Determination of saliva epigenetic age in infancy, and its association with parental socio-economic characteristics and pregnancy outcomes.

Epigenetic age acceleration (AA) has been associated with adverse environmental exposures and many chronic conditions. We estimated, in the NINFEA birth cohort, infant saliva epigenetic age, and investigated whether parental socio-economic position (SEP) and pregnancy outcomes are associated with infant epigenetic AA. A total of 139 saliva samples collected at on average 10.8 (range 7-17) months were used to estimate Horvath's DNA methylation age. Epigenetic AA was defined as the residual from a linear regression of epigenetic age on chronological age. Linear regression models were used to test the associations of parental SEP and pregnancy outcomes with saliva epigenetic AA. A moderate positive association was found between DNA methylation age and chronological age, with the median absolute difference of 6.8 months (standard deviation [SD] 3.9). The evidence of the association between the indicators of low SEP and epigenetic AA was weak; infants born to unemployed mothers or with low education had on average 1 month higher epigenetic age than infants of mothers with high education and employment (coefficient 0.78 months, 95% confidence intervals [CIs]: -0.79 to 2.34 for low/medium education; 0.96, 95% CI: -1.81 to 3.73 for unemployment). There was no evidence for association of gestational age, birthweight or caesarean section with infant epigenetic AA. Using the Horvath's method, DNA methylation age can be fairly accurately predicted from saliva samples already in the first months of life. This study did not reveal clear associations between either pregnancy outcomes or parental socio-economic characteristics and infant saliva epigenetic AA.

Socioeconomic inequalities in reproductive outcomes in the Italian NINFEA birth cohort and the Piedmont Birth Registry.

BACKGROUND: socioeconomic inequalities in reproductive outcomes have been consistently reported in several countries. In a European collaborative study conducted in 2012 whose aim was to investigate the association between socioeconomic position (SEP), measured through maternal education, and preterm delivery inconsistent results were found for the NINFEA birth cohort. However, NINFEA contributed to that study with the first 2,500 pregnancies only, and estimates were not adjusted for any potential confounders assuming that SEP is a distal exposure, that could not be affected by other preterm risk factors. OBJECTIVES: to investigate the relationship between SEP and the reproductive outcomes using the entire NINFEA cohort and compare the results with the population-based Piedmont Birth Registry (PBR), accounting for potential baseline collider bias both in the cohort and in the registry. DESIGN: observational study. SETTING AND PARTICPANTS: 5,323 NINFEA singletons, whose mothers registered into the study before the 36th week of gestation, were analysed. Analyses on maternal education were replicated in the 2011 PBR of 35,318 singletons live births. Factors affecting the likelihood of being a member of the NINFEA study or becoming pregnant in the general population were treated as potential confounders to adjust for baseline collider bias. MAIN OUTCOME MEASURES: the association of maternal education and a recently developed household income indicator with both preterm delivery (<37th weeks of gestation) and low birth weight (<2,500 gr) were analysed. RESULTS: in the NINFEA cohort, low SEP was positively associated with both preterm delivery and low birth weight, with slightly stronger associations for household income, especially on low birth weight. Results were consistent with those obtained in the PBR data, where an inverse relationship between maternal education and the two reproductive outcomes was found. In both populations, there was confounding due to maternal age and parity, showing that independently of the nature of the source population, baseline factors that affect the probability of being a member of such source population have to be accounted for to allow causal inference. CONCLUSIONS: low SEP is associated with adverse reproductive outcomes in a contemporary Italian population.

[The NINFEA project and the emerging forms of engagement of citizens in epidemiological research]. / Il progetto NINFEA e le nuove forme di coinvolgimento dei cittadini nella ricerca epidemiologica.

In the last decade a new form of participation of the citizens in research activities and in the production of knowledge has emerged.This development has started to reach epidemiological research, as illustrated in the recent section "EpiChange" of the journal Epidemiologia e Prevenzione. The conduction of epidemiological research through the engagement of citizens and new forms of production of knowledge - including peer-production - is still in its infancy. In 2005,we started in Italy a birth cohort, the NINFEA project, which uses the Internet to recruit pregnant women and to follow-up their children. Participants are volunteers who decide to take part in the research project. In this paper, we consider the aspects of the NINFEA project that are consistent with the concept of collaborative production of knowledge. In particular,we discuss issues related to the motivation of the participants, the selection of the research hypotheses to be evaluated and the definition of the population of interest of the study.

Exploring educational disparities in risk of preterm delivery: a comparative study of 12 European birth cohorts.

BACKGROUND: An association between education and preterm delivery has been observed in populations across Europe, but differences in methodology limit comparability. We performed a direct cross-cohort comparison of educational disparities in preterm delivery based on individual-level birth cohort data. METHODS: The study included data from 12 European cohorts from Denmark, England, France, Lithuania, the Netherlands, Norway, Italy, Portugal, and Spain. The cohorts included between 2434 and 99 655 pregnancies. The association between maternal education and preterm delivery (22-36 completed weeks of gestation) was reported as risk ratios, risk differences, and slope indexes of inequality with 95% confidence intervals (CIs). RESULTS: Singleton preterm live delivery proportion varied between 3.7% and 7.5%. There were large variations between the cohorts in the distribution of education and maternal characteristics. Nevertheless, there were similar educational differences in risk of preterm delivery in 8 of the 12 cohorts with slope index of inequality varying between 2.2 [95% CI 1.1, 3.3] and 4.0 [95% CI 1.4, 6.6] excess preterm deliveries per 100 singleton deliveries among the educationally most disadvantaged, and risk ratio between the lowest and highest education category varying from 1.4 [95% CI 1.1, 1.8] to 1.9 [95% CI 1.2, 3.1]. No associations were found in the last four cohorts. CONCLUSIONS: Educational disparities in preterm delivery were found all over Europe. Despite differences in the distributions of education and preterm delivery, the results were remarkably similar across the cohorts. For those few cohorts that did not follow the pattern, study and country characteristics did not explain the differences.

Piccolipiù, a multicenter birth cohort in Italy: protocol of the study.

BACKGROUND: The fetal and infant life are periods of rapid development, characterized by high susceptibility to exposures. Birth cohorts provide unique opportunities to study early-life exposures in association with child development and health, as well as, with longer follow-up, the early life origin of adult diseases. Piccolipiù is an Italian birth cohort recently set up to investigate the effects of environmental exposures, parental conditions and social factors acting during pre-natal and early post-natal life on infant and child health and development. We describe here its main characteristics. METHODS/DESIGN: Piccolipiù is a prospective cohort of expected 3000 newborns, who will be recruiting in six maternity units of five Italian cities (Florence, Rome, Trieste, Turin and Viareggio) since October 2011. Mothers are contacted during pregnancy or at delivery and are offered to participate in the study. Upon acceptance, their newborns are recruited at birth and followed up until at least 18 years of age. At recruitment, the mothers donate a blood sample and complete a baseline questionnaire. Umbilical cord blood, pieces of umbilical cord and heel blood spots are also collected. Postnatal follow-up currently occurs at 6, 12, and 24 months of age using on-line or postal self administered questionnaire; further questionnaires and medical examinations are envisaged. Questionnaires collect information on several factors, including mother's and/or child's environmental exposures, anthropometric measures, reproductive factors, diet, supplements, medical history, cognitive development, mental health and socioeconomic factors. Health promotion materials are also offered to parents. DISCUSSION: Piccolipiù will broaden our understanding of the contribution of early-life factors to infant and child health and development. Several hypotheses on the developmental origins of health can be tested or piloted using the data collected from the Piccolipiù cohort. By pooling these data with those collected by other existing birth cohorts it will be possible to validate previous findings and to study rare exposures and outcomes.

[Access to health care for asthma in Italian children and adolescents]. / Ricorso alle cure per asma in bambini e adolescenti italiani.

Bronchial asthma represents the most frequent chronic illness in the paediatric age. Although a number of guidelines for the diagnosis, treatment and prevention of the disease exist, some studies have shown that their application on a large scale is still lacking, in this way leading to the inadequate treatment of symptoms and the frequent use of emergency visits and hospitalization. Within the scope of the SIDRIA-2 project, this article describes the main aspects of diagnosis, management and treatment of asthma in children (6/7 years old) and adolescents (13/14 years old). The information was obtained from the SIDRIA questionnaire completed by the parents. The analysis of data demonstrated some relevant differences between the actual management of asthma in the paediatric age in Italy and the suggestions available from the guidelines and the literature. Moreover, some choices in the management of asthma were associated to the socio-economic level of families of children and adolescents, such as a lower use of spirometry and a higher frequency of hospitalization in disadvantaged subjects.