuiri-Hänninen T, Saari A, Lamidi ML, Dunkel L, Sankilampi U. Transient Postnatal Gonadal Activation and Growth Velocity in Infancy. Pediatrics 2016; 138:peds.2015-3561. [PMID: 27283013 DOI: 10.1542/peds.2015-3561] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Transient activation of the hypothalamic-pituitary-gonadal axis with a sex steroid surge is observed in boys and girls during the first months of life. However, the role of sex steroids in the regulation of growth has not been substantiated in infancy. We tested the hypothesis that testosterone (T) surge, known to be higher in infant boys than in girls during the transient postnatal gonadal activation regulates linear growth in infants. METHODS To characterize in detail the linear growth velocity (GV) differences between genders in the normal population in early infancy, we evaluated growth of 18 570 healthy infants (51.0% boys) with 162 003 height measurements from birth to 12 months of age. GV was monitored and compared with serially measured urinary T and estradiol levels and serum insulin-like growth factor 1 levels in 84 healthy infants (45% boys) during the first 6 months of life. RESULTS GV was significantly faster from birth to 6 months of age in boys than in girls (P ≤ .01). The greatest GV difference, 4.1 cm per year, was observed at 1 month of age, simultaneously with the peak of postnatal gonadal activation. In the mixed model analysis, GV showed a significant positive association with T in both genders (parameter estimate up to 0.62, 95% confidence interval 0.44-0.81). CONCLUSIONS These results provide a new insight into the regulation of growth in infants and elucidate a novel biological role of the transient postnatal gonadal activation in growth regulation.
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Saari A, Sankilampi U. [Finland is a pioneer in childhood growth monitoring--Is is evidence-based?]. DUODECIM; LAAKETIETEELLINEN AIKAKAUSKIRJA 2016; 132:505-513. [PMID: 27132291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In Finland, growth monitoring is a fundamental part of preventive child health care, aiming at an early detection of childhood illnesses as well as weight gain or loss. However, evidence-based studies on growth monitoring are practically lacking. Updated growth curves must be representative of the monitored population. Screening of Turner syndrome and celiac disease with novel growth monitoring methods could facilitate early diagnosis. Electronic health records provide an alternative to develop an automated growth monitoring program, which was found to be distinctly better than the manually orientated one in primary care. Systematic growth monitoring seems to be beneficial, although true population- based evidence on effectiveness is scarce.
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Lauhkonen E, Koponen P, Nuolivirta K, Paassilta M, Toikka J, Saari A, Korppi M. Obesity and bronchial obstruction in impulse oscillometry at age 5-7 years in a prospective post-bronchiolitis cohort. Pediatr Pulmonol 2015; 50:908-14. [PMID: 25044353 DOI: 10.1002/ppul.23085] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 05/30/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS Obesity has been linked with asthma symptoms, need for asthma treatment and reduced lung function but not with increased bronchial reactivity in children. The aim of this study was to evaluate the association between previous or current weight status and current lung function and bronchial reactivity to exercise at early school age. METHODS Ninety-nine children hospitalized for bronchiolitis at the age of less than 6 months were studied with impulse oscillometry (IOS) at the mean age of 6.3 years. Data on birth weight and weight gain in infancy before hospitalization were collected during hospitalization. Current weight and height data were transformed into age- and sex-specific height-related body mass index z scores (zBMI) using the Finnish national population-based weight and height data as reference. RESULTS Some significant though only low or modest correlations were found between current zBMI and baseline, post-exercise and post-bronchodilator IOS values in adjusted linear regression analysis. Seven obese children by zBMI had higher post-bronchodilator airway impedance (Zrs) and resistance (Rrs) at 5 Hz and lower post-bronchodilator frequency dependency of resistance (dRrs/df) than normal weight children. There were no significant differences in responses to exercise or to bronchodilators between currently obese or overweight children and normal weight children. Birth weight less than 3,000 g was associated with larger exercise-induced changes in Zrs and Rrs at 5 Hz, and in reactance (Xrs) at 5 Hz, than those with birth weight more than 3,000 g. CONCLUSIONS Preliminary evidence was found that obesity may be associated with airway obstruction, but not with bronchial hyper-reactivity.
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Korhonen PH, Suursalmi PH, Kopeli T, Nieminen R, Lehtimäki L, Luukkaala T, Korppi M, Saari A, Moilanen E, Tammela OKT. Inflammatory activity at school age in very low birth weight bronchopulmonary dysplasia survivors. Pediatr Pulmonol 2015; 50:683-90. [PMID: 24668942 DOI: 10.1002/ppul.23038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 02/28/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Airway inflammation is involved in the pathogenesis of bronchopulmonary dysplasia (BPD). The aim of the study was to evaluate the inflammatory activity in plasma and exhaled air in very low birth weight (VLBW) BPD survivors at school age. METHODS Twenty-one 6-14-year-old former VLBW (birth weight ≤1,500 g) children with severe radiographic BPD (radBPD), 19 without radBPD (nonBPD group) and 19 non-asthmatic term controls underwent measurement of eosinophil cationic protein, IL-6, IL-8, adiponectin, adipsin, leptin, and resistin in plasma, leukotriene B4 and 8-isoprostane in exhaled breath condensate, and NO in exhaled breath. Background data were obtained from patient records, clinical examination and parental questionnaire. Both univariate and multivariate models were applied in the statistical analysis. RESULTS There were no significant differences between the groups in any of the inflammatory markers measured. Five (25%) radBPD and 2 (11%) nonBPD children reported asthma (P = 0.058). In logistic regression analysis, exposure to chorioamnionitis was associated with low IL-8 (OR 29.0, 95% CI 3.27-258) and postnatal corticosteroid therapy with high adiponectin (OR 32.0, 95% CI 1.29-793). High body mass index standard deviation score (BMI-SDS) was associated with high plasma adipsin (OR 2.47, 95% CI 1.07-5.75) and leptin (OR 5.76, 95%CI 1.83-18.2) levels. CONCLUSIONS The inflammatory activity seems to decrease by school age in VLBW BPD survivors. Chorioamnionitis and postnatal corticosteroid treatment may modulate the inflammatory responsiveness in VLBW subjects even up to school age. The respiratory outcome in VLBW infants might be improved by preventing excessive weight gain.
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Törmänen S, Lauhkonen E, Saari A, Koponen P, Korppi M, Nuolivirta K. Excess weight in preschool children with a history of severe bronchiolitis is associated with asthma. Pediatr Pulmonol 2015; 50:424-30. [PMID: 24753502 DOI: 10.1002/ppul.23053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 03/21/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND The relationship between excess weight gain and asthma in childhood remains inadequately defined. The aim of this study was to evaluate, as part of a prospective post-bronchiolitis follow-up, whether there is a link between earlier or current overweight or obesity and asthma or asthma symptoms at 5-7 years of age. METHODS In all, 151 former bronchiolitis patients were followed-up until the mean age of 6.45 years. At the control visit, the weights and heights were measured, and the asthma symptoms and medications for asthma were recorded. The weight status was expressed as body mass index (BMI) z-scores (zBMI). RESULTS There were 10 obese and 31 overweight (zBMI over national references) children. In adjusted analyses, presence of current asthma at 6-7 years of age (aOR 3.05, 95% CI 1.02-9.93) differed between overweight and normal weight children. Further, asthma ever, asthma at age 4-5 years, asthma at age 5-6 years, use of bronchodilators ever and use of ICSs during the last 12 months were more common in currently overweight than in normal weight children. Obesity was associated only with current asthma and asthma ever. Instead, there were no significant associations between birth weight, excess weight gain in infancy, or overweight at age 1.5 years, and later asthma, asthma symptoms or use of asthma medication. CONCLUSION Asthma was more common in currently overweight than in normal weight former bronchiolitis patients at preschool age and early school age.
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Saari A, Virta LJ, Sankilampi U, Dunkel L, Saxen H. Antibiotic exposure in infancy and risk of being overweight in the first 24 months of life. Pediatrics 2015; 135:617-26. [PMID: 25825533 DOI: 10.1542/peds.2014-3407] [Citation(s) in RCA: 257] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Antibiotics have direct effects on the human intestinal microbiota, particularly in infancy. Antibacterial agents promote growth in farm animals by unknown mechanisms, but little is known about their effects on human weight gain. Our aim was to evaluate the impact of antibiotic exposure during infancy on weight and height in healthy Finnish children. METHODS The population-based cohort comprised 6114 healthy boys and 5948 healthy girls having primary care weight and height measurements and drug purchase data from birth to 24 months. BMI and height, expressed as z-scores at the median age of 24 months (interquartile range 24 to 26 months), were compared between children exposed and unexposed to antibiotics using analysis of covariance with perinatal factors as covariates. RESULTS Exposed children were on average heavier than unexposed children (adjusted BMI-for-age z-score difference in boys 0.13 SD [95% confidence interval 0.07 to 0.19, P < .001] and in girls 0.07 SD [0.01 to 0.13, P < .05]). The effect was most pronounced after exposure to macrolides before 6 months of age (boys 0.28 [0.11 to 0.46]; girls 0.23 [0.04 to 0.42]) or >1 exposure (boys 0.20 [0.10 to 0.30]; girls 0.13 [0.03 to 0.22]). CONCLUSIONS Antibiotic exposure before 6 months of age, or repeatedly during infancy, was associated with increased body mass in healthy children. Such effects may play a role in the worldwide childhood obesity epidemic and highlight the importance of judicious use of antibiotics during infancy, favoring narrow-spectrum antibiotics.
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Saari A, Harju S, Mäkitie O, Saha MT, Dunkel L, Sankilampi U. Systematic growth monitoring for the early detection of celiac disease in children. JAMA Pediatr 2015; 169:e1525. [PMID: 25730696 DOI: 10.1001/jamapediatrics.2015.25] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Growth-monitoring programs in children aim to achieve the early detection of disorders that affect growth. Celiac disease (CD) is underdiagnosed in the pediatric population in which the presenting features often include faltering linear growth, short stature, or poor weight gain. OBJECTIVES To develop new evidence-based cutoffs for screening for growth disorders and to evaluate the performance of these cutoffs among children with CD measured regularly in a nationwide growth screening program. DESIGN, SETTING, AND PARTICIPANTS A longitudinal retrospective study that included longitudinal growth data of healthy children (the reference population) from primary health care and children with CD (the cases) from primary health care and 3 university hospital outpatient clinics in Finland (Kuopio University Hospital, Tampere University Hospital, and Helsinki University Hospital) from January 1, 1994, to April 9, 2009. Children of the reference population were between 0 and 20 years of age and children with CD were between 1 and 16 years of age. In the reference population of 51,332 healthy children, 5 age-specific and sex-specific growth-screening parameters (height standard deviation score and body mass index standard deviation score distance from the population mean, distance from target height, change in height standard deviation score, and change in body mass index standard deviation score) were developed. Performance of these parameters and their combination was evaluated in 177 children with CD by analyzing longitudinal growth data from birth until diagnosis of CD. MAIN OUTCOME AND MEASURE The screening accuracy for detecting abnormal growth in children with CD, assessed using receiver operating characteristics analysis expressed as the area under the curve. RESULTS Celiac disease was detected with good accuracy (area under the curve [95% CI] = 0.88 [0.84-0.93] for girls and 0.84 [0.77-0.91] for boys) when screening was performed using the combination of all 5 growth-screening parameters. When the specificity of the screening was set at 90%, growth was already abnormal in 57% of the girls with CD and 48% of the boys with CD 2 years prior to diagnosis. CONCLUSIONS AND RELEVANCE Prior to diagnosis, growth faltered in most children with CD. These children could have been detected several years earlier by a well-established growth-monitoring program. Acceptable screening accuracy can be achieved for CD via the use of several growth-monitoring parameters in combination, preferably using computerized screening algorithms that are integrated into an electronic health record system.
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Karvonen M, Saari A, Hannila ML, Lönnqvist T, Dunkel L, Sankilampi U. Elevated head circumference-to-height ratio is an early and frequent feature in children with neurofibromatosis type 1. Horm Res Paediatr 2013; 79:97-102. [PMID: 23466600 DOI: 10.1159/000347119] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 01/14/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Children with neurofibromatosis type 1 (NF1) tend to be macrocephalic and short. Our aim was to define the incidence and diagnostic accuracy of elevated head circumference-to-height ratio (HCHR) in children with NF1 and to assess if elevated HCHR would facilitate early diagnosis of NF1. METHODS Retrospective analysis of growth and health data of 80 NF1 patients aged 0-7 years was performed. The incidence and diagnostic accuracy of elevated HCHR for NF1 was analyzed using receiver operating characteristic curves. RESULTS The median age when the first elevated (≥2.0 SDS) HCHR value was detected was 0.3 years (range 0.0-5.3). At the median age of diagnosis (3.6 years), 53.8% of NF1 children exhibited elevated HCHR. The diagnostic accuracy of HCHR alone was 0.78 (95% CI 0.72-0.84), but in comparison with the seven National Institutes of Health diagnostic criteria for NF1, elevated HCHR was the second most prevalent feature. CONCLUSION Elevated HCHR is an early and frequent feature in NF1 children. Taking HCHR into account would facilitate the early detection of NF1.
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Sankilampi U, Saari A, Laine T, Miettinen PJ, Dunkel L. Use of electronic health records for automated screening of growth disorders in primary care. JAMA 2013; 310:1071-2. [PMID: 24026604 DOI: 10.1001/jama.2013.218793] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Sankilampi U, Hannila ML, Saari A, Gissler M, Dunkel L. New population-based references for birth weight, length, and head circumference in singletons and twins from 23 to 43 gestation weeks. Ann Med 2013; 45:446-54. [PMID: 23768051 DOI: 10.3109/07853890.2013.803739] [Citation(s) in RCA: 191] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Birth size curves are needed for clinical and epidemiological purposes. We constructed birth weight (BW), length (BL), and head circumference (BHC) references, assessed effects of twinness and parity, and defined cut-off points for small, appropriate, and large for gestational age. MATERIALS AND METHODS Birth register data of all 753,036 infants born in 1996-2008 in Finland were cleaned to create references reflecting optimal intrauterine growth. The final data included 533,666 singletons and 15,033 twins (median gestation weeks (gws) 40.0 and 37.1, respectively, 41.6% primiparous). Sex-specific BW, BL, and BHC references were constructed from 23 to 43 gws separately for singletons and twins born to primiparous or multiparous mothers. GAMLSS method was used for modelling. RESULTS In singletons from 36 gws onwards, increased BW and BL were observed in comparison to previous reference from 1979-1983. Twins diverged from singletons from 30 gws onwards. At 37.0 gws, mean BW was 400 g lower and mean BL 1.2 cm shorter than in singletons. From 30 gws onwards, birth size was larger in infants of multiparous than primiparous mothers. CONCLUSIONS Population-based birth size references are available for the evaluation of birth size. Accounting for plurality and parity improves the accuracy of birth size evaluation.
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Mustila T, Raitanen J, Keskinen P, Saari A, Luoto R. Pragmatic controlled trial to prevent childhood obesity in maternity and child health care clinics: pregnancy and infant weight outcomes (the VACOPP Study). BMC Pediatr 2013; 13:80. [PMID: 23688259 PMCID: PMC3664621 DOI: 10.1186/1471-2431-13-80] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 05/15/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND According to current evidence, the prevention of obesity should start early in life. Even the prenatal environment may expose a child to unhealthy weight gain; maternal gestational diabetes is known to be among the prenatal risk factors conducive to obesity. Here we report the effects of antenatal dietary and physical activity counselling on pregnancy and infant weight gain outcomes. METHODS The study was a non-randomised controlled pragmatic trial aiming to prevent childhood obesity, the setting being municipal maternity health care clinics. The participants (n = 185) were mothers at risk of developing gestational diabetes mellitus and their offspring. The children of the intervention group mothers were born between 2009 and 2010, and children of the control group in 2008. The intervention started between 10-17 gestational weeks and consisted of individual counselling on diet and physical activity by a public health nurse, and two group counselling sessions by a dietician and a physiotherapist. The expectant mothers also received a written information leaflet to motivate them to breastfeed their offspring for at least 6 months. We report the proportion of mothers with pathological glucose tolerance at 26-28 weeks' gestation, the mother's gestational weight gain (GWG) and newborn anthropometry. Infant weight gain from 0 to 12 months of age was assessed as weight-for-length standard deviation scores (SDS) and mixed effect linear regression models. RESULTS Intervention group mothers had fewer pathological oral glucose tolerance test results (14.6% vs. 29.2%; 95% CI 8.9 to 23.0% vs. 20.8 to 39.4%; p-value 0.016) suggesting that the intervention improved gestational glucose tolerance. Mother's GWG, newborn anthropometry or infant weight gain did not differ significantly between the groups. CONCLUSION Since the intervention reduced the prevalence of gestational diabetes mellitus, it may have the potential to diminish obesity risk in offspring. However, results from earlier studies suggest that the possible effect on the offspring's weight gain may manifest only later in childhood. TRIAL REGISTRATION Clinical Trials gov: NCT00970710.
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