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Background:Global prevalence of overweight/obesity and gestational diabetes (GDM) is increasing. In pregnant women both conditions affect offspring’s later health. Overweight/obesity is a risk factor of GDM; to what extent maternal overweight/obesity explains long-term effects of GDM in offspring is unknown.Objective:To evaluate effects of maternal pre-pregnancy overweight/obesity (body mass index (BMI) ⩾25 kg m−2) and GDM, occurring together or separately, on body composition among adult offspring.Methods:Participants include 891 individuals aged 24.1 years (s.d. 1.4) from two longitudinal cohort studies (ESTER and AYLS). Adult offspring of normoglycemic mothers with overweight/obesity (ONOO, n=153), offspring of mothers with GDM (OGDM; n=191) and controls (n=547) underwent anthropometric measurements and bioimpedance analysis. Gestational diabetes mellitus was diagnosed by oral glucose tolerance test. Data were analyzed by linear regression models adjusted for confounders.Results:Compared with controls, ONOO-participants showed higher BMI (men 1.64 kg m−2(95% confidence interval 0.57, 2.72); women 1.41 kg m−2(0.20, 2.63)) and fat percentage (men 2.70% (0.99, 4.41); women 2.98% (0.87, 5.09)) with larger waist circumferences (men 3.34 cm (0.68, 5.99); women 3.09 cm (0.35, 5.83)). Likewise, OGDM-participants showed higher fat percentage (men 1.97% (0.32, 3.61); women 2.32% (0.24, 4.41)). Body mass index was non-significantly different between OGDM-participants and controls (men 0.88 kg m−2(−0.17, 1.92); women 0.82 kg m−2(−0.39, 2.04)). Also waist circumferences were larger (men 2.63 cm (−0.01, 5.28); women 3.39 cm (0.60, 6.18)); this difference was statistically significant in OGDM-women only. Differences in body composition measures were stronger among offspring of women with both GDM and overweight/obesity. For instance, fat mass was higher among OGDM-participants of overweight mothers (men 4.24 kg (1.36, 7.11) vs controls; women 5.22 kg (1.33, 9.11)) than OGDM participants of normal weight mothers (men 1.50 kg (−2.11, 5.11) higher vs controls; women 1.57 kg (−3.27, 6.42)).Conclusions:Maternal pre-pregnancy overweight and GDM are associated with unhealthy body size and composition in offspring over 20 years later. Effects of maternal pre-pregnancy overweight appear more pronounced.

This is a brief review of the normal changes in adolescent behaviour and the interplay between biology and social factors that occur at and around puberty, in an attempt to explain when this transition may become problematic The onset of puberty is a biological marker for an individual's transition from a non-reproductive to a reproductive state. Adolescence is a normal developmental transition associated with clearly visible physical changes, reorganization and pruning of neuronal circuits in the brain and the occurrence of new behaviours and interests. It is a time when new life tasks (orientation towards peers of the other sex, romantic and sexual involvement and mastering an educational career) need to be mastered. Parent-child conflict increases and becomes more intense as the adolescent struggles for more independence while still requiring support. These normal changes can become problematic if biological and social expectations diverge e.g. entering puberty very early or very late. While early pubertal onset in boys is likely to have beneficial effects, in girls precocious pubertal timing may have a negative impact on body-image, affect (or emotional well-being) and sex-role expectations. Other individual biological predispositions and genetic endowment may interact with social factors (e.g. peers, parenting style, neighbourhood) making adolescence either an adaptive or a challenging transition. There is a lack of sufficiently large longitudinal studies that have been able to study this interaction between genetics, biology and social environment on adolescent development. The Avon Longitudinal Study of Parents and Children (ALSPAC) cohort provides a unique opportunity to investigate the impact of pubertal timing on social behaviour. Planned assessments and concepts are outlined.

This is a brief review of the normal changes in adolescent behaviour and the interplay between biology and social factors that occur at and around puberty, in an attempt to explain when this transition may become problematic The onset of puberty is a biological marker for an individual's transition from a non-reproductive to a reproductive state. Adolescence is a normal developmental transition associated with clearly visible physical changes, reorganization and pruning of neuronal circuits in the brain and the occurrence of new behaviours and interests. It is a time when new life tasks (orientation towards peers of the other sex, romantic and sexual involvement and mastering an educational career) need to be mastered. Parent-child conflict increases and becomes more intense as the adolescent struggles for more independence while still requiring support. These normal changes can become problematic if biological and social expectations diverge e.g. entering puberty very early or very late. While early pubertal onset in boys is likely to have beneficial effects, in girls precocious pubertal timing may have a negative impact on body-image, affect (or emotional well-being) and sex-role expectations. Other individual biological predispositions and genetic endowment may interact with social factors (e.g. peers, parenting style, neighbourhood) making adolescence either an adaptive or a challenging transition. There is a lack of sufficiently large longitudinal studies that have been able to study this interaction between genetics, biology and social environment on adolescent development. The Avon Longitudinal Study of Parents and Children (ALSPAC) cohort provides a unique opportunity to investigate the impact of pubertal timing on social behaviour. Planned assessments and concepts are outlined.

Abstract. On the assumption of the truth of the Riemann hypothesis for the Riemann zeta function we construct a class of modified von-Mangoldt functions with slightly better mean value properties than the well known function $\Lambda $. For every $\varepsilon \in (0,1/2)$ there is a $\tilde {\Lambda} : \Bbb N \to \Bbb C$ such that¶ i) $\tilde {\Lambda} (n) = \Lambda (n) (1 + O(n^{-1/4\,} \log n))$ and¶ii) $\sum \limits_{n \leqq x} \tilde {\Lambda} (n) \left(1- {{n}\over{x}}\right) = {{x}\over{2}} + O(x^{1/4+\varepsilon }) (x \geqq 2).$¶Unfortunately, this does not lead to an improved error term estimation for the unweighted sum $\sum \limits_{n \leqq x} \tilde {\Lambda} (n)$, which would be of importance for the distance between consecutive primes.

Background: Eating is a primary biological need. Feeding is of great importance for the development and consolidation of the social relationship between infant and the primary caretaker. A minority of children and their parents, however, have distressing experiences around feeding and eating that can lead to long-term problems in the parent-child relationship and the child’s health.Objective: To provide a review of the prevalence, etiological factors and consequences of feeding problems, and to describe a behavioral approach to the treatment of feeding problems.Method: Literature review.Results: Major feeding problems in infancy are refusal to eat any food or solid food, very selective eating, lack of appetite and failure to thrive with feeding problems. The prevalence of severe feeding problems has been estimated to be around 6–10%, and of failure to thrive to be between 3 and 4% in the general infant population. Feeding problems often lead to impaired growth and as a consequence have been found to affect the cognitive, behavioral and social development of children. Disturbances of mother-infant interaction, both as an etiological factor and as a secondary problem, are often found. A developmental task-orientated biological-behavioral model of the etiology of feeding problems is introduced and an approach to treating food refusal and failure to thrive is described. Behavior modification techniques, modified for the treatment of feeding problems, are introduced. A multi-disciplinary behavioral treatment approach to feeding problems has been reported in case series to be highly successful for treating feeding problems.Conclusions: Feeding problems are frequent and, if untreated, can have adverse consequences on the child’s development. There is evidence for the effectiveness of a multi-disciplinary behaviorally and developmentally orientated treatment approach in small case series. However, sufficiently large randomized controlled trials of the effectiveness of behavioral treatment approaches in clinical practice are lacking.

Forty‐seven children with non‐organic failure to thrive (NOFT) were identified from a whole‐population survey of children's growth and development. A significant proportion (N=17) of these 47 children were found to have oral‐motor dysfunction (OMD) identified using a previously validated assessment tool. NOFT children with OMD and those with normal oral‐motor function (N=30) were compared in order to ascertain whether there were any neurodevelopmental differences which might explain this finding. We hypothesized that children with OMD might have a subtle neurodevelopmental disorder. Few psychosocial variables discriminated the two groups. However, cognitive stimulation within the home and cognitive‐growth fostering during mealtimes was much poorer for children with OMD. Some evidence has suggested that NOFT children with OMD may be‘biologically’more vulnerable from birth. We suggest that the continued use of the term‘non‐organic’to describe failure to thrive in such children is questionable and requires redefining.

Objective: To determine the influence of breast-feeding on the prevalence and persistence of sleeping problems in southern Finland (SF) and southern Germany (SG). Design: Prospective binational population study of infants admitted to special care units (SCUs) in geographically defined areas in SF and SG. Subjects: In SF, the number of SCU infants was 1057 (very preterm, 47; preterm, 258; term, 752); 485 term infants were control subjects. In SG, the number of SCU infants was 4427 (very preterm, 284; preterm, 1419; term, 2724). Main outcome measure: Parent reports of child sleeping problems at 5, 20, and 56 months of age. Results: Night waking at 5 months of age was less frequent for SCU very preterm (25.5%), preterm (40.6%), and term infants (48%) than for term control subjects (56.7% to 59.9%) in SF. No differences in sleeping behavior according to gestation were found at 20 and 56 months. Sleeping problems were greater in SF infants (25.5% to 48%) than in SG infants (15.1% to 19.1%) at 5 months of age and were explained by a higher rate of breast-feeding in SF. Breast-feeding had no long-term effects on night waking or on co-sleeping in SF. In contrast, breast-fed infants continued to wake more often in SG. Conclusions: Breast-feeding rather than gestational age is strongly related to night waking. More support for dealing with night waking might prevent early termination of breast-feeding. (J Pediatr 1998;133:224-31)

Background and aims: Some studies have observed poorer cognitive development in children born late preterm (34-36 weeks gestation) and early term (37-38 weeks gestation). Few studies have measured school performance in these children. We compared school performance in children born at full term (39-41 weeks gestation) with those born early term, late preterm and moderately/very preterm (< 34 weeks gestation).Methods: We analysed data on 7,655 children from the Millennium Cohort Study who were attending school in England in 2006. School performance was measured using the Foundation Stage Profile (FSP), a statutory assessment by teachers at the end of the child's first school year (age 5). The FSP comprises 13 assessment scales (scored from 0-9). Children who achieve an average of 6 points per scale and at least 6 in certain scales are classified as “reaching a good level of overall achievement”.Results: 51% of full term children had not reached a good level of overall achievement; this proportion increased with prematurity (55% in early term, 59% in late preterm, 64% in moderately/very preterm children). Compared with full term children, there were significantly elevated odds even in late preterm (adjusted OR 1.4, 95% CI: 1.1, 1.7) and early term (adjusted OR 1.2, 95% 1.0, 1.3) children. Early term birth accounted for a similar population attributable fraction (3%) as for all the preterm groups combined (gestation 23-36 weeks) (3%).Conclusions: Late preterm and early term birth are associated with an elevated risk of poorer school performance at age 5.

Background: Assessing educational outcomes in high-risk populations is crucial for defining long term functional outcomes. Standardised tests are costly and time-consuming for large-scale investigations. A valid and reliable teacher-report measure would be advantageous.Aim: To assess the psychometric properties of the 'Teacher Academic Attainment Scale' (TAAS).Methods: Participants comprised 340 children aged 10-11 years (n=187 born extremely preterm [< 26 weeks] and n=153 born at term) were assessed using the reading and mathematics scales of the Wechsler Individual Achievement Test-II (WIAT-II), a Gold Standard measure. Class teachers completed the TAAS, a 7-item questionnaire for assessing academic attainment. The TAAS was also completed at 6 years of age for 266 children.Results: Cronbach's alpha=0.95 indicated excellent internal consistency, and a significant correlation (r=0.77, p< 0.001) between TAAS scores at 6 and 11 years indicated good long-term test-retest reliability. Significantly higher TAAS scores for term vs. preterm children demonstrated discriminative validity. TAAS scores at both 6 and 11 years were significantly correlated with WIAT-II reading (r=0.69 & r=0.75, p< 0.001) and mathematics (r=0.75 & r=0.82, p< 0.001) scores demonstrating good predictive and concurrent validity, respectively. TAAS scores < 2.5 were good predictors of learning impairment in reading (sensitivity 93% specificity 78%) and mathematics (sensitivity 90% specificity 87%).Conclusions: The TAAS is a brief, psychometrically sound teacher-report of academic attainment that yields both continuous and categorical outcomes. It provides a highly reliable, valid, cost- and time-efficient outcome measure for large-scale multi-site studies both within and across countries.

Methods: Changes in dyadic mother-child interactions were investigated in a geographically defined prospective whole-population sample of very preterm and/or very low birth weight children (VLBW/VP; n = 265) and compared to a matched sample of fullterm controls (n = 276).Results: At both 6 and 8 years, VLBW/VP children were less persistent and socially engaging and their mothers behaved less sensitive and more controlling. Differences in maternal behavior between groups disappeared once adjusted for child IQ. The patterns of change over two years in child overall activity, maternal sensitivity and verbal control, as well as harmony of interactions were similar in both groups. However, significant improvements in task persistence and social interaction were found for VLBW/VP children only. Structural equation modeling confirmed that bidirectional influences shaped mother and child behavior development and, specifically, that VLBW/VP child characteristics predicted maternal behavior over time.Conclusions: Mothers of very preterm children are not less sensitive or controlling but their behavior is attuned to the level of cognitive functioning of their children with the aim to facilitate attention regulation and task persistence.

AIMS: To investigate the effects of small for gestational age (SGA) in very low birthweight (VLBW) infants on growth and development until the fifth year of life. METHODS: VLBW (< 1500 g) infants, selected from a prospective study, were classified as SGA (n = 115) on the basis of birth weight below the 10th percentile for gestational age and were compared with two groups of appropriate for gestational age (AGA) infants matched according to birth weight (AGA-BW; n = 115) or gestation at birth (AGA-GA; n = 115). Prenatal, perinatal, and postnatal risk factors were recorded, and duration and intensity of treatment were computed from daily assessments. Body weight, length, and head circumference were measured at birth, five and 20 months (corrected for prematurity), and at 56 months. General development was assessed at five and 20 months with the Griffiths scale of babies abilities, and cognitive development at 56 months with the Columbia mental maturity scales, a vocabulary (AWST) and language comprehension test (LSVTA). RESULTS: Significant group differences were found in complications (pregnancy, birth, and neonatal), parity, and multiple birth rate. The AGA-GA group showed most satisfactory growth up to 56 months, with both the AGA-BW and SGA groups lagging behind. The AGA-GA group also scored significantly more highly on all developmental and cognitive tests than the other groups. Developmental test results were similar for the SGA and AGA-BW groups at five and 20 months, but AGA-BW infants (lowest gestation) had lower scores on performance intelligence quotient and language comprehension at 56 months than the SGA group. When prenatal and neonatal complications, parity, and multiple birth were accounted for, group differences in growth remained, but differences in cognitive outcome disappeared after five months. CONCLUSIONS: Being underweight and with a short gestation (SGA and VLBW) leads to poor weight gain and head growth in infancy but does not result in poorer growth than in infants of the same birth weight but shorter gestation (AGA-BW) in the long term. SGA is related to early developmental delay and later language problems; however, neonatal complications may have a larger detrimental effect on long term cognitive development of VLBW infants than whether they are born SGA or AGA.