1
|
Ter Borg S, Koopman N, Verkaik-Kloosterman J. An Evaluation of Food and Nutrient Intake among Pregnant Women in The Netherlands: A Systematic Review. Nutrients 2023; 15:3071. [PMID: 37447397 DOI: 10.3390/nu15133071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Nutritional deficiencies during pregnancy can have serious consequences for the health of the (unborn) child. This systematic review provides an updated overview of the available food and nutrient intake data for pregnant women in The Netherlands and an evaluation based on the current recommendations. Embase, MEDLINE, and national institute databases were used. Articles were selected if they had been published since 2008 and contained data on food consumption, nutrient intake, or the status of healthy pregnant women. A qualitative comparison was made with the 2021 Dutch Health Council recommendations and reference values. A total of 218 reports were included, representing 54 individual studies. Dietary assessments were primarily performed via food frequency questionnaires. Protein, vitamin A, thiamin, riboflavin, vitamin B6, folate, vitamin B12, vitamin C, iron, calcium, and magnesium intakes seemed to be adequate. For folate and vitamin D, supplements were needed to reach the recommended intake. The reasons for concern are the low intakes of fruits, vegetables, and (fatty) fish, and the intakes of alcohol, sugary drinks, and salt. For several foods and nutrients, no or limited intake data were found. High-quality, representative, and recent data are needed to evaluate the nutrient intake of pregnant women in order to make accurate assessments and evaluations, supporting scientific-based advice and national nutritional policies.
Collapse
Affiliation(s)
- Sovianne Ter Borg
- National Institute for Public Health and the Environment, 3721 BA Bilthoven, The Netherlands
| | - Nynke Koopman
- National Institute for Public Health and the Environment, 3721 BA Bilthoven, The Netherlands
| | | |
Collapse
|
2
|
Hoyt AT, Wilkinson AV, Langlois PH, Galeener CA, Ranjit N, Dabelea DM, Moore BF. Prenatal Exposure to Tobacco and Childhood Cognition and Behavior: Effect Modification by Maternal Folate Intake and Breastfeeding Duration. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01524-x. [PMID: 37029873 DOI: 10.1007/s10578-023-01524-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 04/09/2023]
Abstract
In this exploratory analysis, we assessed whether nutrition modified the association between prenatal exposure to tobacco and childhood cognition/behavior among 366 Colorado-based mothers and their offspring (born ≥ 37 weeks with birthweights ≥ 2500 g). Interaction by folate (≥ 1074 µg/day) and breastfeeding (≥ 5 months) was assessed by including a product term with cotinine (≥ limit of detection [LOD]) in regression models for NIH Toolbox and Child Behavior Checklist T-scores. Main effects were observed between cotinine ≥ LOD and inhibitory control (- 3.2; 95% CI: - 6.8, 0.3), folate < 1074 µg/day and anxious/depressed symptoms (1.1; 95% CI: 0.1, 2.1), and breastfeeding < 5 months and receptive language (- 4.3; 95% CI: - 8.5, - 0.02), though these findings would not survive Bonferroni correction. Breastfeeding modified the tobacco-behavior associations. Sleep (3.8; 95% CI: 0.5, 7.1; interaction p-value = 0.02), depressive (4.6; 95% CI: 1.0, 8.2; interaction p-value = 0.01) and total problems (5.8; 95% CI: - 0.7, 12.4; interaction p-value = 0.09) were observed among tobacco-exposed offspring who breastfed > 5 months, but not for shorter durations. Our findings support the need for smoking cessation campaigns throughout pregnancy and throughout the postpartum period breastfeeding to reduce neurobehavioral risks in the offspring.
Collapse
Affiliation(s)
- Adrienne T Hoyt
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health - Austin Regional Campus, Austin, TX, USA
| | - Anna V Wilkinson
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health - Austin Regional Campus, Austin, TX, USA
| | - Peter H Langlois
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health - Austin Regional Campus, Austin, TX, USA
| | - Carol A Galeener
- Department of Management, Policy and Community Health, Fleming Center Health for Care Management Houston, UTHealth School of Public Health- Houston Regional Campus, Houston, TX, USA
| | - Nalini Ranjit
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health - Austin Regional Campus, Austin, TX, USA
| | - Dana M Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Brianna F Moore
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health - Austin Regional Campus, Austin, TX, USA.
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Aurora, CO, USA.
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
- University of Colorado Anschutz Medical Campus, 1890 N Revere Ct, Aurora, CO, 80045, USA.
| |
Collapse
|
3
|
Hoyt AT, Wilkinson AV, Langlois PH, Galeener CE, Ranjit N, Sauder KA, Dabelea DM, Moore BF. Prenatal exposure to tobacco and adverse birth outcomes: effect modification by folate intake during pregnancy. Matern Health Neonatol Perinatol 2022; 8:6. [PMID: 36096906 PMCID: PMC9465971 DOI: 10.1186/s40748-022-00141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/01/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Fetal exposure to tobacco increases the risk for many adverse birth outcomes, but whether diet mitigates these risks has yet to be explored. Here, we examined whether maternal folate intake (from foods and supplements) during pregnancy modified the association between prenatal exposure to tobacco and with preterm delivery, small-for-gestational age (SGA) births, or neonatal adiposity. METHODS Mother-child pairs (n = 701) from Healthy Start were included in this analysis. Urinary cotinine was measured at ~ 27 weeks gestation. Diet was assessed using repeated 24-h dietary recalls. Neonatal adiposity (fat mass percentage) was measured via air displacement plethysmography. Interaction was assessed by including a product term between cotinine (< / ≥ limit of detection [LOD]) and folate (< / ≥ 25th percentile [1077 µg/day]) in separate logistic or linear regression models, adjusting for maternal age, race, ethnicity, education, pre-pregnancy body mass index, and infant sex. RESULTS Approximately 26% of women had detectable levels of cotinine. Folate intake was significantly lower among women with cotinine ≥ LOD as compared to those with cotinine < LOD (1293 µg/day vs. 1418 µg/day; p = 0.01). Folate modified the association between fetal exposure to tobacco with neonatal adiposity (p for interaction = 0.07) and SGA (p for interaction = 0.07). Among those with lower folate intake, fetal exposure to tobacco was associated with lower neonatal adiposity (mean difference: -2.09%; 95% CI: -3.44, -0.74) and increased SGA risk (OR: 4.99; 95% CI: 1.55, 16.14). Conversely, among those with higher folate intake, there was no difference in neonatal adiposity (mean difference: -0.17%; 95% CI: -1.13, 0.79) or SGA risk (OR: 1.15; 95% CI: 0.57, 2.31). CONCLUSIONS Increased folate intake during pregnancy (from foods and/or supplements) may mitigate the risk of fetal growth restriction among those who are unable to quit smoking or cannot avoid secondhand smoke during pregnancy.
Collapse
Affiliation(s)
- Adrienne T Hoyt
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health - Austin Regional Campus, Austin, TX, USA
| | - Anna V Wilkinson
- Department of Epidemiology, UTHealth School of Public Health - Austin Regional Campus, Human Genetics, and Environmental Sciences, Austin, TX, USA
| | - Peter H Langlois
- Department of Epidemiology, UTHealth School of Public Health - Austin Regional Campus, Human Genetics, and Environmental Sciences, Austin, TX, USA
| | - Carol E Galeener
- Department of Management, Policy and Community Health, UTHealth School of Public Health- Houston Regional Campus, Fleming Center Health for Care Management, Houston, TX, USA
| | - Nalini Ranjit
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health - Austin Regional Campus, Austin, TX, USA
| | - Katherine A Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) CenterDepartment of PediatricsSchool of Medicine, Colorado School of Public Health, University of Colorado, Denver, USA
| | - Dana M Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Department of Pediatrics, Department of Epidemiology, University of Colorado School of Medicine, Colorado School of Public Health, Aurora, CO, USA
| | - Brianna F Moore
- Department of Epidemiology, UTHealth School of Public Health - Austin Regional Campus, Human Genetics, and Environmental Sciences, Austin, TX, USA.
| |
Collapse
|
4
|
Yang L, Wang W, Mao B, Qiu J, Guo H, Yi B, He X, Lin X, Lv L, Xu X, Liu Q, Cao Y, Chen Y. Maternal Folic Acid Supplementation, Dietary Folate Intake, and Low Birth Weight: A Birth Cohort Study. Front Public Health 2022; 10:844150. [PMID: 35757618 PMCID: PMC9218084 DOI: 10.3389/fpubh.2022.844150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/08/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives To investigate the independent and collective effects of maternal folic acid supplementation or dietary folate intake on the risk of low birth weight (LBW), and to further comprehensively examine the joint associations of folic acid supplementation and dietary folate intake with LBW by various clinical subtypes. Design Participants were recruited from Gansu Provincial Maternity and Child Care Hospital. A standardized and structured questionnaire was distributed to collect demographic factors, reproductive and medical history, occupational and residential history, physical activity, and diet. Data on pregnancy-related complications and birth outcomes were extracted from medical records. Unconditional logistic regression models were used to estimate the odds ratio (OR) and 95% confidence interval (95% CI) for single and joint associations of folic acid supplementation and dietary folate intake with LBW. Setting A birth cohort data analysis using the 2010–2012 Gansu Provincial Maternity and Child Care Hospital in Lanzhou, China. Participants In total, 9,231 pregnant women and their children were enrolled in the study. Results Compared with non-users, folic acid supplementation was associated with a reduced risk of LBW (OR: 0.80, 95% CI: 0.66–0.97), and the reduced risk was mainly seen for term-LBW (OR: 0.59, 95% CI: 0.41–0.85), and multiparous-LBW (OR: 0.72, 95% CI: 0.54–0.94). There were no significant associations between dietary folate intake and LBW, and there was no interaction between folic acid supplement and dietary folate intake on LBW. Conclusions Our study results indicated that folic acid supplementation was associated with a reduced risk of LBW, and there was no interaction between folic acid supplements and dietary folate intake on LBW.
Collapse
Affiliation(s)
- Liping Yang
- Department of Public Health and Infection Management, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Wenjuan Wang
- Department of Information Administration, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Baohong Mao
- Department of Information Administration, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Jie Qiu
- Department of Information Administration, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Huaqi Guo
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Yi
- Department of Information Administration, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Xiaochun He
- Department of Information Administration, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Xiaojuan Lin
- Department of Information Administration, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Ling Lv
- Department of Information Administration, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Xiaoying Xu
- Department of Information Administration, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Qing Liu
- Department of Information Administration, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Yongchun Cao
- Department of Operation Management, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Yiming Chen
- Department of Human Resource, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| |
Collapse
|
5
|
Mao YY, Yang L, Li M, Liu J, Zhu QX, He Y, Zhou WJ. Periconceptional Folic Acid Supplementation and the Risk of Spontaneous Abortion among Women Who Prepared to Conceive: Impact of Supplementation Initiation Timing. Nutrients 2020; 12:nu12082264. [PMID: 32751085 PMCID: PMC7469034 DOI: 10.3390/nu12082264] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/18/2020] [Accepted: 07/26/2020] [Indexed: 12/02/2022] Open
Abstract
It is unclear whether periconceptional folic acid (FA) supplementation decreases the risk of spontaneous abortion (SA). The impact of supplementation initiation timing has not been ascertained. This cohort study aimed to investigate the association between maternal periconceptional FA supplementation and risk of SA, with due consideration of the supplementation initiation timing. Through the National Free Pre-conception Health Examination Project (NFPHEP), we identified 65,643 pregnancies on FA supplementation in Chongqing, China between 2010 and 2015. After adjusting for covariates, maternal periconceptional FA supplementation was associated with a lower risk of SA (adjusted risk ratio [aRR]: 0.52; 95% confidence interval [CI]: 0.48–0.56). Pregnant women with FA supplementation initiated at least 3 months before conception had a 10% lower risk of SA (aRR: 0.46; 95% CI: 0.42–0.50) than those with FA supplementation initiated 1–2 months before conception (aRR: 0.56; 95% CI: 0.50–0.62) or after conception (aRR: 0.56; 95% CI: 0.51–0.61). These associations might not thoroughly account for FA supplementation, and to some extent our findings confirm the role of the utilization of healthcare in preventing SAs. Women who initiated healthcare, including taking FA earlier during the periconceptional period, could have a lower risk of SA.
Collapse
Affiliation(s)
- Yan-Yan Mao
- NHC Key Laboratory of Reproduction Regulation, Shanghai Institute of Planned Parenthood Research, Fudan University, Shanghai 200237, China; (Y.-Y.M.); (M.L.); (Q.-X.Z.); (W.-J.Z.)
| | - Liu Yang
- NHC Key Laboratory of Birth Defects and Reproductive Health, Chongqing Population and Family Planning Science and Technology Research Institute, Chongqing 400020, China; (L.Y.); (J.L.)
| | - Min Li
- NHC Key Laboratory of Reproduction Regulation, Shanghai Institute of Planned Parenthood Research, Fudan University, Shanghai 200237, China; (Y.-Y.M.); (M.L.); (Q.-X.Z.); (W.-J.Z.)
| | - Jun Liu
- NHC Key Laboratory of Birth Defects and Reproductive Health, Chongqing Population and Family Planning Science and Technology Research Institute, Chongqing 400020, China; (L.Y.); (J.L.)
| | - Qian-Xi Zhu
- NHC Key Laboratory of Reproduction Regulation, Shanghai Institute of Planned Parenthood Research, Fudan University, Shanghai 200237, China; (Y.-Y.M.); (M.L.); (Q.-X.Z.); (W.-J.Z.)
| | - Yang He
- NHC Key Laboratory of Birth Defects and Reproductive Health, Chongqing Population and Family Planning Science and Technology Research Institute, Chongqing 400020, China; (L.Y.); (J.L.)
- Correspondence: ; Tel.: +86-23-8671-4517
| | - Wei-Jin Zhou
- NHC Key Laboratory of Reproduction Regulation, Shanghai Institute of Planned Parenthood Research, Fudan University, Shanghai 200237, China; (Y.-Y.M.); (M.L.); (Q.-X.Z.); (W.-J.Z.)
| |
Collapse
|
6
|
The determinants of maternal homocysteine in pregnancy: findings from the Ottawa and Kingston Birth Cohort. Public Health Nutr 2020; 23:3170-3180. [PMID: 32188521 DOI: 10.1017/s1368980019004002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Observational studies have linked elevated homocysteine to vascular conditions. Folate intake has been associated with lower homocysteine concentration, although randomised controlled trials of folic acid supplementation to decrease the incidence of vascular conditions have been inconclusive. We investigated determinants of maternal homocysteine during pregnancy, particularly in a folic acid-fortified population. DESIGN Data were from the Ottawa and Kingston Birth Cohort of 8085 participants. We used multivariable regression analyses to identify factors associated with maternal homocysteine, adjusted for gestational age at bloodwork. Continuous factors were modelled using restricted cubic splines. A subgroup analysis examined the modifying effect of MTHFR 677C>T genotype on folate, in determining homocysteine concentration. SETTING Participants were recruited in Ottawa and Kingston, Canada, from 2002 to 2009. PARTICIPANTS Women were recruited when presenting for prenatal care in the early second trimester. RESULTS In 7587 participants, factors significantly associated with higher homocysteine concentration were nulliparous, smoking and chronic hypertension, while factors significantly associated with lower homocysteine concentration were non-Caucasian race, history of a placenta-mediated complication and folic acid supplementation. Maternal age and BMI demonstrated U-shaped associations. Folic acid supplementation of >1 mg/d during pregnancy did not substantially increase folate concentration. In the subgroup analysis, MTHFR 677C>T modified the effect of folate status on homocysteine concentration. CONCLUSIONS We identified determinants of maternal homocysteine relevant to the lowering of homocysteine in the post-folic acid fortification era, characterised by folate-replete populations. A focus on periconceptional folic acid supplementation and improving health status may form an effective approach to lower homocysteine.
Collapse
|
7
|
Chen Z, Gong L, Zhang P, Li Y, Liu B, Zhang L, Zhuang J, Xiao D. Epigenetic Down-Regulation of Sirt 1 via DNA Methylation and Oxidative Stress Signaling Contributes to the Gestational Diabetes Mellitus-Induced Fetal Programming of Heart Ischemia-Sensitive Phenotype in Late Life. Int J Biol Sci 2019; 15:1240-1251. [PMID: 31223283 PMCID: PMC6567811 DOI: 10.7150/ijbs.33044] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/01/2019] [Indexed: 12/20/2022] Open
Abstract
Rationale: The incidence of gestational diabetes mellitus (GDM) is increasing worldwide. However, whether and how GDM exposure induces fetal programming of adult cardiac dysfunctional phenotype, especially the underlying epigenetic molecular mechanisms and theranostics remain unclear. To address this problem, we developed a late GDM rat model. Methods: Pregnant rats were made diabetic on day 12 of gestation by streptozotocin (STZ). Experiments were conducted in 6 weeks old offspring. Results: There were significant increases in ischemia-induced cardiac infarction and gender-dependent left ventricular (LV) dysfunction in male offspring in GDM group as compared to controls. Exposure to GDM enhanced ROS level and caused a global DNA methylation in offspring cardiomyocytes. GDM attenuated cardiac Sirt 1 protein and p-Akt/Akt levels, but enhanced autophagy-related proteins expression (Atg 5 and LC3 II/LC3 I) as compared to controls. Ex-vivo treatment of DNA methylation inhibitor, 5-Aza directly inhibited Dnmt3A and enhanced Sirt 1 protein expression in fetal hearts. Furthermore, treatment with antioxidant, N-acetyl-cysteine (NAC) in offspring reversed GDM-mediated DNA hypermethylation, Sirt1 repression and autophagy-related gene protein overexpression in the hearts, and rescued GDM-induced deterioration in heart ischemic injury and LV dysfunction. Conclusion: Our data indicated that exposure to GDM induced offspring cardiac oxidative stress and DNA hypermethylation, resulting in an epigenetic down-regulation of Sirt1 gene and aberrant development of heart ischemia-sensitive phenotype, which suggests that Sirt 1-mediated signaling is the potential therapeutic target for the heart ischemic disease in offspring.
Collapse
Affiliation(s)
- Zewen Chen
- Lawrence D. Longo, MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA.,Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lei Gong
- Lawrence D. Longo, MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Peng Zhang
- Lawrence D. Longo, MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Yong Li
- Lawrence D. Longo, MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Bailin Liu
- Lawrence D. Longo, MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Lubo Zhang
- Lawrence D. Longo, MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Jian Zhuang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Daliao Xiao
- Lawrence D. Longo, MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| |
Collapse
|
8
|
Hoyt AT, Canfield MA, Romitti PA, Botto LD, Anderka MT, Krikov SV, Feldkamp ML. Does Maternal Exposure to Secondhand Tobacco Smoke During Pregnancy Increase the Risk for Preterm or Small-for-Gestational Age Birth? Matern Child Health J 2018; 22:1418-1429. [PMID: 29574536 DOI: 10.1007/s10995-018-2522-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Introduction While associations between active smoking and various adverse birth outcomes (ABOs) have been reported in the literature, less is known about the impact of secondhand smoke (SHS) on many pregnancy outcomes. Methods We examined the relationship between maternal exposure to SHS during pregnancy and preterm (< 37 weeks gestation) and small-for-gestational age (SGA; assessed using sex-, race/ethnic-, and parity-specific growth curves) singleton births using non-smoking controls from the National Birth Defects Prevention Study (1997-2011). Multivariable logistic regression models for household, workplace/school, and combined SHS exposure-controlled for maternal education, race/ethnicity, pre-pregnancy body mass index, and high blood pressure-were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Interaction was assessed for maternal folic acid supplementation, alcohol use, age at delivery, and infant sex. Results Infants of 8855 mothers were examined in the preterm birth analysis with 666 (7.5%) categorized as preterm, 574 moderately preterm (32-36 weeks), and 92 very preterm (< 32 weeks). For the SGA analysis, infants of 8684 mothers were examined with 670 (7.7%) categorized as SGA. The aORs for mothers reporting both household and workplace/school SHS were elevated for preterm (aOR 1.99; 95% CI 1.13-3.50) and moderately preterm birth (32-36 weeks) (aOR 2.17; 95% CI 1.22-3.88). No results for the SGA analysis achieved significance, nor was evidence of interaction evident. Conclusion The findings suggest an association between SHS from multiple exposure sources and preterm birth, but no evidence for association with SGA births. Continued study of SHS and ABOs is needed to best inform public health prevention programs.
Collapse
Affiliation(s)
- Adrienne T Hoyt
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, 1100 W. 49th St., Austin, TX, 78714-9347, USA.
| | - Mark A Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, 1100 W. 49th St., Austin, TX, 78714-9347, USA
| | - Paul A Romitti
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Lorenzo D Botto
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Marlene T Anderka
- Massachusetts Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, MA, USA
| | - Sergey V Krikov
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
9
|
Tuenter A, Bautista Nino PK, Vitezova A, Pantavos A, Bramer WM, Franco OH, Felix JF. Folate, vitamin B12, and homocysteine in smoking-exposed pregnant women: A systematic review. MATERNAL AND CHILD NUTRITION 2018; 15:e12675. [PMID: 30182513 PMCID: PMC6585731 DOI: 10.1111/mcn.12675] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/02/2018] [Accepted: 07/19/2018] [Indexed: 11/28/2022]
Abstract
Smoking exposure is associated with pregnancy complications, as are levels of folate, vitamin B12, and homocysteine. In nonpregnant adults, smoking exposure is associated negatively with folate and vitamin B12 levels and positively with homocysteine levels. A complete overview of the literature on this topic in pregnant women is lacking. To evaluate evidence of associations of maternal smoking exposure during pregnancy and levels of folate, homocysteine, and vitamin B12 in pregnancy and in cord blood, we searched MEDLINE, Embase, CINAHL, Cochrane, Scopus, Web of Science, and reference lists of relevant studies until August 2017. We selected studies in pregnant women describing the association of passive or active smoking and levels of folate, homocysteine, and/or vitamin B12. Data were extracted by two independent reviewers. We included 32 studies of 2,015 identified references with a total of 37,822 participants and more than 6,000 smokers. Twenty‐eight studies measured folate, 14 measured vitamin B12, and 13 measured homocysteine. Nineteen out of 28 studies assessing folate reported significantly lower levels in pregnant women exposed to smoking compared with those unexposed. Vitamin B12 levels were lower in smoking mothers in eight out of 14 studies. Homocysteine levels tended to be higher in mothers exposed to smoking. Smoking exposure during pregnancy is generally associated with lower folate and vitamin B12 levels and higher homocysteine levels. This may help raise further awareness about the consequences of smoking and the need to encourage stopping smoking in all, especially in pregnant women.
Collapse
Affiliation(s)
- Annelies Tuenter
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Paula K Bautista Nino
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Anna Vitezova
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Athanasios Pantavos
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Janine F Felix
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
10
|
Ke J, Dong N, Wang L, Li Y, Dasgupta C, Zhang L, Xiao D. Role of DNA methylation in perinatal nicotine-induced development of heart ischemia-sensitive phenotype in rat offspring. Oncotarget 2017; 8:76865-76880. [PMID: 29100355 PMCID: PMC5652749 DOI: 10.18632/oncotarget.20172] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 06/30/2017] [Indexed: 02/04/2023] Open
Abstract
Background and purpose Maternal cigarette smoking increases the risk of cardiovascular disease in offspring. Recently, we have demonstrated that perinatal nicotine exposure alters heart development and increases heart susceptibility to ischemia/reperfusion (I/R) injury in rat offspring. The present study tested the hypothesis that DNA methylation plays a key role in the nicotine-induced development of heart ischemia-sensitive phenotype in offspring. Experimental approach Nicotine was administered to pregnant rats via subcutaneous osmotic minipumps from gestational day 4 until postnatal day 10. After birth, the postnatal offspring were treated with the DNA methylation inhibitor, 5-aza-2'-deoxycytidine (5-Aza) or saline from postnatal day 3 to day 10. Experiments were conducted in 1 month old offspring. Key results Perinatal nicotine increased I/R-induced left ventricular (LV) injury, and decreased post-ischemic recovery of the LV function and coronary flow rate in both male and female offspring. Nicotine differentially increased DNMT3a expression and global DNA methylation levels in LV tissues. Treatment with 5-Aza inhibited nicotine-induced an increase in DNMT3a and global DNA methylation, and blocked the nicotine-induced increase in I/R injury and dysfunction in the heart. In addition, nicotine attenuated protein kinases Cε and large-conductance Ca(2+)-activated K(+) (BKca) channel β1 subunit protein abundances in the heart, which were reversed by 5-Aza treatment. Conclusions and implications The present findings provide novel evidence that the increased DNA methylation plays a causal role in nicotine-induced development of heart ischemic sensitive phenotype, and suggest a potential therapeutic target of DNA demethylation for the fetal programming of heart ischemic disease later in life.
Collapse
Affiliation(s)
- Jun Ke
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Wang
- Department of Traditional Chinese Medicine, People's Hospital of Shanghai Putuo District, Shanghai, China.,Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Yong Li
- Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Chiranjib Dasgupta
- Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Lubo Zhang
- Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Daliao Xiao
- Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| |
Collapse
|
11
|
Wang Y, Cao Z, Peng Z, Xin X, Zhang Y, Yang Y, He Y, Xu J, Ma X. Folic acid supplementation, preconception body mass index, and preterm delivery: findings from the preconception cohort data in a Chinese rural population. BMC Pregnancy Childbirth 2015; 15:336. [PMID: 26670558 PMCID: PMC4681173 DOI: 10.1186/s12884-015-0766-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 12/02/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Folic acid (FA) supplementation before and during the first trimester can reduce the risk of occurrence of preterm delivery (PTD). Preconception body mass index (BMI) is also associated with PTD. This study aimed to investigate the combined effect of FA supplements and preconception BMI on the risk of PTD. METHODS The data of a cohort from 2010-2011 that was obtained through a preconception care service in China was used (including 172,206 women). A multivariable regression model was used to investigate the association between maternal preconception conditions and the risk of PTD. The interaction of preconception BMI and FA supplementation was measured by a logistic regression model. RESULTS Taking FA supplements in the preconception period or in the first trimester reduced the risk of PTD (odds ratio [OR] = 0.58 and OR = 0.61, respectively). Women with an abnormal BMI had an increased risk of PTD (OR = 1.09, OR = 1.10, and OR = 1.17 for underweight, overweight, and obese, respectively). Preconception BMI showed an interaction with the protective effect of FA supplementation for PTD. With regard to the interaction of FA supplementation, the adjusted odds ratio (aOR) was 0.57 (95% CI: 0.51, 0.64) in underweight women, 0.85 (95% CI: 0.73, 0.98) in overweight women, and 0.77 (95% CI, 0.65, 0.91) in obese women. Preconception BMI also showed an interaction with the time of FA supplementation. Women with a normal BMI who began to take FA supplements in the preconception period had the lowest risk of PTD (aORs: 0.58 vs. 0.65 beginning in the first trimester). The aORs at preconception and the first trimester in the underweight group were 0.56 vs. 0.60. The aORs at preconception and the first trimester were 0.94 vs. 0.65 and 1.15 vs. 0.60 in the overweight and obesity groups, respectively. CONCLUSIONS In our study, FA supplements reduced the risk of PTD, while abnormal BMI raised the risk of PTD, although higher BMI categories did not have this higher risk once adjusted analysis was conducted. The protective effect of FA supplementation for PTD was reduced in women with overweight or obesity. To get better protection of FA supplementation, women with normal BMI or underweight should begin to use in preconception, while women with overweight or obesity should begin to use after conception.
Collapse
Affiliation(s)
- Yuanyuan Wang
- National Research Institute for Family Planning, No. 12, Dahuisi Road, Haidian District, Beijing, 100081, China.
- Graduate School of Peking Union Medical College, No. 9, Dongdansantiao, Dongcheng District, Beijing, 100730, China.
| | - Zongfu Cao
- National Research Institute for Family Planning, No. 12, Dahuisi Road, Haidian District, Beijing, 100081, China.
- Graduate School of Peking Union Medical College, No. 9, Dongdansantiao, Dongcheng District, Beijing, 100730, China.
| | - Zuoqi Peng
- National Research Institute for Family Planning, No. 12, Dahuisi Road, Haidian District, Beijing, 100081, China.
| | - Xiaona Xin
- National Research Institute for Family Planning, No. 12, Dahuisi Road, Haidian District, Beijing, 100081, China.
- Graduate School of Peking Union Medical College, No. 9, Dongdansantiao, Dongcheng District, Beijing, 100730, China.
| | - Ya Zhang
- National Research Institute for Family Planning, No. 12, Dahuisi Road, Haidian District, Beijing, 100081, China.
| | - Ying Yang
- National Research Institute for Family Planning, No. 12, Dahuisi Road, Haidian District, Beijing, 100081, China.
| | - Yuan He
- National Research Institute for Family Planning, No. 12, Dahuisi Road, Haidian District, Beijing, 100081, China.
| | - Jihong Xu
- National Research Institute for Family Planning, No. 12, Dahuisi Road, Haidian District, Beijing, 100081, China.
| | - Xu Ma
- National Research Institute for Family Planning, No. 12, Dahuisi Road, Haidian District, Beijing, 100081, China.
- Graduate School of Peking Union Medical College, No. 9, Dongdansantiao, Dongcheng District, Beijing, 100730, China.
| |
Collapse
|
12
|
Martinussen MP, Bracken MB, Triche EW, Jacobsen GW, Risnes KR. Folic acid supplementation in early pregnancy and the risk of preeclampsia, small for gestational age offspring and preterm delivery. Eur J Obstet Gynecol Reprod Biol 2015; 195:94-99. [PMID: 26500184 DOI: 10.1016/j.ejogrb.2015.09.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/11/2015] [Accepted: 09/17/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess whether folic acid intake during the first trimester of pregnancy is related to pregnancy outcomes preeclampsia, low birth weight or preterm birth. STUDY DESIGN Prospective cohort study of 3647 women who were followed from the first trimester of pregnancy. Detailed information on quantity of folic acid intake before and during the first three months of pregnancy was recorded. Pregnancy outcome data were abstracted from obstetric records. RESULTS Lean mothers who used folic acid supplementation the month before pregnancy had a 40% reduced risk of developing preeclampsia. The adjusted odds ratio (OR) with 95% confidence intervals (95%CI) for preeclampsia in lean mothers (BMI<25) who used folic acid supplements the month before pregnancy was 0.6 (95% CI 0.4-1.0). Obese mothers who used folic acid supplementation in the first trimester had an increased, but not statistically significant risk for preterm birth (adjusted OR 1.9 with 95% CI 0.9-4.0). There were no significant associations between folic acid supplementation and low birth weight. CONCLUSION Our study supports a possible protective effect of folate intake in early pregnancy on preeclampsia in lean mothers. There was no support for any beneficial effect of folic acid use on preterm birth or low birth weight, and we found no evidence of any harmful effects of folate use for the outcomes included in our study.
Collapse
Affiliation(s)
- Marit P Martinussen
- Department of Obstetrics and Gynecology, St. Olav's University Hospital, Trondheim, Norway; Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Michael B Bracken
- Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale University, New Haven, CT, USA
| | - Elizabeth W Triche
- Mandell Center for Multiple Sclerosis and Neuroscience Research, Mount Sinai Rehabilitation Hospital, St. Francis Care, Hartford, CT, USA
| | - Geir W Jacobsen
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kari R Risnes
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Pediatrics, St. Olav's University Hospital, Trondheim, Norway
| |
Collapse
|
13
|
Lin C, Yon JM, Lee BJ, Kang JK, Yun YW, Nam SY. Punicalagin improves chorioallantoic and yolk sac vasculogenesis and teratogenesis of embryos induced by nicotine exposure. J Funct Foods 2015. [DOI: 10.1016/j.jff.2015.08.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
14
|
Kim JH, Jeong KS, Ha EH, Park H, Ha M, Hong YC, Bhang SY, Lee SJ, Lee KY, Lee SH, Kim Y, Kim MH, Chang N. Relationship between prenatal and postnatal exposures to folate and risks of allergic and respiratory diseases in early childhood. Pediatr Pulmonol 2015; 50:155-63. [PMID: 24616290 DOI: 10.1002/ppul.23025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 02/02/2014] [Accepted: 02/09/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND It is uncertain whether folate is risk or preventive factor for allergic and respiratory diseases. OBJECTIVE To determine the relationship between maternal or offspring folate status and subsequent development of allergic and respiratory diseases in early childhood. METHODS In total, 917 mother-child pairs from a prospective birth cohort in South Korea were studied. Data regarding the children's allergic and respiratory outcomes were obtained from standardized questionnaires completed by the mothers at postnatal months 6, 12, and 24. Serum folate levels were measured in the mothers at mid- and late-pregnancy, and in their children at 24 months of age. Atopic biomarkers were measured in the cord blood (CB) and at 24 months after birth. Biomarkers and clinical outcomes were analyzed and compared between the mother-child pairs divided into two groups according to median serum folate status at mid- and late-pregnancy. RESULTS Serum folate levels during mid-pregnancy were inversely associated with CB eosinophil count (adjusted odds ratio [OR] 0.72, 95% confidence interval [CI], 0.54-0.96) and positively associated with CB interleukin-10 levels (1.47, 1.11-1.94). Maternal folate level above the median value (≥9.5 ng/ml) during mid-pregnancy was associated with a decreased risk for the child of lower respiratory tract infections (LRTIs) at 6 months of age (adjusted OR 0.50, 95% CI 0.28-0.91) and atopic dermatitis (AD) at 24 months (adjusted OR 0.52, 95% CI 0.31-0.88), but not with LRTIs and AD at other ages. CONCLUSIONS A relatively high maternal serum folate level in mid-pregnancy was associated with a decreased risk of LRTIs and AD in early childhood.
Collapse
Affiliation(s)
- Ja Hyeong Kim
- Department of Pediatrics, Ulsan University Hospital, University of Ulsan Collage of Medicine, Ulsan, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Hodgetts VA, Morris RK, Francis A, Gardosi J, Ismail KM. Effectiveness of folic acid supplementation in pregnancy on reducing the risk of small-for-gestational age neonates: a population study, systematic review and meta-analysis. BJOG 2014; 122:478-90. [PMID: 25424556 DOI: 10.1111/1471-0528.13202] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To assess the effect of timing of folic acid (FA) supplementation during pregnancy on the risk of the neonate being small for gestational age (SGA). DESIGN A population database study and a systematic review with meta-analysis including the results of this population study. SETTING AND DATA SOURCES A UK regional database was used for the population study and an electronic literature search (from inception until August 2013) for the systematic review. PARTICIPANTS AND INCLUDED STUDIES Singleton live births with no known congenital anomalies; 111,736 in population study and 188,796 in systematic review. OUTCOME MEASURES, DATA EXTRACTION AND ANALYSIS The main outcome was SGA based on customised birthweight centile. Associations are presented as odds ratios (OR) and adjusted odds ratios (aOR), adjusted for maternal and pregnancy-related characteristics. RESULTS Of 108,525 pregnancies with information about FA supplementation, 92,133 (84.9%) had taken FA during pregnancy. Time of commencement of supplementation was recorded in 39,416 pregnancies, of which FA was commenced before conception in 10,036, (25.5%) cases. Preconception commencement of FA supplementation was associated with reduced risk of SGA <10th centile (aOR 0.80, 95% CI 0.71-0.90, P < 0.01) and SGA <5th centile (aOR 0.78, 95% CI 0.66-0.91, P < 0.01). This result was reproduced when the data were pooled with other studies in the systematic review, showing a significant reduction in SGA (<5th centile) births with preconception commencement of FA (aOR 0.75, 95% CI 0.61-0.92, P < 0.006). In contrast, postconception folate had no significant effect on SGA rates. CONCLUSION Supplementation with FA significantly reduces the risk of SGA at birth but only if commenced preconceptually independent of other risk factors. SYSTEMATIC REVIEW REGISTRATION This systematic review was prospectively registered with PROSPERO number CRD42013004895.
Collapse
Affiliation(s)
- V A Hodgetts
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | | | | | | |
Collapse
|
16
|
Bortolus R, Blom F, Filippini F, van Poppel MNM, Leoncini E, de Smit DJ, Benetollo PP, Cornel MC, de Walle HEK, Mastroiacovo P. Prevention of congenital malformations and other adverse pregnancy outcomes with 4.0 mg of folic acid: community-based randomized clinical trial in Italy and the Netherlands. BMC Pregnancy Childbirth 2014; 14:166. [PMID: 24884885 PMCID: PMC4045958 DOI: 10.1186/1471-2393-14-166] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 04/25/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND In 2010 a Cochrane review confirmed that folic acid (FA) supplementation prevents the first- and second-time occurrence of neural tube defects (NTDs). At present some evidence from observational studies supports the hypothesis that FA supplementation can reduce the risk of all congenital malformations (CMs) or the risk of a specific and selected group of them, namely cardiac defects and oral clefts. Furthermore, the effects on the prevention of prematurity, foetal growth retardation and pre-eclampsia are unclear.Although the most common recommendation is to take 0.4 mg/day, the problem of the most appropriate dose of FA is still open.The aim of this project is to assess the effect a higher dose of peri-conceptional FA supplementation on reducing the occurrence of all CMs. Other aims include the promotion of pre-conceptional counselling, comparing rates of selected CMs, miscarriage, pre-eclampsia, preterm birth, small for gestational age, abruptio placentae. METHODS/DESIGN This project is a joint effort by research groups in Italy and the Netherlands. Women of childbearing age, who intend to become pregnant within 12 months are eligible for the studies. Women are randomly assigned to receive 4 mg of FA (treatment in study) or 0.4 mg of FA (referent treatment) daily. Information on pregnancy outcomes are derived from women-and-physician information.We foresee to analyze the data considering all the adverse outcomes of pregnancy taken together in a global end point (e.g.: CMs, miscarriage, pre-eclampsia, preterm birth, small for gestational age). A total of about 1,000 pregnancies need to be evaluated to detect an absolute reduction of the frequency of 8%. Since the sample size needed for studying outcomes separately is large, this project also promotes an international prospective meta-analysis. DISCUSSION The rationale of these randomized clinical trials (RCTs) is the hypothesis that a higher intake of FA is related to a higher risk reduction of NTDs, other CMs and other adverse pregnancy outcomes. Our hope is that these trials will act as catalysers, and lead to other large RCTs studying the effects of this supplementation on CMs and other infant and maternal outcomes. TRIAL REGISTRATION Italian trial: ClinicalTrials.gov Identifier: NCT01244347.Dutch trial: Dutch Trial Register ID: NTR3161.
Collapse
Affiliation(s)
- Renata Bortolus
- Office for Research Promotion, Department of the Hospital Management and Pharmacy, Verona University Hospital, P.le A. Stefani, 1-37126 Verona, Italy
| | - Fenneke Blom
- Community Genetics, Department of Clinical Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Francesca Filippini
- Office for Research Promotion, Department of the Hospital Management and Pharmacy, Verona University Hospital, P.le A. Stefani, 1-37126 Verona, Italy
| | - Mireille NM van Poppel
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Emanuele Leoncini
- Alessandra Lisi International Centre on Birth Defects and Prematurity-ICBD, WHO Collaborating Centre, Rome, Italy
| | | | | | - Martina C Cornel
- Community Genetics, Department of Clinical Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Hermien EK de Walle
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pierpaolo Mastroiacovo
- Alessandra Lisi International Centre on Birth Defects and Prematurity-ICBD, WHO Collaborating Centre, Rome, Italy
| |
Collapse
|
17
|
Caspers KM, Romitti PA, Lin S, Olney RS, Holmes LB, Werler MM. Maternal periconceptional exposure to cigarette smoking and congenital limb deficiencies. Paediatr Perinat Epidemiol 2013; 27:509-20. [PMID: 24134526 PMCID: PMC4445653 DOI: 10.1111/ppe.12075] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Congenital limb deficiencies (LD)s are characterised by the failure or disruption in formation of limbs or digits. Epidemiological research on maternal exposure to cigarette smoke and LDs is inconclusive. METHODS Data from the National Birth Defects Prevention Study were used to examine LDs and maternal exposure to active or passive cigarette smoke. Mothers of LD case (n = 906) and unaffected control (n = 8352) pregnancies from October 1997 through December 2007 reported on exposure type and quantity. Logistic regression was used to estimate adjusted odds ratio (OR) and 95% confidence interval [95% CI]; interactions with folic acid (FA) intake were tested. RESULTS For any LD, ORs were elevated for active (1.24 [95% CI 1.01, 1.53]), passive (home) (1.28 [95% CI 1.03, 1.59]), and 'active and passive' (1.34 [95% CI 1.05, 1.70]) exposures. The ORs for longitudinal LDs were elevated for passive (home) (1.62 [95% CI 1.14, 2.31]) and 'active and passive' (1.62 [95% CI 1.09, 2.41]) exposures. The OR for pre-axial LDs were elevated for any (1.39 [95% CI 1.01, 1.90]), active (1.53 [95% CI 1.03, 2.29]), passive (home) (1.82 [95% CI 1.23, 2.69]), and 'active and passive' (1.87 [95% CI 1.20, 2.92]) exposures. For lower limbs, ORs were elevated for passive (home) (1.44 [95% CI 1.01, 2.04]) and smoking 15 or more cigarettes/day (2.25 [95% CI 1.27, 3.97]). Interactions showed that ORs for any passive smoke exposure were 0.43 and 0.59 higher in the absence of FA intake for any and terminal transverse LDs. CONCLUSIONS Maternal active smoking and exposure to passive cigarette smoke emerged as a potential teratogen that affects limb and digit formation. FA was not found to mitigate the impact.
Collapse
Affiliation(s)
- Kristin M. Caspers
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA
| | - Paul A. Romitti
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA
| | - Shao Lin
- Department of Health, New York State, Albany, NY
| | | | - Lewis B. Holmes
- Genetics and Teratology Unit, Massachusetts General Hospital, Boston, MA
| | | | | |
Collapse
|
18
|
Stamm RA, Houghton LA. Nutrient intake values for folate during pregnancy and lactation vary widely around the world. Nutrients 2013; 5:3920-47. [PMID: 24084052 PMCID: PMC3820052 DOI: 10.3390/nu5103920] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/03/2013] [Accepted: 09/03/2013] [Indexed: 11/18/2022] Open
Abstract
Folate is a B-vitamin with particular importance during reproduction due to its role in the synthesis and maintenance of DNA. Folate is well known for its role in preventing neural tube defects (NTDs) during the periconceptional period. There is also an increased need for folate throughout pregnancy to support optimal growth and development of the fetus and blood volume expansion and tissue growth of the mother. During lactation, women are at risk of folate deficiency due to increased demands to accommodate milk folate levels. Nutrient Intake Values (NIVs) for folate have been calculated to take into account additional needs during pregnancy and lactation. However, these values vary widely between countries. For example, the folate requirement that is set to meet the needs of almost all healthy women during pregnancy varies from 300 µg/day in the United Kingdom to 750 µg/day in Mexico. Currently, there is no accepted standardized terminology or framework for establishing NIVs. This article reviews country-specific NIVs for folate during pregnancy and lactation and the basis for setting these reference values.
Collapse
Affiliation(s)
- Rosemary A Stamm
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand.
| | | |
Collapse
|
19
|
Baron R, Manniën J, de Jonge A, Heymans MW, Klomp T, Hutton EK, Brug J. Socio-demographic and lifestyle-related characteristics associated with self-reported any, daily and occasional smoking during pregnancy. PLoS One 2013; 8:e74197. [PMID: 24019956 PMCID: PMC3760841 DOI: 10.1371/journal.pone.0074197] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 07/30/2013] [Indexed: 11/18/2022] Open
Abstract
Smoking during pregnancy is a risk factor for various adverse birth outcomes. In order to develop effective interventions, insight is needed into the characteristics associated with pregnant women who smoke. Unknown is whether these characteristics differ for women who smoke daily and women who smoke occasionally. Our study sample, drawn from the DELIVER study (Sept 2009-March 2011), consisted of 6107 pregnant women in primary care in the Netherlands who were up to 34 weeks pregnant. The associations of thirteen socio-demographic or lifestyle-related characteristics with 'any smoking', 'daily smoking' and 'occasional smoking' during pregnancy were tested using multiple binary logistic regression with general estimating equations (GEE). Characteristics most strongly associated with any smoking were low education (OR 10.3; 95% confidence interval (CI) 7.0-15.4), being of Turkish ethnicity (OR 3.9; 95%CI 2.3-6.7) and having no partner (OR 3.7; 95%CI 2.3-6.0). Women of Dutch ethnicity were three times more likely to smoke than those from Dutch-speaking Caribbean countries and non-religious women were much more likely to smoke than religious women. Low education was markedly more strongly associated with daily smoking than with occasional smoking (OR 20.3; 95%CI 13.2-31.3 versus OR 6.0; 95%CI 3.4-10.5). Daily smokers were more likely to be associated with other unfavorable lifestyle-related characteristics, such as not taking folic acid, being underweight, and having had an unplanned pregnancy. There is still much potential for health gain with respect to smoking during pregnancy in the Netherlands. Daily and occasional smokers appear to differ in characteristics, and therefore possibly require different interventions.
Collapse
Affiliation(s)
- Ruth Baron
- Department of Midwifery Science, AVAG/EMGO Institute for Health and Care Research, Free University Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Judith Manniën
- Department of Midwifery Science, AVAG/EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, AVAG/EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Martijn W. Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Methodology and Applied Biostatistics, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Trudy Klomp
- Department of Midwifery Science, AVAG/EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Eileen K. Hutton
- Department of Midwifery Science, AVAG/EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Johannes Brug
- EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
20
|
Giudicelli F, Brabant AL, Grit I, Parnet P, Amarger V. Excess of methyl donor in the perinatal period reduces postnatal leptin secretion in rat and interacts with the effect of protein content in diet. PLoS One 2013; 8:e68268. [PMID: 23840890 PMCID: PMC3698130 DOI: 10.1371/journal.pone.0068268] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 05/28/2013] [Indexed: 11/19/2022] Open
Abstract
Methionine, folic acid, betaine and choline interact in the one-carbon metabolism which provides methyl groups for methylation reactions. An optimal intake of these nutrients during pregnancy is required for successful completion of fetal development and evidence is growing that they could be involved in metabolic long-term programming. However, the biological pathways involved in the action of these nutrients are still poorly known. This study investigated the interaction between methyl donors and protein content in maternal diet during the preconceptual, pregnancy and lactation periods and the consequences on the rat offspring in the short and long term. Methyl donor supplementation reduced leptin secretion in offspring, whereas insulin levels were mostly affected by protein restriction. The joint effect of protein restriction and methyl donor excess strongly impaired postnatal growth in both gender and long term weight gain in male offspring only, without affecting food intake. In addition, rats born from protein restricted and methyl donor supplemented dams gained less weight when fed a hypercaloric diet. Methylation of the leptin gene promoter in adipose tissue was increased in methyl donor supplemented groups but not affected by protein restriction only. These results suggest that maternal methyl donor supplementation may influence energy homeostasis in a gender-dependent manner, without affecting food intake. Moreover, we showed that macronutrients and micronutrients in maternal diet interact to influence the programming of the offspring.
Collapse
Affiliation(s)
- Fanny Giudicelli
- INRA, UMR1280, Physiologie des Adaptations Nutritionnelles, Nantes, France
- Université de Nantes, UMR 1280, Physiologie des Adaptations Nutritionnelles, Nantes, France
| | - Anne-Laure Brabant
- INRA, UMR1280, Physiologie des Adaptations Nutritionnelles, Nantes, France
- Université de Nantes, UMR 1280, Physiologie des Adaptations Nutritionnelles, Nantes, France
| | - Isabelle Grit
- INRA, UMR1280, Physiologie des Adaptations Nutritionnelles, Nantes, France
- Université de Nantes, UMR 1280, Physiologie des Adaptations Nutritionnelles, Nantes, France
| | - Patricia Parnet
- INRA, UMR1280, Physiologie des Adaptations Nutritionnelles, Nantes, France
- Université de Nantes, UMR 1280, Physiologie des Adaptations Nutritionnelles, Nantes, France
| | - Valérie Amarger
- INRA, UMR1280, Physiologie des Adaptations Nutritionnelles, Nantes, France
- Université de Nantes, UMR 1280, Physiologie des Adaptations Nutritionnelles, Nantes, France
| |
Collapse
|
21
|
Haworth KE, Farrell WE, Emes RD, Ismail KMK, Carroll WD, Borthwick HAD, Yates AM, Hubball E, Rooney A, Khanam M, Aggarwal N, Jones PW, Fryer AA. Combined influence of gene-specific cord blood methylation and maternal smoking habit on birth weight. Epigenomics 2013; 5:37-49. [DOI: 10.2217/epi.12.72] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Aim: Evidence suggests that folic acid intake affects birth weight and that these effects may be mediated via the fetal epigenome. Our previous array data indicate that methylation in human cord blood at gene-specific CpGs is associated with birth weight percentile (BWP). Our aims were to investigate associations with BWP in specific CpGs identified by the array analysis in a significantly larger cohort and investigate the effects of other relevant factors on this association. Materials & methods: Methylation status was examined in candidate CpGs in 129 cord blood samples using Pyrosequencing™. The effects of other potentially important factors; maternal smoking, folate-related metabolite levels and genetic variation in the MTHFR gene, were examined. Linear and logistic regression analyses were used to identify relationships between BWP and methylation levels in the context of other key factors. Results: Increased cord methylation at CpGs in GSTM5 and MAP2K3 was associated with a reduced risk of having a birth weight below the 50th percentile (p = 0.010; odds ratio [OR]: 0.33 and p = 0.024; OR: 0.24, respectively) while higher methylation levels in APOB were associated with an increased risk (p = 0.023; OR: 2.56). Smoking during pregnancy modified the effect of methylation on BWP. Thus, compared with nonsmokers with a GSTM5 methylation level of >25% (median BWP: 54.7%), those who had smoked during pregnancy and whose GSTM5 methylation was <25% had the lowest median BWP (12.0%; p = 0.001). Furthermore, this latter group had the highest proportion of cases with BWPs below 50% (92.9 compared with 47.8% in nonsmokers with a GSTM5 methylation level of >25%; p = 0.013; OR: 14.2). Similar results were identified for MAP2K3, while the link with APOB reflected the inverse relationship between methylation at this locus and BWP. Conclusion: Our data suggest that gene-specific methylation of cord DNA is associated with BWP and this methylation provides an additional effect on BWP to that of smoking during pregnancy.
Collapse
Affiliation(s)
- Kim E Haworth
- Institute of Science & Technology in Medicine, Keele University School of Medicine, Stoke-on-Trent, Staffordshire, UK
| | - William E Farrell
- Institute of Science & Technology in Medicine, Keele University School of Medicine, Stoke-on-Trent, Staffordshire, UK
| | - Richard D Emes
- School of Veterinary Medicine & Science, University of Nottingham, Sutton Bonington Campus, Sutton Bonington, Leicestershire, UK
| | - Khaled MK Ismail
- School of Clinical & Experimental Medicine, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK and Birmingham Women’s NHS Foundation Trust, Edgbaston, Birmingham UK
| | - William D Carroll
- Department of Paediatrics, Derbyshire Children’s Hospital, Derby, UK
| | - Hazel-Ann D Borthwick
- Institute of Science & Technology in Medicine, Keele University School of Medicine, Stoke-on-Trent, Staffordshire, UK
| | - Alexandra M Yates
- Institute of Science & Technology in Medicine, Keele University School of Medicine, Stoke-on-Trent, Staffordshire, UK
| | - Emma Hubball
- Maternity Centre, University Hospital of North Staffordshire, Stoke-on-Trent, Staffordshire, UK
| | - Angela Rooney
- Maternity Centre, University Hospital of North Staffordshire, Stoke-on-Trent, Staffordshire, UK
| | - Mazeda Khanam
- Institute of Science & Technology in Medicine, Keele University School of Medicine, Stoke-on-Trent, Staffordshire, UK
| | - Neyha Aggarwal
- Institute of Science & Technology in Medicine, Keele University School of Medicine, Stoke-on-Trent, Staffordshire, UK
| | - Peter W Jones
- Department of Primary Care Sciences, Keele University, Stoke-on-Trent, Staffordshire, UK
| | - Anthony A Fryer
- Institute of Science & Technology in Medicine, Keele University School of Medicine, Stoke-on-Trent, Staffordshire, UK
| |
Collapse
|
22
|
Resveratrol prevents nicotine-induced teratogenesis in cultured mouse embryos. Reprod Toxicol 2012; 34:340-6. [DOI: 10.1016/j.reprotox.2012.05.097] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 05/02/2012] [Accepted: 05/25/2012] [Indexed: 11/18/2022]
|
23
|
Protective effect of resveratrol against nicotine-induced teratogenesis in cultured mouse embryos. Reprod Toxicol 2012. [DOI: 10.1016/j.reprotox.2012.05.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
24
|
Steenweg-de Graaff J, Roza SJ, Steegers EA, Hofman A, Verhulst FC, Jaddoe VW, Tiemeier H. Maternal folate status in early pregnancy and child emotional and behavioral problems: the Generation R Study. Am J Clin Nutr 2012; 95:1413-21. [PMID: 22572645 DOI: 10.3945/ajcn.111.030791] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Maternal prenatal folate status has been linked to neurodevelopmental disorders, but the association with child emotional and behavioral problems is unclear. OBJECTIVES We assessed the association of maternal folate status during pregnancy with child emotional and behavioral problems. Also, we examined whether any association between folate status and child problems is a consequence of maternal folic acid supplement use or variation in maternal MTHFR genotype. DESIGN Within a population-based cohort, we measured maternal plasma folate concentrations in early pregnancy and assessed folic acid supplement use by questionnaire. Mothers of European descent were genotyped for the MTHFR 677 C→T polymorphism. Child emotional and behavioral problems were assessed with the Child Behavior Checklist at 3 y in 3209 children. RESULTS Children of mothers with prenatal folate deficiency were at higher risk of emotional problems (OR: 1.57; 95% CI: 1.03, 2.38) but not behavioral problems (OR: 1.00; 95% CI: 0.64, 1.56) after adjustment for confounders. A higher risk of emotional problems was also found in children whose mothers started using folic acid supplements late or did not use supplements at all (OR: 1.45; 95% CI: 1.14, 1.84) than in children whose mothers started periconceptionally. However, low plasma folate concentrations only partly explained this association (OR: 1.38; 95% CI: 1.08, 1.78). Although related to plasma folate concentrations, maternal MTHFR genotype did not explain the association of folate status with offspring emotional problems. CONCLUSION Low maternal folate status during early pregnancy is associated with a higher risk of emotional problems in the offspring.
Collapse
|
25
|
Early determinants of obesity: genetic, epigenetic, and in utero influences. Int J Pediatr 2012; 2012:463850. [PMID: 22701495 PMCID: PMC3371343 DOI: 10.1155/2012/463850] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 03/26/2012] [Indexed: 01/06/2023] Open
Abstract
There is an emerging body of work indicating that genes, epigenetics, and the in utero environment can impact whether or not a child is obese. While certain genes have been identified that increase one's risk for becoming obese, other factors such as excess gestational weight gain, gestational diabetes mellitus, and smoking can also influence this risk. Understanding these influences can help to inform which behaviors and exposures should be targeted if we are to decrease the prevalence of obesity. By helping parents and young children change certain behaviors and exposures during critical time periods, we may be able to alter or modify one's genetic predisposition. However, further research is needed to determine which efforts are effective at decreasing the incidence of obesity and to develop new methods of prevention. In this paper, we will discuss how genes, epigenetics, and in utero influences affect the development of obesity. We will then discuss current efforts to alter these influences and suggest future directions for this work.
Collapse
|
26
|
Leermakers ETM, Taal HR, Bakker R, Steegers EAP, Hofman A, Jaddoe VWV. A common genetic variant at 15q25 modifies the associations of maternal smoking during pregnancy with fetal growth: the generation R study. PLoS One 2012; 7:e34584. [PMID: 22496830 PMCID: PMC3319619 DOI: 10.1371/journal.pone.0034584] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 03/07/2012] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Maternal smoking during pregnancy is associated with fetal growth retardation. We examined whether a common genetic variant at chromosome 15q25 (rs1051730), which is known to be involved in nicotine metabolism, modifies the associations of maternal smoking with fetal growth characteristics. METHODS This study was performed in 3,563 European mothers participating in a population-based prospective cohort study from early pregnancy onwards. Smoking was assessed by postal questionnaires and fetal growth characteristics were measured by ultrasound examinations in each trimester of pregnancy. RESULTS Among mothers who did not smoke during pregnancy (82.9%), maternal rs1051730 was not consistently associated with any fetal growth characteristic. Among mothers who continued smoking during pregnancy (17.1%), maternal rs1051730 was not associated with head circumference. The T-allele of maternal rs1051730 was associated with a smaller second and third trimester fetal femur length [differences -0.23 mm (95%CI -0.45 to -0.00) and -0.41 mm (95%CI -0.69 to -0.13), respectively] and a smaller birth length [difference -2.61 mm (95%CI -5.32 to 0.11)]. The maternal T-allele of rs1051730 was associated with a lower third trimester estimated fetal weight [difference -33 grams (95%CI -55 to -10)], and tended to be associated with birth weight [difference -38 grams (95%CI -89 to 13)]. This association persisted after adjustment for smoking quantity. CONCLUSIONS Our results suggest that maternal rs1051730 genotype modifies the associations of maternal smoking during pregnancy with impaired fetal growth in length and weight. These results should be considered as hypothesis generating and indicate the need for large-scale genome wide association studies focusing on gene--fetal smoke exposure interactions.
Collapse
Affiliation(s)
- Elisabeth T. M. Leermakers
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Paediatrics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - H. Rob Taal
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Paediatrics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Rachel Bakker
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eric A. P. Steegers
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Vincent W. V. Jaddoe
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Paediatrics, Erasmus Medical Center, Rotterdam, the Netherlands
| |
Collapse
|