OBJECTIVE:To compare stillbirth rates and risks for small for gestational age (SGA), large for gestational age (LGA) and appropriate for gestational age (AGA) pregnancies at 24-44 completed weeks of gestation using a birth-based and fetuses-at-risk approachs. DESIGN:Population-based, multi-country study. SETTING:National data systems in 15 high- and middle-income countries. POPULATION:Live births and stillbirths. METHODS:A total of 151 country-years of data, including 126 543 070 births across 15 countries from 2000 to 2020, were compiled. Births were categorised into SGA, AGA and LGA using INTERGROWTH-21st standards. Gestation-specific stillbirth rates, with total births as the denominator, and gestation-specific stillbirth risks, with fetuses still in utero as the denominator, were calculated from 24 to 44 weeks of gestation. MAIN OUTCOME MEASURES:Gestation-specific stillbirth rates and risks according to size at birth. RESULTS:The overall stillbirth rate was 4.22 per 1000 total births (95% CI 4.22-4.23) across all gestations. Applying the birth-based approach, the stillbirth rates were highest at 24 weeks of gestation, with 621.6 per 1000 total births (95% CI 620.9-622.2) for SGA pregnancies, 298.4 per 1000 total births (95% CI 298.1-298.7) for AGA pregnancies and 338.5 per 1000 total births (95% CI 337.9-339.0) for LGA pregnancies. Applying the fetuses-at-risk approach, the gestation-specific stillbirth risk was highest for SGA pregnancies (1.3-1.4 per 1000 fetuses at risk) prior to 29 weeks of gestation. The risk remained stable between 30 and 34 weeks of gestation, and then increased gradually from 35 weeks of gestation to the highest rate of 8.4 per 1000 fetuses at risk (95% CI 8.3-8.4) at ≥42 weeks of gestation. The stillbirth risk ratio (RR) was consistently high for SGA compared with AGA pregnancies, with the highest RR observed at ≥42 weeks of gestation (RR 9.2, 95% CI 15.2-13.2), and with the lowest RR observed at 24 weeks of gestation (RR 3.1, 95% CI 1.9-4.3). The stillbirth RR was also consistently high for SGA compared with AGA pregnancies across all countries, with national variability ranging from RR 0.70 (95% CI 0.43-0.97) in Mexico to RR 8.6 (95% CI 8.1-9.1) in Uruguay. No increased risk for LGA pregnancies was observed. CONCLUSIONS:Small for gestational age (SGA) was strongly associated with stillbirth risk in this study based on high-quality data from high- and middle-income countries. The highest RRs were seen in preterm gestations, with two-thirds of the stillbirths born as preterm births. To advance our understanding of stillbirth, further analyses should be conducted using high-quality data sets from low-income settings, particularly those with relatively high rates of SGA.

OBJECTIVE:To examine the prevalence of novel newborn types among 165 million live births in 23 countries from 2000 to 2021. DESIGN:Population-based, multi-country analysis. SETTING:National data systems in 23 middle- and high-income countries. POPULATION:Liveborn infants. METHODS:Country teams with high-quality data were invited to be part of the Vulnerable Newborn Measurement Collaboration. We classified live births by six newborn types based on gestational age information (preterm <37 weeks versus term ≥37 weeks) and size for gestational age defined as small (SGA, <10th centile), appropriate (10th-90th centiles), or large (LGA, >90th centile) for gestational age, according to INTERGROWTH-21st standards. We considered small newborn types of any combination of preterm or SGA, and term + LGA was considered large. Time trends were analysed using 3-year moving averages for small and large types. MAIN OUTCOME MEASURES:Prevalence of six newborn types. RESULTS:We analysed 165 017 419 live births and the median prevalence of small types was 11.7% - highest in Malaysia (26%) and Qatar (15.7%). Overall, 18.1% of newborns were large (term + LGA) and was highest in Estonia 28.8% and Denmark 25.9%. Time trends of small and large infants were relatively stable in most countries. CONCLUSIONS:The distribution of newborn types varies across the 23 middle- and high-income countries. Small newborn types were highest in west Asian countries and large types were highest in Europe. To better understand the global patterns of these novel newborn types, more information is needed, especially from low- and middle-income countries.

ABSTRACTObjectiveTo examine the contribution of preterm birth and size-for-gestational age in stillbirths using six ‘newborn types’.DesignPopulation-based multi-country analyses.SettingBirths collected through routine data systems in 12 countries.Sample119,644,788 total births from 22+0to 44+6weeks gestation identified from 2000 to 2020.MethodsWe included 605,557 stillbirths from 22+0weeks gestation from 12 countries. We classified all births, including stillbirths, by six ‘newborn types’ based on gestational age information (preterm, PT, <37+0weeks vs term, T, ≥37+0weeks) and size-for-gestational age defined as small (SGA, <10thcentile), appropriate (AGA, 10th-90thcentiles), or large (LGA, >90thcentile) for gestational age, according to the international newborn size for gestational age and sex INTERGROWTH-21ststandards.Main Outcome MeasuresDistribution of stillbirths, stillbirth rates and rate ratios according to six newborn types.Results605,557 (0.50%) of the 119,644,788 total births resulted in stillbirth after 22+0weeks. Most stillbirths (74.3%) were preterm. Around 21.0% were SGA types (PT+SGA (16.0%), T+SGA (5.0%)) and 14.3% were LGA types (PT+LGA (10.1%), T+LGA (4.2%)). The median rate ratio (RR) for stillbirth was highest in PT+SGA babies (RR=78.8, interquartile range (IQR), 68.2, 111.5) followed by PT+AGA (RR=24.5, IQR, 19.3, 29.4), PT+LGA (RR=23.0, IQR,13.7, 29.0) and T+SGA (RR=5.5, IQR, 5.0, 6.0) compared with T+AGA. Stillbirth rate ratios were similar for T+LGA vs T+AGA (RR=0.7, IQR, 0.7, 1.1). At the population level, 21.5% of stillbirths were attributable to small-for-gestational-age.ConclusionsIn these high-quality data from high/middle income countries, almost three quarters of stillbirths were born preterm and a fifth were small-for-gestational age, with the highest stillbirth rates associated with the coexistence of preterm and SGA. Further analyses are needed to better understand patterns of gestation-specific risk in these populations, and also patterns in lower-income contexts, especially those with higher rates of intrapartum stillbirth and SGA.FundingThe Children’s Investment Fund Foundation, 1803-02535KEY FINDINGS1.WHAT WAS KNOWN?Stillbirth (pregnancy loss after 22+0weeks) is a devastating outcome. Global estimates indicating 1.9 million late gestation stillbirths (≥28+0weeks) worldwide in 2021 underestimate the overall burden. Many of the pathways to stillbirth result in fetal death before term (preterm stillbirth, <37+0weeks of gestational age). In addition, babies with fetal growth restriction (frequently assessed using the proxy small for gestational age (SGA, <10thcentile)) are at higher risk of stillbirth than their appropriately grown peers. Stillbirths are therefore more likely to be low birthweight (LBW, <2,500g). Being large for gestational age (LGA, >90thcentile) at term may also be associated with increased risk of stillbirth.2.WHAT WAS DONE THAT IS NEW?Combining information on gestational age (preterm (PT), or term (T)) and attained size for-gestational-age (small-for-gestational-age (SGA), appropriate-for-gestational age (AGA), large-for-gestational age (LGA)) we defined six ‘newborn types’: four small (PT+SGA, PT+AGA, PT+LGA, T+SGA), one large (T+LGA), and one reference (T+AGA). We compiled livebirth and stillbirth data from 15 high- and middle-income countries as part of the Vulnerable Newborn Collaboration. A total of 119,039,231 livebirths and 605,557 stillbirths ≥22+0weeks from 12 countries between 2000 and 2020 met the inclusion criteria. We examined the distribution of stillbirths by these ‘newborn types’, and calculated type-specific stillbirth rates and rate ratios.3.WHAT WAS FOUND?Most stillbirths (74.3%) were preterm, compared to fewer than 1-in-10 (9.0%) livebirths. A fifth (21.0%) of stillbirths were SGA compared to 1-in-20 (5.4%) livebirths. Preterm SGA had 78.8 times higher stillbirth rates compared to term AGA (Rate ratio (RR)=78.8, interquartile range (IQR), 68.2,111.5). Overall, preterm types had a 25 times higher stillbirth rate than term types (RR=25.0, IQR,20.1, 29.5). At the population level, over a fifth of stillbirths (21.5%) were attributable to being SGA, indicating a substantial impact of growth restriction on stillbirth in these settings. 14.3% of stillbirths and 17.5% of livebirths were LGA. There was no evidence of increased stillbirth rates for LGA types. The distribution of these ‘newborn types’ are similar amongst stillbirths and neonatal deaths.4.WHAT NEXT?Categorisation of all births, including stillbirths, into these ‘newborn types’ was analytically possible using routinely collected data in these 12 upper-middle- or high-income contexts and led to programmatic relevant findings. However, as the majority (98%) of the world’s stillbirths are in low-and middle-income countries, more data are needed to improve understanding of patterns in stillbirths in a wider range of contexts, especially in settings with higher rates of intrapartum stillbirth and those with very high SGA rates such as South Asia. Further analyses, including assessing gestational age-specific risk, could provide more information on pathways to stillbirth and enable targeted interventions to underlying causes such as infection and obstetric complications. When analysing these vulnerability pathways, omitting stillbirths neglects an important part of the burden and its effects on families and society.

Objective To compare neonatal mortality associated with six novel vulnerable newborn types in 125.5 million live births across 15 countries, 2000-2020.Design Population-based, multi-country study.Setting National data systems in 15 middle- and high-income countries.Methods We used individual-level data sets identified for the Vulnerable Newborn Measurement Collaboration. We examined the contribution to neonatal mortality of six newborn types combining gestational age (preterm [PT] versus term [T]) and size-for-gestational age (small [SGA], <10th centile, appropriate [AGA], 10th-90th centile or large [LGA], >90th centile) according to INTERGROWTH-21st newborn standards. Newborn babies with PT or SGA were defined as small and T + LGA was considered as large. We calculated risk ratios (RRs) and population attributable risks (PAR%) for the six newborn types.Main outcome measures Mortality of six newborn types.Results Of 125.5 million live births analysed, risk ratios were highest among PT + SGA (median 67.2, interquartile range [IQR] 45.6-73.9), PT + AGA (median 34.3, IQR 23.9-37.5) and PT + LGA (median 28.3, IQR 18.4-32.3). At the population level, PT + AGA was the greatest contributor to newborn mortality (median PAR% 53.7, IQR 44.5-54.9). Mortality risk was highest among newborns born before 28 weeks (median RR 279.5, IQR 234.2-388.5) compared with babies born between 37 and 42 completed weeks or with a birthweight less than 1000 g (median RR 282.8, IQR 194.7-342.8) compared with those between 2500 g and 4000 g as a reference group.Conclusion Preterm newborn types were the most vulnerable, and associated with the highest mortality, particularly with co-existence of preterm and SGA. As PT + AGA is more prevalent, it is responsible for the greatest burden of neonatal deaths at population level.

OBJECTIVE:We aimed to compare the prevalence and neonatal mortality associated with large for gestational age (LGA) and macrosomia among 115.6 million live births in 15 countries, between 2000 and 2020. DESIGN:Population-based, multi-country study. SETTING:National healthcare systems. POPULATION:Liveborn infants. METHODS:We used individual-level data identified for the Vulnerable Newborn Measurement Collaboration. We calculated the prevalence and relative risk (RR) of neonatal mortality among live births born at term + LGA (>90th centile, and also >95th and >97th centiles when the data were available) versus term + appropriate for gestational age (AGA, 10th-90th centiles) and macrosomic (≥4000, ≥4500 and ≥5000 g, regardless of gestational age) versus 2500-3999 g. INTERGROWTH 21st served as the reference population. MAIN OUTCOME MEASURES:Prevalence and neonatal mortality risks. RESULTS:Large for gestational age was common (median prevalence 18.2%; interquartile range, IQR, 13.5%-22.0%), and overall was associated with a lower neonatal mortality risk compared with AGA (RR 0.83, 95% CI 0.77-0.89). Around one in ten babies were ≥4000 g (median prevalence 9.6% (IQR 6.4%-13.3%), with 1.2% (IQR 0.7%-2.0%) ≥4500 g and with 0.2% (IQR 0.1%-0.2%) ≥5000 g). Overall, macrosomia of ≥4000 g was not associated with increased neonatal mortality risk (RR 0.80, 95% CI 0.69-0.94); however, a higher risk was observed for birthweights of ≥4500 g (RR 1.52, 95% CI 1.10-2.11) and ≥5000 g (RR 4.54, 95% CI 2.58-7.99), compared with birthweights of 2500-3999 g, with the highest risk observed in the first 7 days of life. CONCLUSIONS:In this population, birthweight of ≥4500 g was the most useful marker for early mortality risk in big babies and could be used to guide clinical management decisions.

OBJECTIVE:To examine the contribution of preterm birth and size-for-gestational age in stillbirths using six 'newborn types'. DESIGN:Population-based multi-country analyses. SETTING:Births collected through routine data systems in 13 countries. SAMPLE:125 419 255 total births from 22+0 to 44+6 weeks' gestation identified from 2000 to 2020. METHODS:We included 635 107 stillbirths from 22+0 weeks' gestation from 13 countries. We classified all births, including stillbirths, into six 'newborn types' based on gestational age information (preterm, PT, <37+0 weeks versus term, T, ≥37+0 weeks) and size-for-gestational age defined as small (SGA, <10th centile), appropriate (AGA, 10th-90th centiles) or large (LGA, >90th centile) for gestational age, according to the international newborn size for gestational age and sex INTERGROWTH-21st standards. MAIN OUTCOME MEASURES:Distribution of stillbirths, stillbirth rates and rate ratios according to six newborn types. RESULTS:635 107 (0.5%) of the 125 419 255 total births resulted in stillbirth after 22+0 weeks. Most stillbirths (74.3%) were preterm. Around 21.2% were SGA types (PT + SGA [16.2%], PT + AGA [48.3%], T + SGA [5.0%]) and 14.1% were LGA types (PT + LGA [9.9%], T + LGA [4.2%]). The median rate ratio (RR) for stillbirth was highest in PT + SGA babies (RR 81.1, interquartile range [IQR], 68.8-118.8) followed by PT + AGA (RR 25.0, IQR, 20.0-34.3), PT + LGA (RR 25.9, IQR, 13.8-28.7) and T + SGA (RR 5.6, IQR, 5.1-6.0) compared with T + AGA. Stillbirth rate ratios were similar for T + LGA versus T + AGA (RR 0.7, IQR, 0.7-1.1). At the population level, 25% of stillbirths were attributable to small-for-gestational-age. CONCLUSIONS:In these high-quality data from high/middle income countries, almost three-quarters of stillbirths were born preterm and a fifth small-for-gestational age, with the highest stillbirth rates associated with the coexistence of preterm and SGA. Further analyses are needed to better understand patterns of gestation-specific risk in these populations, as well as patterns in lower-income contexts, especially those with higher rates of intrapartum stillbirth and SGA.

Highly prevalent maternal psychosocial complaints are accompanied by increases in glucocorticoid stress hormones, which may predispose the offspring for type 2 diabetes and cardiovascular disease later in adulthood. The aim of the current research is to study whether prenatal maternal psychosocial stress is associated with parameters of blood glucose metabolism in their children aged 5-6 years. The study design was a prospective birth cohort (the Amsterdam Born Children and their Development study, the Netherlands). Depressive symptoms, pregnancy-related anxiety, parenting daily hassles and job strain were recorded by questionnaire (gestational week 16). A cumulative score was also calculated. Possible sex differences in the associations were considered. The subjects were 1952 mother-child pairs. Outcome measures were fasting glucose (n = 1952), C-peptide and insulin resistance (HOMA2-IR) (n = 1478) in the children at the age of 5-6 years. The stress scales, single and cumulative, were not associated with glucose/C-peptide/insulin resistance (all P > 0.05). We did not find evidence for sex differences. In conclusion, we did not find evidence for an association between psychosocial stress during early pregnancy and parameters of glucose metabolism in offspring at the age of 5-6 years. Differences emerging later in life or in response to a metabolic challenge should not be ruled out.

Objective: To investigate whether (1) maternal psychosocial stress (depression/anxiety) during pregnancy is associated with offspring vascular function and (2) whether any association differs depending on the gestational timing of exposure to stress. We also investigated whether any association is likely to be due to intrauterine mechanisms by (3) comparing with the association of paternal stress with offspring vascular function and (4) examining whether any prenatal association is explained by maternal postnatal stress.Methods and results: Associations were examined in a UK birth cohort, with offspring outcomes (systolic and diastolic blood pressure, SBP and DBP, endothelial function assessed by brachial artery flow-mediated dilatation (FMD); arterial stiffness assessed by carotid to radial pulse wave velocity (PWV), brachial artery distensibility (DC), and brachial artery diameter (BD) assessed at age 10-11 years (n = 4318). Maternal depressive symptoms and anxiety were assessed at 18 and 32 weeks gestation and 8 months postnatally. Paternal symptoms were assessed at week 19. With the exception of DBP and BD, there were no associations of maternal depressive symptoms with any of the vascular outcomes. Maternal depressive and anxiety symptoms were associated with lower offspring DBP and wider BD, though the latter attenuated to the null with adjustment for confounding factors. Paternal symptoms were not associated with offspring outcomes. Maternal postnatal depressive symptoms were associated with lower offspring SBP.Conclusions: We found no evidence to support the hypothesis that maternal stress during pregnancy adversely affects offspring vascular function at age 10-12 years via intrauterine mechanisms.

. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . European Journal of Public Health, Vol. 23, No. 3, 480–485 The Author 2012. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. doi:10.1093/eurpub/cks089 Advance Access published on 18 July 2012 . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . Risk factors of preterm birth and low birth weight babies among Roma and non-Roma mothers: a population-based study

The autonomic nervous system (ANS) controls mainly automatic bodily functions that are engaged in homeostasis, like heart rate, digestion, respiratory rate, salivation, perspiration and renal function. The ANS has two main branches: the sympathetic nervous system, preparing the human body for action in times of danger and stress, and the parasympathetic nervous system, which regulates the resting state of the body. ANS activity can be measured invasively, for instance by radiotracer techniques or microelectrode recording from superficial nerves, or it can be measured non-invasively by using changes in an organ's response as a proxy for changes in ANS activity, for instance of the sweat glands or the heart. Invasive measurements have the highest validity but are very poorly feasible in large scale samples where non-invasive measures are the preferred approach. Autonomic effects on the heart can be reliably quantified by the recording of the electrocardiogram (ECG) in combination with the impedance cardiogram (ICG), which reflects the changes in thorax impedance in response to respiration and the ejection of blood from the ventricle into the aorta. From the respiration and ECG signals, respiratory sinus arrhythmia can be extracted as a measure of cardiac parasympathetic control. From the ECG and the left ventricular ejection signals, the preejection period can be extracted as a measure of cardiac sympathetic control. ECG and ICG recording is mostly done in laboratory settings. However, having the subjects report to a laboratory greatly reduces ecological validity, is not always doable in large scale epidemiological studies, and can be intimidating for young children. An ambulatory device for ECG and ICG simultaneously resolves these three problems. Here, we present a study design for a minimally invasive and rapid assessment of cardiac autonomic control in children, using a validated ambulatory device 1-5, the VU University Ambulatory Monitoring System (VU-AMS, Amsterdam, the Netherlands, www.vu-ams.nl).

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OBJECTIVE:Autonomic nervous system (ANS) misbalance is a potential causal factor in the development of cardiovascular disease. The ANS may be programmed during pregnancy due to various maternal factors. Our aim is to study maternal prenatal psychosocial stress as a potential disruptor of cardiac ANS balance in the child. METHODS:Mothers from a prospective birth cohort (ABCD study) filled out a questionnaire at gestational week 16 [IQR 12-20], that included validated instruments for state anxiety, depressive symptoms, pregnancy-related anxiety, parenting daily hassles and job strain. A cumulative stress score was also calculated (based on 80(th) percentiles). Indicators of cardiac ANS in the offspring at age 5-6 years are: pre-ejection period (PEP), heart rate (HR), respiratory sinus arrhythmia (RSA) and cardiac autonomic balance (CAB), measured with electrocardiography and impedance cardiography in resting supine and sitting positions. RESULTS:2,624 mother-child pairs, only single births, were available for analysis. The stress scales were not significantly associated with HR, PEP, RSA and CAB (p≥0.17). Accumulation of maternal stress was also not associated with HR, PEP, RSA and CAB (p≥0.07). CONCLUSION:Results did not support the hypothesis that prenatal maternal psychosocial stress deregulates cardiac ANS balance in the offspring, at least in rest, and at the age of five-six years.

OBJECTIVE:Prenatal maternal stress could have permanent effects on the offspring's tissue structure and function, which may predispose to cardiovascular diseases. We investigated whether maternal psychosocial stress is a prenatal factor affecting the blood pressure (BP) of offspring. STUDY DESIGN:In the Amsterdam Born Children and their Development (ABCD) study, around gestational week 16, depressive symptoms, state-anxiety, pregnancy-related anxiety, parenting daily hassles and job strain were recorded by questionnaire. A cumulative stress score was also calculated (based on 80(th) percentiles). Systolic and diastolic BP and mean arterial pressure (MAP) were measured in the offspring at age 5-7 years. Inclusion criteria were: no use of antihypertensive medication during pregnancy; singleton birth; no reported cardiovascular problems in the child (N = 2968 included). RESULTS:After adjustment for confounders, the single stress scales were not associated with systolic and diastolic BP, MAP and hypertension (p>0.05). The presence of 3-4 psychosocial stressors prenatally (4%) was associated with 1.5 mmHg higher systolic and diastolic BP (p = 0.046; p = 0.04) and 1.5 mmHg higher MAP in the offspring (p = 0.02) compared to no stressors (46%). The presence of 3-4 stressors did not significantly increase the risk for hypertension (OR 1.8; 95% CI 0.93.4). Associations did not differ between sexes. Bonferroni correction for multiple testing rendered all associations non-significant. CONCLUSIONS:The presence of multiple psychosocial stressors during pregnancy was associated with higher systolic and diastolic BP and MAP in the child at age 5-7. Further investigation of maternal prenatal stress may be valuable for later life cardiovascular health.

Background The aim of the current study was to investigate whether exposure to prenatal maternal anxiety and depression influenced later offspring glucose, lipid and inflammatory markers via intrauterine mechanisms. Methods Data from a prospective birth cohort based in the South West of England were used. Our analysis included 2839 mother-children duos and 2361 father-child duos for outcomes assessed at mean age 9.9 years (non-fasting cholesterol, triglycerides, low density and high density lipoprotein cholesterol (LDLc and HDLc), C-reactive protein (CRP) and interleukin 6 (IL–6) and 2011 and 1726 parent-child duos for outcomes at mean age 15.4 years (fasting glucose, insulin, lipids and CRP). We compared associations of maternal exposures with offspring outcomes to those of the same paternal exposures with offspring outcomes. The rationale for this comparison was that if maternal depression/anxiety influenced offspring outcomes via intrauterine mechanisms we would expect stronger maternal compared with paternal associations. We also examined whether any association of exposures during pregnancy reflected a postnatal effect, with persistence of depression/anxiety into the postnatal period. Results Maternal anxiety at 18 and 32 weeks gestation, and maternal depression at 32 weeks gestation were associated with increased CRP in children at 9.9 years (mean difference (95% CI): 0.031 (0.005 to 0.057), 0.030 (0.004 to 0.056), and 0.021 (0.003 to 0.040) respectively), but not at 15.4 years. These associations remained when adjusting for potential confounders (maternal age, ethnicity, pre-pregnancy BMI, parity, social class, smoking and alcohol consumption). Paternal anxiety and depression (measured at 18 weeks gestation)were also associated with increased CRP in children at 9.9 years (mean difference (95% CI): 0.039 (0.003 to 0.076) and 0.026 (0–0.052) respectively), but not at 15.4 years. The magnitudes of the paternal associations were similar to those seen in mothers. Maternal and paternal postnatal depression/anxiety symptoms were also associated with offspring CRP at age 9.9 and appeared to explain much of the antenatal association. There were no consistent associations between maternal or paternal anxiety or depression during the antenatal or postnatal periods and any of offspring glucose, insulin, IL-6 or lipids at either age. Conclusion We have found evidence of a relationship between maternal and paternal anxiety and depression during pregnancy and CRP levels in childhood, which does not persist to adolescence. Our results suggest that these associations are unlikely to be explained by intrauterine mechanisms and may be explained by shared familial confounding or postnatal effects.

BACKGROUND:Prevalence rates of psychosocial stress during pregnancy are substantial. Evidence for associations between psychosocial stress and birth outcomes is inconsistent. This study aims to identify and characterize different clusters of pregnant women, each with a distinct pattern of psychosocial stress, and investigate whether birth outcomes differ between these clusters.METHODS:Latent class analysis was performed on data of 7740 pregnant women (Amsterdam Born Children and their Development study). Included constructs were depressive symptoms, state anxiety, job strain, pregnancy-related anxiety and parenting stress.RESULTS:Five clusters of women with distinct patterns of psychosocial stress were objectively identified. Babies born from women in the cluster characterized as 'high depression and high anxiety, moderate job strain' (12%) had a lower birth weight, and those in the 'high depression and high anxiety, not employed' cluster (15%) had an increased risk of pre-term birth.CONCLUSIONS:Babies from pregnant women reporting both high levels of anxiety and depressive symptoms are at highest risk for adverse birth outcomes.

BACKGROUND:In the Netherlands separate reference charts have been developed for native and immigrant groups to deal with differences in growth patterns in later childhood. The use of these charts, however, is complicated by methodological issues; they do not represent all large Dutch immigrant groups in separate charts despite the differences that have been suggested and the evidence of ethnic disparities in growth dates back to 1997.AIM:Anthropometric measurements from a contemporary multi-ethnic cohort study were created to quantify differences in childhood growth by creating growth charts, separately for boys and girls between the ages of 0-3 years.SUBJECTS AND METHODS:The infants modelled in the charts had a mother born in the Netherlands (n = 3107), Suriname (n = 225), Turkey (n = 203) and Morocco (n = 336). Charts with and without correction for country of origin of the mother were created by using the LMST method.RESULTS:All models including the covariate country of origin of the mother fitted the data better (p < 0.0005), but the observed differences were small.CONCLUSION:Most remarkable differences were found in the BMI and weight measurements for age charts. Especially girls from mothers born in Turkey and Morocco had an increasingly heavier weight for their age than girls from mothers born in the Netherlands.

BACKGROUND:Prenatal exposure to maternal stress may program the fetal HPA axis, potentially leading to altered metabolism in later life, associated with adiposity and diabetes. AIMS:This association is little studied in humans, and thus we explore whether high maternal job strain during early pregnancy, as well as maternal cortisol levels are associated with increased body mass index (BMI), central adiposity or body fat mass in the offspring at age five. Additionally, we explore whether these associations are modified by gender or mediated by gestational age and fetal growth restriction. STUDY DESIGN:2939 pregnant women (ABCD cohort study) completed a questionnaire around gestational week 16 including the Job Content Questionnaire, assessing job strain. Serum total cortisol was assessed in a subsample (n=1320). Gestational age (≥37 weeks), standardized birth weight and information on many covariates were available. At the age five health check, height, weight (BMI, kg/m(2)), waist circumference (waist-to-height ratio, WHtR) and Fat Mass Index (FMI, kg/m(2)) were assessed. RESULTS:Job strain was not associated with higher BMI, WHtR or FMI. Higher maternal cortisol was independently associated with marginally higher FMI in girls, but marginally lower FMI in boys (β 0.09 and β -0.10 per 100 unit increase in serum cortisol, respectively. p<0.01). This association was not mediated by gestational age or fetal growth restriction. CONCLUSIONS:Results show that prenatal maternal job strain and cortisol may not program obesity and adiposity in the next generation in humans, but gender differences should always be considered.