Context:
Elevated lipid levels during late pregnancy are associated with complications and adverse outcome for both mother and newborn. However, it is inconclusive whether a disturbed lipid profile ...during early pregnancy has similar negative associations.
Objective:
Our objective was to investigate whether nonfasting maternal total cholesterol and triglyceride levels during early pregnancy are associated with six major adverse pregnancy outcomes.
Methods:
Data were derived from the Amsterdam Born Children and Their Development (ABCD) cohort study. Random blood samples of nonfasting total cholesterol and triglyceride levels were determined during early gestation (median = 13, interquartile range = 12–14 wk). Outcome measures were pregnancy-induced hypertension (PIH), preeclampsia, preterm birth, small/large for gestational age (SGA/LGA), and child loss. Only nondiabetic women with singleton deliveries were included; the baseline sample consisted of 4008 women. Analysis for PIH and preeclampsia were performed in nulliparous women only (n = 2037).
Results:
Mean (sd) triglyceride and total cholesterol levels were 1.33 (0.55) and 4.98 (0.87) mmol/liter, respectively. The incidence of pregnancy complications and perinatal outcomes were as follows: PIH, 4.9%; preeclampsia, 3.7%; preterm birth, 5.3%; SGA, 9.3%; LGA, 9.3%; and child loss, 1.4%. After adjustments, every unit increase in triglycerides was linearly associated with an increased risk of PIH odds ratio (OR) = 1.60, P = 0.021, preeclampsia (OR = 1.69, P = 0.018), LGA (OR = 1.48, P < 0.001), and induced preterm delivery (OR = 1.69, P = 0.006). No associations were found for SGA or child loss. Total cholesterol was not associated with any of the outcome measures.
Conclusions:
Elevated maternal triglyceride levels measured during early pregnancy are associated with pregnancy complications and adverse pregnancy outcomes. These results suggest that future lifestyle programs in women of reproductive age with a focus on lowering triglyceride levels (i.e. diet, weight reduction, and physical activity) may help to prevent hypertensive complications during pregnancy and adverse birth outcomes.
Low vitamin D levels during pregnancy may account for reduced fetal growth and for altered neonatal development. The present study explored the association between maternal vitamin D status measured ...early in pregnancy and birth weight, prevalence of small-for-gestational-age (SGA) infants and postnatal growth (weight and length), as well as the potential role of vitamin D status in explaining ethnic disparities in these outcomes. Data were derived from a large multi-ethnic cohort in The Netherlands (Amsterdam Born Children and their Development (ABCD) cohort), and included 3730 women with live-born singleton term deliveries. Maternal serum vitamin D was measured during early pregnancy (median 13 weeks, interquartile range: 12–14), and was labelled ‘deficient’ ( ≤ 29·9 nmol/l), ‘insufficient’ (30–49·9 nmol/l) or ‘adequate’ ( ≥ 50 nmol/l). Six ethnic groups were distinguished: Dutch, Surinamese, Turkish, Moroccan, other non-Western and other Western. Associations with neonatal outcomes were analysed using multivariate regression analyses. Results showed that compared with women with adequate vitamin D levels, women with deficient vitamin D levels had infants with lower birth weights ( − 114·4 g, 95 % CI − 151·2, − 77·6) and a higher risk of SGA (OR 2·4, 95 % CI 1·9, 3·2). Neonates born to mothers with a deficient vitamin D status showed accelerated growth in weight and length during the first year of life. Although a deficient vitamin D status influenced birth weight, SGA risk and neonatal growth, it played a limited role in explaining ethnic differences. Although vitamin D supplementation might be beneficial to those at risk of a deficient vitamin D status, more research is needed before a nationwide policy on the subject can be justified.
Objective To investigate whether randomly sampled maternal total cholesterol (TC) and triglycerides (TG) levels during early pregnancy are associated with birth weight (BW) and postnatal growth. ...Study design Data were derived from the prospective Amsterdam Born Children and their Development cohort study. Randomly sampled TC and TG levels were determined in early gestation (median, 13; IQR, 12-14 weeks). Outcome measures were BW SDS and weight-for-gestational age; postnatal outcome measures were SDS in weight, length, and body mass index during the first year of life (total n = 2502). Results The highest TG level was associated with a higher BW SDS (differences 0.20 ± 0.06 between highest and middle quintile; P = .002) and with a higher prevalence (13%) of an infant large for gestational age compared with middle quintile (9%; P = .04). Infants from mothers in the lowest TG quintile had lower SDS in weight, length, and body mass index until age 3 months, and displayed accelerated postnatal growth patterns. Maternal TC was not associated with BW or postnatal growth. Conclusion High maternal TG levels in the first term of pregnancy were associated with higher BWs and subsequently a higher occurrence of infants large for gestational age, whereas low TG levels were associated with accelerated postnatal growth.
Small birth size and rapid postnatal growth have been associated with higher future blood pressure. The timing of these effects, the relative importance of weight gain and linear growth and the role ...of infant feeding need to be clarified.
We assessed how blood pressure relates to birth weight, infant and childhood growth and infant feeding (duration of exclusive breastfeeding and timing of introduction of complementary feeding) in 2227 children aged 5 years from a prospective cohort study (Amsterdam Born Children and their Development). Postnatal growth was represented by statistically independent measures of relative weight gain (weight gain independent of height) and linear growth in four age periods during infancy (0-1 month; 1-3 months; 3-6 months; 6-12 months) and from 12 months to 5 years.
Lower birth weight was associated with higher childhood diastolic blood pressure (-0.38 mm Hg.SD-1; P = 0.007). Faster relative weight gain and linear growth after 1 month were positively associated with systolic and diastolic blood pressure. Associations of linear growth with systolic blood pressure ranged from 0.47 to 1.49 mm Hg.SD-1; P<0.01 for all. Coefficients were similar for different periods of infancy and also for relative weight gain and linear growth. Compared to breastfeeding <1 month, breastfeeding >1 month was associated with lower blood pressure (e.g. >6 months -1.56 mm Hg systolic blood pressure; P<0.001). Compared to >6 months, introduction of complementary feeding <6 months was associated with higher blood pressure (e.g. 4-6 months 0.91 mm Hg systolic blood pressure; P = 0.004).
After the age of one month faster growth in either weight or height is associated with higher childhood blood pressure. It is unknown whether faster weight gain and linear growth carry the same risk for adult hypertension and cardiovascular morbidity. Longer breastfeeding and delayed introduction of complementary feeding may be associated with lower adult blood pressure.
BACKGROUND: Maternal n-3, n-6, and trans fatty acids are claimed to affect fetal growth, yet evidence is limited. OBJECTIVE: We investigated the association between maternal n-3, n-6, and trans fatty ...acids measured early in pregnancy and fetal growth. DESIGN: Amsterdam pregnant women (n = 12 373) were invited to complete a questionnaire (response 67%) and donate blood around the 12th pregnancy week for nutrient analysis. For 4336 women, fatty acid concentrations were measured in plasma phospholipids (gas-liquid chromatography). Associations of these concentrations with birth weight and small-for-gestational-age (SGA) risk were analyzed (liveborn singleton term deliveries, n = 3704). RESULTS: Low concentrations of individual n-3 fatty acids and 20:3n-6, the precursor of arachidonic acid (20:4n-6), but high concentrations of the other n-6 fatty acids and the main dietary trans fatty acid (18:1n-9t) were associated with lower birth weight (estimated difference in univariate analysis -52 to -172 g for extreme quintile compared with middle quintile). In general, SGA risk increased accordingly. After adjustment for physiologic, lifestyle-related and sociodemographic factors, low concentrations of most n-3 fatty acids and 20:3n-6 and high concentrations of 20:4n-6 remained associated with lower birth weight (-52 to -57 g), higher SGA risk, or both (odds ratios: 1.38-1.50). Infants of the 7% of women with the most adverse fatty acid profile were on average 125 g lighter and twice as likely to be small for gestational age. CONCLUSION: An adverse maternal fatty acid profile early in pregnancy is associated with reduced fetal growth, which, if confirmed, gives perspective for the dietary prevention of lower birth weight.
Context:
Overt hypothyroidism in pregnant women is associated with poorer neurodevelopment in their children. Findings from studies investigating the effect of less severe impairments in the maternal ...thyroid function on cognitive functioning in offspring are difficult to interpret for a number of reasons, including lack of objective cognitive tests, preschool age at assessment, and small sample sizes.
Objective:
We aimed to assess the effect of the maternal thyroid status in early pregnancy on their offspring's cognitive performance at 5 to 6 years of age.
Design and Participants:
This was a prospective study that included the data of 1765 healthy 5- to 6-year-old children from the Amsterdam Born Children and their Development study. Maternal serum free T4 and TSH were obtained at a median gestational age of 90 (interquartile range, 83 to 100) days.
Main Outcome Measures:
Cognitive performance was tested using a computerized assessment program that measured response speed, response speed stability, visuomotor skills, response selection, and response inhibition.
Results:
Maternal hypothyroxinemia (ie, maternal free T4 in the lowest 10% of distribution) was associated with a 41.3 (95% confidence interval, 20.3–62.4) ms slower response speed in a simple reaction time task. In this test, it was also associated with a decreased stability in response speed. The relations found persisted after adjustment for family background and perinatal conditions. The effect of hypothyroxinemia on these outcomes was dependent on its interaction with TSH level.
Conclusions:
Lower maternal free T4 concentration at the end of the first trimester predicted slower response speed and decreased stability in response speed in offspring at 5 to 6 years of age.
BACKGROUND: Maternal folate depletion has been proposed as a primary explanation for the excess risk of fetal growth restriction associated with short interpregnancy intervals. OBJECTIVE: We aimed to ...evaluate the folate depletion hypothesis in a community-based cohort of pregnant women. DESIGN: Using a subsample of the cohort (multiparous participants who delivered a liveborn singleton infant, n = 3153), we investigated the relation between an increase in the interpregnancy interval (from 1 to 24 mo, natural log transformation) and birth weight and the risk of small-for-gestational-age (SGA) in 3 strata of maternal periconceptional folic acid use: nonuse, late use (begun after conception), and early use (begun before conception). RESULTS: Each increase in the interpregnancy interval on the natural log (ln) scale was associated with a mean (±SE) increase of 63.1 ± 20.3 g in birth weight (P = 0.002). This relation was mitigated by folic acid use: the change in birth weight was increases of 165.2 ± 39.6 g for nonuse (P < 0.001) and 33.5 ± 35.6 g for late use (P = 0.347) and a decrease of 5.9 ± 33.6 g for early use (P = 0.861). The birth weight differences were directly translated into SGA risk. Odds ratios per 1-mo increase in ln(interpregnancy interval) were significant for the total group (0.61; 95% CI: 0.46, 0.82) and for nonuse (0.38; 0.24, 0.60) and nonsignificant for late (0.83; 0.48, 1.44) and early (1.28; 0.58, 2.84) use. CONCLUSIONS: Folate depletion apparently contributes to the excess risk of fetal growth restriction that is associated with short interpregnancy intervals. As a preventive option, postnatal supplementation may be beneficial, but confirmation is needed.
Background
An association between education and preterm delivery has been observed in populations across Europe, but differences in methodology limit comparability. We performed a direct cross‐cohort ...comparison of educational disparities in preterm delivery based on individual‐level birth cohort data.
Methods
The study included data from 12 European cohorts from Denmark, England, France, Lithuania, the Netherlands, Norway, Italy, Portugal, and Spain. The cohorts included between 2434 and 99 655 pregnancies. The association between maternal education and preterm delivery (22–36 completed weeks of gestation) was reported as risk ratios, risk differences, and slope indexes of inequality with 95% confidence intervals (CIs).
Results
Singleton preterm live delivery proportion varied between 3.7% and 7.5%. There were large variations between the cohorts in the distribution of education and maternal characteristics. Nevertheless, there were similar educational differences in risk of preterm delivery in 8 of the 12 cohorts with slope index of inequality varying between 2.2 95% CI 1.1, 3.3 and 4.0 95% CI 1.4, 6.6 excess preterm deliveries per 100 singleton deliveries among the educationally most disadvantaged, and risk ratio between the lowest and highest education category varying from 1.4 95% CI 1.1, 1.8 to 1.9 95% CI 1.2, 3.1. No associations were found in the last four cohorts.
Conclusions
Educational disparities in preterm delivery were found all over Europe. Despite differences in the distributions of education and preterm delivery, the results were remarkably similar across the cohorts. For those few cohorts that did not follow the pattern, study and country characteristics did not explain the differences.
Much remains to be understood about the socioeconomic inequalities in hypertension that continue to exist. We investigated the association of socioeconomic status with blood pressure and ...prehypertension in childhood. In a prospective cohort, 3024 five- to six-year–old children had blood pressure measurements and available information on potential explanatory factors, namely birth weight, gestational age, smoking during pregnancy, pregnancy-induced hypertension, familial hypertension, maternal body mass index, breastfeeding duration, domestic tobacco exposure, and body mass index. The systolic and diastolic blood pressures of children from mid-educated women were 1.0-mm Hg higher (95% CI, 0.4–1.7) and 0.9-mm Hg higher (95% CI, 0.3–1.4), and the blood pressures of children with low-educated women were 2.2-mm Hg higher (95% CI, 1.4–3.0) and 1.7-mm Hg higher (95% CI, 1.1–2.4) compared with children with high-educated women. Children with mid- (odds ratio, 1.50; 95% CI, 1.18–1.92) or low-educated mothers (odds ratio, 1.80; 95% CI, 1.35–2.42) were more likely to have prehypertension compared with children with high-educated mothers. Using path analyses, birth weight, breastfeeding duration, and body mass index were determined as having a role in the association of maternal education with offspring blood pressure and prehypertension. The socioeconomic gradient in hypertension appears to emerge from childhood as the results show a higher blood pressure and more prehypertension in children from lower socioeconomic status families. Socioeconomic disparities could be reduced by improving 3 factors in particular, namely birth weight, breastfeeding duration, and body mass index, but other factors might also play a role.
Prevalence rates of psychosocial stress during pregnancy are substantial. Evidence for associations between psychosocial stress and birth outcomes is inconsistent. This study aims to identify and ...characterize different clusters of pregnant women, each with a distinct pattern of psychosocial stress, and investigate whether birth outcomes differ between these clusters.
Latent class analysis was performed on data of 7740 pregnant women (Amsterdam Born Children and their Development study). Included constructs were depressive symptoms, state anxiety, job strain, pregnancy-related anxiety and parenting stress.
Five clusters of women with distinct patterns of psychosocial stress were objectively identified. Babies born from women in the cluster characterized as 'high depression and high anxiety, moderate job strain' (12%) had a lower birth weight, and those in the 'high depression and high anxiety, not employed' cluster (15%) had an increased risk of pre-term birth.
Babies from pregnant women reporting both high levels of anxiety and depressive symptoms are at highest risk for adverse birth outcomes.
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