Hein Raat

The Generation R Study: Biobank update 2015

The Generation R Study is a population-based prospective cohort study from fetal life until adulthood. The study is designed to identify early environmental and genetic causes and causal pathways leading to normal and abnormal growth, development and health from fetal life, childhood and young adulthood. In total, 9,778 mothers were enrolled in the study. Data collection in children and their parents include questionnaires, interviews, detailed physical and ultrasound examinations, behavioural observations, Magnetic Resonance Imaging and biological samples. Efforts have been conducted for collecting biological samples including blood, hair, faeces, nasal swabs, saliva and urine samples and generating genomics data on DNA, RNA and microbiome. In this paper, we give an update of the collection, processing and storage of these biological samples and available measures. Together with detailed phenotype measurements, these biological samples provide a unique resource for epidemiological studies focused on environmental exposures, genetic and genomic determinants and their interactions in relation to growth, health and development from fetal life onwards.

Perinatal complications increase the risk of postpartum depression. The Generation R Study

Please cite this paper as: Blom E, Jansen P, Verhulst F, Hofman A, Raat H, Jaddoe V, Coolman M, Steegers E, Tiemeier H. Perinatal complications increase the risk of postpartum depression. The Generation R Study. BJOG 2010;117:1390–1398.

Are starting and continuing breastfeeding related to educational background? The generation R study.

OBJECTIVE. To assess the effect of a womans educational level on starting and continuing breastfeeding and to assess the role of sociodemographic, lifestyle-related, psychosocial, and birth characteristics in this association. METHODS. We used the data of 2914 participants in a population-based prospective cohort study. Information on educational level, breastfeeding, sociodemographic (maternal age, single parenthood, parity, job status), lifestyle-related (BMI, smoking, alcohol use), psychosocial (whether the pregnancy was planned, stress), and birth (gestational age, birth weight, cesarean delivery, place and type of delivery) characteristics were obtained between pregnancy and 12 months postpartum. Odds ratios and 95% confidence intervals of starting and continuing breastfeeding for educational level were obtained by logistic regression, adjusted for each group of covariates and for all covariates simultaneously. RESULTS. Of 1031 highest-educated mothers, 985 (95.5%) started breastfeeding; the percentage was 73.1% (255 of 349) in the lowest-educated mothers. At 6 months, 39.3% (405 of 1031) of highest-educated mothers and 15.2% (53 of 349) of lowest-educated mothers were still breastfeeding. Educationally related differences were present in starting breastfeeding and the continuation of breastfeeding until 2 months but not in breastfeeding continuation between 2 and 6 months. Lifestyle-related and birth characteristics attenuated the association between educational level and breastfeeding, but the association was hardly affected by sociodemographic and psychosocial characteristics. CONCLUSIONS. Decisions to breastfeed were underlain by differences in educational background. The underlying pathways require further research. For the time being, interventions on promoting breastfeeding should start early in pregnancy and should increase their focus on low-educated women.

Primary prevention of overweight in children and adolescents: A meta-analysis of the effectiveness of interventions aiming to decrease sedentary behaviour

The objectives of this meta-analysis were to provide an overview of the evidence regarding the effects of interventions, implemented in the school- and general population setting, aiming to prevent excessive sedentary behaviour in children and adolescents on (1) the amount of sedentary behaviour and (2) BMI. Differences in effects on sedentary behaviour and BMI between single health behaviour interventions (sedentary behaviour only) and multiple health behaviour interventions were explored.A literature search was conducted in PubMed, EMBASE, Web of Science, PsycINFO and Cochrane Database of Systematic Reviews. Thirty-four (R)CT studies evaluating 33 general population interventions, published between 1990 and April 2011, aiming to decrease sedentary behaviour in normal weight children or adolescents (0–18u2009years) were included. Intervention duration ranged from 7u2009days to 4u2009years. Mean change in sedentary behaviour and BMI from baseline to post-intervention was calculated using a random effects model.Results showed significant decreases for the amount of sedentary behaviour and BMI. For sedentary behaviour the post-intervention mean difference was −17.95u2009min/day (95%CI:-26.61;–9.28); the change-from-baseline mean difference was −20.44u2009min/day (95%CI:-30.69;–10.20). For BMI the post-intervention mean difference was −0.25u2009kg/m² (95%CI:-0.40;–0.09); the change-from-baseline mean difference was −0.14u2009kg/m² (95%CI:-0.23;–0.05). No differences were found between single and multiple health behaviour interventions.Interventions in the school- and general population setting aiming to reduce only sedentary behaviour and interventions targeting multiple health behaviours can result in significant decreases in sedentary behaviour. Studies need to increase follow-up time to estimate the sustainability of the intervention effects found.

Cyber and traditional bullying victimization as a risk factor for mental health problems and suicidal ideation in adolescents

Purpose To examine whether traditional and cyber bullying victimization were associated with adolescents mental health problems and suicidal ideation at two-year follow-up. Gender differences were explored to determine whether bullying affects boys and girls differently. Methods A two-year longitudinal study was conducted among first-year secondary school students (Nu200a=u200a3181). Traditional and cyber bullying victimization were assessed at baseline, whereas mental health status and suicidal ideation were assessed at baseline and follow-up by means of self-report questionnaires. Logistic regression analyses were conducted to assess associations between these variables while controlling for baseline problems. Additionally, we tested whether gender differences in mental health and suicidal ideation were present for the two types of bullying. Results There was a significant interaction between gender and traditional bullying victimization and between gender and cyber bullying victimization on mental health problems. Among boys, traditional and cyber bullying victimization were not related to mental health problems after controlling for baseline mental health. Among girls, both traditional and cyber bullying victimization were associated with mental health problems after controlling for baseline mental health. No significant interaction between gender and traditional or cyber bullying victimization on suicidal ideation was found. Traditional bullying victimization was associated with suicidal ideation, whereas cyber bullying victimization was not associated with suicidal ideation after controlling for baseline suicidal ideation. Conclusions Traditional bullying victimization is associated with an increased risk of suicidal ideation, whereas traditional, as well as cyber bullying victimization is associated with an increased risk of mental health problems among girls. These findings stress the importance of programs aimed at reducing bullying behavior, especially because early-onset mental health problems may pose a risk for the development of psychiatric disorders in adulthood.

Socio-demographic and lifestyle determinants of ‘Western-like’ and ‘Health conscious’ dietary patterns in toddlers

Determinants of a childs diet shortly after weaning and lactation have been relatively understudied. The aim of the present study was hence to identify common dietary patterns in toddlers and to explore parental and child indicators of these dietary patterns. The study was a population-based, prospective birth-cohort study in Rotterdam, the Netherlands. Food consumption data of 2420 children aged 14 months were used. A Health conscious dietary pattern characterised by pasta, fruits, vegetables, oils, legumes and fish, and a Western-like dietary pattern characterised by snacks, animal fats, confectionery and sugar-containing beverages were extracted using principal component analysis. Low paternal education, low household income, parental smoking, multiparity, maternal BMI, maternal carbohydrate intake and television-watching of child were determinants of a Western-like diet, whereas parental age, dietary fibre intake during pregnancy, introduction of solids after 6 months and female sex were inversely associated with a Western-like diet of the child. Maternal co-morbidity, alcohol consumption during pregnancy and female sex were inversely associated with a Health conscious dietary pattern of the child, while single parenthood, folic acid use and dietary fibre intake during pregnancy were positively associated. All aforementioned associations were statistically significant. In conclusion, both Western-like and Health conscious diets can already be identified in toddlers. Particularly, adherence to a Western-like diet is associated with unfavourable lifestyle factors of the parents and child, and low socio-economic background. These findings can form a basis for future epidemiological studies regarding dietary patterns and health outcomes in young children.

Explaining differences in birthweight between ethnic populations. The Generation R Study

Objectiveu2002 To examine whether differences in birthweight of various ethnic groups residing in the Netherlands can be explained by determinants of birthweight.

Influenza vaccination in asthmatic children: effects on quality of life and symptoms

This study aimed to detect the effect of influenza vaccination on quality of life, symptomatology and spirometry in asthmatic children. A randomised double-blind placebo-controlled trial in 696 (296 in 1999–2000 and 400 in 2000–2001) asthmatic children aged 6–18u2005yrs, which were vaccinated with either vaccine or placebo, was performed. Children participated for only one influenza season. They recorded symptoms in a diary and reported when symptom scores reached a predefined severity level. If this occurred research nurses visited them twice, first to take a pharyngeal swab and spirometry, and a week later to assess quality of life over the past illness week. Compared with placebo, vaccination improved health-related quality of life in the weeks of illness related to influenza-positive swabs. However, no effect was found for respiratory symptoms recorded in the diaries during those weeks. Similarly, no differences were found for quality of life in all weeks of illness or for respiratory symptoms throughout the seasons. Influenza vaccination was found to have a moderately beneficial effect on quality of life in influenza-positive weeks of illness in children with asthma.

Reliability and Validity of the Dutch Version of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA)

Background The Brief Infant-Toddler Social and Emotional Assessment (BITSEA) is a relatively new and short (42-item) questionnaire that measures psychosocial problems in toddlers and consists of a Problem and a Competence scale. In this study the reliability and validity of the Dutch version of the BITSEA were examined for the whole group and for gender and ethnicity subgroups. Methods Parents of 7140 two-year-old children were invited in the study, of which 3170 (44.4%) parents completed the BITSEA. For evaluation of the score distribution, the presence of floor/ceiling effects was determined. The internal consistency (Cronbachs alpha) was evaluated and in subsamples the test-retest, parent-childcare provider interrater reliability and concurrent validity with regard to the Child Behavioral Checklist (CBCL). Discriminative validity was evaluated by comparing scores of parents that worry and parents that do not worry about their childs development. Results The BITSEA showed no floor or ceiling effects. Psychometric properties of the BITSEA Problem and Competence scale were respectively: Cronbachs alphas were 0.76 and 0.63. Test-retest correlations were 0.75 and 0.61. Interrater reliability correlations were 0.30 and 0.17. Concurrent validity was as hypothesised. The BITSEA was able to discriminate between parents that worry about their child and parents that do not worry. The psychometric properties of the BITSEA were comparable across gender and ethnic background. Conclusion The results in this large-scale study of a diverse sample support the reliability and validity of the BITSEA Problem scale. The BITSEA Competence scale needs further study. The performance of the BITSEA appears to be similar in subgroups by gender and ethnic background.

Motivators and Barriers to a Healthy Postpartum Lifestyle in Women at Increased Cardiovascular and Metabolic Risk: A Focus-Group Study

Objective. To describe the motivators and barriers to the adoption of a healthy postpartum lifestyle after a pregnancy complicated by preeclampsia, intrauterine growth restriction, and/or gestational diabetes. Methods. Thirty-six women with complicated pregnancies participated in six focus-group interviews that aimed to explore the perceptions of modifiable determinants of postpartum lifestyle. Results. Although women expressed that they intended to live a healthy postpartum lifestyle, it was generally not achieved. The motivators included improving their own current health condition as well as modeling a healthy lifestyle for their children. Important barriers were reported to be lack of knowledge, poor recovery, and lack of professional support after delivery. Conclusions. The reported motivators and barriers can be used to develop a postpartum lifestyle intervention.