Infant exposure to persistent organic pollutants (POPs) may contribute to obesity. However, many studies so far have been small, focused on transplacental exposure, used an inappropriate measure to ...assess postnatal exposure through breastfeeding if any, or did not discern between prenatal and postnatal effects.
We investigated prenatal and postnatal exposure to POPs and infant growth (a predictor of obesity).
We pooled data from seven European birth cohorts with biomarker concentrations of polychlorinated biphenyl 153 (PCB-153) (n = 2,487), and p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE) (n = 1,864), estimating prenatal and postnatal POPs exposure using a validated pharmacokinetic model. Growth was change in weight-for-age z-score between birth and 24 months. Per compound, multilevel models were fitted with either POPs total exposure from conception to 24 months or prenatal or postnatal exposure.
We found a significant increase in growth associated with p,p'-DDE, seemingly due to prenatal exposure (per interquartile increase in exposure, adjusted β = 0.12; 95% CI: 0.03, 0.22). Due to heterogeneity across cohorts, this estimate cannot be considered precise, but does indicate that an association with infant growth is present on average. In contrast, a significant decrease in growth was associated with postnatal PCB-153 exposure (β = -0.10; 95% CI: -0.19, -0.01).
To our knowledge, this is the largest study to date of POPs exposure and infant growth, and it contains state-of-the-art exposure modeling. Prenatal p,p'-DDE was associated with increased infant growth, and postnatal PCB-153 with decreased growth at European exposure levels.
Introduction
We are exposed to numerous pollutants inside our homes. The perinatal period represents a particular window of vulnerability during which these exposures can have negative health effects ...over a more or less long term. The objective of this article is to formulate guidelines for health care professionals and intended for parents to reduce exposure to chemical pollutants at home, based on the scientific literature and already existing guidelines.
Methods
We have followed the methodological procedures set forth by the French authority for health (HAS) to establish guidelines to limit exposure to pollutants in homes. This narrative review of the scientific literature was conducted with two principal objectives: (1) to identify priority substances emitted within homes and that have a reprotoxic potential and (2) to identify measures to limit exposure to these residential pollutants. The guidelines were developed from the data in the literature and from advice already made available by diverse institutions about environmental health during the perinatal period.
Results
Domestic pollutants are numerous and come from both common (that is, shared, eg, painting, cleaning, and maintenance work) and specific (use of household pesticides) sources. Numerous pollutants are suspected or known to produce developmental toxicity, that is, to be toxic to children during developmental stages. Removing some products from the home, protecting the vulnerable (ie, pregnant women and young children) from exposure, and airing the home are among the preventive measures proposed to limit exposure to these chemical substances.
Conclusion
Health care professionals can provide advice to parents during the perinatal period to diminish exposure to household pollutants. The lack of interventional studies nonetheless limits the level of evidence for most of these recommendations.
Background: Per- and polyfluoroalkyl substances (PFAS) are chemical substances spread throughout the environment worldwide. Exposure during pregnancy represents a specific window of vulnerability for ...child health. Objective: Our objective was to assess the impact of prenatal exposure to multiple PFAS on emotional and behavioral functions in 12-y-old children. Method: In the PELAGIE mother-child cohort (France), prenatal exposure to nine PFAS was measured from concentrations in cord serum samples. Behavior was assessed at age 12 y using the parent-reported Strengths and Difficulties Questionnaire (SDQ) and the self-reported Dominic Interactive for Adolescents (DIA) for 444 children. Associations were estimated using negative binomial models for each PFAS. Bayesian kernel machine regression (BKMR) models were performed to assess the exposure mixture effect on children's behavior. Results: In our study population, 73% of mothers had spent more than 12 y in education. Higher scores on SDQ externalizing subscale were observed with increasing cord-serum concentration of perfluorooctanoic acid (PFOA) and perfluorononanoic acid (PFNA) adjusted mean ratio (aMR) = 1.18, 95% confidence interval (CI): 1.03, 1.34, and aMR=1.14 (95% CI: 1.00, 1.29) for every doubling of concentration, respectively. Results for the hyperactivity score were similar aMR = 1.20 (95% CI: 1.04, 1.40) and aMR = 1.18 (95% CI: 1.02, 1.36), respectively. With regard to major depressive disorder and internalizing subscales, perfluorodecanoic acid (PFDA) was associated with higher self- reported DIA scores aMR= 1.14 (95% CI: 1.01, 1.27) and aMR= 1.11 (95% CI: 1.02, 1.21), respectively. In terms of the anxiety subscale, PFDA and PFNA were associated with higher scores aMR = 1.11 (95% CI: 1.02, 1.21) and aMR = 1.10 (95% CI: 1.01, 1.19), respectively. Concurrent increases in the PFAS concentrations included in the BKMR models showed no change in the SDQ externalizing and DIA internalizing subscales scores. Conclusion: Prenatal exposure to PFNA and PFOA were associated with increasing scores for measures of externalizing behaviors, specifically hyperactivity. We also identified associations between PFNA and PFDA prenatal exposure levels and increasing scores related to internalizing behaviors (general anxiety and major depressive disorder), which adds to the as yet sparse literature examining the links between prenatal exposure to PFAS and internalizing disorders.
Indoor pollutants can have short- and long-term health effects, especially if exposure occurs during prenatal life or early childhood. This study describe the perceptions, knowledge, and practices of ...adults concerning indoor environmental pollution. Adults of 18 to 45 years of age were recruited in the department of Ille-et-Vilaine (Brittany-France) in 2019 through a stratified random draw in the waiting rooms of general practitioners (GPs) (
= 554) who completed a self-questionnaire. The 71% who had already heard of this type of pollution were older (
= 0.001), predominantly women (
= 0.007), not expecting a baby (
= 0.005), and had a higher knowledge score (
< 0.001). The average knowledge score was 6.6 ± 6.6 out of 11, which was higher for participants living in a couple and with a higher level of education (
< 0.001). Some practices were well implemented (>80% of participants) (aeration during renovation) whereas others were insufficiently practiced (<60% of participants) (paying attention to the composition of cosmetic products). Factors associated differed depending on the frequency of integration: living in a couple and having a child for well implemented practices and educational level, knowledge level, and perception for those under implemented. Knowledge must be improved to modify perceptions and certain practices, making sure not to increase social inequalities in health.
Growth charts are an essential clinical tool for evaluating a child's health and development. The current French reference curves, published in 1979, have recently been challenged by the 2006 World ...Health Organization (WHO) growth charts.
To evaluate and compare the growth of French children who were born between 1981 and 2007, with the WHO growth charts and the French reference curves currently used.
Anthropometric measurements from French children, who participated in 12 studies, were analyzed: 82,151 measurements were available for 27,257 children in different age groups, from birth to 18 years. We calculated and graphically compared mean z-scores based on the WHO and French curves, for height, weight and Body Mass Index (BMI) according to age and sex. The prevalence of overweight using the WHO, the French and International Obesity Task Force definitions were compared.
Our population of children was on average 0.5 standard deviations taller than the French reference population, from the first month of life until puberty age. Mean z-scores for height, weight and BMI were closer to zero based on the WHO growth charts than on the French references from infancy until late adolescence, except during the first six months. These differences not related to breastfeeding rates. As expected, the prevalence of overweight depended on the reference used, and differences varied according to age.
The WHO growth charts may be appropriate for monitoring growth of French children, as the growth patterns in our large population of French children were closer to the WHO growth charts than to the French reference curves, from 6 months onwards. However, there were some limitations in the use of these WHO growth charts, and further investigation is needed.
Worldwide, chronic obstructive pulmonary disease (COPD) remains largely underdiagnosed.
To assess whether the use of Global Initiative for Chronic Obstructive Lung Disease (GOLD) questions and COPD ...coordination, either alone or combined, would detect new COPD cases in primary care.
GPs in Brittany, France, systematically enrolled patients aged 40-80 years over a 4-month period in this French multicentre cluster randomised controlled study.
GPs were randomly allocated to one of four groups: control (standard of care), GOLD questions (adapted from symptoms and risk factors identified by GOLD), COPD coordination, and GOLD questions with COPD coordination. New cases of COPD were those confirmed by spirometry: post-bronchodilator forced expiratory volume in 1 second over forced vital capacity of <0.7.
In total, 11 430 consultations were conducted by 47 GPs, who enrolled 3162 patients who did not have prior diagnosed asthma or COPD. Among these, 802 (25%) were enrolled in the control, 820 (26%) in the GOLD questions, 802 (25%) in the COPD coordination, and 738 (23%) in the GOLD questions with COPD coordination groups. In the control group, COPD was not evoked, and no spirometry was prescribed. All new cases of COPD diagnosed (
= 24, 0.8%) were in the intervention groups, representing 6.8% of patients who performed spirometry. Statistically significantly more new cases of COPD were detected with COPD coordination (
= 0.01).
Interventions that can be easily implemented, such as the GOLD questions and COPD coordination, can identify new cases of COPD. Studies are needed to identify the most appropriate case-finding strategies for GPs to detect COPD in primary care for each country.
Pregnant women are ubiquitously exposed to organic solvents, such as glycol ethers. Several studies suggest potential developmental neurotoxicity following exposure to glycol ethers with a lack of ...clarity of possible brain mechanisms.
We investigated the association between urinary levels of glycol ethers of women during early pregnancy and motor inhibition function of their 10- to 12-year-old children by behavioral assessment and brain imaging.
Exposure to glycol ethers was assessed by measuring six metabolites in urine (<19 weeks of gestation) of 73 pregnant women of the PELAGIE mother-child cohort (France). Maternal urinary levels were classified as low, medium, or high. Children underwent functional magnetic resonance imaging (fMRI) examinations during which motor inhibition function was assessed with a Go/No-Go task. Analyses were performed using linear regression for task performance and generalized linear mixed-effect models for brain activation, FWER-corrected for multiple testing at the spatial cluster level. Confounders were considered by restriction and a priori adjustment.
Higher maternal butoxyacetic acid (BAA) urinary concentrations were associated with poorer child performance (β = −1.1; 95% CI: −1.9, −0.2 for high vs low). There was also a trend for ethoxyacetic acid (EAA) towards poorer performance (β = −0.3; 95% CI: −0.7, 0.01). Considering inhibition demand, there were increased activity in occipital regions in association with moderate EAA (left cuneus) and moderate methoxyacetic acid (MAA) (right precuneus). When children succeeded to inhibit, high ethoxyethoxyacetic acid (EEAA) and moderate phenoxyacetic acid (PhAA) levels were associated with differential activity in frontal cortex, involved in inhibition network.
Prenatal urinary levels of two glycol ether metabolites were associated with poorer Go/No-Go task performance. Differential activations were observed in the brain motor inhibition network in relation with successful inhibition, but not with cognitive demand. Nevertheless, there is no consistence between performance indicators and cerebral activity results. Other studies are highly necessary given the ubiquity of glycol ether exposure.
•Glycol ethers are widely used in industry and expose ubiquitously the general population.•Several epidemiological studies suggest that prenatal exposure to glycol ethers may have adverse effects on neurodevelopment.•The present study observes inconsistent poorer performances and differential brain activities during a motor inhibition task.•There is a lack of mechanistic and epidemiological studies to interpret the results, replication is strongly required.
Numerous industries use organic solvents, and many workers from various occupational sectors are exposed to these known neurotoxicants, including pregnant women. Our objective is to explore whether ...occupational exposure of pregnant women to solvents may impair the neurodevelopment of their babies and consequently affect their behavior in childhood.
Within the French birth cohort PELAGIE, parents assessed their children's internalizing and externalizing behaviors using items from the Child Behavior Checklist and the Preschool Social Behavior Questionnaire at age 2, and the Strength and Difficulties Questionnaire at age 6. The occupational exposure to solvents of the pregnant women was self-reported prospectively at the beginning of their pregnancy (N = 715). We applied structural equation modeling to capture the longitudinal association of prenatal exposure to solvents with children's behavioral traits at 2 and 6 years.
Increased externalizing behavior score at age 2 was associated with prenatal exposure to solvents (standardized score: 0.34 (95% CI = 0.11, 0.57) for occasional exposure and 0.26 (0.05, 0.48) for regular exposure). This association was attenuated at age 6 (0.22 (- 0.02, 0.47) for occasional exposure and 0.07 (- 0.14, 0.28) for regular exposure). No association was observed for internalizing behavior.
Pregnant women's occupational exposure to solvents may affect their children's behavior in early childhood. This effect may be attenuated with aging or diluted by the effects of other postnatal predictors.
It has been suggested that prenatal exposure to n-3 long-chain fatty acids protects against asthma and other allergy-related diseases later in childhood. The extent to which fish intake in pregnancy ...protects against child asthma and rhinitis symptoms remains unclear. We aimed to assess whether fish and seafood consumption in pregnancy is associated with childhood wheeze, asthma and allergic rhinitis.
We pooled individual data from 60 774 mother-child pairs participating in 18 European and US birth cohort studies. Information on wheeze, asthma and allergic rhinitis prevalence was collected using validated questionnaires. The time periods of interest were: infancy (0-2 years), preschool age (3-4 years), and school age (5-8 years). We used multivariable generalized models to assess associations of fish and seafood (other than fish) consumption during pregnancy with child respiratory outcomes in cohort-specific analyses, with subsequent random-effects meta-analyses.
The median fish consumption during pregnancy ranged from 0.44 times/week in The Netherlands to 4.46 times/week in Spain. Maternal fish intake during pregnancy was not associated with offspring wheeze symptoms in any age group nor with the risk of child asthma adjusted meta-analysis relative risk (RR) per 1-time/week = 1.01, 95% confidence interval 0.97-1.05) and allergic rhinitis at school age (RR = 1.01, 0.99-1.03). These results were consistently found in further analyses by type of fish and seafood consumption and in sensitivity analyses.
We found no evidence supporting a protective association of fish and seafood consumption during pregnancy with offspring symptoms of wheeze, asthma and allergic rhinitis from infancy to mid childhood.
Objectives
To investigate the contribution of whole-body post-mortem computed tomography (PMCT) in sudden unexpected death in infants and children.
Methods
Forty-seven cases of sudden unexpected ...death in children investigated with radiographic skeletal survey, whole-body PMCT and autopsy were enrolled. For imaging interpretation, non-specific post-mortem modifications and abnormal findings related to the presumed cause of death were considered separately. All findings were correlated with autopsy findings.
Results
There were 31 boys and 16 girls. Of these, 44 children (93.6 %) were younger than 2 years. The cause of death was found at autopsy in 18 cases (38.3 %), with 4 confirmed as child abuse, 12 as infectious diseases, 1 as metabolic disease and 1 as bowel volvulus. PMCT results were in accordance with autopsy in all but three of these 18 cases. Death remains unexplained in 29 cases (61.7 %) and was correlated with no abnormal findings on PMCT in 27 cases. Major discrepancies between PMCT and autopsy findings concerned pulmonary analysis.
Conclusions
Whole-body PMCT may detect relevant findings that can help to explain sudden unexpected death and is essential for detecting non-accidental injuries. We found broad concordance between autopsy and PMCT, except in a few cases of pneumonia. It is a non-invasive technique acceptable to relatives.
Key Points
• Whole-body post-mortem computed tomography (PMCT) is an effective non-invasive method.
• Whole-body PMCT is essential for detecting child abuse in unexpected death.
• There is concordance on cause of death between PMCT and autopsy.
• Whole-body PMCT could improve autopsy through dissection and sampling guidance.
• PMCT shows findings that may be relevant when parents reject autopsy.
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