Jonathan Y. Bernard

Breastfeeding Duration and Cognitive Development at 2 and 3 Years of Age in the EDEN Mother-Child Cohort.

OBJECTIVEnTo investigate the dose-response relationship between breastfeeding duration and cognitive development in French preschool children.nnnSTUDY DESIGNnIn the French EDEN Mother-Child Cohort Study, we evaluated language ability with the Communicative Development Inventory (CDI) in 1387 2-year-old children and overall development with the Ages and Stages Questionnaire (ASQ) in 1199 3-year-old children. Assessments were compared between breastfed and non-breastfed children and also according to breastfeeding duration in multivariable linear models, controlling for a wide range of potential confounders. We tested departure from linearity.nnnRESULTSnAfter adjustments, ever-breastfed children scored 3.7 ± 1.8 (P = .038) points higher than never-breastfed children on the CDI and 6.2 ± 1.9 (P = .001) points higher on the ASQ. Among breastfed children, exclusive and any-breastfeeding durations were positively associated with both CDI and ASQ scores. The fine motor domain of ASQ was associated with any-breastfeeding duration, and the problem solving domain with exclusive-breastfeeding duration. We did not observe significant departures from linearity. No interactions were found between the childs sex, parental education or socioeconomic status, and breastfeeding duration.nnnCONCLUSIONnLonger breastfeeding duration was associated with better cognitive and motor development in 2- and 3-year-old children and a dose-response relationship was suggested.

The Dietary n6:n3 Fatty Acid Ratio during Pregnancy Is Inversely Associated with Child Neurodevelopment in the EDEN Mother-Child Cohort

Long-chain polyunsaturated fatty acids (LC-PUFAs) of the n6 (ω6) and n3 series are essential for the development of a childs brain. Fetal LC-PUFA exposure as well as infant exposure via breast milk depend on the maternal intake of these LC-PUFAs and of their respective dietary precursors (PUFAs). We aimed to investigate the associations between maternal LC-PUFA and PUFA [(LC)PUFA] dietary intake during pregnancy and child neurodevelopment at ages 2 and 3 y. In 1335 mother-child pairs from the EDEN cohort, we evaluated associations between daily maternal (LC)PUFA intake during the last 3 months of pregnancy with the childs language at age 2 y and with different assessments of development at age 3 y. Associations were investigated separately in breastfed and never-breastfed children. We examined interactions between the ratios of n6 and n3 (LC)PUFA intakes (n6:n3 fatty acid ratio) and duration of breastfeeding. Breastfeeding mothers had a lower n6:n3 fatty acid ratio (8.4 vs. 8.8; P = 0.02). Among never-breastfed children (n = 338), we found negative associations between maternal dietary n6:n3 fatty acid ratios and neurodevelopment, as reflected by the childs language at age 2 y (β ± SE = -2.1 ± 0.7; P = 0.001) and development assessed with the Ages and Stages Questionnaire at age 3 y (-1.5 ± 0.8; P = 0.05). Among mothers with a high n6:n3 fatty acid ratio only, breastfeeding duration was positively associated with language at age 2 y (P-interaction < 0.05). This suggests that the ratio between maternal dietary n6 and n3 (LC)PUFA intake possibly influences the childs brain development during fetal life but not during or by breastfeeding. However, breastfeeding might compensate for prenatal imbalance in maternal dietary n6:n3 fatty acid ratio.

Factors associated with breastfeeding initiation: A comparison between France and French-speaking Canada

Background Breastfeeding is associated with multiple domains of health for both mothers and children. Nevertheless, breastfeeding initiation is low within certain developed countries. Furthermore, comparative studies of initiation rates using harmonised data across multiple regions is scarce. Objective The aim of the present study was to investigate and compare individual-level determinants of breastfeeding initiation using two French-speaking cohorts. Methods Participants included ~ 3,900 mothers enrolled in two cohort studies in Canada and France. Interviews, questionnaires, and medical records were utilised to collect information on maternal, family, and medical factors associated with breastfeeding initiation. Results Rates of breastfeeding initiation were similar across cohorts, slightly above 70%. Women in both Canada and France who had higher levels of maternal education, were born outside of their respective countries and who did not smoke during pregnancy were more likely to initiate breastfeeding with the cohort infant. Notably, cohort effects of maternal education at the university level were found, whereby having ‘some university’ was not statistically significant for mothers in France. Further, younger mothers in Canada, who delivered by caesarean section and who had previous children, had reduced odds of breastfeeding initiation. These results were not found for mothers in France. Conclusions and Implications for Practice While some similar determinants were observed, programming efforts to increase breastfeeding initiation should be tailored to the characteristics of specific geographical regions which may be heavily impacted by the social, cultural and political climate of the region, in addition to individual and family level factors.

Prenatal Caffeine Exposure and Child IQ at Age 5.5 Years: The EDEN Mother-Child Cohort.

BACKGROUNDnEvidence from animal studies suggests maternal caffeine intake during pregnancy has detrimental effects on subsequent brain development in offspring. However, human data in this area are limited. The aim of this study was to assess whether caffeine intake by women during pregnancy is associated with impaired cognitive development in offspring at age 5.5 years.nnnMETHODSnMultivariate modeling was conducted using data of 1083 mother-child pairs from a population-based birth cohort in France followed from pregnancy to age 5.5 years of the children. Measures included an estimate of maternal caffeine intake during pregnancy, childrens IQ at age 5.5, and individual and family characteristics.nnnRESULTSnPrenatal caffeine exposure was common in the sample (91%) with 12% displaying an intake ≥200 mg/day (high). Multivariable modeling showed a significant negative relationship between caffeine intake and childrens IQ at 5.5 years (-.94 [95% confidence interval = -1.70, -.17] full IQ unit per 100 mg daily caffeine intake). In particular, children of mothers consuming ≥200 mg/day were more likely to have borderline or lower IQ compared with children of mothers consuming <100 mg/day (13.5% vs. 7.3%; odds ratio = 2.30, 95% confidence interval = 1.13, 4.69).nnnCONCLUSIONSnWe found an association between caffeine intake during pregnancy and impaired cognitive development in offspring, a result in line with animal data. More epidemiologic and biologically grounded research is needed to determine whether this association is causal. This finding suggests that conservative guidelines regarding the maximum caffeine intake recommended in pregnancy (i.e., 200 mg/day) should be maintained.

Persistent maternal depressive symptoms trajectories influence children's IQ: The EDEN mother–child cohort

This study assessed the association between timing and course of maternal depression from pregnancy onwards and childrens cognitive development at ages 5 to 6. Potential interaction effects with child sex and family socioeconomic status were explored.

Breastfeeding, Polyunsaturated Fatty Acid Levels in Colostrum and Child Intelligence Quotient at Age 5-6 Years

Objective To examine the relationship of polyunsaturated fatty acid (PUFA) in breast milk with childrens IQ. Study design In the French Etude des Déterminants pré‐ et postnatals précoces du développement et de la santé de lEnfant (EDEN) mother‐child cohort, colostrum samples were collected at the maternity unit. Colostrum omega‐6 and omega‐3 PUFA were analyzed by gas chromatography. At age 5‐6 years, the IQs of 1080 children were assessed using the Wechsler Preschool and Primary Scale of Intelligence‐III. The relationships of breastfeeding duration and PUFA levels with childrens IQs were examined by linear regression. Results Full scale IQ of ever breastfed children was 4.5 (95% CI: 2.7, 6.2) higher than never breastfed children in the unadjusted model, but this was not statistically significant in the adjusted model (1.3 points higher [‐0.4, 3.0]). Any breastfeeding duration was associated with full scale (0.20 [0.00, 0.41] points/month) and verbal (0.31 [0.09, 0.52]) IQ. Colostrum linoleic acid (LA) levels were negatively associated with Verbal IQ (‐0.6 [‐1.1, 0.0] points per 1% level increase). Children exposed to colostrum high in LA and low in docosahexaenoic acid (DHA) had lower IQs than those exposed to colostrum high in DHA (3.0 [0.5, 5.5] points) and those exposed to colostrum low in LA and DHA (4.4 [1.6, 7.3] points). Finally, the association between breastfeeding duration and child IQ was stronger when LA levels were high. Conclusions Duration of breastfeeding and colostrum PUFA levels were associated with childrens IQs in the EDEN cohort. These data support breastfeeding and add evidence for the role of early PUFA exposure on childhood cognition.

Predicting changes in language skills between 2 and 3 years in the EDEN mother–child cohort

Objective. To examine the factors predicting changes in language skills between 2 and 3 years. Methods. By using longitudinal data concerning 1002 children from the EDEN study, linear regression was used to predict 3-year language performance from 2-year language performance and the risk factors associated with language delays. Logistic regressions were performed to examine two change trajectories: children who fall below the 10th percentile of language skills between 2 and 3 years (declining trajectory), and those who rose above the 10th percentile (resilient trajectory). Results. The final linear model accounted for 43% of the variance in 3-year language scores, with 2-year language scores accounting for 22%. Exposure to alcohol during pregnancy, earlier birth term, lower level of parental education and lower frequency of maternal stimulation were associated with the declining trajectory. Breastfeeding was associated with the resilient trajectory. Conclusions. This study provides a better understanding of the natural history of early language delays by identifying biological and social factors that predict changes in language skills between the ages of 2 and 3 years.

Ages and Stages Questionnaire at 3 Years for Predicting IQ at 5–6 Years

This study assesses the predictive value of the 36-month Ages & Stages Questionnaires score for IQ at age 5 to 6 years in a sample of the general population. OBJECTIVES: To assess the predictive value of the 36-month Ages & Stages Questionnaire (ASQ) score for IQ score at age 5 to 6 years in the general population and to identify factors associated with IQ <85 once the ASQ score is taken into account. METHODS: Data were collected from 939 children enrolled in a population-based prospective cohort study. Developmental outcomes at 36 months were assessed via the ASQ and at 5 to 6 years via the Wechsler Preschool and Primary Scale of Intelligence. The ASQ threshold was identified via the receiver operating characteristic curve. Additional predictive factors to obtain an IQ <85 were investigated, and their interaction with ASQ score was studied. RESULTS: Sixty-nine children (7.3%) had an IQ <85. A 36-month ASQ score threshold of 270 was optimal to identify children with an IQ <85 at 5 to 6 years, with a 0.77 ± 0.11 sensitivity and 0.68 ± 0.03 specificity. Maternal educational level and occupational activity at the time of ASQ completion were associated with the risk of an IQ <85 at a given ASQ level. In the multivariate model, no interaction between the studied factors and ASQ score reached significance. CONCLUSIONS: In the general pediatric population, 36-month ASQ parental reports could be used to identify children at later risk of cognitive delay. Low maternal education level should also be considered as a major risk factor for lower IQ in preschool children regardless of ASQ score.

Nutrition Transition and Biocultural Determinants of Obesity among Cameroonian Migrants in Urban Cameroon and France.

Native of rural West Cameroon, the Bamiléké population is traditionally predisposed to obesity. Bamiléké who migrated to urban areas additionally experience the nutrition transition. We investigated the biocultural determinants of obesity in Bamiléké who migrated to urban Cameroon (Yaoundé), or urban France (Paris). We conducted qualitative interviews (n = 36; 18 men) and a quantitative survey (n = 627; 266 men) of adults using two-stage sampling strategy, to determine the association of dietary intake, physical activity and body weight norms with obesity of Bamiléké populations in these three socio-ecological areas (rural Cameroon: n = 258; urban Cameroon: n = 319; urban France: n = 50). The Bamiléké valued overweight and traditional energy-dense diets in rural and urban Cameroon. Physical activity levels were lower, consumption of processed energy-dense food was frequent and obesity levels higher in new migrants living in urban Cameroon and France. Female sex, age, duration of residence in urban areas, lower physical activity and valorisation of overweight were independently associated with obesity status. This work argues in favour of local and global health policies that account for the origin and the migration trajectories to prevent obesity in migrants.

OP V – 4 In-utero exposure to phenols and phthalates and the intelligence quotient of boys at 5 years

Background/aim There are concerns neuro-developmental due to exposure to endocrine disrupting chemicals. Previous epidemiological studies have mainly focused on phthalate metabolites and bisphenol A. Our study aimed to assess associations between in-utero exposure to the afore mentioned compounds and other ubiquitous phenolic compounds and the Intelligence Quotient (IQ) of boys at 5–6 years. Methods In 452 mother-son dyads from the French EDEN cohort, we measured 11 phthalate metabolites and 9 phenolic compounds (4 parabens, benzophenone-3, bisphenol A, 2 dichlorophenols and triclosan) in spot urine samples collected between 22 and 29 gestational weeks. Verbal and performance IQ of children was assessed at 5–6 years by a psychologist using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI). We used adjusted Structural Equation Models (SEM) and the Benjamini and Hochberg false discovery rate (FDR) correction to assess the associations between maternal urine phenol and phthalate metabolite concentrations considered simultaneously and the boys’ IQ. Results No phenol or phthalate metabolite concentration was negatively associated with child verbal or performance IQ (p-values≥0.09). Mono (3-carboxypropyl) phthalate tended to be associated with increased verbal IQ (β=0.136, 95% confidence interval, 0.01; 0.27) but this association disappeared after correction for multiple comparison (corrected p- 64 value, 0.71). Conclusion To our knowledge, our study is the first to consider developmental exposure to parabens, dichlorophenols, triclosan and benzophenone-3 in relation to child cognitive development. Our findings did not suggest an inverse association between in-utero phenols and phthalates exposure and child verbal and performance IQ.