Effect of environmental phthalate exposure on pregnancy duration and birth outcomes

Objectives: The objective of this study was to evaluate the impact of phthalate exposure on pregnancy duration and birth outcomes based on the Polish Mother and Child Cohort (REPRO_PL). Material and Methods: Phthalate exposure was determined by measuring 11 phthalate metabolites (mono-ethyl phthalate (MEP), mono-iso-butyl phthalate (MiBP), mono-n-butyl phthalate (MnBP), 3OH-mono-n-butyl phthalate (OH-MnBP), mono-benzyl phthalate (MBzP), mono‑ (2-ethylhexyl) phthalate (MEHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono-hydroxy-iso-nonyl phthalate (MHiNP), mono-oxo-iso-nonyl phthalate (MOiNP), and mono-n-octyl phthalate (MOP)) in the urine collected from 165 mothers during the third trimester of pregnancy by high performance liquid chromatography with tandem mass spectrometry (HPLC-MS/MS). The following measures at birth were considered: gestational age, birth weight, length as well as head and chest circumference. Results: Pregnancy duration was inversely associated with natural log concentrations (μg/g creatinine) of MEP (standardized regression coefficient (β) = –0.2, p = 0.04) after adjustment for a variety of confounders. Significant impact of MOiNP on head circumference (β = –0.1, p = 0.05) was also observed. Conclusions: The study findings add further support to the hypothesis that phthalate exposure may be associated with shorter pregnancy duration and a decreased head circumference, and underscore importance of public health interventions to reduce that exposure

A systematic review of maternal smoking during pregnancy and fetal measurements with meta-analysis

Funding: The study was supported by the European Cooperation in Science and Technology, who provided funds for publication. KMG is supported by the National Institute for Health Research through the NIHR Southampton Biomedical Research Centre and by the European Union's Seventh Framework Programme (FP7/2007-2013), projects Early Nutrition and ODIN under grant agreement numbers 289346 and 613977.Peer reviewedPublisher PD

The relationship between physical activity level and selected cardiovascular risk factors and mortality of males ≥ 50 years in Poland – The results of follow-up of participants of National Multicenter Health Survey WOBASZ

Objectives: The role of leisure-time physical activity in reducing all-cause and cardiovascular mortality is well explored. The knowledge on occupational and commuting physical activity continues to be ambiguous and misleading. The aim of the study is to assess the influence of different kinds of physical activity on cardiovascular mortality risk in men. Material and Methods: Data analysis on physical activity level and other selected cardiovascular risk factors acquired from 3577 men in the age between 50–80 years who participated in the National Multicenter Health Survey WOBASZ (Wieloośrodkowe Ogólnopolskie Badanie Stanu Zdrowia), Poland (2003–2005) was linked with male mortality in 2004–2009. Data about causes of deaths were obtained from the Central Statistical Office and the Population Electronic Register. Results: Among males aged 50–59 years, the strongest risk factor was living in large settlements and provincial capitals as a place of residence and the most protective factor was occupational physical activity. In the age group 60–69 years and 70–80 years, the strongest protective effect was observed for leisure-time physical activity. In men aged between 70–80 years (unlike in the 50–59 years age group), the protective effect of large settlements and provincial capitals as a place of residence was noted. Conclusions: Occupational physical activity significantly reduced cardiovascular mortality in men aged 50–69 years, while for leisure-time activity the positive effect was observed in age group 60–69 years and 70–80 years. On the other hand, for the inhabitants of large settlements and provincial capitals, significantly higher risk of cardiovascular mortality in the age group 50–69 years and lower risk in the age group ≥ 70 years was noted, both in comparison with smaller places of residence

Analysis of tasks of occupational health services accomplished in Poland, 1997–2014. Do we exploit the full potential of prophylactic examinations of workers?

Background: Mandatory medical reports can be used to evaluate the scope of activity of occupational health services (OHS), including the number and kind of services. Material and Methods: The analysis comprised data for the period 1997–2014, derived from mandatory reports MZ-35A submitted by OHS units. Results: During the analyzed period the number of occupational medicine physicians decreased from 8507 to 6741, while the number of OHS units – responsible for prophylactic care – increased from 4967 to 6261. In the years under report 3,961 million mandatory health check-ups were performed, of which 99.3% resulted in issuing fitness for work certificates. Pre-employment examinations made 38.8%, while periodical ones – 52.8% and control ones – 6.7% of all check-ups. Moreover, 336 700 examinations of apprentices, students, vocational courses attendants and Ph.D. students were performed to evaluate any contradictions for vocational training. In 2014, there were 1871 workers provided with preventive care per 1 occupational physician. It was estimated that despite legal obligation, only 22.2% of employers had signed agreements with OHS units. Conclusions: The analysis of the number and kind of services provided by OHS units revealed high but not fully exploited potential for efficient prophylaxis of both directly occupational work-related and indirectly work-exacerbated diseases. Med Pr 2017;68(1):105–11

A systematic review of maternal smoking during pregnancy and fetal measurements with meta-analysis

Background Maternal smoking during pregnancy is linked to reduced birth weight but the gestation at onset of this relationship is not certain. We present a systematic review of the literature describing associations between maternal smoking during pregnancy and ultrasound measurements of fetal size, together with an accompanying meta-analysis. Methods Studies were selected from electronic databases (OVID, EMBASE and Google Scholar) that examined associations between maternal smoking or smoke exposure and antenatal fetal ultrasound measurements. Outcome measures were first, second or third trimester fetal measurements. Results There were 284 abstracts identified, 16 papers were included in the review and the metaanalysis included data from eight populations. Maternal smoking was associated with reduced second trimester head size (mean reduction 0.09 standard deviation (SD) [95% CI 0.01, 0.16]) and femur length (0.06 [0.01, 0.10]) and reduced third trimester head size (0.18SD [0.13, 0.23]), femur length (0.27 SD [0.21, 0.32]) and estimated fetal weight (0.18 SD [0.11, 0.24]). Higher maternal cigarette consumption was associated with a lower z score for head size in the second (mean difference 0.09 SD [0, 0.19]) and third (0.15 SD [0.03, 0.26]) trimesters compared to lower consumption. Fetal measurements were not reduced for those whose mothers quit before or after becoming pregnant compared to mothers who had never smoked. Conclusions Maternal smoking during pregnancy is associated with reduced fetal measurements after the first trimester, particularly reduced head size and femur length. These effects may be attenuated if mothers quit or reduce cigarette consumption during pregnancy

Associations between maternal physical activity in early and late pregnancy and offspring birth size: remote federated individual level meta-analysis from eight cohort studies.

OBJECTIVE: Evidence on the impact of leisure time physical activity (LTPA) in pregnancy on birth size is inconsistent. We aimed to examine the association between LTPA during early and late pregnancy and newborn anthropometric outcomes. DESIGN: Individual level meta-analysis, which reduces heterogeneity across studies. SETTING: A consortium of eight population-based studies (seven European and one US) comprising 72,694 participants. METHODS: Generalised linear models with consistent inclusion of confounders (gestational age, sex, parity, maternal age, education, ethnicity, BMI, smoking and alcohol intake) were used to test associations between self-reported LTPA at either early (8-18 weeks gestation) or late pregnancy (30+ weeks) and the outcomes. Results were pooled using random effects meta-analyses. MAIN OUTCOME MEASURES: Birth weight, Large-for-gestational age (LGA), macrosomia, small-for-gestational age (SGA), %body fat and ponderal index at birth. RESULTS: Late, but not early, gestation maternal moderate-to-vigorous physical activity (MVPA), vigorous activity and LTPA energy expenditure were modestly inversely associated with BW, LGA, macrosomia and ponderal index, without heterogeneity (all: I-square=0%). For each extra hour/week of MVPA, RR for LGA and macrosomia were 0.97 (95% CI: 0.96, 0.98) and 0.96 (95%CI: 0.94, 0.98) respectively. Associations were only modestly reduced after additional adjustments for maternal BMI and gestational diabetes. No measure of LTPA was associated with risk for SGA. CONCLUSIONS: Physical activity in late, but not early, pregnancy is consistently associated with modestly lower risk of LGA and macrosomia, but not SGA. This article is protected by copyright. All rights reserved.Includes MRC, Wellcome Trust and NIHR

Deriving the dietary approaches to stop hypertension (DASH) score in women from seven pregnancy cohorts from the European alphabet consortium

The ALPHABET consortium aims to examine the interplays between maternal diet quality, epigenetics and offspring health in seven pregnancy/birth cohorts from five European countries. We aimed to use the Dietary Approaches to Stop Hypertension (DASH) score to assess diet quality, but different versions have been published. To derive a single DASH score allowing cross-country, cross-cohort and cross-period comparison and limiting data heterogeneity within the ALPHABET consortium, we harmonised food frequency questionnaire (FFQ) data collected before and during pregnancy in ≥26,500 women. Although FFQs differed strongly in length and content, we derived a consortium DASH score composed of eight food components by combining the prescriptive original DASH and the DASH described by Fung et al. Statistical issues tied to the nature of the FFQs led us to re-classify two food groups (grains and dairy products). Most DASH food components exhibited pronounced between-cohort variability, including non-full-fat dairy products (median intake ranging from 0.1 to 2.2 servings/day), sugar-sweetened beverages/sweets/added sugars (0.3–1.7 servings/day), fruits (1.1–3.1 servings/day), and vegetables (1.5–3.6 servings/day). We successfully developed a harmonized DASH score adapted to all cohorts being part of the ALPHABET consortium. This methodological work may benefit other research teams in adapting the DASH to their study’s specificities

Occupational Exposure to Endocrine-Disrupting Chemicals and Birth Weight and Length of Gestation: A European Meta-Analysis

BACKGROUND: Women of reproductive age can be exposed to endocrine-disrupting chemicals (EDCs) at work and exposure to EDCs in pregnancy may affect fetal growth. OBJECTIVES: We assessed whether maternal occupational exposure to EDCs during pregnancy as classified by application of a job exposure matrix was associated with birth weight, term low birth weight (LBW), length of gestation, and preterm delivery. METHODS: Using individual participant data from 133,957 mother-child pairs in 13 European cohorts spanning births from 1994 to 2011, we linked maternal job titles with exposure to 10 EDC groups as assessed through a job exposure matrix. For each group, we combined the two levels of exposure categories (possible and probable) and compared birth outcomes with the unexposed group (exposure unlikely). We performed meta-analyses of cohort-specific estimates. RESULTS: Eleven percent of pregnant women were classified as exposed to EDCs at work during pregnancy based on job title. Classification of exposure to one or more EDC group was associated with an increased risk of term LBW (OR 1.25, 95%CI 1.04, 1.49), as were most specific EDC groups; this association was consistent across cohorts. Further, the risk increased with increasing number of EDC groups (OR 2.11 95%CI 1.10, 4.06 for exposure to 4 or more EDC groups). There were few associations (p < 0.05) with the other outcomes; women holding job titles classified as exposed to bisphenol A or brominated flame retardants were at higher risk for longer length of gestation. CONCLUSION: Results from our large population-based birth cohort design indicate that employment during pregnancy in occupations classified as possibly or probably exposed to EDCs was associated with an increased risk of term LBW

Changes in parental smoking during pregnancy and risks of adverse birth outcomes and childhood overweight in Europe and North America : An individual participant data meta-analysis of 229,000 singleton births

Author summaryWhy was this study done? Maternal smoking during pregnancy is an important risk factor for various birth complications and childhood overweight. It is not clear whether this increased risk is also present if mothers smoke during the first trimester only or reduce the number of cigarettes during pregnancy. The associations of paternal smoking with birth and childhood outcomes also remain unknown. What did the researchers do and find? We conducted an individual participant data meta-analysis using data from 229,158 families from 28 pregnancy and birth cohorts from Europe and North America to assess the associations of parental smoking during pregnancy, specifically of quitting or reducing smoking and maternal and paternal smoking combined, with preterm birth, small size for gestational age, and childhood overweight. We observed that smoking in the first trimester only did not increase the risk of preterm birth and small size for gestational age but was associated with a higher risk of childhood overweight, as compared to nonsmoking. Reducing the number of cigarettes during pregnancy, without quitting, was still associated with higher risks of these adverse outcomes. Paternal smoking seems to be associated, independently of maternal smoking, with the risks of childhood overweight. What do these findings mean? Population strategies should focus on parental smoking prevention before or at the start of, rather than during, pregnancy. Future studies are needed to assess the specific associations of smoking in the preconception and childhood periods with offspring outcomes. Background Fetal smoke exposure is a common and key avoidable risk factor for birth complications and seems to influence later risk of overweight. It is unclear whether this increased risk is also present if mothers smoke during the first trimester only or reduce the number of cigarettes during pregnancy, or when only fathers smoke. We aimed to assess the associations of parental smoking during pregnancy, specifically of quitting or reducing smoking and maternal and paternal smoking combined, with preterm birth, small size for gestational age, and childhood overweight. Methods and findings We performed an individual participant data meta-analysis among 229,158 families from 28 pregnancy/birth cohorts from Europe and North America. All 28 cohorts had information on maternal smoking, and 16 also had information on paternal smoking. In total, 22 cohorts were population-based, with birth years ranging from 1991 to 2015. The mothers' median age was 30.0 years, and most mothers were medium or highly educated. We used multilevel binary logistic regression models adjusted for maternal and paternal sociodemographic and lifestyle-related characteristics. Compared with nonsmoking mothers, maternal first trimester smoking only was not associated with adverse birth outcomes but was associated with a higher risk of childhood overweight (odds ratio [OR] 1.17 [95% CI 1.02-1.35],Pvalue = 0.030). Children from mothers who continued smoking during pregnancy had higher risks of preterm birth (OR 1.08 [95% CI 1.02-1.15],Pvalue = 0.012), small size for gestational age (OR 2.15 [95% CI 2.07-2.23],Pvalue <0.001), and childhood overweight (OR 1.42 [95% CI 1.35-1.48],Pvalue <0.001). Mothers who reduced the number of cigarettes between the first and third trimester, without quitting, still had a higher risk of small size for gestational age. However, the corresponding risk estimates were smaller than for women who continued the same amount of cigarettes throughout pregnancy (OR 1.89 [95% CI 1.52-2.34] instead of OR 2.20 [95% CI 2.02-2.42] when reducing from 5-9 to = 10 to 5-9 andPeer reviewe