Characteristics of Overweight and Obesity at Age Two and the Association with Breastfeeding in Hawai’i Women,Infants, and Children (WIC) Participants

Childhood obesity is associated with many adverse health effects during childhood and is linked to an increased risk for obesity in adulthood. The objective of this study was to determine the characteristics of early childhood overweight and obesity and assess the impact of breastfeeding. Data from Hawai’i’s Special Supplemental Nutrition Program for Women, Infants and Children (WIC) were analyzed for children 2 years of age born between 2005 and 2009 and their mothers. Childhood overweight and obesity was examined using a log-binomial regression model to estimate prevalence ratios. In the sample population, 12.5 % of children were overweight and 8.5 % of children were obese. Significant differences in childhood overweight and obesity were seen between breastfeeding duration and other socio-demographic groups. Children who were breastfed for 6 months or more had a lower risk of childhood obesity at age two compared to those who were never breastfed (APR 0.79, 95 % CI 0.69–0.91) with adjustment for child race/ethnicity, maternal age, trimester of prenatal care entry, maternal smoking status, and child birth weight. The prevalence of early childhood overweight and obesity is associated with shorter durations of breastfeeding. Early and continued breastfeeding support and education for mothers in the WIC program that improves duration of breastfeeding may help reduce the risk of early childhood obesity.     

Temporal Trends in Social Disparities in Maternal Smoking and Breastfeeding in Canada, 1992–2008

A steady decrease in maternal smoking during pregnancy and a steady increase in breastfeeding rates have been observed in Canada in the past two decades. However, the extent to which all socioeconomic classes have benefited from this progress is unknown. Therefore, this study was undertaken to determine: (1) whether progress achieved benefited the entire population or was limited to specific strata; and (2) whether disparities among strata decreased, stayed the same, or increased over time. We used data from the National Longitudinal Survey of Children and Youth, which enrolled children aged 0–3 years between 1994 and 2008. Data collected at entry was analyzed in a cross-sectional manner. Between birth years 1992–1996 and 2005–2008, smoking during pregnancy decreased from 11.5 % (95 % CI 10.0–13.0 %) to 5.2 % (95 % CI 4.1–6.3 %) among mothers with a college or university degree and from 43.0 % (95 % CI 38.8–47.2 %) to 38.6 % (95 % CI 32.9–44.2 %) among those with less than secondary education. During the same period, the rate of breastfeeding initiation increased from 83.8 % (95 % CI 81.9–85.6 %) to 91.5 % (95 % CI 90.2–92.8 %) among mothers with a college or university degree and from 63.1 % (95 % CI 58.9–67.4 %) to 74.7 % (95 % CI 69.8–79.7 %) among those with less than secondary education. The risks of smoking and of not breastfeeding remained significantly higher in the least educated category than in the most educated throughout the study period, and these associations remained statistically significant after controlling for maternal age. Gaps between the least and the most educated mothers narrowed for breastfeeding but widened for smoking during pregnancy.     

Association of Bisphenol A Exposure with Breastfeeding and Perceived Insufficient Milk Supply in Mexican Women

Introduction Estrogen inhibits lactation and bisphenol A (BPA) is a high production environmental estrogen. We hypothesize an inhibitory effect of BPA on lactation and aim to analyze the association between third trimester pregnancy urinary BPA and breastfeeding rates 1 month postpartum. Methods Odds ratios (OR) and 95 % confidence intervals (95 % CI) of breastfeeding and perceived insufficient milk supply (PIM) in relation to maternal peripartum urinary BPA concentrations were calculated in 216 mothers. Results 97.2 % of mothers in the lowest BPA tertile were breastfeeding at 1 month postpartum, compared to 89.9 % in highest (p = 0.01). Adjusted ORs (95 % CI) for not breastfeeding at 1 month were 1.9 (0.3, 10.7) and 4.3 (0.8, 21.6) for second and third BPA tertiles, respectively, compared to the lowest (p = 0.06, trend). 4.2 % reported PIM in the lowest BPA tertile, compared to 8.7 % in the highest (p = 0.03). Adjusted ORs (95 % CI) for PIM were 1.8 (0.4, 7.7) and 2.2 (0.5, 9.5), for the second and third BPA tertiles, respectively, compared to the lowest (p = 0.29, trend). Discussion These results suggest an association between maternal BPA exposure and decreased breastfeeding.     

The effects of maternal exposure to second-hand smoke on breast-feeding duration: A prospective cohort study

Aim

Encouraging exclusive breastfeeding up to 6 months is one of the main priorities for public health. However, the rate of exclusive breastfeeding is decreasing in Iran. Moreover, there have been few studies conducted on the effects of maternal exposure to cigarette smoke on breastfeeding duration in Iran. Considering the importance of breast milk for infant development, the future health of the baby and ultimately the family, this study was designed to assess the effect of maternal exposure to second-hand smoke on exclusive breastfeeding duration.

Subjects and methods

The effect of smoke exposure on exclusive breastfeeding was investigated in a prospective cohort study. The study included 170 mothers in the exposed group and 170 mothers in the non-exposed group. There were losses to follow-up (12 %), so a statistical analysis was carried out on a total of 299 women. Breastfeeding duration and maternal exposure to second-hand smoke were recorded in three follow-up interviews, including 3–5 days, 3 months and 6 months after delivery. Maternal exposure to second-hand smoke was assessed by self-reports. A Kaplan-Meier survival analysis and Cox regression model were used for data analysis.

Results

Maternal exposure to second-hand smoke during the postpartum period can cause a significant reduction in exclusive breastfeeding during a 6-month period (p?<?0.001). According to the Cox regression model, heavily exposed (hazard ratio?=?2.22, 95 % confidence interval: 1.45–3.39) and lightly exposed mothers (hazard ratio?=?1.65, 95 % confidence interval: 1.25–2.42) were more likely to stop exclusive breastfeeding earlier compared with non-exposed women.

Conclusion

Maternal exposure to second-hand smoke is associated with an increased risk of discontinuation of exclusive breastfeeding before 6 months. A stance of no smoking at home and avoidance of passive smoking could possibly improve the rate of breastfeeding in Iran.     

Outcomes and Factors Associated with Breastfeeding for <8 Weeks Among Preterm Infants: Findings from 6 States and NYC, 2004–2007

To examine breastfeeding outcomes and factors associated with breastfeeding <8 weeks among preterm infants. Pregnancy Risk Assessment Monitoring System (PRAMS) data for seven sites from 2004 to 2007 were used. Logistic regression was used to identify correlates of short breastfeeding duration among preterm infants. Among preterm infants, short breastfeeding duration (<8 weeks) was associated with maternal age ≤19 years (OR 1.75; 95 % CI: 1.22, 2.50), infant birth weight between 1,500 and 2,499 g (OR 1.29; 95 % CI: 1.01, 1.65), maternal obesity (OR 1.52; 95 % CI: 1.17, 1.98), smoking (OR 2.61; 95 % CI: 1.87, 3.63), and hypertension (OR 1.34; 95 % CI: 1.06, 1.69). Receiving a phone number for breastfeeding help (OR 0.59; 95 % CI: 0.44, 0.78) and not receiving a gift pack with formula (OR 0.64; 95 % CI: 0.47, 0.87) were associated with decreased odds of short duration. Speaking with a provider about breastfeeding prenatally was associated with increased odds of short duration (OR 1.75; 95 % CI: 1.33, 2.30). These findings strengthen the hypothesis that infant and maternal health are determinants of breastfeeding preterm infants and suggest a need to provide additional support to smokers, obese and hypertensive women, and mothers of infants with birth weights between 1,500 and 2,499 g, to help them sustain breastfeeding. Support from hospitals, such as providing a telephone number for breastfeeding help, and not providing a gift pack with formula, can also make a difference. These practices should be adopted by hospitals.     

Predictors of Exclusive Breastfeeding at Least 8 Weeks Among Asian and Native Hawaiian or Other Pacific Islander Race Subgroups in Hawaii, 2004–2008

Breastfeeding is nurturing, cost-effective, and beneficial for the health of mother and child. Babies receiving formula are sick more often and are at higher risk for childhood obesity, diabetes, asthma, and other conditions compared with breastfed children. National and international organizations recommend exclusive breastfeeding for 6 months. Exclusive breastfeeding in Asian and Native Hawaiian or Other Pacific Islander (NHOPI) subgroups is not well characterized. Data from the 2004–2008 Hawaii Pregnancy Risk Assessment Monitoring System, a population-based surveillance system on maternal behaviors and experiences before, during, and after pregnancy, were analyzed for 8,508 mothers with a recent live birth. We examined exclusive breastfeeding status for at least 8 weeks. We calculated prevalence risk ratios across maternal race groups accounting for maternal and socio-demographic characteristics. The overall estimate of exclusive breastfeeding for at least 8 weeks was 36.3 %. After adjusting for maternal age, pre-pregnancy weight, cesarean delivery, return to work/school, and self-reported postpartum depressive symptoms, the racial differences in prevalence ratios for exclusive breastfeeding for each ethnic group compared to Whites were: Samoan (aPR = 0.54; 95 % CI 0.43–0.69), Filipino (aPR = 0.58; 95 % CI 0.53–0.63), Japanese (aPR = 0.58; 95 % CI 0.52–0.65), Chinese (aPR = 0.64; 95 % CI 0.58–0.70), Native Hawaiian (aPR = 0.67; 95 % CI 0.61–0.72), Korean (aPR = 0.72; 95 % CI 0.64–0.82), and Black (aPR = 0.79; 95 % CI 0.65–0.96) compared to white mothers. Providers and community groups should be aware that just over one-third of mothers breastfeed exclusively at least 8 weeks with lower rates among Asian, NHOPI, and Black mothers. Culturally appropriate efforts to promote exclusive breastfeeding are recommended particularly among Asian subgroups that have high breastfeeding initiation rates that do not translate into high exclusivity rates.     

Investigating the Association of Lactation History and Postmenopausal Breast Cancer Risk in the Women's Health Initiative

Prolonged lactation (≥24 mo) has been associated with reduced breast cancer risk. This research examined this association in postmenopausal women in the Women's Health Initiative (WHI) Hormone Trial (HT) and Observational Study (OS). This retrospective cohort analysis included 69,358 predominantly overweight (65.4%), white (83.2%) postmenopausal women without breast cancer. Women in the HT were randomized to 0.625 mg conjugated equine estrogen (CEE), 0.625 CEE + 2.5 mg medroxyprogesterone acetate (CEE/MPA), or placebo. OS participants had no restrictions on hormone use. Lactation history was assessed via WHI Reproductive History Questionnaire. Most women breastfed at least 1 mo (58.0%); 35.4% breastfed 1–2 children; and 6.5% stated having breastfed ≥24mo. Women in the HT–CEE who breastfed their first child between 20–24 yr of age demonstrated a nonsignificant decreased risk of breast cancer (HR: 0.62; 95% CI: 0.38, 1.01). OS participants who reported CEE/MPA hormone use and age of first breastfeeding ≥30 yr showed a significant increased risk of breast cancer (HR: 1.66; 95% CI: 1.14, 2.41). Risk was increased if age of last breastfeeding was ≥35yr (HR: 1.50; 95% CI: 1.05, 2.14). This research did not demonstrate a significantly decreased risk of postmenopausal breast cancer in women who breastfed for ≥24 mo during their lifetime.     

Body Image Dissatisfaction,Obesity and Their Associations with Breastfeeding in Mexican Women,a Cross-Sectional Study

Introduction In Mexico the breastfeeding rate is low and the obesity rate is high. Body image concerns, particularly prevalent in obese women, are associated with low breastfeeding rate; however, this association has never been examined in Mexican women. To fill this need, we examined the association between body image dissatisfaction (BID) and breastfeeding across levels of maternal weight status in Mexican women. Methods A cross-sectional study was used, utilizing data from the Mexican National Health and Nutrition Survey (ENSANUT) for 2012. The breastfeeding (Never or breastfed less than 30 days, Still breastfeeding, Ever breastfed) of the last child (age?≤?3 years), BID (Stunkard Figure Rating Scale), anthropometric (Body Mass Index, BMI), and associated characteristics were collected. Weighted-multinomial logistic regression models were utilized to examine the adjusted association between BID and breastfeeding and the effect modification of maternal weight status. Results Overall, 2422 women aged 20–49 years met the eligibility criteria. Of these, 247 (10.8%) had never breastfed or breastfed less than 30 days, 826 (32%) were still breastfeeding, and 1349 (57.2%) had breastfed. A total of 38.2% were overweight (25?≤?BMI?<?30 kg m²) and 26.2% were obese (BMI?≥?30 kg m²). In the adjusted model, while stratifying by maternal weight status levels, a greater BID was associated with a lower odds of sill breastfeeding (OR 0.58, 95% CI 0.45–0.75) and having breastfed (OR 0.65, 95% CI 0.50–0.83) only among women with BMI?≥?30 kg m². Discussion The results highlight the potential relationship between body image concerns and breastfeeding in Mexican women with obesity. However, the causality of such relationship needs further investigation, ideally using a longitudinal study design.     

Sexual and physical abuse in childhood is associated with depression and anxiety over the life course: systematic review and meta-analysis

Objectives

To determine whether depression and anxiety in adulthood are associated with abuse exposure in childhood.

Methods

A search of PUBMED, EMBASE and PSYCHINFO databases (2002–2012) was supplemented by hand searches of bibliographies of articles and reviews. We included studies contrasting abuse exposure vs. no-abuse exposure before age 16 years to depression and anxiety after age 16 years. Data on sample and exposure and outcome instruments, covariates and odds ratios (ORs) with the respective 95 % confidence intervals (CI) were extracted. Combined ORs and 95 % CI were calculated using random effects models. Heterogeneity was quantified using the I ² test.

Results

Inclusion criteria were met by 19 studies with 115,579 study participants, for assessing depression (n = 14) and anxiety (n = 13). The combined ORs for depression were 2.04 (95 % CI: 1.65–2.53) for sexual abuse and 1.49 (95 % CI: 1.29–1.72) for physical abuse. The combined ORs for anxiety were 2.52 (95 % CI: 2.12–2.98) for sexual abuse and 1.70 (95 % CI: 1.33–2.18) for physical abuse.

Conclusions

High levels of depression, anxiety and distress are reported in adults exposed to childhood sexual and physical abuse. These findings require increased awareness for the potential needs of adults exposed to child abuse and public health interventions to prevent child abuse.     

The Association of Maternal Pre-pregnancy Body Mass Index with Breastfeeding Initiation

Recent evidence extends the health benefits of breastfeeding to include reduction of maternal body mass index (BMI) and childhood obesity. Since most women decide if they will breastfeed prior to pregnancy, it is important to understand, given the high population prevalence of obesity, if maternal underweight, overweight or obese status is associated with breastfeeding initiation. Population-based study. Florida resident birth certificate records. All live singleton births (2004–2009), excluding observations that lacked the primary outcomes of maternal pre-pregnancy BMI and breastfeeding initiation (final sample of 1,161,949 unique observations). Odds of initiating breastfeeding, adjusted by maternal and infant factors, stratified by pre-pregnancy BMI, categorized as underweight, normal, overweight and obese. Adjusting for the known maternal factors associated with breastfeeding initiation, underweight and obese women were significantly less likely to initiate breastfeeding than women with normal BMI, (adjusted odds ratio 0.87, 95 % confidence interval 0.85–0.89 for underweight women; 0.84, 95 % CI 0.83–0.85 for obese women). The magnitude of these findings did not significantly vary by race or ethnicity. Medicaid status and adherence to the Institute of Medicine’s 2009 pregnancy weight gain recommendations had only minor influences on breastfeeding initiation. Among adolescents, only underweight status predicted breastfeeding initiation; obesity did not. Underweight and obese women have significantly lower rates of breastfeeding initiation compared to women with normal pre-pregnancy BMI. Future studies need to address the health care, social, and physical barriers that interfere with breastfeeding initiation, especially in underweight and obese women, regardless of race, ethnicity or income.     

Household Food Insecurity,Maternal Nutritional Status,and Infant Feeding Practices Among HIV-infected Ugandan Women Receiving Combination Antiretroviral Therapy

Household food insecurity (HHFI) may be a barrier to both optimal maternal nutritional status and infant feeding practices, but few studies have tested this relationship quantitatively, and never among HIV-infected individuals. We therefore described the prevalence of HHFI and explored if it was associated with poorer maternal nutritional status, shorter duration of exclusive breastfeeding (EBF) and fewer animal-source complementary foods. We assessed these outcomes using bivariate and multivariate analyses among 178 HIV-infected pregnant and breastfeeding (BF) women receiving combination antiretroviral therapy in the PROMOTE trial (NCT00993031), a prospective, longitudinal cohort study in Tororo, Uganda. HHFI was common; the prevalence of severe, moderate, and little to no household hunger was 7.3, 39.9, and 52.8 %, respectively. Poor maternal nutritional status was common and women in households experiencing moderate to severe household hunger (MSHH) had statistically significantly lower body mass index (BMIs) at enrollment (21.3 vs. 22.5, p < 0.01) and prior to delivery (22.6 vs. 23.8, p < 0.01). BMI across time during pregnancy, but not gestational weight gain, was significantly lower for MSHH [adjusted beta (95 % CI) ?0.79 (?1.56, ?0.02), p = 0.04; ?2.06 (?4.31, 0.19), p = 0.07], respectively. The prevalence (95 % CI) of EBF at 6 months was 67.2 % (59.7–73.5 %), and the proportion of women BF at 12 months was 80.4 % (73.3–85.7 %). MSHH was not associated with prevalence of EBF at 6 months or BF at 12 months. However, among those women still EBF at 4 months (81.4 % of population), those experiencing MSHH were significantly more likely to cease EBF between 4 and 6 months (aHR 2.38, 95 % CI 1.02–5.58). The prevalence of HHFI, maternal malnutrition, and suboptimal infant feeding practices are high and the causal relationships among these phenomena must be further explored.     

The Association of State Law to Breastfeeding Practices in the US

We assessed the relationship between breastfeeding initiation and duration with laws supportive of breastfeeding enacted at the state level. We analyzed breastfeeding practices using the 2003–2010 National Health and Nutrition Examination Survey. We evaluated three measures of breastfeeding practices: Mother’s reported breastfeeding initiation, a proxy report of infants ever being breastfeed, and a proxy report of infants being breastfeed for at least 6 months. Survey data were linked to eight laws supportive of breastfeeding enacted at the state level. The most robust laws associated with increased infant breastfeeding at 6 months were an enforcement provision for workplace pumping laws [OR (95 % CI) 2.0 (1.6, 2.6)] and a jury duty exemption for breastfeeding mothers [OR (95 % CI) 1.7 (1.3, 2.1)]. Having a private area in the workplace to express breast milk [OR (95 % CI) 1.3 (1.1, 1.7)] and having break time to breastfeed or pump [OR (95 % CI) 1.2 (1.0, 1.5)] were also important for infant breastfeeding at 6 months. This research responds to breastfeeding advocates’ calls for evidence-based data to generate the necessary political action to enact legislation and laws to protect, promote, and support breastfeeding. We identify the laws with the greatest potential to reach the Healthy People 2020 targets for breastfeeding initiation and duration.     

Maternal smoking during pregnancy and childhood obesity

A recent cohort study suggested that maternal smoking during pregnancy might be a risk factor for childhood obesity. Data from the obligatory school entry health examination in six Bavarian (Germany) public health offices in 1999-2000 were used to assess the relation between maternal smoking during pregnancy and childhood obesity (n = 6,483 German children aged 5.00-6.99 years). A body mass index greater than the 90th percentile was defined as overweight, and a body mass index greater than the 97th percentile was defined as obesity. The main exposure was maternal smoking during pregnancy. The prevalences of overweight and obesity, expressed as percentages, increased in the following order: never smoked (overweight: 8.1, 95% confidence interval (CI): 7.2, 9.0; obesity: 2.2, 95% CI: 1.7, 2.7); less than 10 cigarettes daily (overweight: 14.1, 95% CI: 11.1, 17.7; obesity: 5.7, 95% CI: 3.7, 8.2); and 10 or more cigarettes daily (overweight: 17.0, 95% CI: 10.1, 26.2; obesity: 8.5, 95% CI: 3.7, 16.1). The adjusted odds ratios for maternal smoking during pregnancy were 1.43 (95% CI: 1.07, 1.90) for overweight and 2.06 (95% CI: 1.31, 3.23) for obesity. A dose-dependent association between overweight/obesity and maternal smoking during pregnancy was observed that could not be explained by a wide range of confounders, suggesting that intrauterine exposure to inhaled smoke products rather than lifestyle factors associated with maternal smoking accounts for this finding.     

Maternal smoking very early in pregnancy is related to child overweight at age 5-7 y

BACKGROUND: Despite being associated with lower birth weight, maternal smoking in the last 2 trimesters of pregnancy has been associated with increased risk of offspring overweight in several studies. To date, only one study has examined whether smoking in the first trimester only, which is not associated with birth weight, is also associated with childhood overweight. OBJECTIVE: This study uses prospective data to examine associations between maternal smoking in the first compared with later trimesters of pregnancy and child overweight at age 5-7 y. DESIGN: Data from a prospective cohort of 369 Spanish children born in 1997-1998 were used. Logistic regression was used to estimate associations between maternal smoking during different time periods and odds of child overweight later in life. RESULTS: Maternal smoking during the first trimester was more strongly associated with overweight (adjusted odds ratio: 2.65; 95% CI: 1.26, 5.54) than smoking later in pregnancy (1.88, 0.85, 4.15). Smoking limited to the first month of pregnancy was also associated with child overweight. Neither paternal smoking nor maternal smoking before or after pregnancy was associated with child overweight. Significant interactions with breastfeeding duration indicated that first-trimester smoking was associated with overweight only among children breastfed for <6 mo, suggesting prolonged breastfeeding may help to counter adverse effects of smoking in early pregnancy. CONCLUSIONS: These data suggest maternal smoking very early in pregnancy may increase risk of later overweight in children and provide further support for promoting smoking cessation before rather than during early pregnancy. Further studies are needed to confirm these results.     

Smoking,physical exercise,BMI and late foetal death: a study within the Danish National Birth Cohort

The aim of this paper was to estimate the effect of maternal and paternal smoking on foetal death (miscarriage and stillbirth) and to estimate potential interactions with physical exercise and pre-pregnancy body mass index. We selected 87,930 pregnancies from the population-based Danish National Birth Cohort. Information about lifestyle, occupational, medical and obstetric factors was obtained from a telephone interview and data on pregnancy outcomes came from the Danish population based registries. Cox regression was used to estimate the hazard ratios (adjusted for potential confounders) for predominantly late foetal death (miscarriage and stillbirth). An interaction contrast ratio was used to assess potential effect measure modification of smoking by physical exercise and body mass index. The adjusted hazard ratio of foetal death was 1.22 (95 % CI 1.02–1.46) for couples where both parents smoked compared to non-smoking parents (miscarriage: 1.18, 95 % CI 0.96–1.44; stillbirth: 1.32, 95 % CI 0.93–1.89). On the additive scale, we detected a small positive interaction for stillbirth between smoking and body mass index (overweight women). In conclusion, smoking during pregnancy was associated with a slightly higher hazard ratio for foetal death if both parents smoked. This study suggests that smoking may increase the negative effect of a high BMI on foetal death, but results were not statistically significant for the interaction between smoking and physical exercise.     

Maternal overweight and smoking: prenatal risk factors for caries development in offspring during the teenage period

This study aimed to investigate pre- and perinatal determinants as risk factors for caries development in offspring. In this longitudinal register-based cohort study, we included all children (n = 18,142), of 13 years of age who resided in the county of Stockholm, Sweden, in 2000. The cohort was followed until individuals were 19 years of age. In total, 15,538 subjects were examined. Dental caries (decayed, missing and filled teeth/surfaces), were collected from the Public Health Care Administration in Stockholm. Data concerning pre- and perinatal factors, as well as parental socio-demographic determinants, were collected from the Swedish Medical Birth Register and Swedish National Registers at Statistics Sweden. Mean approximal caries increment (DMFSa) was 1.34 ± 2.74. The results showed that the prenatal factors, “maternal smoking” and “maternal overweight” exhibited an increased risk of approximal caries increment, (OR 1.33; 95% CI = 1.22–1.44) and (OR 1.21; 95% CI = 1.07–1.37), respectively. Concerning maternal overweight, the excess risk enhanced in relation to the magnitude of the caries increment and maternal smoking was significant across the various DMFSa outcome cut-off levels. In conclusion, this study demonstrates that the prenatal factors, maternal overweight, as well as smoking, are risk factors for approximal caries development in offspring during the teenage period.     

Measuring Dosage: A Key Factor When Assessing the Relationship Between Prenatal Case Management and Birth Outcomes

To assess whether a measure of prenatal case management (PCM) dosage is more sensitive than a dichotomous PCM exposure measure when evaluating the effect of PCM on low birthweight (LBW) and preterm birth (PTB). We constructed a retrospective cohort study (N = 16,657) of Iowa Medicaid-insured women who had a singleton live birth from October 2005 to December 2006; 28 % of women received PCM. A PCM dosage measure was created to capture duration of enrollment, total time with a case manager, and intervention breadth. Propensity score (PS)-adjusted odds ratios (ORs), and 95 % confidence intervals (95 % CIs) were calculated to assess the risk of each outcome by PCM dosage and the dichotomous PCM exposure measure. PS-adjusted ORs of PTB were 0.88 (95 % CI 0.70–1.11), 0.58 (95 % CI 0.47–0.72), and 1.43 (95 % CI 1.23–1.67) for high, medium, and low PCM dosage, respectively. For LBW, the PS-adjusted ORs were 0.76 (95 % CI 0.57–1.00), 0.64 (95 % CI 0.50–0.82), and 1.36 (95 % CI 1.14–1.63), for high, medium, and low PCM dosage, respectively. The PCM dichotomous participation measure was not significantly associated with LBW (OR = 0.95, 95 % CI 0.82–1.09) or PTB (0.97, 95 % CI 0.87–1.10). The reference group in each analysis is No PCM. PCM was associated with a reduced risk of adverse pregnancy outcomes for Medicaid-insured women in Iowa. PCM dosage appeared to be a more sensitive measure than the dichotomous measure of PCM participation.     

Why do studies show different associations between intrauterine exposure to maternal smoking and age at menarche?

Purpose

Studies suggests that intrauterine exposure to maternal smoking both accelerates or delays age at menarche. We hypothesize that these opposing findings relate to different infant and childhood growth patterns across cohorts.

Total Trihalomethanes in Public Drinking Water Supply and Birth Outcomes: A Cross-Sectional Study

Reproductive effects of long-term, low-dose exposure to disinfectant by-products have not been consistently documented in large populations despite the known toxicity of high exposures and the wide-spread occurrence of low concentrations in public drinking water. We investigated the effect of low-dose exposure to total trihalomethanes (TTHM) on birth weight and gestational term in New York State. All singleton live births from 1998 through 2003 in 62 counties in New York State were linked with public water supply (PWS) system boundaries based on mother’s residential address on birth certificate. Using the data from public water supply system, TTHM measurements were assigned geographically and temporally to each birth record linked with PWS boundary. Individual level maternal information including mother’s race, ethnicity, education, employment status, smoking, age, along with adequacy of prenatal care utilization and infant’s gender was used in a logistic model to adjust for potential confounding. A small non-linear association was detected between TTHM exposure and low birth weight (<2,500 g) births (OR 1.14; 95 % confidence interval (CI) 1.08–1.21), preterm births (OR 1.14; 95 % CI 1.08–1.20) and for small for gestational age births (OR 1.10; 95 % CI 1.04–1.16) suggesting a small increase in risk for these birth outcomes with chronic low maternal exposure to drinking water containing trihalomethanes. Maternal exposure to TTHMs during pregnancy may be associated with low birth weight, preterm births and small for gestational age births.