Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 49
Filtrar
Mais filtros










Intervalo de ano de publicação
1.
JAMA Netw Open ; 2(10): e1912902, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31617922

RESUMO

Importance: Air pollutants interact with estrogen nuclear receptors, but their effect on thyroid signaling is less clear. Thyroid function is of particular importance for pregnant women because of the thyroid's role in fetal brain development. Objective: To determine the short-term association of exposure to air pollution in the first trimester with thyroid function throughout pregnancy. Design, Setting, and Participants: In this cohort study, 9931 pregnant women from 4 European cohorts (the Amsterdam Born Children and Their Development Study, the Generation R Study, Infancia y Medio Ambiente, and Rhea) and 1 US cohort (Project Viva) with data on air pollution exposure and thyroid function during pregnancy were included. The recruitment period for the Amsterdam Born Children and Their Development Study was January 2003 to March 2004; for Generation R, April 2002 to January 2006; for Infancia y Medio Ambiente, November 2003 to January 2008; for Rhea, February 2007 to February 2008; and for Project Viva, April 1999 to November 2002. Statistical analyses were conducted from January 2018 to April 2019. Main Outcomes and Measures: Residential air pollution concentrations (ie, nitrogen oxide and particulate matter [PM]) during the first trimester of pregnancy were estimated using land-use regression and satellite-derived aerosol optical depth models. Free thyroxine, thyrotropin, and thyroid peroxidase antibody levels were measured across gestation. Hypothyroxinemia was defined as free thyroxine below the fifth percentile of the cohort distribution with normal thyrotropin levels, following the American Thyroid Association guidelines. Results: Among 9931 participants, the mean (SD) age was 31.2 (4.8) years, 4853 (48.9%) had more than secondary educational levels, 5616 (56.6%) were nulliparous, 404 (4.2%) had hypothyroxinemia, and 506 (6.7%) tested positive for thyroid peroxidase antibodies. Concentrations of nitrogen dioxide and PM with an aerodynamic diameter of 2.5 µm or less (PM2.5) were lower and had less variation in women in the US cohort than those in European cohorts. No associations of nitrogen oxide with thyroid function were found. Higher exposures to PM2.5 were associated with higher odds of hypothyroxinemia in pregnant women (odds ratio per 5-µg/m3 change, 1.21; 95% CI, 1.00-1.47). Although exposure to PM with an aerodynamic diameter of 10 µm or less was not significantly associated with hypothyroxinemia, the coefficient was similar to that for the association of PM2.5 with hypothyroxinemia (odds ratio per 10-µg/m3 change, 1.18; 95% CI, 0.93-1.48). Absorbances of PM2.5 and PM with aerodynamic diameter from 2.5 to 10 µg and were not associated with hypothyroxinemia. There was substantial heterogeneity among cohorts with respect to thyroid peroxidase antibodies (P for heterogeneity, <.001), showing associations of nitrogen oxide and PM with thyroid autoimmunity only in the women in the Generation R Study. Conclusions and Relevance: The findings of this study suggest that first-trimester exposures to PM2.5 were associated with mild thyroid dysfunction throughout pregnancy. The association of PM2.5 exposure with thyroid function during pregnancy is of global health importance because air pollution exposure is widespread and hypothyroxinemia may adversely influence the brain development of offspring.

2.
Thyroid ; 29(9): 1316-1326, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31426724

RESUMO

Background: Thyroid hormone is essential for optimal fetal brain development. Evidence suggests that both low and high maternal thyroid hormone availability may have adverse effects on child neurodevelopmental outcomes, but the effect on behavioral problems remains unclear. We studied the association of maternal thyrotropin (TSH) and free thyroxine (fT4) concentrations during the first 18 weeks of pregnancy with child attention-deficit hyperactivity disorder (ADHD). Methods: A total of 7669 mother-child pairs with data on maternal thyroid function and child ADHD were selected from three prospective population-based birth cohorts: INfancia y Medio Ambiente (INMA; N = 1073, Spain), Generation R (N = 3812, The Netherlands), and Avon Longitudinal Study of Parents and Children (ALSPAC; N = 2784, United Kingdom). Exclusion criteria were multiple pregnancy, fertility treatment, usage of medication affecting the thyroid, and pre-existing thyroid disease. We used logistic regression models to study the association of maternal thyroid function with the primary outcome, ADHD, assessed via the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria by parents and/or teachers at a median child age of 4.5 to 7.6 years, and with the secondary outcome, an ADHD symptom score above the 90th percentile. Effect modification by gestational age and sex was tested with interaction terms and stratified analyses. Results: Overall, 233 (3%) children met the criteria for ADHD. When analyzed continuously, neither fT4 nor TSH was associated with a higher risk of ADHD (odds ratio [OR] 1.1, 95% confidence interval [CI 1.0-1.3], p = 0.060 and OR 0.9 [CI 0.9-1.1], p = 0.385, respectively) or with high symptom scores. When investigating effect modification by gestational age, a higher fT4 was associated with symptoms above the 90th percentile but only in the first trimester (for fT4 per 1 SD: OR 1.2 [CI 1.0-1.4], p = 0.027). However, these differential effects by gestational age were not consistent. No significant effect modification by sex was observed. Conclusions: We found no clear evidence of an association between maternal thyroid function and child ADHD.

3.
Environ Int ; 131: 105049, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31362153

RESUMO

INTRODUCTION: Prenatal exposure to organochlorine compounds (OCs) can increase the risk of reported respiratory symptoms in children. It remains unclear whether these compounds can also impact on lung function. We assessed the association between prenatal exposure to OCs and lung function during childhood. METHODS: We included 1308 mother-child pairs enrolled in a prospective cohort study. Prenatal concentrations of p,p'-dichlorodiphenyltrichloroethane [p,p'-DDT], p,p'-dichlorodiphenyldichloroethylene [p,p'-DDE], hexachlorobenzene [HCB], and seven polychlorinated biphenyls [PCBs] were measured in cord blood. Spirometry was performed in the offspring at ages 4 (n = 636) and 7 years (n = 1192). RESULTS: More than 80% of samples presented quantifiable levels of p,p'-DDE, HCB, PCB-138, PCB-153, and PCB-180; p,p'-DDE was the compound with the highest median concentrations. At 4 years, prenatal p,p'-DDE exposure was associated with a decrease in forced expiratory volume in 1 s (FEV1) in all quartiles of exposure (e.g., third quartile [0.23-0.34 ng/mL]: ß for FEV1 -53.61 mL, 95% CI -89.87, -17.35, vs. the lowest). Prenatal p,p'-DDE levels also decreased forced vital capacity (FVC) and FEV1/FVC, but associations did not reach statistical significance in most exposure quartiles. At 7 years, p,p'-DDE was associated with a decrease in FVC and FEV1 in only the second quartile of exposure (e.g. ß for FEV1 -36.96 mL, 95% CI -66.22, -7.70, vs. the lowest). Prenatal exposure to HCB was associated with decreased FVC and FEV1, but in only the second quartile and at 7 years (e.g. [0.07-0.14 ng/mL]: ß for FEV1 -25.79 mL, 95% CI -55.98, 4.39, vs. the lowest). PCBs were not consistently associated with lung function. CONCLUSION: Prenatal exposure to p,p'-DDE may decrease lung function during childhood, especially FEV1 and at medium levels of exposure. Further and deeper knowledge on the impact of environmental chemicals during pregnancy on lung development is needed.

4.
Environ Int ; 130: 104830, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31247476

RESUMO

BACKGROUND: Several studies have investigated the possible association between prenatal exposure to perfluoroalkyl substances (PFASs) and birth anthropometry. However, none has assessed fetal size longitudinally. We studied the possible association between PFASs and fetal biometry. METHODS: In 1230 mother-child pairs of three cohorts from the Spanish INMA-Project, we analyzed perfluorohexanesulfonic acid (PFHxS), perfluorooctanesulfonic acid (PFOS), perfluorooctanoic acid (PFOA), and perfluorononanoic acid (PFNA) in first-trimester maternal plasma (collection: 2003-2008). We measured abdominal circumference (AC), femur length (FL), biparietal diameter (BPD), and estimated fetal weight (EFW) by ultrasounds at 12, 20, and 34 gestational weeks. We conducted multivariable linear regression analyses between log2-transformed (PFASs) and SD-scores of fetal parameters in each cohort and subsequent meta-analysis. We also assessed effect modification by sex and maternal smoking. RESULTS: PFHxS, PFOA, PFOS, and PFNA medians were: 0.58, 2.35, 6.05, and 0.65 ng/mL, respectively. There were no associations for the whole population in any trimester of pregnancy. However, we found an indication that maternal smoking modified the effect in different directions depending on the PFAS. Among smokers (31%), we found negative associations between both PFOA and PFNA and FL or EFW at week 20 (% change ranging between -6.8% and -5.7% per twofold PFAS increase) and positive associations between PFHxS or PFOS and BPD at week 34 (6.8% and 6.3%, respectively). CONCLUSIONS: Results did not suggest an overall association between prenatal PFASs and fetal growth. The results among smokers should be taken with caution and further studies are warranted to elucidate the possible role of smoking in this association.

5.
Lancet Respir Med ; 6(5): 379-388, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29496485

RESUMO

BACKGROUND: DNA methylation profiles associated with childhood asthma might provide novel insights into disease pathogenesis. We did an epigenome-wide association study to assess methylation profiles associated with childhood asthma. METHODS: We did a large-scale epigenome-wide association study (EWAS) within the Mechanisms of the Development of ALLergy (MeDALL) project. We examined epigenome-wide methylation using Illumina Infinium Human Methylation450 BeadChips (450K) in whole blood in 207 children with asthma and 610 controls at age 4-5 years, and 185 children with asthma and 546 controls at age 8 years using a cross-sectional case-control design. After identification of differentially methylated CpG sites in the discovery analysis, we did a validation study in children (4-16 years; 247 cases and 2949 controls) from six additional European cohorts and meta-analysed the results. We next investigated whether replicated CpG sites in cord blood predict later asthma in 1316 children. We subsequently investigated cell-type-specific methylation of the identified CpG sites in eosinophils and respiratory epithelial cells and their related gene-expression signatures. We studied cell-type specificity of the asthma association of the replicated CpG sites in 455 respiratory epithelial cell samples, collected by nasal brushing of 16-year-old children as well as in DNA isolated from blood eosinophils (16 with asthma, eight controls [age 2-56 years]) and compared this with whole-blood DNA samples of 74 individuals with asthma and 93 controls (age 1-79 years). Whole-blood transcriptional profiles associated with replicated CpG sites were annotated using RNA-seq data of subsets of peripheral blood mononuclear cells sorted by fluorescence-activated cell sorting. FINDINGS: 27 methylated CpG sites were identified in the discovery analysis. 14 of these CpG sites were replicated and passed genome-wide significance (p<1·14 × 10-7) after meta-analysis. Consistently lower methylation levels were observed at all associated loci across childhood from age 4 to 16 years in participants with asthma, but not in cord blood at birth. All 14 CpG sites were significantly associated with asthma in the second replication study using whole-blood DNA, and were strongly associated with asthma in purified eosinophils. Whole-blood transcriptional signatures associated with these CpG sites indicated increased activation of eosinophils, effector and memory CD8 T cells and natural killer cells, and reduced number of naive T cells. Five of the 14 CpG sites were associated with asthma in respiratory epithelial cells, indicating cross-tissue epigenetic effects. INTERPRETATION: Reduced whole-blood DNA methylation at 14 CpG sites acquired after birth was strongly associated with childhood asthma. These CpG sites and their associated transcriptional profiles indicate activation of eosinophils and cytotoxic T cells in childhood asthma. Our findings merit further investigations of the role of epigenetics in a clinical context. FUNDING: EU and the Seventh Framework Programme (the MeDALL project).


Assuntos
Asma/genética , Ilhas de CpG , Metilação de DNA , Eosinófilos/imunologia , Epigênese Genética , Asma/sangue , Criança , Pré-Escolar , DNA/sangue , Feminino , Estudo de Associação Genômica Ampla , Humanos , Masculino , Linfócitos T Citotóxicos
6.
Obesity (Silver Spring) ; 26(3): 588-596, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29399981

RESUMO

OBJECTIVE: The objective of this study was to evaluate the associations between maternal metabolic parameters and early childhood BMI trajectories. METHODS: Two thousand two hundred fifty-one children born in Spain between 2004 and 2008 were analyzed. Five BMI z score trajectories from birth to age 4 years were identified by using latent class growth analysis. Multinomial regression assessed the associations between maternal metabolic parameters and offspring's BMI trajectories. RESULTS: Children in the reference BMI trajectory had average size at birth followed by a slower BMI gain. Maternal prepregnancy obesity was associated with trajectories of accelerated BMI gain departing from either higher (relative risk ratio [RRR] = 1.77; 95% CI: 1.07-2.91) or lower size at birth (RRR = 1.91; 95% CI: 1.17-3.12). Gestational weight gain (GWG) above clinical guidelines was associated with a trajectory of higher birth size followed by accelerated BMI gain (RRR = 2.14; 95% CI: 1.53-2.97). Maternal serum triglycerides were negatively associated with BMI trajectories departing from lower birth sizes. Gestational diabetes, maternal serum cholesterol, and C-reactive protein were unrelated to children's BMI trajectories. CONCLUSIONS: Maternal prepregnancy obesity, GWG, and serum triglycerides are associated with longitudinal BMI trajectories in early childhood that may increase disease risk in later life. Health initiatives should promote healthy weight status before and during pregnancy to improve maternal and child health.


Assuntos
Índice de Massa Corporal , Obesidade/fisiopatologia , Complicações na Gravidez/fisiopatologia , Ganho de Peso/fisiologia , Adulto , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez
7.
J Epidemiol Community Health ; 72(3): 216-222, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29279360

RESUMO

BACKGROUND: The effect of mild-to-moderate maternal iodine deficiency on the neuropsychological development of their offspring is uncertain. We aimed to assess the association between iodine status during pregnancy and the cognitive and motor development of children at 4-5 years. METHODS: We conducted a prospective cohort study in four Spanish regions with recruitment of pregnant women between 2003 and 2008 and follow-up of their children up to 4-5 years (mean (SD)=4.8 (0.6)). Cognitive and motor function was assessed in 1803 children using the McCarthy Scales of Children's Abilities. Dietary iodine and supplementation were measured through questionnaires twice during pregnancy. Urinary iodine concentration (UIC) was measured in spot samples. The residuals of a regression of UIC against creatinine were used to define a variable corrected for creatinine (UIC~Cr). RESULTS: Neither iodine supplements nor iodised salt consumption or maternal UIC were associated with cognitive or motor function. After adjusting for creatinine, children of women with UIC~Cr <100 µg/L had 3.93 (95% CI -6.18 to -1.69) general cognitive scores lower than the reference (150-249 µg/L). Dietary iodine was inversely associated with motor scores and milk but not other dairy products or seafood consumption accounted for this association (beta: -1.36; 95% CI -2.12 to -0.61; per one daily milk serving). CONCLUSIONS: We found an association between low maternal urinary iodine and lower cognitive scores in childhood, although only when corrected for creatinine, adding to the evidence that iodine deficiency may have potential harmful effects on neurodevelopment. Iodine supplementation does not appear to improve child's neurodevelopment at 4-5 years.

8.
Eur J Nutr ; 57(5): 1807-1816, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28456846

RESUMO

PURPOSE: Median urinary iodine concentration (UIC) is used to describe the iodine status of a population. However, the link between UIC and iodine intake may vary during pregnancy. The aim of this study was to compare UIC during and after pregnancy, adjusting for factors that affect iodine intake. METHODS: Two repeated measures of UIC and data on maternal iodine intake estimated through questionnaires were collected during pregnancy and 1-4 years after pregnancy in a subsample of women (n = 598) from a mother and child cohort study in Spain. Random-effects interval regression was used to assess the changes in UIC according to pregnancy status. RESULTS: Median UIC was similar during (133 µg/L) and after pregnancy (139 µg/L). After adjusting for iodised salt, iodine supplement consumption, and socio-demographic related variables, UIC was 24.0% (95% CI 11.3, 38.2) higher after than during pregnancy. This difference was maintained in a subsample of women with exhaustive information on diet (n = 291): 26.2%, 95% CI 10.3, 44.4. CONCLUSIONS: In an iodine sufficient area for the general population, iodine excretion was lower during than after pregnancy when factors affecting iodine intake were controlled for. Current recommendations of median UIC during pregnancy are based on the equivalence between iodine intake and UIC estimated from studies in non-pregnant populations, which might lead to overestimation of iodine deficiency during gestation. Further studies should evaluate the equivalence between iodine intake and its urinary excretion during pregnancy.

9.
ERJ Open Res ; 3(3)2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28845428

RESUMO

While there is evidence for variations in prevalence rates of childhood wheeze and asthma between countries, longitudinal, individual-level data are needed to understand these differences. The aim of this study was to examine variations in prevalence rates of childhood asthma, wheeze and wheeze with asthma in Europe. We analysed datasets from 10 MeDALL (Mechanisms of the Development of ALLergy) cohorts in eight countries, representing 26 663 children, to calculate prevalence rates of wheeze and asthma by child age and wheeze with asthma at age 4 years. Harmonised variables included outcomes parent-reported wheeze and parent-reported doctor-diagnosed asthma, and covariates maternal education, parental smoking, pets, parental asthma, doctor-diagnosed allergic rhinitis, doctor-diagnosed eczema and wheeze severity. At age 4 years, asthma prevalence varied from 1.72% in Germany to 13.48% in England and the prevalence of wheeze varied from 9.82% in Greece to 55.37% in Spain. Adjusted estimates of the proportion of 4-year-old children with wheeze diagnosed with asthma remained highest in England (38.14%, 95% CI 31.38-44.90%) and lowest in Spain (15.94%, 95% CI 6.16-25.71%). The large differences in prevalence rates of asthma, wheeze and wheeze with asthma at age 4 years between European cohorts may indicate that childhood asthma is more readily diagnosed in some countries while going unrecognised elsewhere.

10.
Int J Epidemiol ; 46(5): 1465-1477, 2017 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-28338907

RESUMO

Background: It has been suggested that prenatal exposure to n-3 long-chain fatty acids protects against asthma and other allergy-related diseases later in childhood. The extent to which fish intake in pregnancy protects against child asthma and rhinitis symptoms remains unclear. We aimed to assess whether fish and seafood consumption in pregnancy is associated with childhood wheeze, asthma and allergic rhinitis. Methods: We pooled individual data from 60 774 mother-child pairs participating in 18 European and US birth cohort studies. Information on wheeze, asthma and allergic rhinitis prevalence was collected using validated questionnaires. The time periods of interest were: infancy (0-2 years), preschool age (3-4 years), and school age (5-8 years). We used multivariable generalized models to assess associations of fish and seafood (other than fish) consumption during pregnancy with child respiratory outcomes in cohort-specific analyses, with subsequent random-effects meta-analyses. Results: The median fish consumption during pregnancy ranged from 0.44 times/week in The Netherlands to 4.46 times/week in Spain. Maternal fish intake during pregnancy was not associated with offspring wheeze symptoms in any age group nor with the risk of child asthma [adjusted meta-analysis relative risk (RR) per 1-time/week = 1.01, 95% confidence interval 0.97-1.05)] and allergic rhinitis at school age (RR = 1.01, 0.99-1.03). These results were consistently found in further analyses by type of fish and seafood consumption and in sensitivity analyses. Conclusion: We found no evidence supporting a protective association of fish and seafood consumption during pregnancy with offspring symptoms of wheeze, asthma and allergic rhinitis from infancy to mid childhood.


Assuntos
Asma/epidemiologia , Ácidos Graxos Ômega-3/administração & dosagem , Fenômenos Fisiológicos da Nutrição Pré-Natal , Rinite Alérgica/epidemiologia , Alimentos Marinhos , Animais , Criança , Pré-Escolar , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Prevalência , Análise de Regressão , Sons Respiratórios , Inquéritos e Questionários , Estados Unidos/epidemiologia
11.
Int J Equity Health ; 15(1): 145, 2016 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-27628650

RESUMO

BACKGROUND: An important health issue in urban areas is how changes arising from the regeneration of city-areas affect social determinants of health and equity. This paper examines the impacts attributable to a new fish market and to delays in the regeneration of a port area in a deteriorated region of the Bay of Pasaia (Spain). Potential differential impacts on local residents and socially vulnerable groups were evaluated to determine health inequalities. METHODS: An in-depth, prospective and concurrent Health-Impact-Assessment (HIA) focused on equity was conducted by the regional Public Health Department, following the Merseyside guidelines. Data from different sources was triangulated and impacts were identified using qualitative and quantitative methods. RESULTS: The intervention area is characterised by poor social, environmental, and health indicators. The distinctness of the two projects generates contrasting health and inequality impacts: generally positive for the new fish market and negative for the port area. The former creates recreational spaces and improves urban quality and social cohesion. By contrast, inaction and stagnation of the project in the port area perpetuates deterioration, a lack of safety, and poor health, as well as increased social frustration. CONCLUSIONS: In addition to assessing the health impacts of both projects this HIA promoted intersectoral partnerships, boosted a holistic and positive view of health and incorporated health and equity into the political discourse. Community-level participatory action enabled public health institutions to respond to new urban planning challenges and responsibilities in a more democratic manner.


Assuntos
Participação da Comunidade , Avaliação do Impacto na Saúde , População Urbana/estatística & dados numéricos , Reforma Urbana/organização & administração , Humanos , Saúde da População , Estudos Prospectivos , Saúde Pública , Pesquisa Qualitativa , Regeneração , Fatores Socioeconômicos , Espanha
12.
Environ Res ; 151: 11-20, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27448728

RESUMO

BACKGROUND: Results regarding the association between mercury exposure and anthropometry at birth, gestational length and placental weight are inconsistent, as is the role of seafood intake in these associations. OBJECTIVE: We assessed whether prenatal mercury exposure is associated with anthropometry at birth, placental weight and gestational length in a population with a relatively high exposure to mercury from seafood consumption. METHODS: Total mercury (T-Hg) was determined in cord blood from 1869 newborns with birth outcome measures, within the Spanish multicenter INMA cohort from 2004 to 2008. We adjusted cohort specific linear and Cox regression models to evaluate the association between T-Hg and birth anthropometry (weight, length, and head circumference), placental weight and gestational length. Non-spontaneous labor was taken to be censoring in the survival analysis. Final estimates were obtained using meta-analysis. RESULTS: Geometric mean T-Hg was 8.2µg/L. A doubling of T-Hg was associated with a 7.7g decrease in placental weight (95% CI: -13.6, -1.8) and marginally with head circumference (beta: -0.052cm, 95% CI: -0.109, 0.005). T-Hg was also inversely related to weight and length, although with weaker estimates. Mercury exposure was not associated with the length of gestation. The inverse relation between T-Hg and growth was enhanced when the intake of different seafood groups was adjusted for in the models. CONCLUSIONS: Prenatal mercury exposure may be associated with reduced placental and fetal growth. Confounding by fish intake should be considered when assessing these relationships.


Assuntos
Tamanho Corporal , Poluentes Ambientais/análise , Troca Materno-Fetal , Mercúrio/análise , Adulto , Animais , Feminino , Sangue Fetal/química , Peixes , Contaminação de Alimentos , Humanos , Recém-Nascido , Masculino , Exposição Materna , Placentação , Gravidez
13.
Environ Res ; 147: 50-8, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26851724

RESUMO

BACKGROUND AND OBJECTIVE: Preterm birth is a major determinant of infant mortality and morbidity. Air pollution has been suggested as a risk factor for preterm delivery; however, the scientific evidence on this impact remains inconsistent. We assessed the association between residential exposure to air pollution during pregnancy and preterm birth (gestational age at delivery <37 weeks) in Spain. METHODS: This study was based on 2409 pregnant women participating in the INMA birth cohorts in Asturias, Gipuzkoa, Sabadell and Valencia. Ambient levels of nitrogen dioxide (NO2) and benzene were estimated for each woman's residence for each trimester and for the whole pregnancy, using temporally adjusted land-use regression models. The association between air pollution exposure and preterm birth was assessed for each cohort separately by means of logistic regression models controlling for potential confounders, under single- and two-pollutant models, for all the women in the study and for those spending more than 15h/day at home. Combined estimates of the association across cohorts were obtained through meta-analysis. RESULTS: Throughout the whole sample, suggestive but no statistically significant associations were found between exposure and preterm birth. For pregnant women spending more time at home significant associations were found for both pollutants, under single- and two-pollutant models. Under the last ones, NO2 exposure during the second trimester and the whole pregnancy was associated with a higher risk of preterm delivery (OR=1.58, (95%CI: 1.04-2.42) per 10µg/m(3) increase). Benzene exposure during the third trimester was also associated with preterm birth in that subsample (OR=1.45, (95%CI: 1.00-2.09) per 1µg/m(3) increase). CONCLUSION: We found suggestive associations between NO2 and benzene exposure during pregnancy and preterm birth. Estimates of the association were higher among women who spent more time at home, probably reflecting a better exposure assessment in this group.


Assuntos
Poluentes Atmosféricos/toxicidade , Benzeno/toxicidade , Exposição Materna , Dióxido de Nitrogênio/toxicidade , Nascimento Prematuro/epidemiologia , Adolescente , Adulto , Poluentes Atmosféricos/análise , Benzeno/análise , Estudos de Coortes , Monitoramento Ambiental , Feminino , Humanos , Modelos Logísticos , Dióxido de Nitrogênio/análise , Gravidez , Nascimento Prematuro/induzido quimicamente , Características de Residência , Fatores de Risco , Fatores Socioeconômicos , Espanha/epidemiologia , Adulto Jovem
14.
JAMA Pediatr ; 170(4): 381-90, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26882542

RESUMO

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


Assuntos
Dieta , Desenvolvimento Fetal/fisiologia , Peixes , Sobrepeso/etiologia , Obesidade Pediátrica/etiologia , Complicações na Gravidez , Alimentos Marinhos , Animais , Índice de Massa Corporal , Criança , Desenvolvimento Infantil , Pré-Escolar , Estudos de Coortes , Europa (Continente) , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Sobrepeso/epidemiologia , Obesidade Pediátrica/epidemiologia , Gravidez , Fatores de Risco , Estados Unidos
15.
Environ Health Perspect ; 124(1): 157-63, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26058084

RESUMO

BACKGROUND: Several studies have reported decreases in birth size associated with exposure to organochlorine compounds (OCs), but uncertainties remain regarding the critical windows of prenatal exposure and the effects on fetal body segments. OBJECTIVE: We examined the relationship between prenatal OC concentrations and fetal anthropometry. METHODS: We measured 4,4´-dichlorodiphenyldichloroethylene (4,4´-DDE), hexachlorobenzene (HCB), and polychlorinated biphenyl (PCB) congeners (138, 153, and 180) in 2,369 maternal and 1,140 cord serum samples in four Spanish cohorts (2003-2008). We used linear mixed models to obtain longitudinal growth curves for estimated fetal weight (EFW), abdominal circumference (AC), biparietal diameter (BPD), and femur length (FL) adjusted by parental and fetal characteristics. We calculated standard deviation (SD) scores of growth at 0-12, 12-20, and 20-34 weeks of gestation as well as size at gestational week 34 for the four parameters. We studied the association between OCs and the fetal outcomes by cohort-specific linear models and subsequent meta-analyses. RESULTS: PCBs were associated with a reduction in AC up to mid-pregnancy, and BPD and FL from gestational week 20 onward. An inverse association was also found between HCB and AC growth in early pregnancy. The reduction of these parameters ranged from -4% to -2% for a doubling in the OC concentrations. No association between 4,4´-DDE and fetal growth was observed. CONCLUSIONS: To our knowledge, this is the first study to report an association between prenatal exposure to some PCBs and HCB and fetal growth: AC during the first two trimesters of pregnancy, and BPD and FL later in pregnancy. CITATION: Lopez-Espinosa MJ, Murcia M, Iñiguez C, Vizcaino E, Costa O, Fernández-Somoano A, Basterrechea M, Lertxundi A, Guxens M, Gascon M, Goñi-Irigoyen F, Grimalt JO, Tardón A, Ballester F. 2016. Organochlorine compounds and ultrasound measurements of fetal growth in the INMA cohort (Spain). Environ Health Perspect 124:157-163; http://dx.doi.org/10.1289/ehp.1408907.


Assuntos
Desenvolvimento Fetal/efeitos dos fármacos , Hidrocarbonetos Clorados/toxicidade , Exposição Materna/efeitos adversos , Adulto , Feminino , Humanos , Gravidez , Espanha , Ultrassonografia Pré-Natal
16.
Environ Health Perspect ; 124(2): 235-42, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26115483

RESUMO

BACKGROUND: Air pollution exposure during pregnancy has been associated with impaired fetal growth. However, few studies have measured fetal biometry longitudinally, remaining unclear as to whether there are windows of special vulnerability. OBJECTIVE: The aim was to investigate the impact of nitrogen dioxide (NO2) exposure on fetal and neonatal biometry in the Spanish INMA study. METHODS: Biparietal diameter (BPD), femur length (FL), abdominal circumference (AC), and estimated fetal weight (EFW) were evaluated for up to 2,478 fetuses in each trimester of pregnancy. Size at 12, 20, and 34 weeks of gestation and growth between these points, as well as anthropometry at birth, were assessed by SD scores derived using cohort-specific growth curves. Temporally adjusted land-use regression was used to estimate exposure to NO2 at home addresses for up to 2,415 fetuses. Associations were investigated by linear regression in each cohort and subsequent meta-analysis. RESULTS: A 10-µg/m(3) increase in average exposure to NO2 during weeks 0-12 was associated with reduced growth at weeks 0-12 in AC (-2.1%; 95% CI: -3.7, -0.6) and EFW (-1.6%; 95% CI: -3.0, -0.3). The same exposure was inversely associated with reduced growth at weeks 20-34 in BPD (-2.6%; 95% CI: -3.9, -1.2), AC (-1.8%; 95% CI: -3.3, -0.2), and EFW (-2.1%; 95% CI: -3.7, -0.2). A less consistent pattern of association was observed for FL. The negative association of this exposure with BPD and EFW was significantly stronger in smoking versus nonsmoking mothers. CONCLUSIONS: Maternal exposure to NO2 in early pregnancy was associated with reduced fetal growth based on ultrasound measures of growth during pregnancy and measures of size at birth.


Assuntos
Poluentes Atmosféricos/toxicidade , Desenvolvimento Fetal/efeitos dos fármacos , Exposição Materna , Dióxido de Nitrogênio/toxicidade , Adolescente , Adulto , Poluentes Atmosféricos/efeitos adversos , Antropometria , Estudos de Coortes , Feminino , Humanos , Masculino , Dióxido de Nitrogênio/efeitos adversos , Gravidez , Espanha , Ultrassonografia Pré-Natal , Adulto Jovem
17.
Environ Res ; 142: 471-8, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26257032

RESUMO

INTRODUCTION: Prenatal exposure to perfluoroalkyl substances (PFAS) might affect child health; thus estimating PFAS fetal burden is relevant. PFAS fetal burden is best estimated in cord samples; previous studies have used either maternal plasma or serum during pregnancy as proxy, but their validity is not clear. We aimed to evaluate PFAS transfer between mother and fetus and determine its predictors in a Spanish birth cohort. METHODS: We measured perfluorobutane sulfonate (PFBS), perfluorohexane sulfonate (PFHxS), perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), and perfluorononanoate (PFNA) in maternal blood and cord serum from 66 mother-child pairs. We used Spearman's rank coefficients to correlate PFAS concentrations in first trimester maternal plasma and serum, with cord serum samples. We assessed PFAS placental transfer by calculating maternal to cord ratios and examined their association with maternal socio-demographic characteristics and child sex using linear regression models. RESULTS: Median concentrations of PFAS (ng/mL) of PFHxS, PFOS, PFOA, and PFNA in maternal plasma (0.79, 6.18, 2.85 and 0.84, respectively) and serum (0.84, 6.99, 2.97 and 0.85) were higher than in cord serum (0.40, 1.86, 1.90 and 0.32). PFBS was not detected. Positive Spearman's correlations (p-values<0.001) were found between maternal plasma and serum (⍴≥0.80), maternal plasma and cord (⍴≥0.66), and maternal serum and cord samples (⍴≥0.67). Maternal plasma to cord ratios were above 1 (PFHxS: 2.35 [95%CI: 2.05, 2.70], PFOS: 3.33 [3.05, 3.62], PFOA: 1.37 [1.27, 1.48], PFNA: 2.39 [2.18, 2.63]); maternal serum to cord ratios were similar. Maternal to cord ratios decreased with maternal age, but not with other socio-demographic factors. CONCLUSIONS: Our results suggest that PFAS fetal body burden can be assessed using as proxy maternal plasma or serum collected early in pregnancy. Maternal age might influence PFAS placental transfer.


Assuntos
Poluentes Ambientais/farmacocinética , Sangue Fetal/química , Fluorcarbonetos/farmacocinética , Exposição Materna , Troca Materno-Fetal , Circulação Placentária , Adulto , Estudos de Coortes , Poluentes Ambientais/sangue , Feminino , Fluorcarbonetos/sangue , Humanos , Modelos Lineares , Masculino , Gravidez , Fatores Socioeconômicos , Espanha
18.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 33(3): 145-148, mar. 2015. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-134565

RESUMO

En octubre de 2012 se detectó un brote de gastroenteritis aguda por Shigella sonnei en una escuela del norte de España que afectó a 112 personas: el 63,7% fueron escolares y docentes y el 35,7% convivientes. El origen fue un niño enfermo con antecedente de viaje a país endémico, y el desencadenante, las deficiencias higiénicas existentes en uno de los aseos de la escuela. La aplicación de estrictas medidas de higiene fueron determinantes para el control del brote (AU)


In October 2012, an outbreak of acute gastroenteritis caused by Shigella sonnei was detected in a nursery and primary school in the north of Spain affecting 112 people: 63.7% were pupils and teachers and 35.7% their co-habitants. The source was a sick child who had travelled to an endemic country, and the key trigger factor was inadequate hygiene in one of the toilets of the school. The enforcement of strict hygiene measures was essential for controlling the outbreak (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Adolescente , Lactente , Pessoa de Meia-Idade , Adulto Jovem , Shigella sonnei , Surtos de Doenças , Disenteria Bacilar/epidemiologia , Espanha/epidemiologia , Instituições Acadêmicas , Disenteria Bacilar/microbiologia , Disenteria Bacilar/prevenção & controle
19.
Gac. sanit. (Barc., Ed. impr.) ; 29(1): 4-9, ene.-feb. 2015. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-132994

RESUMO

Objetivos Estimar la prevalencia de la lactancia materna exclusiva en la cohorte INMA (Infancia y Medio Ambiente) de Guipúzcoa durante los primeros 6 meses de vida del bebé. Identificar las razones de su abandono y determinar los factores asociados. Método La población de estudio está formada por 638 mujeres embarazadas (www.proyectoinma.org) seguidas desde el primer trimestre de embarazo hasta los 14 meses de edad de sus hijos. Para determinar los factores asociados con el abandono de la lactancia materna exclusiva se utilizan modelos de regresión logística en dos etapas diferentes (4 meses/fase temprana y 6 meses/fase tardía).Resultados La prevalencia de lactancia materna exclusiva fue del 84,8% al alta hospitalaria, el 53,7% a los 4 meses y el 15,4% a los 6 meses de vida. Las razones descritas por las madres sobre el abandono de la lactancia materna exclusiva asociadas a la fase temprana son problemas de lactancia, escasa ganancia de peso e hipogalactia. Otros factores que influyen en la etapa temprana son la intención previa durante el embarazo de dar lactancia materna exclusiva, la paridad, la comarca de residencia y la clase social. En la etapa tardía influye el tiempo de baja por maternidad. Conclusiones Los resultados de este estudio pueden ser de utilidad para los profesionales sanitarios y desde una perspectiva de salud pública, ya que permiten diseñar estrategias para apoyar a las madres lactantes, teniendo en cuenta las razones principales de abandono temprano y tras la reincorporación a la vida laboral (AU)


Objective To estimate the prevalence of exclusive breastfeeding (EB) during the first 6 months of life in the Gipuzkoa birth cohort, identify the reasons for abandonment of EB, and establish the associated factors.Methods The study population consisted of 638 pregnant women from the INMA-Gipuzkoa (Infancia y Medio Ambiente, www.proyectoinma.org) birth cohort, who were followed up from the third trimester of pregnancy until the child was aged 14 months. To determine the factors related to abandonment of EB, logistic regression models were used in two different stages (4 months or early stage and 6 months or late stage).Results The prevalence of EB within the Gipuzkoa cohort was 84.8% after hospital discharge, 53.7% at 4 months of life and 15.4% at 6 months of life. The reasons given by the mothers for early EB cessation were: breastfeeding problems, low weight gain and hypogalactia. Other factors influencing the early phase were the intention to provide EB, parity, area of residence and social class. Abandonment in the late stage was influenced by the length of maternity leave. Conclusions From a public health perspective, the results of this study could help health professionals to develop strategies to support breastfeeding mothers, taking into account the main reasons for early and late abandonment (AU)


Assuntos
Humanos , Aleitamento Materno/estatística & dados numéricos , Nutrição do Lactente , Cuidado do Lactente , Retorno ao Trabalho/estatística & dados numéricos , Transtornos da Nutrição do Lactente/prevenção & controle , Classe Social
20.
Paediatr Perinat Epidemiol ; 29(2): 113-22, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25565408

RESUMO

BACKGROUND: Maternal clinical thyroid disorders can cause reproductive complications. However, the effects of mild thyroid dysfunctions are not yet well established. The aim was to evaluate the association of maternal thyroid function during the first half of pregnancy with birthweight and preterm delivery. METHODS: We analysed data on 2170 pregnant women and their children from a prospective population-based cohort study in four Spanish areas. Mid-gestation maternal serum and urine samples were gathered to determine thyroid-stimulating hormone (TSH), free thyroxine (fT4 ), and urinary iodine concentration (UIC). Thyroid status was defined according to percentile distribution as: euthyroid (TSH and fT4 >5th and <95th percentiles); hypothyroxinaemia (fT4 < 5 th percentile and TSH normal), hypothyroidism (TSH > 95th percentile and fT4 normal or <5th percentile), hyperthyroxinaemia (fT4 > 95 th percentile and TSH normal), and hyperthyroidism (TSH < 5 th percentile and fT4 normal or >95th percentile). Response variables were birthweight, small and large for gestational age (SGA/LGA), and preterm delivery. RESULTS: An inverse association of fT4 and TSH with birthweight was found, the former remaining when restricted to euthyroid women. High fT4 levels were also associated with an increased risk of SGA [odds ratio, 95% confidence interval (CI) 1.28 (95% CI 1.08, 1.51)]. Mean birthweight was higher in the hypothyroxinaemic group (ß = 109, P < 0.01). Iodine intake and UIC were not associated with birth outcomes. CONCLUSIONS: High maternal fT4 levels during the first half of pregnancy were related to lower birthweight and increased risk of SGA newborns, suggesting that maternal thyroid function may affect fetal growth, even within the normal range.


Assuntos
Peso ao Nascer/fisiologia , Hipotireoidismo/sangue , Mães , Nascimento Prematuro/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/sangue , Glândula Tireoide/metabolismo , Adulto , Feminino , Idade Gestacional , Humanos , Hipotireoidismo/complicações , Hipotireoidismo/epidemiologia , Hipotireoidismo/fisiopatologia , Recém-Nascido , Iodo/sangue , Razão de Chances , Gravidez , Nascimento Prematuro/etiologia , Estudos Prospectivos , Espanha/epidemiologia , Tireotropina/sangue , Tiroxina/sangue
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA