Hyperglycemia and lower diet quality in pregnant overweight women and increased infant size at birth and at 13 months of age — STEPS study

Aims

To study whether maternal overweight and/or hyperglycemia combined with life-style factors in healthy women predisposes to adverse pregnancy or infant health outcomes, such as differences in growth.

Methods

At 26–28 weeks of gestation 82 overweight pregnant women (prepregnancy BMI ≥ 25 kg/m²) and 67 normal weight pregnant women (prepregnancy BMI < 25 kg/m²) participating to STEPS study attended 2-hour oral glucose tolerance test (OGTT) with measurement of plasma glucose and insulin and calculation of HOMA, QUICKI and Matsuda ISI indices. Birth weights and lengths were obtained from hospital records and weights and heights at 13 months from study visits. Maternal physical activity and diet quality were studied with questionnaires.

Results

Glucose concentrations were higher in overweight non-diabetic women (0 h = 4.9, 1 h = 7.7, 2 h = 6.2 mmol/l, n = 80) than normal weight women (0 h = 4.5, 1 h = 6.8, 2 h = 5.6 mmol/l, all P < 0.05, n = 66) as were insulin concentrations at baseline (12.3 vs. 9.0 mU/l, P < 0.05), but not later (1 h = 88.1 vs. 72.8 mU/l; 2 h = 63.5 vs. 55.5 mU/l, both P > 0.05). Insulin resistance was higher and sensitivity lower (P < 0.05 for all) in overweight than in normal weight women. The offspring of overweight mothers were 273 g heavier at birth and 700 g heavier at 13 months of age than the offspring of normal weight women (P < 0.001). Normal weight women had preferable diet quality (P = 0.023). No differences were seen in self-reported physical activity between overweight and normal weight women.

Conclusions

Maternal prepregnancy overweight increases risk of hyperglycemia in late-pregnancy and increased infant size at birth and 13 months possibly predisposing the infant to health risks later in life.     

Links between parents' and girls' television viewing behaviors: a longitudinal examination

OBJECTIVE: This longitudinal study examines links between parents' television (TV)-related parenting practices and their daughter's daily TV viewing hours. STUDY DESIGN: Participants included 173 non-Hispanic white girls and their parents who were examined when girls were age 9 and 11 years. Girls' daily TV viewing hours, mothers' and fathers' daily TV viewing hours, parents' use of TV as a recreational activity, family TV co-viewing, and parents' restriction of girls' access to TV were assessed. RESULTS: Approximately 40% of girls exceeded the TV-viewing recommendations (ie, < or =2 hours/day). Girls watched significantly more TV when their parents were high-volume TV viewers, relied heavily on TV as a recreational activity, watched TV with them, and failed to limit their access to TV. A parenting risk score was calculated by collapsing information across all parenting variables. In comparison with girls exposed to 1 or fewer parenting risk factors at age 9, girls exposed to 2 or more parenting risk factors were 5 to 10 times more likely to exceed TV viewing recommendations at age 9 and 11. CONCLUSIONS: Efforts to reduce TV viewing among children should encourage parents to limit their own TV viewing, reduce family TV viewing time, and limit their children's access to TV.     

Characteristics and risk factors for adverse birth outcomes in pregnant black adolescents

OBJECTIVES: To describe maternal characteristics and birth outcomes in a group of pregnant minority adolescents and to characterize the impact of maternal age (<15 years versus 15-17 years) on birth outcomes. STUDY DESIGN: A 10-year retrospective chart review was conducted in 1120 pregnant black adolescents (< or =17 years of age) who had received prenatal care at an inner-city maternity clinic in Baltimore, Md. RESULTS: Pregnant black adolescents had a higher incidence of low birth weight infants, preterm delivery, and fetal death compared with normative data from the United States. Younger adolescents were more likely to have inadequate utilization of prenatal care (P<.01). Older adolescents had a higher incidence of gonorrhea infections (P=.046), greater rates of self-reported substance abuse (P=.063), and a higher history of cigarette smoking (P<.01). Low prepregnancy body mass index (BMI), inadequate weight gain, and poor prenatal care utilization were strong independent predictors of preterm birth (P<.05). Low prepregnancy BMI, inadequate weight gain, female infant, and self-reported cigarette smoking history were significantly associated with decreased infant birth weight (P<.05). CONCLUSIONS: Pregnant black adolescents had increased risks of adverse pregnancy outcomes. This population should be studied further to develop age-appropriate and population-specific interventions to improve birth outcomes.     

Gestational and neonatal characteristics of children with cystic fibrosis: a cohort study

OBJECTIVE: To examine whether the birth weight (BW) and the risks of being pre-term, low birth weight (LBW), and small for gestational age (SGA) of children with cystic fibrosis (CF) are different from nonaffected children. STUDY DESIGN: Retrospective cohort study. We examined all the children with CF born in Tuscany, Italy, from 1991 to 2002 (n = 70) comparing them to the entire population of non-CF-affected children born in the same period (n = 290,059). RESULTS: The mean BW of newborns with CF was 246.2 g lower than the mean BW of the non-CF neonatal population (P = .0003). Children with CF had a higher risk of being born pre-term (RR 2.62, P = .001), LBW (RR 2.66, P = .0009), and SGA (RR = 1.74, P = .04) than the non-CF-affected children. The mean BW of term newborns with CF was 205.7 g lower than that of term non-CF-affected babies (P = .0002). CONCLUSIONS: Our data show an association between CF and reduced BW and show a greater risk of being pre-term for babies with CF.     

The prevalence of overweight and obesity in pediatric survivors of cancer

OBJECTIVE: To compare the prevalence of overweight in a cohort of pediatric survivors of cancer with that in the general population. STUDY DESIGN: We reviewed the charts of 441 cancer survivors followed at a Canadian tertiary care pediatric hospital and calculated their most recent body mass index. We compared this cohort with population data generated from the Canadian Community Health Survey. RESULTS: At a median age of 14.7 years (range, 3.4 to 19.5 years) and a median time from diagnosis of 9.7 years (range, 3.4 to 19.2 years), 140 of 441 patients (31.7%) were overweight or obese. Only 12 of the 441 patients (2.7%) were underweight. Males age 6 to 11 years (odds ratio [OR] = 2.29; 95% confidence interval [CI] = 1.36 to 3.86; P < .001) and male survivors of acute lymphoblastic leukemia (OR = 1.55; 95% CI = 1.03 to 2.52; P = .04) were more likely to be overweight than the general population. No other age or diagnostic group had an increased risk of overweight. CONCLUSIONS: The prevalence of overweight was not increased in this cohort compared with the general population. However, almost 1/3 of these patients are overweight, necessitating a clinical and research focus on preventing and combating overweight in childhood cancer survivors.     

Effectiveness of the IMFeD tool for the Identification and Management of Feeding Difficulties in Taiwanese children

Background

The Identification and Management of Feeding Difficulties (IMFeD?) tool was introduced in 2011 for management of children with feeding difficulties and has been used in various countries around the world. This study aimed to assess its acceptance and effectiveness in clinical practice in Taiwan.

Inflammation, insulin, and endothelial function in overweight children and adolescents: the role of exercise

OBJECTIVES: To assess subclinical inflammation, fasting insulin, and endothelial function before and after exercise in overweight children and adolescents. STUDY DESIGN: Twenty-five children (body mass index [BMI] >85th percentile) were assessed for brachial artery flow-mediated dilation (FMD), nitroglycerin-induced dilation, C-reactive protein (CRP), lipids, glucose, insulin, oral glucose tolerance, body composition, aerobic fitness (peak oxygen uptake [VO 2 peak]), and blood pressure. Twenty of these persons were equally and randomly assigned to either 8 weeks of stationary cycling or to a non-exercising control group. RESULTS: A baseline correlation was found between CRP and fasting insulin (r = 0.62; P < .001), which remained significant after adjusting for baseline variables (r = 0.53; P < .05). After 8 weeks, significant improvements were observed in the exercise group compared with the control group for VO 2 peak (exercise group = 21.8 +/- 2.1 to 23.2 +/- 1.5 mL/kg/minute vs control group = 23.4 +/- 1.6 to 20.9 +/- 2.2 mL/kg/minute; P < .05), high-density lipoprotein (HDL) cholesterol (exercise group = 1.02 +/- 0.03 to 1.10 +/- 0.04 mmol/L vs control group = 1.08 +/- 0.07 to 0.99 +/- 0.09 mmol/L; P < .05), and FMD area under the curve (AUC) (exercise group = 746 +/- 66 to 919 +/- 94 %*sec vs control group = 731 +/- 102 to 515 +/- 73 %*sec; P < .05). CONCLUSIONS: In overweight children and adolescents, CRP is independently associated with fasting insulin. Eight weeks of aerobic exercise improves fitness, HDL cholesterol, and endothelial function in this group.     

Predicting neurosensory disabilities at two years of age in a national cohort of extremely premature infants

Background

Extreme prematurity carries a high risk of neurosensory disability.

Aims

Examine which information obtained pre-, peri- and postnatally may be predictive of neurosensory disabilities at 2 years of age.

Study design

Prospective observational study of all infants born in Norway in 1999 and 2000 with gestational age (GA) 22-27 completed weeks or birth weight (BW) of 500-999 g.

Outcome measures

Incidence of neurosensory disabilities.

Results

Of 373 surviving children, 30 (8%) had major neurosensory disabilities (26 CP, 6 blind, 3 deaf), and a further 46 (12%) had minor visual or hearing disabilities. The rate of major neurosensory disabilities was 19 of 99 (19%) for children with GA 23-25 vs. 8 of 189 (4%) for GA 26-27 weeks (p < 0.001). In a multivariable model, only morbidities detected in the neonatal intensive care unit (NICU) were associated with major neurosensory disabilities; adjusted odds ratios (95% confidence intervals) were 68.6 (18.7, 252.2) for major abnormalities on cerebral ultrasound, 6.8 (1.7, 27.4) for retinopathy of prematurity (ROP) grade > 2, 3.2 (1.0, 9.7) for ROP grade 1-2, 6.5 (1.9, 22.3) for prolonged use (≥ 21 days) of steroid treatment for lung disease and 3.1 (1.0, 9.4) for clinical chorioamnionitis. The visual outcome was strongly related to the degree of ROP (p < 0.001), and all who had a normal hearing screen in the NICU had normal hearing at 2 years.

Conclusion

NICU morbidities, rather than GA or intrauterine growth are the significant predictors of major neurosensory disabilities among extreme prematurity surviving to discharge from the NICU.     

Relationship of maternal weight status and weight gain rate during pregnancy to the development of advanced beta cell autoimmunity in the offspring: a prospective birth cohort study

Arkkola T, Kautiainen S, Takkinen H‐M, Kenward MG, Nevalainen J, Uusitalo U, Simell O, Ilonen J, Knip M, Veijola R, Virtanen SM. Relationship of maternal weight status and weight gain rate during pregnancy to the development of advanced beta cell autoimmunity in the offspring: a prospective birth cohort study. Objective: This study set out to examine how maternal initial body mass index (BMI) and weight gain during pregnancy associate with advanced beta cell autoimmunity in the offspring. Subjects: A population‐based birth cohort of 4093 children with increased human leukocyte antigen (HLA)‐conferred susceptibility to type 1 diabetes (T1D) and their mothers were recruited between 1997 and 2002 in two university hospital regions in Finland. Methods: The children were monitored for T1D‐associated autoantibodies at 3‐ to 12‐month intervals. Advanced beta cell autoimmunity was defined as repeated positivity for islet cell antibodies and at least one of the other three autoantibodies (antibodies to insulin, glutamate decarboxylase and islet antigen 2). Mothers were asked to record the results of the weight measurements during their first and last visits to the antenatal clinic. The initial BMI and weight gain rate were calculated for each woman. Results: Altogether, 175 children developed advanced beta cell autoimmunity or T1D during the follow‐up. Maternal BMI before pregnancy or weight gain during pregnancy was not associated with the end‐point. Maternal vocational education was associated with child's smaller risk of developing advanced beta cell autoimmunity.