Karien Viljoen

Fish intake during pregnancy, fetal growth, and gestational length in 19 European birth cohort studies.

BACKGROUND Fish is a rich source of essential nutrients for fetal development, but in contrast, it is also a well-known route of exposure to environmental pollutants. OBJECTIVE We assessed whether fish intake during pregnancy is associated with fetal growth and the length of gestation in a panel of European birth cohort studies. DESIGN The study sample of 151,880 mother-child pairs was derived from 19 population-based European birth cohort studies. Individual data from cohorts were pooled and harmonized. Adjusted cohort-specific effect estimates were combined by using a random- and fixed-effects meta-analysis. RESULTS Women who ate fish >1 time/wk during pregnancy had lower risk of preterm birth than did women who rarely ate fish (≤ 1 time/wk); the adjusted RR of fish intake >1 but <3 times/wk was 0.87 (95% CI: 0.82, 0.92), and for intake ≥ 3 times/wk, the adjusted RR was 0.89 (95% CI: 0.84, 0.96). Women with a higher intake of fish during pregnancy gave birth to neonates with a higher birth weight by 8.9 g (95% CI: 3.3, 14.6 g) for >1 but <3 times/wk and 15.2 g (95% CI: 8.9, 21.5 g) for ≥ 3 times/wk independent of gestational age. The association was greater in smokers and in overweight or obese women. Findings were consistent across cohorts. CONCLUSION This large, international study indicates that moderate fish intake during pregnancy is associated with lower risk of preterm birth and a small but significant increase in birth weight.

Fish intake in pregnancy and child growth: A pooled analysis of 15 European and US birth cohorts

IMPORTANCE Maternal fish intake in pregnancy has been shown to influence fetal growth. The extent to which fish intake affects childhood growth and obesity remains unclear. OBJECTIVE To examine whether fish intake in pregnancy is associated with offspring growth and the risk of childhood overweight and obesity. DESIGN, SETTING, AND PARTICIPANTS Multicenter, population-based birth cohort study of singleton deliveries from 1996 to 2011 in Belgium, France, Greece, Ireland, Italy, the Netherlands, Norway, Poland, Portugal, Spain, and Massachusetts. A total of 26,184 pregnant women and their children were followed up at 2-year intervals until the age of 6 years. EXPOSURES Consumption of fish during pregnancy. MAIN OUTCOMES AND MEASURES We estimated offspring body mass index percentile trajectories from 3 months after birth to 6 years of age. We defined rapid infant growth as a weight gain z score greater than 0.67 from birth to 2 years and childhood overweight/obesity at 4 and 6 years as body mass index in the 85th percentile or higher for age and sex. We calculated cohort-specific effect estimates and combined them by random-effects meta-analysis. RESULTS This multicenter, population-based birth cohort study included the 26,184 pregnant women and their children. The median fish intake during pregnancy ranged from 0.5 times/week in Belgium to 4.45 times/week in Spain. Women who ate fish more than 3 times/week during pregnancy gave birth to offspring with higher body mass index values from infancy through middle childhood compared with women with lower fish intake (3 times/week or less). High fish intake during pregnancy (>3 times/week) was associated with increased risk of rapid infant growth, with an adjusted odds ratio (aOR) of 1.22 (95% CI, 1.05-1.42) and increased risk of offspring overweight/obesity at 4 years (aOR, 1.14 [95% CI, 0.99-1.32]) and 6 years (aOR, 1.22 [95% CI, 1.01-1.47]) compared with an intake of once per week or less. Interaction analysis showed that the effect of high fish intake during pregnancy on rapid infant growth was greater among girls (aOR, 1.31 [95% CI, 1.08-1.59]) than among boys (aOR, 1.11 [95% CI, 0.92-1.34]; P = .02 for interaction). CONCLUSIONS AND RELEVANCE High maternal fish intake during pregnancy was associated with increased risk of rapid growth in infancy and childhood obesity. Our findings are in line with the fish intake limit proposed by the US Food and Drug Administration and Environmental Protection Agency.

Longitudinal follow-up of the relationship between dietary intake and growth and development in the Lifeways cross-generation cohort study 2001-2013.

In this paper we will review evidence on the early life and familial influences on childhood growth and development, with particular reference to the Lifeways cross-generation cohort study in the Republic of Ireland. The Lifeways cross-generation cohort study was established in 2001-2013 through two maternity hospitals in the Republic of Ireland and was one of many new cohort studies established worldwide in the millennium period. Mothers were recruited at first booking visit, completing a self-administered questionnaire, which included a 147 item semi-quantitative FFQ. Longitudinal follow-up is ongoing in 2013, with linkage data to hospital and general practice records and examination of children when aged 5 and 9 years. The study is one of very few containing data on grandparents of both lineages with at least one grandparent recruited at baseline. There have been consistent associations between parental and grandparental health status characteristics and childrens outcomes, including infant birth-weight, BMI when child was aged 5 years and childhood wheeze or asthma when child was aged 3 and aged 5 years. In conclusion, empirical evidence to date shows consistent familial and cross-generational patterns, particularly in the maternal line.

Body mass index is associated with the maternal lines but height is heritable across family lines in the Lifeways Cross-Generation Cohort Study.

Objectives Overweight and obesity is a problem in children in particular and determining pathways of transmission is important in prevention. We aimed to examine associations for body mass index (BMI) across three generations of the same families. Participants Members of 556 families in the Lifeways Cross-Generation Cohort Study 2001–2014. Setting Community-based study with linkage to health records in the Republic of Ireland. Methods Employing a novel mixed-method approach which adjusts for age and familial group, BMI correlations were estimated at three ages of the index child, that is, at birth and at ages 5 and 9. Height was also examined for comparative purposes. Results Correlation of offsprings BMI with that of the mother increased with age (correlation coefficient 0.15 increasing to 0.28, p value <0.001 in all cases) while no consistent pattern was seen with offspring and fathers. There was an association also with each parent and their own mother. Offsprings BMI was correlated to a lesser extent with that of the maternal grandmother while for girls only there was an association with that of the paternal grandmother at ages 0 and 5 (correlation coefficients 0.25, 0.28, p values 0.02, 0.01, respectively). In contrast, height of the child was strongly associated with those of all family members at age 5, but at birth and at age 9 only there was an association with those of the parents and the paternal grandfather. Correlation of offsprings height with those of the mother and father increased with age. Conclusions The results suggest that BMI is predominantly associated with the maternal line, possibly either with intrauterine development, or inherited through the X chromosome, or both, while height is a more complex trait with genetic influences of the parents and that of the paternal grandfather predominating.

PP30 Primary Care Utilisation and its Socio-Economic Determinants: findings from the Lifeways Cross-Generation Cohort Study During the Recession Period in the Republic of Ireland

Background Worldwide there is a well-established association between rates of primary and secondary health care utilisation and socio-economic deprivation. The collapse of the Celtic Tiger economy and recession in 2006/7 may have had a significant impact on health care utilisation. Aim: To examine patterns of primary care utilisation rates in the Irish adult population and its determinants over a 10 year period. Setting: Lifeways is a Cross-Generation Cohort Study of 1082 families recruited initially in the East and West of Ireland. Data were collected by self-administered questionnaire at baseline 2001-3, in 2007 and 2011/12, and from general practitioners in 2003. At the fourth phase of follow-up in 2011 1588 adults in 592 families responded. Methods Respondents provided data on health care utilisation (HCU), morbidity and socio-economic status at three time points and through GP notes. Recession impact was measured by standard questions and a composite economy score calculated (1–15, higher score indicating bigger impact). Rates of HCU were defined as ‘Less frequent’ < = 2 consultations/yr and ‘More frequent’ > = 3 consultations/yr. HCU was compared according to lineage, General Medical Services (GMS) means-tested eligibility to free health care, morbidity and various socio-economic indicators across the 4 time points. We subsequently fit a linear mixed effects model where family id and personal id were modelled as random effects with random intercepts for each family and random intercepts and slopes over time for each individual. Results At each time point, a strong, significant age gradient was noted, with women (mothers and grandmothers) being the more frequent users than men. Grandparents showed an average of 15% higher utilisation than parents (Chi-sq, p < 0.0001). GMS eligibility remained the strongest predictor of HCU at all time points (Chi-sq 172.468, p < 0.0001). At baseline, those with difficulty getting by had significantly higher HCU rates 53.7% vs. 46.3% (Chi-sq 10.212, p < 0.0001). In the final mixed model, economy score, time, GMS eligibility and co-morbidity were all highly significant predictors of healthcare utilisation adjusted for age, sex and region. Significantly higher odds of healthcare utilisation at 10yr follow-up were demonstrated for those who are GMS eligible (OR 6.9 [95% CI 2.5, 19.1], p<0.0001). A significant decrease in the odds of utilisation with increasing economic stress was also evident (6.9 [0.5, 0.9], p=0.02). Conclusion This analysis suggests persistent effects of morbidity characteristics on healthcare utilisation patterns. Exacerbated by the recent recession in adults in the Republic of Ireland.

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.