Michael O'Callaghan

Associations of Gestational Weight Gain With Offspring Body Mass Index and Blood Pressure at 21 Years of Age Evidence From a Birth Cohort Study

Background— Maternal weight gain in pregnancy is positively associated with offspring body mass index (BMI) and obesity risk in childhood, but whether this increased risk extends into adulthood or results in increases in other cardiovascular risk factors such as elevated blood pressure (BP) is unclear. Methods and Results— We used a population-based birth cohort of 2432 individuals (50% male) born in Brisbane, Australia, between 1981 and 1983 to prospectively examine the association between maternal gestational weight gain (GWG) and offspring BMI and BP at 21 years. On average, each mother gained 14.8 kg (SD, 5.1 kg) during her pregnancy. At 21 years of age, offspring mean BMI, systolic BP, and diastolic BP were 24.2 kg/m2 (SD, 4.9 kg/m2), 116.4 mm Hg (SD, 14.5 mm Hg), and 67.7 mm Hg (SD, 8.5 mm Hg), respectively. Offspring BMI was on average 0.3 kg/m2 (95% confidence interval, 0.1 to 0.4 kg/m2) higher for each 0.1-kg/wk greater GWG after adjustment for potential confounding factors. Systolic BP also was greater (0.2 mm Hg per 0.1 kg; 95% confidence interval, −0.2 to 0.6) in offspring whose mothers had higher GWG. Although this association was not statistically significant, it was consistent in magnitude with the association of maternal GWG with offspring BMI and of offspring BMI with BP. Conclusions— Our findings show that greater GWG is associated with greater offspring BMI into early adulthood and that this may translate into higher systolic BP in offspring. Further large studies are required to confirm an effect of GWG on a range of offspring cardiovascular risk factors.

Cohort Profile Update: The Mater-University of Queensland Study of Pregnancy (MUSP)

The Mater-University of Queensland Study of Pregnancy (MUSP) and its outcomes began in 1981 with data collected on 7223 pregnant woman-child pairs (6753 mothers, of whom 520 had 2 study children, less 50 who had multiple births). These women, and their children, were initially followed for up to 21 years. Since then there have been additional follow-ups of the mothers (27 years) and their children (30 years). There has also been a substantial increase in the breadth of topics addressed, with the collection of biological samples, the administration of structured clinical assessments of mental health and cognitive capacity, and markers of physical health such as lung function and blood pressure. MUSP was originally developed as a birth cohort study. It has become a longitudinal study of growth, development and ageing with an emphasis on the generational transmission of a wide range of factors impacting on adult health outcomes. We welcome interest in our study; for study background and publications visit [www.socialscience.uq.edu.au/musp] or contact [j.najman@uq.edu.au].

Associations of excess weight gain during pregnancy with long-term maternal overweight and obesity: evidence from 21 y postpartum follow-up

BACKGROUND The contribution of gestational weight gain (GWG) to the development of obesity may have important implications for mothers in their later lives. However, whether GWG is a strong predictor of body mass index (BMI) 2 decades after the index pregnancy is unknown. OBJECTIVE We examined the long-term effect of GWG by using a community-based birth cohort study. DESIGN We followed a subsample of 2055 women from an original cohort of 7223 women who gave birth in Brisbane, Australia, between 1981 and 1983. Multivariable regression and multinomial regression were used to examine the independent associations of GWG per gestational week and Institute of Medicine (IOM) categories of combined prepregnancy BMI and GWG with BMI and its categories 21 y after the index pregnancy. RESULTS In analyses using GWG per week as a continuous exposure variable, maternal BMI (in kg/m(2)) increased, on average, by 0.52 (95% CI: 0.31, 0.73) for a 0.1-kg/wk greater GWG. This association became stronger when adjusted for maternal prepregnancy BMI. Analyses with IOM categories showed a greater postnatal increase in BMI for women defined as having excessive GWG (3.72, on average; 95% CI: 3.12, 4.31) than for women with adequate GWG. The women who gained excess weight during pregnancy had increased odds of being overweight [odds ratio (OR): 2.15; 95% CI: 1.64, 2.82] or obese (OR: 4.49; 95% CI; 3.42, 5.89) 21 y after the index pregnancy. These associations were independent of other potential factors. CONCLUSION Weight gain during pregnancy independently predicts the long-term weight gain and obesity of women.

Maternal cigarette smoking and child psychiatric morbidity: a longitudinal study.

Objective. Previous studies have linked maternal smoking during pregnancy with behavioral disturbance in children. However, additional evidence is needed to address the causality of the relationship. The present study analyses result from an Australian cohort of 5342 5-year-old children whose mothers were recruited early in pregnancy. Methods. Smoking history was gathered for prepregnancy, first clinic visit (FCV), late pregnancy, and when the child was 6 months and 5 years of age. Behavior problems at the age of 5 were assessed using a modified Child Behavior Check List (CBCL) shown to have high agreement with the complete CBCL. This resulted in the formation of three scales: internalizing; social, attentional and thought; and externalizing behavior problems, which were then dichotimized at the 90th percentile in each case. Logistic regression was used to model these outcomes as a function of maternal smoking at five time points during which it was assessed. A series of models explored the effect of additional adjustment for confounding. The predictors of attrition (29.5%) throughout the cohort were also identified by multivariate modeling. Results. The final analysis was carried out on a cohort of mother-child pairs for whom data and child behavior outcomes were complete. The mean age of children was 5 years, 6 months with a range from 4 to 6 years. The mean age of mothers at the time of birth of the child was 25 years, with a range from 13 to 47 years. Mothers lost to follow-up were more likely to be younger, single, and less well-educated than those who continued participation, although maternal smoking was not an independent determinant. Unadjusted analyses showed strong associations between externalizing child behavior and maternal smoking during pregnancy and at the 5-year follow-up, with relative risks (RRs) up to 2.6 for children of women smoking at least 20 cigarettes per day at the first antenatal clinic visit. A clear dose-response relationship existed in most relationships with higher levels of smoking being associated with higher rates of externalizing behavior problems. Weaker relationships occurred for internalizing behavior and social, attentional and thought behavior problems. Multivariate analysis of the timing in more detail that the association between maternal smoking and child behavior problems persisted, although the evidence for dose-response diminished. Moreover, it was primarily associated with smoking as determined by questions asked at the FCV (RR = 1.52, 2.03, 2.16) for 1 to 9, 10 to 19, and ≥20 cigarettes per day, respectively, compared with nonsmoking and secondarily by smoking determined at the 5-year follow-up (RR = 1.52, 1.87, 1.29) for 1 to 9, 10 to 19, and ≥20 cigarettes per day respectively, compared with nonsmoking. This association appeared to be independent of a wide range of possible confounders such as maternal age, education, social class, marital status and mental health, gestation at FCV, complications during pregnancy, the childs sex, gestational age at birth, and age at last follow-up. Adjustments were also made for the mothers employment since birth, family structure, and maternal mental health at the time of the CBCL assessment. Associations between externalizing behavior problems and maternal smoking at other times, and those between other behavioral problems examined and maternal smoking were not significant. Conclusion. Although previous studies have found evidence for an association between maternal smoking and child behavior problems, the strength of this study lies in its size, its detailed and consistent measurement of maternal smoking, and its ability to control for many social and biological factors linked to maternal smoking and child behavior. The statistical evidence for a causal relationship between maternal smoking as measured at the first antenatal clinic visit and the development of externalizing behavior in children is strongly suggestive, because of the specificity of effect and timing, and the adjustment for a comprehensive range of other risk factors. An alternative explanation that mothers who smoke might be inclined to report behavior problems differently was considered unlikely because the effect was specific to externalizing behavior and the major exposure occurred 5 years before the reported behavior. Additionally, the existence of a factor (beyond those already included in the analysis) that might be related to both behavior problems and any propensity to misreport smoking seems sufficiently implausible to rule out misclassification of smoking status as another alternative explanation for the findings. The timing of the relationship between smoking in pregnancy and externalizing behavior problems, and its independence of small for gestational age status at birth, suggests that placental insufficiency and oxygen deprivation are not important in the pathogenesis. It is possible that nicotine in the fetal brain derived from maternal smoking may alter gene expression and the nature and function of the nicotine receptors developing in early pregnancy. The presence of a separate, although slightly weaker, association between concurrent maternal smoking and externalizing child behavior suggests both biological and social explanations, including a direct psychopharmocologic effect of nicotine through passive smoking. Assuming the relationship to be causal, it is estimated that maternal smoking in early pregnancy may account for 25% of externalizing (aggressive) behavior while maternal smoking when the child is 5 years old may account for an additional 16%. These findings provide further support for antismoking programs in pregnancy and in young family settings.

Bias influencing maternal reports of child behaviour and emotional state

Background: Previous research has indicated that there may be only a modest degree of agreement between different reporters of a childs behaviour (mental health). This raises the possibility that some descriptions of the childs behaviour may reflect the personal characteristics of the respondent. We examine two potential sources of bias that may influence reports of a childs behaviour/mental health. The first is the mental or emotional impairment of the respondent; the second concerns gender-related expectations of children. Methods: Mothers (and their children after the birth) were assessed at first clinic visit, 3–5 days after the birth, then 6 months, 5 years and 14 years after the birth. Some 70% of respondents giving birth remained in the study at the 14-year follow-up, leaving some 5277 cases for this analysis. At the 14-year follow-up, child behaviour (mental health) was assessed using the Child Behaviour Check List and the Youth Self Report. Maternal mental health was determined using the anxiety and depression subscales of the Delusions-Symptoms-States Inventory. Results: Mothers who were not emotionally impaired reported fewer child behaviour problems than did the children themselves. As the mothers current emotional impairment increased, so her reports of the childs behaviour problems increased, when compared with the childs own reports. Further, mothers attributed more internalising symptoms to female respondents, and more externalising symptoms to male respondents, than did the child respondents themselves. Conclusions: Mothers differ systematically from their children when they are reporting their childs behaviour (mental health). The more emotionally impaired the mother, the greater the degree to which she imputes the child to have behaviour problems. Further, female children are attributed to have more internalising behaviours and male children externalising behaviours.

Maternal anxiety and depression, poverty and marital relationship factors during early childhood as predictors of anxiety and depressive symptoms in adolescence

BACKGROUND This paper examines the degree to which symptoms of anxiety and depression at age 14 years are associated with early childhood experience of maternal anxiety and depression, poverty, and mothers marital relationship distress and break-up. METHODS In a longitudinal study, 4434 families were followed-up from infancy to adolescence. RESULTS Maternal anxiety and depression during early childhood were found to have small, but significant, influences upon the development of high anxiety-depression symptoms at age 14, after controlling for the effects of poverty and marital relationship factors. This effect was greater with repeated exposure to high maternal anxiety and depression. Poverty, distressed marital relationship and marital break-up during the childs first five years also produced small, but significant, increases in risk of high anxiety and depression symptoms in adolescence. Stable, single-parent status was not found to be a risk factor. There was no evidence of marked gender differences in risk factors, other than poverty, which had a stronger impact for girls than boys. CONCLUSIONS Overall, the results suggest that maternal anxiety and depression, poverty, parent relationship conflict and marital break-up during early childhood are associated with small, but significant, increased risk of anxiety-depression symptoms in adolescence.

Postnatal depression - myth and reality: maternal depression before and after the birth of a child

Abstract  Background: Much has been written about postnatal depression as a clinical condition. There is some evidence to suggest that a substantial proportion of women who give birth experience a depression in the postnatal period. This paper reports the results of a longitudinal study of the mental health of a large sample of women who were in the early stages of pregnancy at entry to the study. Methods: Each participant was assessed for symptoms of depression at the first clinic visit (entry to the study), and reassessed at various intervals – at 3–5 days, at 6 months, and again at 5 years after the birth of the child – using the DSSI-D (Delusions-Symptoms-States Inventory). Results: Retrospective recall questions indicate that shortly after the birth the majority of women experienced some depressed mood. Of those who experienced depressed mood, the data suggest that the symptoms were not severe, nor did these symptoms generally continue beyond a few weeks. The longitudinal data indicate that levels of depression in our sample are highest either at the first clinic visit or at the 5-year follow-up. Rates of depression at the 6-month follow-up are relatively low by comparison. Conclusion: While most mothers experience periods of depressed mood after the birth of their baby, these periods are generally of short duration and of lesser intensity than a major depression. Mothers appear to experience increasing levels of symptoms of depression as their child grows up. Many of the “cases” of depression experienced at the 5-year follow-up represent a recurrence of a previous experience of depression.

A parent-completed developmental questionnaire: follow up of ex-premature infants

Objective: Premature infants are at increased risk of developmental disability. Early identification of problems allows intervention to ameliorate or attenuate problems. A reliable screening tool allows triage of children in this high‐risk population by identifying those unlikely to need full developmental assessment. To explore the test characteristics of an established parent‐completed developmental assessment questionnaire ‘Ages and Stages Questionnaire’ (ASQ) in follow up of an Australian population of premature infants.

Impact of Family Type and Family Quality on Child Behavior Problems: A Longitudinal Study

OBJECTIVE In the context of substantial changes in family types and even family quality in recent times, this study is concerned with the extent to which family type and quality impacts on child behavior problems. METHOD A sample of 8,556 pregnant women were enrolled in a prospective, longitudinal study. Details of changes in family type and family quality (assessed using Spanier Dyadic Adjustment Scale) were used to predict three second-order syndromes developed from the Child Behavior Checklist and administered to the mothers when the child was 5 years of age. RESULTS Mothers who experienced no partner changes (married and single) reported the lowest rates of child behavior problems for the three syndromes used in this study. In addition, mothers who more often described their relationship with their partner as poor also reported the highest rate of child behavior problems across all three syndromes. Adjustment for possible confounders did not alter these findings. CONCLUSION Both changes of partner and dyadic conflict appear to lead to child behavior problems, with the latter factor appearing to have a greater impact than the former. Mothers who experienced no partner changes and no conflict appeared to have children with the fewest behavior problems.

In utero and postnatal maternal smoking and asthma in adolescence.

Background: Asthma in early childhood has been associated with maternal smoking during pregnancy and parental smoking soon after birth. However, less is known about these exposures and the development of asthma symptoms in adolescence. Methods: Data were taken from the Mater University Study of Pregnancy, a large birth cohort study of mothers and children enrolled in Brisbane, Australia, beginning in 1981. Smoking was assessed at 2 stages during pregnancy and at the 6-month and 5-year follow-up visits. Asthma was assessed from maternal reports that were provided when the child was age 14 years. We conducted multivariable multinomial logistic regression analyses to assess the effect of maternal smoking on asthma symptoms. Results: There was a strong sex interaction such that girls whose mothers had smoked heavily (20 or more cigarettes per day) in pregnancy and at the 6-month follow up had increased odds of experiencing asthma symptoms at age 14 (odds ratio = 1.96; 95% confidence interval = 1.25–3.08). The contribution of heavy smoking during pregnancy appeared to be stronger than heavy smoking after the birth. No similar associations were seen for boys. Conclusion: Female adolescents whose mothers smoked heavily during the fetal period and the early months of life have increased risk of asthma symptoms in adolescence. In utero exposure to heavy smoking was found to have a stronger effect than postnatal environmental tobacco exposure.