Use of Electronic Health Record Data to Study the Association of Sugary Drink Consumption With Child Weight Status

BackgroundSugar-sweetened beverages (SSBs) and, to some extent, fruit juice are modifiable risk factors for childhood obesity. Data on consumption have not been previously systematically collected in the electronic health record (EHR) in a way that could facilitate observational research and population health management.MethodsIn 2017 to 2018, we used data from an EHR-based SSB and fruit juice screener to study the association between consumption and weight status among children 6 months through 17 years of age. We used linear models to examine the cross-sectional association between sugary drinks and BMIz, adjusting for sex, age, race/ethnicity, clinic site, and encounter type. We also used separate mixed-effects models to examine the association of baseline consumption with ∆BMIz.ResultsOur dataset included 22,291 children (15% <2 years; 23% 2–5 years; 34% 6–11 years; 28% 12–17 years) of diverse race/ethnicity (27% African American, 30% Hispanic). Sugary drink consumption was very common; 43% reported ≥2 per day. For children 6 to 17 years, greater consumption was associated cross sectionally with higher BMIz (eg, 6–11 years old children consuming ≥3/day had 0.27 (95% CI, 0.18, 0.36) higher BMIz vs those consuming <1/week). In longitudinal models, sugary drink consumption was related to ∆BMIz for children 2 to 5 at the highest reported levels of consumption (∆0.35 (0.04, 0.65) BMIz/year more for children consuming ≥3/day versus <1x/week). Larger increases in BMIz were seen for 6 to 17 year olds reporting consumption at or above 1x/day, versus <1x/week. No consistent cross-sectional or longitudinal associations were observed among children under 2.ConclusionsIn our EHR-derived data, sugary drink consumption was most associated with high BMIz in school-aged children. Early childhood may be a critical period for intervening on sugary beverage consumption in obesity prevention efforts.     

Relationship Between Maternal and Infant Nutritional Status

Relationship between maternal anthropometry, age, parity, education, work status, and food practices and nutritional status of children 0-6 months post-partum was determined using a cross-sectional design in a univariate situation. Whereas mothers' weight, height, weight for height, and months of lactation were significantly related to the weight for age of the infants, only weight, height, and work status seemed to affect their height for age. In the second stage where stepwise multiple regression analyses were done, maternal height, months of lactation, and weight for height in that order showed a significant relationship (R2 = 0.08) with infants weight for age while mothers' height and working status were the only two factors that affected the height for age of the infants (R2 = 0.04). The findings suggest that there exists a significant relationship between maternal and child anthropometry.     

INSIGHT Study Maternal Return to Work and Infant Weight Outcomes

Objective

Maternal return to work within 12 weeks of delivery is associated with poor child health and development. However, little is known about the impact of return to work on the risk of child obesity. We examined whether timing of maternal return to work is associated with rapid infant weight gain from 0 to 6 months and weight-for-length at 1 year.

Perceptions of Asthma and Exercise,and Associations With Weight Status and Asthma Morbidity in Urban Children

BackgroundGiven the high prevalence of asthma and obesity in minority children, there is a need to identify targets for intervention to decrease the impact of these conditions on children's functioning in this high-risk group.ObjectiveTo examine in urban children with persistent asthma, 1) differences in asthma indicators (eg, FEV1% predicted) by weight status, and by ethnic group/weight status, 2) caregivers’ fears about their child's asthma by weight status, and by ethnic group/weight status, and 3) the proportion of children who qualified for exercise-induced bronchospasm (EIB) via exercise challenge test among those whose caregivers endorse exercise as a trigger for asthma.MethodsIn this sample of urban children (aged 7–9; N = 147), subjective measures included child/caregiver daily report of asthma symptoms and caregiver fears about their child's asthma. Objective lung function was measured twice daily via handheld spirometer and EIB was confirmed via exercise challenge test.ResultsIn the overall sample, a greater proportion of normal-weight children reported asthma symptoms compared to overweight/obese children. Caregiver fears about asthma were more prevalent among Latino caregivers. Non-Latino White children whose caregivers were afraid their child may die when having asthma reported more days with asthma symptoms. Very few children had confirmed EIB compared to the proportion of caregivers who endorsed exercise as a dangerous trigger for asthma.ConclusionsCaregiver fear about asthma and misperceptions of exercise as a dangerous trigger for asthma should be addressed during health care visits with families of children with asthma and interventions including urban children with asthma.     

Maternal Body Dissatisfaction and Accuracy of Infant Weight Perception in Families From Low-Income Backgrounds

ObjectiveTo examine the association between maternal body dissatisfaction and mother's (mis)perception of their infant's weight classification among families from low-income households.MethodsMother-infant dyads were recruited during well-child visits from 2 urban primary care clinics. Maternal body dissatisfaction was measured using the Stunkard Figure Rating Scale. Perception of infant weight was assessed using a 5-point Likert scale. Infant weight-for-length percentiles were calculated using World Health Organization growth charts. Associations between maternal body dissatisfaction score and mother's (mis)perception of their infant's weight classification were examined using logistic regression allowing for nonlinear associations via restricted cubic splines.ResultsMothers (n = 180) were 26.6 ± 5.1 years old and 72% Black; infants were 8.8 ± 2.1 months old. Mean infant weight-for-length percentile was 64 ± 26. On average, mothers wanted to be one body figure smaller than their perceived current body size. Most mothers (82%) accurately perceived their infant's weight classification while few overestimated (7%) or underestimated (11%) their child's weight category. The probability of mothers misperceiving their infant's weight classification increased as maternal body dissatisfaction increased in either extreme in unadjusted (P < .05) and adjusted analysis (P = .06).ConclusionsIncreased maternal body dissatisfaction may be associated with mother's misperception of infant weight classification. Future studies should examine this relationship in a heterogeneous population.     

Interaction between Maternal Prepregnancy Body Mass Index and Gestational Weight Gain Shapes Infant Growth

ObjectiveTo quantify the combined effect of maternal prepregnancy obesity and maternal gestational weight gain (GWG) on the shape of infant growth throughout the first year of life.MethodsA retrospective cohort of mother–child dyads with children born between January 2007 and May 2012 was identified in a linked electronic medical record. Data were abstracted to define the primary exposures of maternal prepregnancy body mass index (BMI) and GWG, and the primary outcome of infant growth trajectory.ResultsWe included 499 mother–child dyads. The average maternal age was 28.2 years; 55% of mothers were overweight or obese before pregnancy, and 42% of mothers had excess GWG, as defined by the Institute of Medicine. Maternal prepregnancy BMI (P < .001) and the interaction between prepregnancy BMI and maternal GWG (P = .02) showed significant association with infant growth trajectory through the first year of life after controlling for breast-feeding and other covariates, while GWG alone did not reach statistical significance (P = .38). Among infants of mothers with excess GWG, a prepregnancy BMI of 40 kg/m² versus 25 kg/m² resulted in a 13.6% (95% confidence interval 5.8, 21.5; P < .001) increase in 3-month infant weight/length percentile that persisted at 12 months (8.4%, 95% confidence interval 0.2, 16.5; P = .04).ConclusionsThe combined effect of excess maternal GWG and prepregnancy obesity resulted in higher infant birth weight, rapid weight gain in the first 3 months of life, with a sustained weight elevation throughout the first year of life. These findings highlight the importance of the preconception and prenatal periods for pediatric obesity prevention.     

Second-Trimester Maternal Serum Markers in Twin Pregnancy With Complete Mole: Report of 2 Cases

We present second-trimester serum marker levels in cases of twin pregnancy with complete hydatidiform mole and a coexistent fetus (CHMCF). Second-trimester inhibin A (InhA) levels have not been previously reported in such cases. Second-trimester maternal serum screening, α-fetoprotein (AFP), unconjugated estriol (uE3), human chorionic gonadotropin (hCG), and InhA measurements combined with maternal age to estimate a patient’s risk of Down syndrome during pregnancy was performed as a routine prenatal test in 2 cases of CHMCF. Hospital records containing serum marker data, patient history, pathology reports, and pregnancy outcome were reviewed. In cases of CHMCF, maternal serum AFP and uE3 levels were similar to those of a normal singleton pregnancy, whereas hCG and InhA levels were markedly increased. Second-trimester maternal serum marker profiles in cases of CHMCF are a composite of normal singleton and molar tissue secretions. We have found, for the first time, that second-trimester InhA levels are markedly increased in these cases. Serum marker levels may be useful in diagnosis of CHMCF, prenatal counseling, and evaluation of risk for persistent trophoblastic disease.     

Maternal Determinants of Pregnancy Success

Pregnancy is a process describing the journey of in utero development of a life born from a fertilized egg called zygote.1 The process is highly conserved to escape eutherians from environmental insul.     

Preoperative Management With Nitrogen Inhalation Therapy for a Low-Birth Weight Infant With Tetralogy of Fallot and Absent Pulmonary Valve

Tetralogy of Fallot and absent pulmonary valve (TOF/APV) is a rare congenital heart disease. Patients with TOF/APV with severe clinical symptoms require surgical intervention for cardiac abnormality in the neonatal period, but the preoperative conditioning for surgical treatment is extremely complicated. We experienced a low-birth-weight patient with TOF/APV who was successfully treated by radical surgery at 63 days of age after long-term intensive management using nitrogen inhalation therapy.     

妊娠期甲状腺功能亢进对围生儿的影响

目的 探讨妊娠期甲状腺功能亢进(甲亢)对围生儿的影响.方法 对35例原有甲亢或符合孕期甲亢诊断标准的孕妇的围生儿(妊娠并甲亢组)作回顾性分析.其中25例孕前即发现有甲亢,孕早期发现7例,孕中期发现3例.28例口服丙硫氧嘧啶(治疗组),7例未服药或仅服少量镇静药物(未治疗组).另选择同期住院的468例无任何并发症的健康孕妇的围生儿为健康对照组.比较3组围生儿死亡、甲状腺功能低下、窒息、畸形发生情况.结果 妊娠并甲亢组围生儿35例中新生儿窒息7例、早产儿6例、低出生体质量儿5例,新生儿甲低3例,围生儿死亡2例,均较健康对照组高,差异有显著性(Pa<0.05);治疗组新生儿窒息3例,早产儿、低出生体质量儿各2例,均较未治疗组明显改善,差异有显著性(Pa<0.05),新生儿畸形和新生儿甲低二组比较无明显差异(Pa>0.05).结论 妊娠期甲亢使围生儿早产、低出生体质量、窒息、甲状腺功能低下等显著增高.加强围生期保健,及时药物治疗,可改善围生儿预后.     

巨大儿与正常出生体质量儿生后早期微量血糖变化

目的探讨巨大儿与正常出生体质量儿生后3d内微量血血糖变化。方法采用德国保灵曼公司生产的电子感应微量血糖测定仪对本院出生巨大儿111例、正常出生体质量儿236例于生后2、4、12、24、72h测定微量血糖,并进行统计分析。结果巨大儿生后2h血糖为(2.39±0.66)mmol/L,明显低于正常出生体质量儿(3.06±0.80)mmol/L(P<0.001),4h血糖为(2.92±0.68)mmol/L,低于正常出生体质量儿(3.10±0.75)mmol/L(P<0.05),其低血糖发生率(11.7%)明显高于正常出生体质量儿(0.4%)。结论巨大儿生后4h内较正常出生体质量儿更易发生低血糖,监测血糖是预防新生儿生后早期低血糖发生的最好方法。     

Association of Picky Eating With Weight Status and Dietary Quality Among Low-Income Preschoolers

Background

Picky eating is common in children. Few studies have examined predictors of picky eating, and the association of picky eating with weight status and dietary quality is inconsistent in the literature. We aimed to identify predictors of picky eating and to test the association of picky eating with child body mass index z-score (BMIz), dietary quality, and micronutrient intake.