Antenatal maternal mental health as determinant of postpartum depression in a population based mother-child cohort (Rhea Study) in Crete, Greece

Antenatal maternal mental health has been identified as an important determinant of postpartum depression (PPD). We investigated the occurrence of depression both antenatally and postnatally and examined whether maternal trait anxiety and depression during pregnancy were associated with PPD at 8 weeks postpartum in a prospective mother-child cohort (Rhea Study) in Crete, Greece. 438 women completed the Edinburgh Postnatal Depression Scale (EPDS) and the Trait subscale of the State-Trait Anxiety Inventory (STAI-Trait) questionnaires assessing antenatal depression and anxiety, respectively, during the third trimester of pregnancy as well as the EPDS at 8 weeks postpartum. The prevalence of women with probable depression (EPDS score a parts per thousand yen13) was 16.7 % at 28-32 weeks of pregnancy and 13.0 % at 8 weeks postpartum. A per 5 unit increase in the STAI-Trait subscale increased the odds for PPD by 70 % (OR = 1.70, 95 % CI 1.41, 2.05), whereas a per unit increase in EPDS during pregnancy increased the odds for PPD by 27 % (OR = 1.27, 95 % CI 1.19, 1.36). Our findings suggest that antenatal maternal psychological well-being has a significant effect on PPD, which might have important implications for early detection during pregnancy of women at risk for postpartum depression

Ocular Rigidity and Outflow Facility in Nonproliferative Diabetic Retinopathy

Purpose. To compare ocular rigidity (OR) and outflow facility (C) in patients with nonproliferative diabetic retinopathy (NPDR) and control subjects. Methods. Twenty-four patients with NPDR (NPDR group) and 24 controls (control group) undergoing cataract surgery were enrolled. NPDR group was further divided into patients with mild NPDR (NPDR1-group) and patients with moderate and/or severe NPDR (NPDR2-group). After cannulation of the anterior chamber, a computer-controlled device was used to infuse saline and increase the intraocular pressure (IOP) in a stepping procedure from 15 to 40 mmHg. Ocular rigidity and outflow facility coefficients were estimated from IOP and volume recordings. Results. Ocular rigidity was 0.0205 μL−1 in NPDR group and 0.0202 μL−1 in control group (P=0.942). In NPDR1-group, OR was 0.017 μL−1 and in NPDR2-group it was 0.025 μL−1 (P=0.192). Outflow facility was 0.120 μL/min/mmHg in NPDR-group compared to 0.153 μL/min/mmHg in the control group at an IOP of 35 mmHg (P=0.151). There was no difference in C between NPDR1-group and NPDR2-group (P=0.709). Conclusions. No statistically significant differences in ocular rigidity and outflow facility could be documented between diabetic patients and controls. No difference in OR and C was detected between mild NPDR and severe NPDR

Pregestational excess weight, maternal obstetric complications and mode of delivery in the Rhea cohort in Crete

Background: There has been a significant increase in overweight and obesity worldwide reaching global epidemic, with dramatic increase also among women of reproductive age or entering pregnancy. Aims of the study were to estimate the prevalence of maternal pregestational overweight and obesity and their association with and contribution to maternal obstetric complications and mode of delivery. Methods: One thousand two hundred eighty-six women with singleton pregnancies were followed-up prospectively from early pregnancy to delivery in Crete. Results: The prevalence of pre-pregnancy overweight and obesity were 20 and 11.5%, respectively. After adjusting for potential confounders, overweight and/or obesity were associated with an increased risk for caesarean deliveries [RRoverweight_vs._normal BMI = 1.21, 95% CI (1.06, 1.38), RRobese_vs._normal BMI = 1.21, 95% CI (1.02, 1.42)], gestational diabetes mellitus [RRobese_vs._normal BMI = 2.11, 95% CI (1.28, 3.47)] and high blood pressure [RRsevery. obese_vs._normal BMI = 3.32, 95% CI (1.36, 8.06)] any time in pregnancy. Pre-pregnancy excess weight has potentially contributed to 21% of planned caesarean deliveries in primiparae (almost 45% of such cases among overweight/obese primiparea were potentially attributed to pregestational excess weight). One-third of gestational hypertension and gestational diabetes cases among overweight/obese mothers could be attributed to pregestational excess weight, although results did not reach statistical significance. Conclusions: Pregestational overweight and obesity continued to increase even more in recent years. Findings further support that maternal excess weight has a significant effect on and contribution to multiple maternal obstetric complications and the mode of delivery, underlining the necessity of obesity prevention, health policy strategies and health care that can result in significant individual and societal benefits

Maternal social capital and birth outcomes in the mother child cohort in Crete, Greece (Rhea study)

This cohort study aimed to estimate the effect of individual maternal social capital during pregnancy on birth outcomes in the context of the Mother child cohort (Rhea study), in Crete - Greece. Women were recruited from four prenatal clinics in Heraklion - Crete for one year beginning in February 2007. 610 women completed the self-administered Social Capital Questionnaire at about the 24th week of gestation. The scale assessed total maternal social capital and four social capital subscales: Participation in the Community, Feelings of Safety, Value of Life and Social Agency, and Tolerance of Diversity. Potential confounders included characteristics that have an established or potential association w th the maternal social capital, and the birth outcomes (preterm birth, small weight for the gestational age, fetal weight growth restriction, weight, length and head circumference). The results of logistic and I near regression models indicated that there was an increase in the risk of preterm birth for every unit increase in maternal participation (range 12-48), and especially in the risk of medically indicated preterm birth. Although the findings suggest that participation is associated with an increased probability for preterm birth, we cannot know whether this is a protective or damaging social capital effect. Women who participate more in their communities may have enhanced access to information and/or resources, easier access to health care and support when they face maternal and fetal conditions that trigger the need for medical intervention. On the other hand, women may be more exposed to social and/or environmental stressors. Future research needs to distinguish between different types of participation and different components of social capital to better understand their associations with birth outcomes. (C) 2011 Elsevier Ltd. All rights reserved

Social capital, tolerance of diversity and adherence to Mediterranean diet: the Rhea Mother-Child Cohort in Crete, Greece

Objective: To estimate the associations of individual maternal social capital and social capital dimensions (Participation in the Community, Feelings of Safety, Value of Life and Social Agency, Tolerance of Diversity) with adherence to the Mediterranean diet during pregnancy. Design: This is a cross-sectional analysis of data from a prospective mother-child cohort (Rhea Study). Participants completed a social capital questionnaire and an FFQ in mid-pregnancy. Mediterranean diet adherence was evaluated through an a priori score ranging from 0 to 8 (minimal-maximal adherence). Maternal social capital scores were categorized into three groups: the upper 10% was the high social capital group, the middle 80% was the medium and the lowest 10% was the low social capital group. Multivariable log-binomial and linear regression models adjusted for confounders were performed. Setting: Heraklion, Crete, Greece. Subjects: A total of 377 women with singleton pregnancies. Results: High maternal Total Social Capital was associated with an increase of almost 1 point in Mediterranean diet score (highest upsilon. lowest group: beta coefficient=0.95, 95 % CI 0.23, 1.68), after adjustment for confounders. Similar dose-response effects were noted for the scale Tolerance of Diversity (highest v. lowest group: adjusted beta coefficient=1.08, 95 % CI 0.39, 1.77). Conclusions: Individual social capital and tolerance of diversity are associated with adherence to the Mediterranean diet in pregnancy. Women with higher social capital may exhibit a higher sense of obligation to themselves and to others that may lead to proactive nutrition-related activities. Less tolerant women may not provide the opportunity to new healthier, but unfamiliar, nutritional recommendations to become part of their regular diet

Is there an association between eating behaviour and attention-deficit/hyperactivity disorder symptoms in preschool children?

There is some evidence that aberrant eating behaviours and obesity co-occur with attention-deficit/hyperactivity disorder (ADHD) symptoms. The present study is the first that aims to investigate the association between eating behaviours and ADHD symptoms in early childhood in a population-based cohort

Gender-specific reference intervals for cord blood leptin in Crete, Greece

Cord leptin is a biomarker of fetal growth and adiposity with a role in predicting weight gain during the first months of life and childhood obesity. Our objective was to calculate gender-specific reference intervals for cord blood leptin in healthy neonates in Crete, Greece. We used data from the prospective mother-child cohort (”Rhea” study) in Crete, Greece. The analysis included 398 neonates chosen with strict inclusion criteria based on maternal and fetal characteristics. Cord leptin reference intervals for male neonates were 1.4-18.2 ng/mL and for females 2.0-25.8 ng/mL. Females had higher leptin levels (median 7.4; IQR 4.7-10.9) compared to males (median 4.9; IQR 3.2-7.6) (p < 0.001). Conclusion Gender-specific reference ranges are essential in clinical practice for correct interpretation of leptin values in cord blood and early detection of childhood obesity

Metabolic profile in early pregnancy is associated with offspring adiposity at 4 years of age: the rhea pregnancy cohort crete, Greece.

CONTEXT: Maternal pre-pregnancy obesity may increase the risk of childhood obesity but it is unknown whether other metabolic factors in early pregnancy such as lipid profile and hypertension are associated with offspring cardiometabolic traits. OBJECTIVE: Our objective was to investigate whether fasting lipid, glucose, and insulin levels during early pregnancy and maternal pre-pregnancy weight status, are associated with offspring adiposity measures, lipid levels and blood pressure at preschool age. DESIGN AND METHODS: The study included 618 mother-child pairs of the pregnancy cohort "Rhea" study in Crete, Greece. Pregnant women were recruited at the first prenatal visit (mean: 12weeks, SD: 0.7). A subset of 348 women provided fasting serum samples for glucose and lipid measurements. Outcomes measures were body mass index, abdominal circumference, sum of skinfold thickness, and blood pressure measurements at 4 years of age. A subsample of 525 children provided non-fasting blood samples for lipid measurements. RESULTS: Pre-pregnancy overweight/obesity was associated with greater risk of offspring overweight/obesity (RR: 1.83, 95%CI: 1.19, 2.81), central adiposity (RR: 1.97, 95%CI: 1.11, 3.49), and greater fat mass by 5.10mm (95%CI: 2.49, 7.71) at 4 years of age. These associations were more pronounced in girls. An increase of 40mg/dl in fasting serum cholesterol levels in early pregnancy was associated with greater skinfold thickness by 3.30mm (95%CI: 1.41, 5.20) at 4 years of age after adjusting for pre-pregnancy BMI and several other confounders. An increase of 10mmHg in diastolic blood pressure in early pregnancy was associated with increased risk of offspring overweight/obesity (RR: 1.22, 95%CI: 1.03, 1.45), and greater skinfold thickness by 1.71mm (95% CI: 0.57, 2.86) at 4 years of age./nCONCLUSIONS: Metabolic dysregulation in early pregnancy may increase the risk of obesity at preschool age.Rhea project was financially supported by European projects (EU FP6-2003-Food-3- NewGeneris, EU FP6. STREP Hiwate, EU FP7Rhea project was financially supported byEuropean projects (EU FP6-2003-Food-3-NewGeneris, EU FP6. STREP Hiwate, EU FP7. ENV.2007.1.2.2.2. Project No 211250 Escape, EUFP7-2008-ENV-1.2.1.4 Envirogenomarkers, EU FP7-HEALTH-2009- single stage CHICOS, EU FP7ENV.2008.1.2.1.6. Proposal No 226285 ENRIECO,EU- FP7- HEALTH-2012 Proposal No 308333HELIX) and the Greek Ministry of Health (Program ofPrevention of obesity and neurodevelopmental disorders in preschool children, in Heraklion district,Crete, Greece: 2011-2014;“Rhea Plus”: Primary Prevention Program of Environmental Risk Factors for Reproductive Health, and Child Health: 2012-15