Evaluation of nutritional status using the minimum dietary diversity for women of reproductive age (MDD-W) tool in breastfeeding mothers in Madagascar.

OBJECTIVES: Women of reproductive age in low-income countries are especially nutritionally vulnerable given the strain that pregnancy and lactation places on the body. The aim of this study was to identify dietary diversity and its associated factors among mothers with young children. METHODS: It is a cross-sectional study conducted in Ampefy, Madagascar from 1 November 2022 to 31 March 2023. Dietary diversity was determined using the minimum dietary diversity for women of reproductive age tool. Data were collected through face-to-face interviews using validated structured questionnaires, and anthropometric status was examined. Frequencies and percentages were calculated, and the comparison of variables was performed between mothers with acceptable and unacceptable dietary diversity using the chi-square test for qualitative variables. A logistic regression analysis was also conducted. RESULTS: A total of 437 mothers with young children participated in the study, resulting in a response rate of 95.0%. The mean age of the participants was 25.84 years (SD = 6.30). The study revealed that 32.95% of participants had unacceptable dietary diversity scores and the associated profile included low education, no transport, homebirth not by personal choice, not breastfeeding within the first hour of birth, not breastfeed exclusively for 6 months, no dietary changes during pregnancy or lactation, and no use of folic acid supplements. CONCLUSION: This study's findings underscore the importance of providing nutrition information to women, in order to improve dietary diversity and overall maternal and child health.

Maternal profile according to Mediterranean diet adherence and small for gestational age and preterm newborn outcomes.

OBJECTIVE: The objective was to evaluate maternal Mediterranean diet (MD) pattern adherence during pregnancy and its association with small for gestational age (SGA) and preterm birth. A secondary objective of the current study was to describe the sociodemographic, lifestyle and obstetric profile of the mothers studied as well as the most relevant paternal and newborn characteristics. DESIGN: The current study is a two-phase retrospective population-based study of maternal dietary habits during pregnancy and their effect on newborn size and prematurity. The descriptive first phase examined maternal dietary habits during pregnancy along with the maternal sociodemographic, lifestyle and obstetric profile in a cross-sectional period study. In the second phase, newborn outcomes were evaluated in a nested case-control study. Adherence to MD during pregnancy was measured with the Spanish version of Kidmed index. SETTING: Obstetrics ward of the La Fe Hospital in Valencia. PARTICIPANTS: All mother-child pairs admitted after delivery during a 12-month period starting from January 2018 were assessed for eligibility. A total of 1118 provided complete outcome data after signing informed consent. RESULTS: 14·5 % met the criteria of poor adherence (PA); 34·8 %, medium adherence (MA); and 50·7 %, optimal adherence (OA). Medium adherence to MD was associated in the adjusted scenarios with a higher risk of giving birth to a preterm newborn. No association was found between MD adherence and SGA. CONCLUSIONS: Early intervention programmes geared towards pregnant women, where women were aided in reaching OA to MD, might reduce the risk of preterm newborn.

Estimation of daily intake of polychlorinated biphenyls not similar to dioxins (NDL-PCB) from fish consumption in Spain in different population groups.

OBJECTIVE: To assess the daily intake of polychlorinated biphenyls not similar to dioxins (NDL-PCB) derived from fish consumption in Spain and compare it with tolerance limits in order to establish a safe threshold so that the nutritional benefits derived from fish consumption may be optimized. DESIGN: Analysis of NDL-PCB in fish samples and ecological study of the estimated intake of NDL-PCB from fish consumption in different Spanish population groups. SUBJECTS: National representative sample of the Spanish population. RESULTS: The intake of NDL-PCB was estimated in two different scenarios: upper bound (UB) and lower bound (LB). Estimating intake using the average concentration of NDL-PCB found in the fish samples, the intake for 'other children' is estimated as: 1·80 (UB) and 5·33 (LB) ng/kg per d at the 50th percentile (P50); 7·39 (UB) and 21·94 (LB) ng/kg per d at the 95th percentile (P95) of fish consumption. Estimated NDL-PCB intake shoots up in the toddler group, reaching values of 30·43 (UB) and 90·37 (LB) ng/kg per d at P95. Estimated intake values are lower than those previously estimated in Europe, something expected since in previous studies intake was estimated through total diet. In adults, our estimated values are 1·59 (UB) and 4·72 (LB) ng/kg per d at P50; 4·95 (UB) and 14·72 (LB) ng/kg per d at P95. CONCLUSIONS: NDL-PCB concentration in fish is under the tolerance limits in most samples. However, daily intake in consumers of large quantities of fish should be monitored and special attention should be given to the youngest age groups due to their special vulnerability and higher exposure.

Systematic review of the association between particulate matter exposure and autism spectrum disorders.

Particulate matter (PM) as an environmental pollutant is suspected to be associated with autism spectrum disorders. The aim of the present study was to review the epidemiological literature currently available on the relation between PM exposure and diagnosis of ASD. The PubMed database was searched from November 2015 up to January 2016 by one of the authors. We included observational studies (cohort and case-control studies) published in English carried out in children within the last 10 years, measuring PM exposure and health outcomes related to ASD. 13 studies met the inclusion criteria. Four of the studies found no association between PM exposure and ASD. The other 8 studies show positive associations restricted to specific exposure windows which however do not reach statistical significance at times. To conclude, the evidence from the studies allows us to conclude that there is an association between PM exposure and ASD whose strength varies according to the particle size studied with the association with PM2.5 and diesel PM being stronger. Given the potential importance for public health, cohort studies with proper adjustment for confounding variables and identification of critical windows of exposure are urgently needed to further improve knowledge about potential causal links between PM exposure and the development of ASD.

Asthma in older people hospitalized with influenza in Spain: A case-control study.

BACKGROUND: Influenza infection is an exacerbating factor for asthma, and its prevention is critical in older patients with asthma. OBJECTIVE: This study investigated the association between asthma and influenza-related hospitalization, in Spain, of patients ages ≥ 65 years and their clinical evolution. METHODS: A multicenter case-control study was carried out in 20 Spanish hospitals during the 2013-2014 and 2014-2015 influenza seasons. Patients ages ≥ 65 years hospitalized with laboratory-confirmed influenza with and without asthma were matched with controls according to the presence of asthma, sex, age, hospital, and date of hospitalization. RESULTS: A total of 561 patients with influenza (15.9% with asthma) and 1258 patients without influenza (8.0% with asthma) were included as cases and controls, respectively. The adjusted risk of influenza for patients with asthma was calculated by multivariate conditional logistic regression. The adjustment variables were the following: smoker/nonsmoker, pneumonia in the 2 years before hospital admission, previous oral treatment with corticosteroids, influenza vaccination during the seasonal campaign, Barthel index (ordinal scale used to measure performance in activities of daily living), level of education, obesity, and the presence of other comorbidities. Patients with asthma presented a great risk of influenza (adjusted odds ratio 2.64 [95% confidence interval, 1.77-3.94]). Compared with patients without asthma, patients with asthma had more symptoms, and these had been present for longer before admission but presented a lower hospital or postdischarge mortality. CONCLUSION: This study indicated that asthma was associated with hospitalization from influenza A infection. Although patients with asthma and with influenza had more symptoms, hospital or postdischarge mortality was lower, probably due to a better response to medical treatment.

Fat intake in children with autism spectrum disorder in the Mediterranean region (Valencia, Spain).

OBJECTIVE: Children with autism spectrum disorder (ASD) have been found to have alterations in dietary fat intake and fat quality. The fat intakes of the foods consumed by children with and without ASD were compared, and the deficiency and excess of these nutrients were examined. METHODS: In a matched case-control study, 3-day food diaries were completed by 105 children with ASD and 495 typically developing (TD) 6- to 9-year-old children in Valencia (Spain). We used the probabilistic approach and estimated average requirement cut-point to evaluate the risk of inadequate nutrients intakes. These were compared between groups and with Spanish recommendations using linear and logistic regression, respectively. RESULTS: Groups did not differ significantly in age, total dietary intake, Healthy Eating Index, or food variety score. Children with ASD had lower saturated fatty acids (SFAs) and ω-3 polyunsaturated fatty acids (PUFAs) intakes, but their total PUFAs and (PUFAs + monounsaturated fatty acids (MUFAs)/SFAs, PUFAs/SFAs intakes and ω-6/ω-3 ratios were higher than TD children. The total fat and cholesterol intakes of both groups were slightly above Spanish recommendations. Both groups had low ω-6 intakes, very low ω-3 intakes, and high ω-6/ω-3 ratios. CONCLUSION: Further research is required to clarify associations between ASD symptomatology, fat-eating patterns and health status.

Pandemic influenza A (H1N1) in non-vaccinated, pregnant women in Spain (2009-2010).

The aim of this study was to investigate the main characteristics of non-vaccinated pregnant women who were hospitalised for influenza A (H1N1) pdm09 pandemic versus pregnant women hospitalised for non-influenza-related reasons in Spain, and to characterise the clinical presentation of the disease in this population to facilitate early diagnosis and future action programmes. Understanding influenza infection during pregnancy is important as pregnant women are a high-risk population for increased morbidity from influenza infection. We investigated the socio-demographic and clinical features of 51 non-vaccinated, pregnant women infected with the pandemic influenza A (H1N1) virus in Spain (cases) and compared them to 114 controls (non-vaccinated and non-infected pregnant women) aged 15-44 years. Substantial and significant odd ratios (ORs) for pandemic influenza A (H1N1) were found for the pregnant women who were obese compared with controls (body mass index > 30) (OR 3.03; 95% confidence intervals 1.13-8.11). The more prevalent symptoms observed in pandemic influenza-infected pregnant women were high temperature, cough (82.4%), malaise (80.5%), myalgia (56.1%), and headaches (54.9%). Our results suggest that the initial symptoms and risk factors for infection of pregnant women with the influenza A (H1N1) pdm09 virus are similar to the symptoms and risk factors for seasonal influenza, which make early diagnosis difficult, and reinforces the need to identify and protect high-risk groups.

Dietary Flavonoids: Mitigating Air Pollution's Cardiovascular Risks.

Air pollution significantly impacts cardiovascular health, yet pollution reduction strategies in cardiovascular disease prevention remain limited. Dietary flavonoids show promise in protecting cardiovascular health, but their potential to mitigate air-pollution-induced risks is unexplored. This study investigates this research gap. Following PRISMA-ScR guidelines, literature from 2014-2024 was searched across MedLine/PubMed, ScienceDirect, and MDPI databases. Of 463 identified studies, 53 were eligible for analysis based on PICO criteria. Findings revealed significant impacts of air pollution on cardiovascular health, including increased disease risks and mortality. Flavonoid intake demonstrated protective effects against these risks. Flavonoid mechanisms include improved endothelial function, antioxidant and anti-inflammatory effects, blood pressure regulation, antiplatelet effects, cardioprotection, and enhanced lipid and glucose metabolism. Higher flavonoid intake was consistently associated with reduced cardiovascular risks. While reducing pollution remains crucial, promoting flavonoid-rich diets is a promising complementary strategy. Public health initiatives should raise awareness about these benefits. Further research on direct interactions between flavonoid intake and air pollution exposure is needed. Current evidence supports integrating dietary interventions into broader strategies to reduce air pollution's cardiovascular impacts.

Cross-Sectional Assessment of Nutritional Status, Dietary Intake, and Physical Activity Levels in Children (6-9 Years) in Valencia (Spain) Using Nutrimetry.

The aims of this research were to evaluate the current nutritional status, dietary intake, and level of physical activity and assess the need for intervention. This was a cross-sectional study with 2724 participating children aged 6-9 years old. Nutritional status was assessed using nutrimetry, dietary intake with a 3-day food-recall questionnaire and physical activity with an ad hoc questionnaire. The nutricode with the highest prevalence was healthy weight/normal stature, with 51.3% of the sample. For the BMI for age Z-score, those in the overweight/obesity category represented 37.5% of the sample, while the thinness category included 7.6%. Intake of calories, proteins, sugar, lipids, SFA, MUFA, and cholesterol were significantly higher than recommended. The thinness groups consumed a significantly higher amount of excess calories while the overweight/obesity groups had the lowest mean excess calorie intake. Children in the thinness category presented the highest rates at both ends of the spectrum for sedentary activities. This study showed the high prevalence of malnutrition in schoolchildren. The results for the risk of thinness and overweight/obesity according to individual nutrient intake should be carefully interpreted. Lifestyle is a fundamental aspect to consider when combating malnutrition, especially at the level of dietary and physical activity habits, to combine various methods of intervention to improve nutritional status.

Constitutional Factors and Irradiation as Risk Factors for Thymoma: A European Case-Control Study.

Little is known about the aetiology of thymoma. This study aims to identify medical risk factors for thymoma as a systematic approach to new hypotheses on the aetiology of this disease. A European multi-centre case-control study was conducted from 1995 to 1997, including incident cases aged 35-69 years with thymoma. Altogether, we accepted 85 cases and 3350 controls, of which we interviewed 77 cases and 2071 population controls about constitutional factors, medical examinations, and former diseases. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated. Medical examinations with X-ray or radiotherapy performed >20 times at least one year before the thymoma diagnosis indicated a possible risk factor for thymoma (OR 1.58, 95% CI 0.93-2.69). Having the first radiotherapy treatment at least one year before the thymoma diagnosis yielded an OR for thymoma of 2.39; 95% CI (0.96-5.99), and if it was at least five years before, the OR for thymoma was 2.81; 95% CI (1.03-7.72). Having a red/auburn hair colour was associated with thymoma, (OR 3.6, 95% CI 1.4-9.5) whereas having pigmented skin was slightly associated with thymoma (OR 1.8, 95% CI 0.8-3.8). Over twenty instances of X-ray examinations or radiotherapy were identified as potential risk factors for thymoma, along with certain constitutional factors. The observed correlations between benign tumours and thymoma could stem from an inherent predisposition to tumour development or result from detection bias. Given that this is the initial analytical study examining medical risk factors for thymoma, all of the results should be approached with caution, acknowledging the possibility that some findings might be incidental.

The Impact of Moringa oleifera Supplementation on Anemia and other Variables during Pregnancy and Breastfeeding: A Narrative Review.

Moringa is a plant commonly used for its medical properties. However, studies have shown contradictory results. The aim of this review is to evaluate the possible association between the use of Moringa during pregnancy and breastfeeding in relation to the health status of both the mother and the baby. A search of the PubMed and EMBASE databases on the literature published during the period 2018-2023 was conducted up until March 2023. The population/exposure/comparison/outcome (PECO) approach was used to select studies on pregnant women, mother-child pairs, and the use of Moringa. Out of the 85 studies initially identified, 67 were excluded, leaving 18 for full-text evaluation. After assessment, 12 were finally included in the review. In the articles included in this work, Moringa is administered during pregnancy or in the postnatal period in the form of leaf powder (MOLP), as a leaf extract (MLE), as an ingredient associated with other supplements or in preparations. It appears to influence several variables during pregnancy and in the postnatal period such as the mother's haematochemical profile, milk production, the child's socio-personal development and the incidence of morbidity during the first 6 months of life. None of the studies analysed reported contraindications to the use of the supplement during pregnancy and lactation.

Athletic Burnout and Its Association with Diet in Children and Adolescents.

Children today are constantly exposed to several risk factors and high levels of stress that can impact their mental, emotional, and physical health, which can trigger burnout. The objective of this study was to determine the prevalence and frequency of burnout in young amateur athletes and to study the role of the Mediterranean diet on burnout risk. An observational, cross-sectional, and descriptive study of 183 basketball players between 8 and 15 years old was carried out. Adherence to the Mediterranean diet was assessed using the KIDMED questionnaire and the risk of burnout was assessed with the Athlete Burnout Questionnaire. Medians, minimums and maximum values for quantitative variables and absolute frequencies and percentages for qualitative variables were obtained. The results show a higher percentage of burnout among girls. The children who meet the established threshold for burnout spend more time watching television. Participants with better adherence to the Mediterranean diet have lower burnout values in both genders and those with a higher risk of burnout have a worse adherence to the Mediterranean diet. Therefore, it is important to implement a balanced diet appropriate to the individual needs of the athlete.

Breastfeeding-Related Practices in Rural Ethiopia: Colostrum Avoidance.

The practices of colostrum avoidance and prelacteal feeding, which are common in many developing countries, including Ethiopia, are firmly rooted in ancient traditions. The main objective of this work is to identify the prevalence of colostrum avoidance and study its associated factors among mothers of children aged less than 2 years old in the Oromia region of Ethiopia. A cross-sectional study on the practice of colostrum avoidance/prelacteal feeding was conducted in a rural community with 114 mothers of children under 2 years old. Our results reflected that colostrum avoidance and prelacteal feeding were practiced by 56.1% of mothers. The percentage of women who started breastfeeding in the first hour after birth, as recommended by the WHO, was 2.6%. Of the women who practiced colostrum avoidance, 67.2% gave birth at home, and 65.6% were attended by relatives. The likelihood of avoiding colostrum increases in mothers who have a lower educational level, who did not receive health care at the time of delivery, who think that colostrum is dirty and dangerous and who did not receive information about breastfeeding from healthcare professionals. The knowledge emanating from this work may be useful in designing new breastfeeding education programs and/or interventions in Ethiopia and other developing countries.

Prevalence of Depression and Fish Consumption among First Year Spanish University Students: UniHcos Project.

The World Health Organization estimates that one fifth of university students have experienced major depressive disorder at some point in their lives. Nutrition may be one of the modifiable factors that influence the development of depression. Specifically, low omega-3 fatty acid and vitamin D levels, both nutrients found in high quantities in fish, have been linked to depressive disorders. The main objective of this study was to evaluate the prevalence of depression among young Spanish university students, in addition to the pattern of fish consumption among students and the possible relationship between fish consumption and the presence of depression. Data were collected retrospectively from a nationally representative sample of 11,485 Spanish university students aged 18 years or older in 11 Spanish universities, from 2012 to 2022. The respondents were analyzed according to frequency of consumption and compliance with weekly recommendations for fish intake and the presence of depression. Regression models were also performed to determine students' odds of depression as a function of compliance with recommendations according to selected sociodemographic variables. The prevalence of depression was 10.5%; it was more prevalent in women, older students and in those with both high and low BMIs. In addition, it was also more prevalent in those that lived outside the family home, with roommates and those who were employed. Sixty-seven percent of the students met the fish intake recommendations. The most common frequency of fish consumption was 1-2 times/week (44.2%), and the least frequent was 2.3% daily fish consumption. Students from northern universities were more likely to consume fish (68.4%) than those from southern universities (66.4%). Non-consumption of fish was found to increase the risk of depression (ORa = 1.45 (1.28-1.64); AF = 31.0% (21.9-39.0)), but it was the student's own conditions that had the greatest influence on the development of the disorder. In summary, a lower consumption of fish seems to be associated with a higher incidence of depression in Spanish university students; however, other social factors of the student may influence the development of the disorder, and all of this should be taken into account for the development of prevention strategies.

Pesticide exposure in farming and forestry and the risk of uveal melanoma.

PURPOSE: Since pesticides are disputed risk factors for uveal melanoma, we studied the association between occupational pesticide exposure and uveal melanoma risk in a case-control study from nine European countries. METHODS: Incident cases of uveal melanoma and population as well as hospital controls were included and frequency-matched by country, 5-year age groups and sex. Self-reported exposure was quantified with respect to duration of exposure and pesticide application method. We calculated the exposure intensity level based on application method and use of personal protective equipment. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated by unconditional logistic regression analyses and adjusted for several potential confounders. RESULTS: 293 case and 3,198 control subjects were interviewed. We did not identify positive associations with activities in farming or forestry, pesticide application or pesticide mixing. No consistent positive associations were seen with exposure intensity level scores either. The only statistically significantly raised association in this study was for exposure to chemical fertilizers in forestry (OR = 8.93; 95% CI 1.73-42.13), but this observation was based on only six exposed subjects. Results did not change when we restricted analyses to morphologically verified cases and excluded proxy interviews as well as cancer controls. We did not observe effect modification by sex or eye color. CONCLUSIONS: Risk estimates for pesticide exposures and occupational activities in agriculture and forestry were not increased and did not indicate a hormonal mechanism due to these exposures.

Atopic dermatitis and indoor use of energy sources in cooking and heating appliances.

BACKGROUND: Atopic dermatitis (AD) prevalence has considerably increased worldwide in recent years. Studying indoor environments is particularly relevant, especially in industrialised countries where many people spend 80% of their time at home, particularly children. This study is aimed to identify the potential association between AD and the energy source (biomass, gas and electricity) used for cooking and domestic heating in a Spanish schoolchildren population. METHODS: As part of the ISAAC (International Study of Asthma and Allergies in Childhood) phase III study, a cross-sectional population-based survey was conducted with 21,355 6-to-7-year-old children from 8 Spanish ISAAC centres. AD prevalence, environmental risk factors and the use of domestic heating/cooking devices were assessed using the validated ISAAC questionnaire. Crude and adjusted odds ratios (cOR, aOR) and 95% confidence intervals (CIs) were obtained. A logistic regression analysis was performed (Chi-square test, p-value < 0.05). RESULTS: It was found that the use of biomass systems gave the highest cORs, but only electric cookers showed a significant cOR of 1.14 (95% CI: 1.01-1.27). When the geographical area and the mother's educational level were included in the logistic model, the obtained aOR values differed moderately from the initial cORs. Electric heating was the only type which obtained a significant aOR (1.13; 95% CI: 1.00-1.27). Finally, the model with all selected confounding variables (sex, BMI, number of siblings, mother's educational level, smoking habits of parents, truck traffic and geographical area), showed aOR values which were very similar to those obtained in the previous adjusted logistic analysis. None of the results was statistically significant, but the use of electric heating showed an aOR close to significance (1.14; 95% CI: 0.99-1.31). CONCLUSION: In our study population, no statistically significant associations were found between the type of indoor energy sources used and the presence of AD.

Risk of Gestational Diabetes Due to Maternal and Partner Smoking.

Pregnant women are among the most vulnerable to environmental exposure to tobacco smoke (EET); which has been linked to problems in the mothers' health; one of the most frequent is gestational diabetes (GD). For this reason, there are specific interventions and prevention strategies designed to reduce this exposure risk. However, currently, they are mostly aimed only at aiding the pregnant women with smoking cessation during pregnancy and do not assess or address the risk from passive exposure due to partner smoking. The aim of this work is to study the exposure to EET of pregnant women considering active and passive smoking and to evaluate its effect on the development of GD. This is an observational case-control study within a retrospective cohort of pregnant women. Information on smoking habits was obtained from both personal interviews and recorded medical history. In total, 16.2% of mothers and 28.3% of partners declared having been active smokers during pregnancy; 36.5% of the women presented EET during pregnancy when both active and passive smoking were considered. After adjustments, the association with the EET and GD of the mother was (aOR 1.10 95% CI: 0.64-1.92); for the EET of the partner, it was (aOR 1.66 95% CI: 1.01-2.77); for both partners, it was (aOR 1.82 95% CI: 1.15-2.89), adjusted by the mother's age and body mass index. There is a lack of education regarding the effects of passive exposure to tobacco smoke. It is essential that pregnant women and their partners are educated on the risks of active and passive smoking; this could improve the effectiveness of other GD prevention strategies.

Systematic review of prenatal exposure to endocrine disrupting chemicals and autism spectrum disorder in offspring.

LAY ABSTRACT: Autism spectrum disorders comprise a complex group with many subtypes of behaviorally defined neurodevelopmental abnormalities in two core areas: deficits in social communication and fixated, restricted, repetitive, or stereotyped behaviors and interests each with potential unique risk factors and characteristics. The underlying mechanisms and the possible causes of autism spectrum disorder remain elusive and while increased prevalence is undoubtable, it is unclear if it is a reflection of diagnostic improvement or emerging risk factors such as endocrine disrupting chemicals. Epidemiological studies, which are used to study the relation between endocrine disrupting chemicals and autism spectrum disorder, can have inherent methodological challenges that limit the quality and strength of their findings. The objective of this work is to systematically review the treatment of these challenges and assess the quality and strength of the findings in the currently available literature. The overall quality and strength were "moderate" and "limited," respectively. Risk of bias due to the exclusion of potential confounding factors and the lack of accuracy of exposure assessment methods were the most prevalent. The omnipresence of endocrine disrupting chemicals and the biological plausibility of the association between prenatal exposure and later development of autism spectrum disorder highlight the need to carry out well-designed epidemiological studies that overcome the methodological challenges observed in the currently available literature in order to be able to inform public policy to prevent exposure to these potentially harmful chemicals and aid in the establishment of predictor variables to facilitate early diagnosis of autism spectrum disorder and improve long-term outcomes.

Parental occupational exposure to endocrine disrupting chemicals and male genital malformations: a study in the Danish National Birth Cohort study.

BACKGROUND: Sex hormones closely regulate development of the male genital organs during fetal life. The hypothesis that xenobiotics may disrupt endogenous hormonal signalling has received considerable scientific attention, but human evidence is scarce. OBJECTIVES: We analyse occurrence of hypospadias and cryptorchidism according to maternal and paternal occupational exposure to possible endocrine disrupting chemicals. METHODS: We conducted a follow-up study of 45,341 male singleton deliveries in the Danish National Birth Cohort during 1997-2009. Information on work during pregnancy was obtained by telephone interviews around gestational week 16. Parents' job titles were classified according to DISCO-88. A job exposure matrix for endocrine disrupting chemicals (EDCs) was implemented to assess occupational exposures. The Medical Birth and National Hospital Register provided data on congenital anomalies diagnosed at birth or during follow-up, which ended in 2009. Crude and adjusted hazard ratios (HR) were obtained from Cox regression models. RESULTS: Among all pregnancies, 6.3% were classified as possibly or probably exposed to EDCs. The most prevalent occupations conferring possible exposure were cleaners, laboratory technicians, hairdressers and agricultural workers (58% of all potentially exposed). The final cumulative incidence of cryptorchidism in boys was 2.2% (1002 cases), and of hypospadias 0.6% (262 cases). The occurrence of hypospadias increased when mothers were probably [HRa = 1.8 (95% CI 1.0-2.6)] or possibly exposed to one or more EDCs [HRa = 2.6 (95% CI 1.8-3.4). Possible paternal exposure to heavy metals increased the risk of hypospadias [HRa 2.2 (95% CI: 1.0-3.4)] and cryptorchidism [HRa 1.9 (95% CI: 1.1-2.7)]. None of the exposure groups reached statistical significance. CONCLUSION: The study provides some but limited evidence that occupational exposure to possible endocrine disrupting chemicals during pregnancy increases the risk of hypospadias.

Unemployment and pregnancy outcomes: a study within the Danish National Birth Cohort.

AIMS: To explore the relation between employment status, type of unemployment and pregnancy outcomes. METHODS: A cohort study of 7,282 pregnancies of unemployed women and 56,014 pregnancies among women in paid jobs was performed within the Danish National Birth Cohort. Pregnancy outcomes were ascertained and information about lifestyle, occupational, medical, and obstetric factors was obtained. Logistic regression was used to calculate odds ratios (OR) for fetal loss, congenital anomalies, multiple births, sex ratio, preterm and very preterm birth and small for gestational age status, adjusting for lifestyle, medical and obstetric factors. RESULTS: There were no differences in pregnancy outcomes between employed and unemployed women but women receiving unemployment benefit had an increased risk of preterm birth (adjusted OR (aOR) 1.16, 95% confidence interval (95% CI) 1.03-1.31) and having a small for gestational age child (aOR 1.08, 95% CI 1.00-1.19) compared with employed women. Women receiving sickness or maternity benefit had an increased risk of multiple birth (aOR 1.70, 95% CI 1.43-2.04), preterm (aOR 1.47, 95% CI 1.22-1.77) and very preterm birth (aOR 1.88, 95% CI 1.22-2.89), while those receiving an unreported type of support had an increased risk of preterm birth (aOR 1.40, 95% CI 1.02-1.93). CONCLUSIONS: We found no indication that being unemployed during pregnancy benefits or endangers the health of the child. Within the subgroups of unemployed women, we observed that women receiving unemployment and sickness or maternity benefits were at higher risk for some adverse pregnancy outcomes.