Untersuchung des Zusammenhangs von Gestationsdiabetes und späterem Übergewicht der Nachkommen unter Berücksichtigung des Einflusses von erhöhtem Geburtsgewicht

Einleitung: Es konnte bereits mehrfach gezeigt werden, dass Gestationsdiabetes (GDM) mit einem gesteigerten Risiko für erhöhtes Geburtsgewicht (Large-for-Gestational-Age/LGA) sowie für das Auftreten von Übergewicht der Nachkommen einhergeht. LGA-Neugeborene sind zudem stärker gefährdet, im späteren Kindes- und Jugendalter an Übergewicht zu leiden. Daraus ergibt sich die Fragestellung, ob ein Zusammenhang zwischen GDM und Übergewicht der Nachkommen insbesondere für Neugeborene mit erhöhtem Geburtsgewicht besteht. Material und Methoden: Die der Untersuchung zugrundeliegenden Daten stammen aus der deutschlandweiten KIGGS-Basiserhebung (2003 bis 2006). Eingeschlossen wurden 10.794 Kinder und Jugendliche (Studienteilnehmer gesamt: 17.640) im Alter von 3 bis 17 Jahren, die mit ihren leiblichen Müttern zusammenleben und zu denen vollständige Informationen hinsichtlich der Hauptvariablen vorlagen. Das Geburtsgewicht wurde mittels Perzentilen nach Voigt et al. (2006) bestimmt, wobei ein Geburtsgewicht über der 90. Perzentile als LGA erfasst wurde. Aktuelles Übergewicht wurde gemäß den Kriterien der International Obesity Task Force (IOTF) ermittelt sowie zusätzlich der BMI Z-Score (WHO-Referenzpopulation) bestimmt. Ergebnisse: Die eingeschlossenen Kinder und Jugendlichen waren im Durchschnitt 10,0 4,2 Jahre alt und in 51,0% Jungen. Es wurden zudem die folgenden Prävalenzen ermittelt: GDM (2,3%), LGA (8,5%), Übergewicht (17,5%). Der BMI Z-Score lag im Mittel bei 0,37 + 1,11. Ein Zusammenhang besteht sowohl zwischen GDM und LGA (Logistische Regression (LR): AOR (95%-KI) 2,19 (1,53; 3,13); p < 0,001) als auch zwischen LGA und Übergewicht (LR: AOR (95%-KI) 1,63 (1,39; 1,92); p < 0,001). Kinder, deren Geburtsgewicht erhöht war, weisen darüber hinaus einen höheren BMI Z-Score auf (Multiple lineare Regression (MLR): (95%-KI) 0,35 (0,28; 0,43); p < 0,001). In der nicht-adjustierten Analyse zeigte sich ein geringer (allerdings nicht statistisch signifikanter) Zusammenhang von GDM und Übergewicht (F-Approximation-Test: OR (95%-KI): 1,26 (0,89; 1,77); p = 0,19) bzw. einer Erhöhung des BMI-Z Scores der Nachkommen (T-Test: GDM–: 0,37 + 1,11; GDM+: 0,51 + 1,21; p = 0,13). Die Stratifizierung hinsichtlich des Geburtsgewichtes ergab keinen Hinweis auf ein ausschließliches Vorhandensein bzw. eine Verstärkung dieser Effekte in der LGA-Untergruppe. Dementsprechend war weder der direkte Effekt von GDM auf Übergewicht bei Kontrolle von LGA (LR: AOR (95%-KI): 1,09 (0,75; 1,58); p = 0,64) noch der Gesamteffekt (LR: AOR (95%-KI): 1,12 (0,78; 1,61); p = 0,55) statistisch signifikant. Dies gilt auch für den BMI Z-Score der Nachkommen (MLR: (95%-KI) 0,05 (0,12; 0,21); p = 0,57 bzw. (95%-KI) 0,07 (0,10; 0,24); p = 0,41). Daraus ergab sich ein durch LGA mediierter Anteil des Gesamteffektes von 19,3% im Falle von Übergewicht bzw. von 26,9% für den BMI Z-Score (Mediationsanalyse nach Imai et al.). Diese Anteile könnten allerdings auch im Falle von statistischer Signifikanz nur als sehr limitiert eingestuft werden. Diskussion: Obwohl ein Zusammenhang von GDM und LGA sowie LGA und Übergewicht nachgewiesen werden konnte und auch der spätere BMI Z-Score LGA-Neugeborener höher ist, scheint LGA die Beziehung zwischen GDM und erhöhtem Gewicht der Nachkommen nicht zu beeinflussen. Die Resultate geben Anlass zu der Vermutung, dass ein erhöhtes Geburtsgewicht nicht als entscheidender Faktor dieser Kausalkette in Frage kommt

Overweight in children and its perception by parents: cross-sectional observation in a general pediatric outpatient clinic

Abstract Background Childhood overweight is a growing problem in industrialized countries. Parents play a major role in the development and the treatment of overweight in their children. A key factor here is the perception of their child’s weight status. As we know of other studies, parental perception of children’s weight status is very poor. This study aimed to determine factors associated with childhood overweight and parental misperception of weight status. The height and weight of children, as reported by parents were compared with measured data. Methods The study was conducted at a general pediatric outpatient clinic in Vienna, Austria. A total of 600 children (aged 0–14 years) participated in the study. Collection of data was performed by means of a questionnaire comprising items relating to parental weight and social demographics. The parents were also asked to indicate their children’s weight and height, as well as the estimated weight status. Children were weighed and measured and BMI was calculated, allowing a comparison of estimated values and weight categories with the measured data. Results Parental BMI, parental weight and a higher birth weight were identified as factors associated with childhood overweight. No association with the parents’ educational status or citizenship could be proven. We compared parents’ estimations of weight and height of their children with measured data. Here we found, that parental estimated values often differ from measured data. Using only parental estimated data to define weight status leads to misclassifications. It could be seen that parents of overweight children tend to underestimate the weight status of their children, compared to parents of children with normal weight. Conclusions Pediatricians should bear in mind that parental assessment often differs from the measured weight of their children. Hence children should be weighed and measured regularly to prevent them from becoming overweight. This is of particular importance in children with higher birth weight and children of overweight parents. Trial registration Study was not registered. The study was approved by the Ethic committee of the city of Vienna. (EK 13–146-VK)

Noise levels in general pediatric facilities: A health risk for the staff?

This study was initiated to investigate noise levels in general pediatric facilities. Although occupational noise limits of 85dBA for LAeq,8h (daily noise exposure) and 140dBC for LCpeak (peak sound level) have proven to prevent hearing loss, even low levels of continuous noise (45dBA and above) can cause adverse health effects (ISO = International Organization for Standardization, A = Austrian VOLV). The sound level measurements of LAeq (equivalent sound level) and LCpeak were conducted with a decibel meter in the examination rooms (EXR) and waiting rooms (WR) of 10 general pediatric practices and outpatient clinics in the city of Vienna, Austria. LAeq,8h was calculated from LAeq, and independent variables with a potential influence on noise levels were also examined. In EXR, the random sample consisted of 5 to 11 measuring periods per facility (mean: 7.1 ± 1.9) with a total duration between 43.85 and 98.45 min. (total: 10:19:04). With LAeq ranging from 67.2 to 80.2dBA, specific recommended limits were exceeded considerably (ISO: 45dBA; A: 50dBA). In WR, the random sample comprised 5 to 18 measurements per facility (mean: 13.7 ± 5.0) with a total duration ranging from 25 to 90 min. (total: 11:25:00). The values for LAeq were between 60.6dBA and 67.0dBA. All of these significantly exceeded recommended limits of 55dBA (ISO) and 5 out of 10 exceeded 65dBA (A). LCpeak reached 116.1dBC in WR and 114.1dBC in EXR. The highest calculated daily noise exposure of pediatricians (LAeq,8h) was 79dBA. Although no significantly increased risk for hearing loss can be concluded from our findings, it must be assumed that noise levels in general pediatrics have the potential to cause stress and associated health issues. Further research is necessary to foster the recognition of noise-related health impairments of pediatric staff as occupational diseases

Ultrasound of the infant hip: manual fixation is equivalent to Graf’s technique regarding image quality—a randomized trial

Abstract Background In Middle Europe ultrasonography is the standard method used to screen for developmental dysplasia of the hip in infants. Our aim was to determine whether manual fixation of the child is equivalent to Graf’s technique regarding image quality. Methods This randomized trial was conducted at a free-standing general pediatric outpatient clinic in Vienna, Austria. Healthy infants in the 1st and between the 6th and 8th week of life with no hip malalignment were included. After randomization, Group 1 was examined using Graf’s fixation device and participants in Group 2 were fixated on the examination couch by their parents. In a second step, all images underwent a blinded evaluation. Results A total of 117 babies (Group 1: n = 62, Group 2: n = 54, excluded: n = 1) were examined and 230 images (Group 1: n = 122, Group 2: n = 108) were evaluated, of which 225 were sonographically normal. Two images, showing a type IIa right hip and a type IIa + left hip respectively, were excluded. One participant had to be excluded as the respective images showed two pathologic hip joints. Two images in Group 1 and three in Group 2 were not evaluable. No statistical association between image quality (11 quality criteria and overall evaluability) and fixation technique (0.12 ≤ p ≤ 1.0 or constant) was found. Conclusions Considering sonographically normal hip joints, we found no evidence that manual fixation differed from Graf’s technique regarding image quality. In future studies, hip pathologies should be included and discomfort of infants and parents during the examination should be addressed. Trial registration German Clinical Trials Register, ID: DRKS00015694), registered retrospectively on October 7th, 2018

Additional file 1: of Overweight in children and its perception by parents: cross-sectional observation in a general pediatric outpatient clinic

Questionnaire. (DOCX 72 kb