In this article we review the epidemiologic evidence for adverse health effects in offspring of fathers of advanced age. First the evidence regarding fetal survival is addressed, and afterward we ...review the evidence regarding morbidity in children with older fathers. The adverse conditions most consistently associated with increased paternal age are stillbirths, musculo-skeletal syndromes, cleft palate, acute lymphoblastic leukemia and retinoblastoma, and neurodevelopmental disorders in the autism spectrum and schizophrenia. Finally, we consider the public health impact of the increasing paternal age. We conclude that the adverse health effects in children that might be caused by the present increase in paternal age are severe but quantitatively of minor importance. However, identification of morbidities that are more frequent in offspring of older fathers, after having taken any maternal age effects and other confounding into account, may lead to a better understanding of the pathogenesis behind such conditions.
This study aims to describe the prevalence of spinal pain among Danish children, explore the differential nature of spinal pain, and investigate socio-demographic factors predisposing spinal pain. A ...descriptive study of 46,726 11–14-year-olds participating in the Danish National Birth Cohort was conducted. Self-reported spinal pain (neck, middle back, and low back pain) was registered and classified according to severity. Socioeconomic data on children and their parents were identified in Statistics Denmark registers. Associations between socio-demographic factors and aspects of spinal pain were estimated using multinomial logistic regression models. To account for sample selection, inverse probability weighting (IPW) was applied. Almost 10% boys and 14% girls reported severe spinal pain, whereas around 30% of all children reported moderate pain. Effect estimates indicated the risk to increase with increasing age. Further, children without biological full siblings, not living with both of their parents, or children living in less-educated or lower-income families were more likely to experience spinal pain. The study conclusions were essentially unaffected by IPW.
Conclusion
: A considerable number of children suffer from spinal pain, and it is more common among children in more disadvantaged families. Etiology of spinal pain needs to be explored further with the aim of informing efficient and targeted prevention.
What is Known:
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Childhood spinal pain may cause marked discomfort and impairment in children
’
s everyday life
,
and is suggested as important predictor of later-in-life spinal pain
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Methodological heterogeneity in previous studies and complexity of measuring pain make inferences at a broader level inadequate
.
What is New:
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Prevalence of severe spinal pain in 11
–
14
-
year
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olds was estimated to almost 10% for boys and 14% for girls, and children in more disadvantaged families were more likely to experience spinal pain
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The results seemed unaffected by sample selection
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Both low and high gestational weight gain have been associated with adverse maternal and infant outcomes, but optimal gestational weight gain remains uncertain and not well defined for all ...prepregnancy weight ranges.
To examine the association of ranges of gestational weight gain with risk of adverse maternal and infant outcomes and estimate optimal gestational weight gain ranges across prepregnancy body mass index categories.
Individual participant-level meta-analysis using data from 196 670 participants within 25 cohort studies from Europe and North America (main study sample). Optimal gestational weight gain ranges were estimated for each prepregnancy body mass index (BMI) category by selecting the range of gestational weight gain that was associated with lower risk for any adverse outcome. Individual participant-level data from 3505 participants within 4 separate hospital-based cohorts were used as a validation sample. Data were collected between 1989 and 2015. The final date of follow-up was December 2015.
Gestational weight gain.
The main outcome termed any adverse outcome was defined as the presence of 1 or more of the following outcomes: preeclampsia, gestational hypertension, gestational diabetes, cesarean delivery, preterm birth, and small or large size for gestational age at birth.
Of the 196 670 women (median age, 30.0 years quartile 1 and 3, 27.0 and 33.0 years and 40 937 were white) included in the main sample, 7809 (4.0%) were categorized at baseline as underweight (BMI <18.5); 133 788 (68.0%), normal weight (BMI, 18.5-24.9); 38 828 (19.7%), overweight (BMI, 25.0-29.9); 11 992 (6.1%), obesity grade 1 (BMI, 30.0-34.9); 3284 (1.7%), obesity grade 2 (BMI, 35.0-39.9); and 969 (0.5%), obesity grade 3 (BMI, ≥40.0). Overall, any adverse outcome occurred in 37.2% (n = 73 161) of women, ranging from 34.7% (2706 of 7809) among women categorized as underweight to 61.1% (592 of 969) among women categorized as obesity grade 3. Optimal gestational weight gain ranges were 14.0 kg to less than 16.0 kg for women categorized as underweight; 10.0 kg to less than 18.0 kg for normal weight; 2.0 kg to less than 16.0 kg for overweight; 2.0 kg to less than 6.0 kg for obesity grade 1; weight loss or gain of 0 kg to less than 4.0 kg for obesity grade 2; and weight gain of 0 kg to less than 6.0 kg for obesity grade 3. These gestational weight gain ranges were associated with low to moderate discrimination between those with and those without adverse outcomes (range for area under the receiver operating characteristic curve, 0.55-0.76). Results for discriminative performance in the validation sample were similar to the corresponding results in the main study sample (range for area under the receiver operating characteristic curve, 0.51-0.79).
In this meta-analysis of pooled individual participant data from 25 cohort studies, the risk for adverse maternal and infant outcomes varied by gestational weight gain and across the range of prepregnancy weights. The estimates of optimal gestational weight gain may inform prenatal counseling; however, the optimal gestational weight gain ranges had limited predictive value for the outcomes assessed.
We aimed to investigate if declines in youth's mental health during lockdown were dependent on housing condition among 7445 youth (median age ~ 20 years) from the Danish National Birth Cohort (DNBC), ...with data collected at 18 years of age and again three weeks into the first national lockdown (April 2020). We examined associations between housing conditions (access to outdoor spaces, urbanicity, household density, and household composition) and changes in mental health (mental well-being, Quality of Life (QoL) and loneliness). We report results from multivariate linear and logistic regression models. Youth without access to outdoor spaces experienced greater declines in mental well-being (vs. garden; mean difference: - 0·75 (95% CI - 1·14, - 0·36)), and correspondingly greater odds of onset of low mental well-being (vs. garden; OR: 1·72 (95% CI 1·20, 2·48)). Youth in higher density households vs. below median or living alone vs. with parents only also had greater odds of onset of low mental well-being (OR: 1·26 (95% CI 1·08, 1·46) and OR: 1·62 (95% CI 1·17, 2·23), respectively). Living in denser households (vs. below median; OR: 1·18 (95% CI 1·06, 1·33), as well as living alone (vs. with parents; OR: 1·38 (95% CI 1·04, 1·82) was associated with onset of low QoL. Living alone more than doubled odds of onset of loneliness compared to living with parents, OR: 2·12 (95% CI 1·59, 2·82). Youth living alone, in denser households, and without direct access to outdoor spaces may be especially vulnerable to mental health declines.
Background
Fever and infections are common events during pregnancy, and have been shown to be associated with neurodevelopmental impairment in the offspring. The evidence in relation to attention ...deficit/hyperactivity disorder (ADHD) is, however, nonexistent for fever and limited for infections. The aim of this study was therefore to investigate the impact of these exposures on the occurrence of ADHD in the offspring, considering gestational timing as well as intensity of exposure.
Methods
The study was conducted within the Danish National Birth Cohort, using data on 89,146 pregnancies enrolled during 1996–2002. Exposure to fever and infections were assessed prospectively in two computer‐assisted telephone interviews during pregnancy and ADHD status in the child was determined using registry information from three nation‐wide patient and prescription registers. Stratified Cox regressions were used to calculate adjusted hazard ratios of ADHD occurrence.
Results
The analyses revealed no overall association between maternal exposure to fever or infections and ADHD in the offspring adjusted hazard ratio (aHR): 1.03, 95% confidence interval (CI): 0.93–1.13 and aHR: 1.01, 95% CI: 0.92–1.11. When the exposures were considered during specific gestational periods, increased rates of ADHD were observed following fever in gestational weeks 9–12 (aHR: 1.33, 95% CI: 1.12–1.58), and genitourinary infections in weeks 33–36 (aHR: 1.60, 95% CI: 1.13–2.26).
Conclusions
Although no overall adverse association between fever and infections in pregnancy and ADHD in the offspring was found, the analyses indicated that exposures during specific time windows of the pregnancy could be associated with increased ADHD occurrence.
Objective
To evaluate whether MAMAACT, an antenatal care (ANC) intervention, aimed at reducing ethnic and social disparities in perinatal mortality, affected perinatal health outcomes.
Design
Cluster ...randomised controlled trial.
Setting
Nineteen of 20 maternity wards in Denmark.
Population
All newborn children within a pre‐implementation period (2014–2017) or an implementation period (2018–2019) (n = 188 658).
Intervention
A 6‐h training session for midwives in intercultural communication and cultural competence, two follow‐up dialogue meetings, and health education materials for pregnant women on warning signs of pregnancy complications in six languages.
Methods
Nationwide register‐based analysis of the MAMAACT cluster randomised controlled trial. Mixed‐effects logistic regression models were used to estimate the change in outcomes from pre‐ to post‐implementation in the intervention group relative to the control group. Results were obtained for the overall study population and for children born to immigrants from low‐ to middle‐income countries, separately. Models were adjusted for confounders selected a priori.
Main Outcome Measures
A composite perinatal mortality and morbidity outcome, including stillbirths, neonatal deaths, Apgar score <7, umbilical arterial pH < 7.0, admissions to a neonatal intensive care unit (NICU) >48 h, and NICU admissions for mechanical ventilation. Additional outcomes were the individual measures.
Results
The intervention increased the risk of the composite outcome (adjusted odds ratio aOR 1.16, 95% confidence interval CI 0.99–1.34), mainly driven by differences in NICU admission risk (composite outcome excluding NICU, aOR 0.98, 95% CI 0.84–1.14). The intervention slightly increased the risk of low Apgar score and decreased the risk of low arterial pH, reflecting, however, small differences in absolute numbers. Other outcomes were unchanged.
Conclusions
Overall, the MAMAACT intervention did not improve the composite perinatal mortality and morbidity outcome (when excluding NICU admissions). The lack of effects may be due to contextual factors including organisational barriers in ANC hindering the midwives from changing practices.
•Higher socioeconomic position is associated with mostly beneficial home environments.•However, certain sources of pollution may be higher in these homes.•Affective disorders, may be especially ...strongly related to the home environment.•Housing age, type and household composition cluster with a number of indoor factors.•Mould and moisture correlate, while candle burning is largely unrelated to other factors.
Housing and indoor home environments are associated with the risk of infections and asthma in children. To better understand the determinants and characteristics of these environments, we aimed to describe the associations between parental health and socioeconomic position and housing and indoor home environments of children in Denmark, and the clustering of the factors within these environments.
Offspring in the Danish National Birth Cohort (DNBC) whose parents responded to the 11-year follow-up were eligible for inclusion. We included complete cases only. Data on the indoor and housing environments (i.e. variables on housing, sources of gaseous and particle pollution, mould and moisture, and pets) were collected through an online questionnaire responded to by a parent. Data on socioeconomic position were obtained through linkage with registry data on maternal education at offspring birth and household equivalized income at offspring birth. Data on parental health were obtained by linking self-reported data from the 11-year follow-up for mother and father with administrative registry data for the mother. We present descriptive statistics and exploratory factor analyses.
A total of 42 723 offspring were included for analyses. The distributions of nearly all indoor and housing environments differed according to educational and income strata, with patterns similar for both education and income. Generally, higher parental educational and income strata had more favorable indoor and housing environments (less secondhand smoking, gas stove use, mould and condensation and higher house ownership, detached house dwellings and newer building age). However, candle use was approximately similar between strata, fireplace use among lower educational and income strata tended towards the extremes (none or daily), and water damage was more common among higher educational and income strata. Parental health was strongly associated with housing and indoor home environment factors - especially parental affective disorders was strongly associated with mould. Four factors were extracted from the exploratory factor analyses, relating primarily in order of extraction to: housing ownership, mould and moisture, candle use and household density.
Parental health and socioeconomic position are strongly related to housing and indoor home environments. Additionally, several factors in these environments correlate strongly and cluster together. Observational studies on associations and causal effects of factors in the indoor and housing environments of children on their morbidity, must consider both of these conclusions to arrive at valid estimates and effects.
Background Atopic dermatitis (AD) appears to be more common in regions with hard domestic water and in children with a fall/winter birth. However, it is unknown whether a synergistic effect exists. ...Objective We sought to evaluate the association between domestic water hardness and season of birth, respectively, with onset of AD within the first 18 months of life in a large Danish birth cohort. Methods Of children from the Danish National Birth Cohort, 52,950 were included. History of physician-diagnosed AD and population characteristics were obtained from interviews. Birth data were obtained from the Civil Registration System, and domestic water hardness data were obtained from the Geological Survey of Denmark and Greenland. The relative prevalence (RP) of AD was calculated by using log-linear binomial regression. Results The prevalence of AD was 15.0% (7,942/52,950). The RP of AD was 5% (RPtrend , 1.05; 95% CI, 1.03-1.07) higher for each 5° increase in domestic water hardness (range, 6.60-35.90 German degrees of hardness 118-641 mg/L). Although the RP of AD was higher in children with a fall (RP, 1.24; 95% CI, 1.17-1.31) or winter (RP, 1.18; 95% CI, 1.11-1.25) birth, no significant interaction was observed with domestic water hardness. The population attributable risk of hard domestic water on AD was 2%. Conclusion We observed that early exposure to hard domestic water and a fall/winter birth was associated with an increase in the relative prevalence of AD within the first 18 months of life. Although the 2 exposures did not interact synergistically, a dose-response relationship was observed between domestic water hardness and AD.
Childhood is a sensitive period with rapid brain development and physiological growth, and adverse events in childhood might interfere with these processes and have long-lasting effects on health. In ...this study, we aimed to describe trajectories of adverse childhood experiences and relate these to overall and cause-specific mortality in early adult life.
For this population-based cohort study, we used unselected annually updated data from Danish nationwide registers covering more than 1 million children born between 1980 and 1998. We distinguished between three different dimensions of childhood adversities: poverty and material deprivation, loss or threat of loss within the family, and aspects of family dynamics such as maternal separation. We used a group-based multi-trajectory clustering model to define the different trajectories of children aged between 0 and 16 years. We assessed the associations between these trajectories and mortality rates between 16 and 34 years of age using a Cox proportional hazards model and an Aalen hazards difference model.
Between Jan 1, 1980 and Dec 31, 2015, 2 223 927 children were included in the Danish Life Course cohort. We excluded 1 064 864 children born after 1998, 50 274 children who emigrated before their 16th birthday, and 11 161 children who died before their 16th birthday, resulting in a final sample of 1 097 628 children. We identified five distinct trajectories of childhood adversities. Compared with children with a low adversity trajectory, those who had early-life material deprivation (hazard ratio 1·38, 95% CI 1·27–1·51), persistent deprivation (1·77, 1·62–1·93), or loss or threat of loss (1·80, 1·61–2·00) had a moderately higher risk of premature mortality. A small proportion of children (36 081 3%) had multiple adversities within all dimensions and throughout the entire childhood. This group had a 4·54 times higher all-cause mortality risk (95% CI 4·07–5·06) than that of children with a low adversity trajectory, corresponding to 10·30 (95% CI 9·03–11·60) additional deaths per 10 000 person-years. Accidents, suicides, and cancer were the most common causes of death in this high adversity population.
Almost half of Danish children in our study experienced some degree of adversity, and this was associated with a moderately higher risk of mortality in adulthood. Among these, a small group of children had multiple adversities across social, health, and family-related dimensions. This group had a markedly higher mortality risk in early adulthood than that of other children, which requires public health attention.
None.
Background
The popularity of the gluten‐free diet and sales of gluten‐free products have increased immensely.
Aims
To investigate whether gluten induces gastrointestinal symptoms, measured by ...self‐reported questionnaires, as well as mental health symptoms in adolescents from a population‐based cohort.
Methods
The eligible participants (n = 273) were recruited from a population‐based cohort of 1266 adolescents and had at least four different gastrointestinal symptoms. Phase one (n = 54) was a run‐in phase where the participants lived gluten‐free for 2 weeks. If they improved they continued to phase 2 (n = 33), a blinded randomised cross‐over trial. Participants were blindly randomised either to start with 7 days of gluten, eating two granola bars containing 10 g of gluten or to 7 days on placebo, eating two granola bars without gluten, followed by the reverse and separated by a 7‐day washout period. The effects of the intervention on gastrointestinal symptoms and mental health symptoms were assessed.
Results
In total, 54/273 participants entered the run‐in phase and 35 were eligible for randomization. A total of 33 were randomised and 32 completed the trial. The median age was 20.3 (IQR 19.2–20.9) and 32/33 participants were females. Compared with a placebo, gluten did not induce gastrointestinal symptoms. The difference in the average VAS was −0.01 (95% confidence interval −2.07 to 2.05). Nor did we find a difference in the outcomes measuring mental health.
Conclusion
Compared with placebo, adding gluten to the diet did not induce gastrointestinal symptoms or worsened mental health in adolescents recruited from a population‐based cohort. The trial registration number is NCT04639921.
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