John Mehegan

Fish and seafood consumption during pregnancy and the risk of asthma and allergic rhinitis in childhood: a pooled analysis of 18 European and US birth cohorts

Background It has been suggested that prenatal exposure to n-3 long-chain fatty acids protects against asthma and other allergy-related diseases later in childhood. The extent to which fish intake in pregnancy protects against child asthma and rhinitis symptoms remains unclear. We aimed to assess whether fish and seafood consumption in pregnancy is associated with childhood wheeze, asthma and allergic rhinitis. Methods We pooled individual data from 60 774 mother-child pairs participating in 18 European and US birth cohort studies. Information on wheeze, asthma and allergic rhinitis prevalence was collected using validated questionnaires. The time periods of interest were: infancy (0-2 years), preschool age (3-4 years), and school age (5-8 years). We used multivariable generalized models to assess associations of fish and seafood (other than fish) consumption during pregnancy with child respiratory outcomes in cohort-specific analyses, with subsequent random-effects meta-analyses. Results The median fish consumption during pregnancy ranged from 0.44 times/week in The Netherlands to 4.46 times/week in Spain. Maternal fish intake during pregnancy was not associated with offspring wheeze symptoms in any age group nor with the risk of child asthma [adjusted meta-analysis relative risk (RR) per 1-time/week = 1.01, 95% confidence interval 0.97-1.05)] and allergic rhinitis at school age (RR = 1.01, 0.99-1.03). These results were consistently found in further analyses by type of fish and seafood consumption and in sensitivity analyses. Conclusion We found no evidence supporting a protective association of fish and seafood consumption during pregnancy with offspring symptoms of wheeze, asthma and allergic rhinitis from infancy to mid childhood.

Parental population exposure to historical socioeconomic and political periods and grand-child’s birth weight in the Lifeways Cross-Generation Cohort Study in the Republic of Ireland

Exposure to deprived socioeconomic conditions during the peri-conception and early childhood periods can have a negative long-term impact on individuals’ health and that of their progeny. We aimed to examine whether relatives’ birth period affected index-child (grand-child) birthweight status in the Lifeways Cross-Generation Cohort in the Republic of Ireland. Participants were 943 mothers and offspring, 890 fathers, 938 maternal grandmothers (MGM), 700 maternal grandfathers (MGF) 537 paternal grandmothers (PGM) and 553 paternal grandfathers (PGF). Index-child’s birthweight was sex-for-gestational age standardised (UK1990 population), and then classified into low birthweight (≤10th percentile) and high-birthweight (≥90th percentile) and compared against normal-birthweight (>10th to <90th percentiles). Four adult birth periods were considered: The Free State (FS, 1916-1938); Emergency Act (EA, 1939-1946); Post-World War-II Baby-Boom (PWWII-BB, 1947-1964); and Modern Ireland (MI, 1964 onwards). Logistic regression was used to assess the crude and adjusted relationship between index-child’s birthweight status and relatives’ birth periods. Overall, there were 8.7% (n=82) index-children in the low-birthweight category, 77.9% (n=735) and 13.4% (n=126) within the normal and high birthweight groups respectively. Index-children whose mothers were born during the PWWII-BB had higher birthweight infants (Crude OR(COR)=1.81 (1.08–3.03) which remained the case only for male index-children when adjusted for co-variables (Adjusted OR(AOR)=4.61(1.71–12.42)). Parents’ combined PWWII-BB birth period was positively associated with male index-child higher birthweight, even adjusted for maternal characteristics (AOR=4.60(1.69–12.50)). MGFs born during the EA were more likely to have grandchildren with low birthweight after adjustment for maternal characteristics (AOR=2.45(1.03-5.85)), particularly for female index-children (AOR=4.74(1.16–19.25)). Both PGMs and PGFs born during the FS period had higher birthweight grandchildren, adjusted for maternal-related co-variables (PGM, AOR=3.23(1.21–8.63); PGF, AOR=3.93(1.11–13.96)), with the effect of PGM more evident in her granddaughter (AOR=6.53(1.25–34.04)). In conclusion, there is some evidence that period of grandparental birth is associated with their grandchildren’s birthweights, suggesting that transgenerational exposures may be particular to historical context, meriting further exploration.

Smoking habit from the paternal line and grand-child’s overweight or obesity status in early childhood: prospective findings from the lifeways cross-generation cohort study

Background/objectives:The role of smoking from the paternal line during the pre-conception period on grand-child’s overweight/obesity and associated underlying pathways are uncertain. We examined whether the smoking status from the paternal line was associated with the grand-child’s higher weight at birth, and overweight or obesity at 5 and 9 years of age. The grandparental smoking effect from the maternal line was also explored.Subjects/methods:Participants were fathers and grandparents and grand-children from the Lifeways Cross Generational Cohort (N = 1021 for the analysis at birth; N = 562 and N = 284 for the analysis at 5 and 9 years, respectively). Paternal and grandparental smoking was defined as smoking versus non-smoking. Children’s weight categories compared were high versus normal weight at birth, and overweight/obesity versus normal weight (based on BMI and waist circumference) at age of five and nine years. Logistic regression models were used to estimate the crude and adjusted associations.Results:After adjustment for several child and parental factors, at age five there was an association between paternal smoking and offspring’s overweight/obesity based on BMI (Adjusted Odds Ratio (AOR), and 95%CI: 1.76, 1.14–2.71, p-value: 0.010), most marked for boys (AOR: 2.05, 1.06–3.96, p-value: 0.032). These associations remained when confined to the children sample with biological fathers only (overall sample, AOR: 1.92, 1.22–3.02, p-value: 0.005; son, AOR: 2.09, 1.06–4.11, p-value: 0.033). At age 9, the paternal grandmothers’ smoking was positively associated with their grandchild’s overweight/obesity status based on waist circumference (AOR: 3.29, 1.29–8.37), and especially with that of her granddaughter (AOR: 3.44, 1.11–10.69). These associations remained when analysing only the children sample with biological fathers (overall sample, AOR: 3.22,1.25–8.29, p-value: 0.016; granddaughter, AOR: 3.55, 1.13–11.15, p-value: 0.030).Conclusion:The smoking habit from the paternal line is associated with grand-children’s adiposity measures during their early childhood, which might be epigenetically transmitted through male-germline cells.

Five Year Follow-Up of a Low GI Dietary Randomised Controlled Trial in Pregnancy - No Long-Term Maternal Effects of a Dietary Intervention

To determine whether a dietary intervention in pregnancy had a lasting effect on maternal outcomes of diet, HbA1c and weight retention 5 years post‐intervention; and to establish whether modifiable maternal behaviours were associated with these outcomes.

Pregnancy diet and offspring asthma risk over a 10-year period: the Lifeways Cross Generation Cohort Study, Ireland

Objective The association of maternal pregnancy diet with offspring asthma risk have been reported. However, literature on longitudinal patterns of asthma risk relative to intrauterine nutrient exposure is limited. We aimed to establish whether vegetable, oily fish and vitamin D intake during pregnancy are associated with childhood asthma risk over a 10-year period in the Irish Republic. Design Mother–child pairs (n=897) from the Lifeways prospective birth cohort, with data on nutrient intake during pregnancy and asthma status, respectively, were eligible for inclusion in the analysis. Data on socioeconomic and morbidity indicators over 10 years of follow-up on mothers and the index child were collected through self-administered questionnaires. Asthma status as diagnosed by the general practitioner at any time point over 10 years was related to maternal vegetable, oily fish and vitamin D intake during pregnancy, while adjusting for gestational age, socioeconomic status, smoking at delivery, breast feeding, season of birth and supplement use. Data were modelled with a marginal model on correlated observations over time within individuals. Results In the fully adjusted model, asthma was inversely associated with higher daily average intake of oily fish (OR 0.23 per serving/day, 95% CI 0.04 to 1.41) and of vegetables (OR 0.96 per serving/day, 95% CI 0.88 to 1.05), but the confidence limits overlapped 1. A higher daily vitamin D intake was associated with reduced odds of asthma (OR 0.93 per μg/day, 95% CI 0.89 to 0.98). Conclusion This analysis suggests higher daily average intake of vitamin D in pregnancy is associated with asthma risk in offspring over the first 10 years of life.

P43 The Healthy Worker Effect? Socio-economic and health status determinants of changing self-rated health in older people in the Lifeways Cross-Generation Study of a Thousand Families

Background There has been renewed interest in the self-rated health (SRH) of older people. Many cohorts, including the Lifeways Cross Generation Cohort Study, have confirmed the role of SRH in predicting mortality. Many have also examined cross-sectional determinants, but few have described the determinants of change in SRH using the same measures 10 years apart, with a particular interest in assessing the relative contributions of change in physical and psychological morbidity and socio-demographic changes. Methods Using generalised estimating equations (GEE), we examine predictors of SRH in Lifeways grandparents who participated in the baseline (n = 710) and year 10 follow-up (n = 843) questionnaire surveys. Morbidity score was determined from summing 6 physician-diagnosed conditions that were self-reported at both time-points. For the cross sectional measures, a binomial distribution with logit link was specified, examining predictors of excellent/very good/good SRH versus fair or poor. For the predictors of change in SRH (range −2 to +2) a linear distribution with identity link was specified and two multivariable GEE models were constructed, firstly with only baseline variables, and secondly with variables reflecting change in morbidity or socioeconomic variables measured at both time-points. Each term in the model was examined conditional on the baseline value of SRH. Results Cross sectional results at both baseline and year 10 confirm that measures of both physical and psychological morbidity, as well as a measure of socio-economic deprivation (eligibility for means-tested General Medical Services – GMS), are predictive of SRH in this cohort. Of the 288 respondents with SRH measured at both time-points the following were significant predictors in the baseline GEE model (B, p): age (−0.018, 0.017), Eastern (urban) region (−0.223, 0.011) and baseline SRH (0.411, <0.001). In the final GEE model, the following were significant (B, p): age (−0.018, 0.011), Eastern region (−0.196, 0.023), baseline SRH (0.337, <0.001), change in morbidity score (0.203, <0.001), developing an activity limiting health condition (−0.701, <0.001), becoming GMS eligible (−0.239, 0.012) and change in employment status from working to other (0.234, 0.011). Conclusion The results of this on-going analysis show some interesting and novel findings. Change in SRH is related to initial level of SRH, but not initial level of morbidity. Even after accounting for change in objective and subjective morbidity, certain socio-economic factors (region and GMS eligibility) are influencing change in SRH. Of particular interest and meriting further investigation is the finding that leaving employment is associated with a positive change in SRH.

P58 Trajectories of Body Mass Index By Age 9 in The Lifeways Cross Generation Cohort Study Children in The Republic Of Ireland

Background The global childhood obesity epidemic poses great challenges in understanding how growth trajectories are determined from early life and across generations. It is increasingly clear that factors causing intra-uterine growth retardation and macrosomia may place children on adverse growth trajectories that lead to overweight and obesity. The Lifeways study was established to study the influence of familial and lifestyle factors including diet on long-term outcomes for children. Methods Of 1082 mother-child pairs recruited antenatally in 2001–3, after exclusion of twins, data were available for 981 children with at least one body mass index (BMI) measurement available at one of 3 waves of follow-up to age of 9 years old. Infants were categorised into low (<2.5 kg, N = 48), normal (2.5–4 kg, N = 761) and high (≥4 kg, N = 172) birth weight categories. We examined a variety of maternal and child characteristics at univariate level in relation to the trajectory groups. A linear mixed model was fitted with wave and birth weight category as factors with a fixed intercept and allowing correlated residuals over time with an unstructured covariance matrix (selected by BIC) and with an interaction term to allow for different trajectories over time, both adjusted and unadjusted for gestational age. Results There was a positive association for maternal age (p < 0.001), pre-pregnancy BMI (p < 0.001), and an inverse association for maternal smoking status (p < 0.001) with these trajectory groups. Maternal fat intake (% Energy Intake) was higher and carbohydrate intake (% Energy Intake) was lower during pregnancy in the low birth-weight group, p = 0.004 and p = 0.008 respectively. There was a statistically significant interaction (p < 0.001), indicating a different pattern of change in trajectory over time in the three groups, whether adjusted for gestational age or not. The low birth weight group showed a rapid catch-up response by age 5, before overtaking the normal weight group by age 9. The high birth weight group continued to track higher than the normal weight group over time. Conclusion These novel prospective cohort data confirm the adverse influence of birth-weight outcomes on subsequent growth trajectories in this cohort of children, in turn associated with maternal characteristics during gestation and pregnancy.

Use of hierarchical cluster analysis to classify prisons in Ireland into mutually exclusive drug-use risk categories

Abstract Aims: The aim of this paper is to propose a methodology for classifying prisons into distinct drug-use risk categories based on prisoners’ use of specified prescription and illegal drugs. The categories of prisons thus defined have particular relevance for the planning of drug-related interventions, education and services in Irish prisons. The methodology may be transferable to, and of value in, prison systems elsewhere. Methods: From the 14 prisons in Ireland, 824 randomly selected prisoners completed a self-administered questionnaire on lifetime, last year and last month use of specified prescription and non-prescription drugs. Questions were derived from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and other sources. Oral fluid samples were collected for verification of recent drug use. The EMCDDA definition of “recent problematic drug use” was used in post hoc hierarchical cluster analysis to define categories of prisons with similar drug-use patterns. Findings: Four categories of prisons, designated “low”, “medium”, “high” and “very high” drug use, were identified. While the prisons comprising each category were known, drug use patterns in individual prisons were not disclosed because of concerns about prisoner confidentiality in a small jurisdiction. The clusters identified were used to contextualise subsequent analyses of drug use, the availability and use of harm-reduction services and differential service requirements by prison category. Conclusions: The methodology described allows for identification of prison categories by drug-use patterns. With restrictions on disclosure of information by individual prison, it provides more valuable information than would derive from data on all prisons combined.