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Background: The EU LifeCycle Project was launched in 2017 to combine, harmonize, and analyze data from more than 250,000 participants across Europe and Australia, involving cohorts participating in the EU-funded LifeCycle Project. The purpose of this cohort description is to provide a detailed overview of the major measures within mental health domains that are available in 17 European and Australian cohorts participating in the LifeCycle Project. Methods: Data on cognitive, behavioral, and psychological development has been collected on participants from birth until adulthood through questionnaire and medical data. We developed an inventory of the available data by mapping individual instruments, domain types, and age groups, providing the basis for statistical harmonization across mental health measures. Results: The mental health data in LifeCycle contain longitudinal and cross-sectional data from birth throughout the life course, covering domains across a wide range of behavioral and psychopathology indicators and outcomes, including executive function, depression, ADHD, and cognition. These data span a unique combination of qualitative data collected through behavioral/cognitive/mental health questionnaires and examination, as well as data from biological samples and indices in the form of imaging (MRI, fetal ultrasound) and DNA methylation data. Harmonized variables on a subset of mental health domains have been developed, providing statistical equivalence of measures required for longitudinal meta-analyses across instruments and cohorts. Conclusion: Mental health data harmonized through the LifeCycle project can be used to study life-course trajectories and exposure-outcome models that examine early life risk factors for mental illness and develop predictive markers for later-life disease.

RationaleSevere fetal malnutrition has been related to an increased risk of respiratory diseases later in life, but evidence for the association of a suboptimal diet during pregnancy with respiratory outcomes in childhood is conflicting. We aimed to examine whether a pro-inflammatory or low-quality maternal diet during pregnancy was associated with child's respiratory health.MethodsWe performed an individual participant meta-analysis among 18 326 mother–child pairs from seven European birth cohorts. Maternal pro-inflammatory and low-quality diets were estimated by energy-adjusted Dietary Inflammatory Index (E-DII) and Dietary Approaches to Stop Hypertension (DASH) scores. Preschool wheezing and school-age asthma were measured using questionnaires and lung function by spirometry.ResultsAfter adjustment for lifestyle and sociodemographic factors, we observed that a higher maternal E-DII score (a more pro-inflammatory diet) during pregnancy was associated only with a lower forced vital capacity (FVC) in children (z-score difference −0.05, 95% CI −0.08– −0.02, per interquartile range increase). No linear associations of the maternal E-DII or DASH score with child's wheezing or asthma were observed. In an exploratory examination of the extremes, a very low DASH score (ConclusionThe main results from this individual participant data meta-analysis do not support the hypothesis that maternal pro-inflammatory or low-quality diet in pregnancy are related to respiratory diseases in childhood.

Introduction The relationship between allergen exposure to animals in pregnancy and the development of allergic symptoms is not clear. Aim To evaluate the association between prenatal and postnatal exposure to pet ownership and development of atopic dermatitis, food allergy and wheezing in children at the age of 1 and 2. Material and methods The mother-child pairs included in this study were part of the Polish Mother and Child Cohort. Mothers in each trimester of pregnancy and 1 year after childbirth have completed a questionnaire on animal exposure. Children's health status was assessed at around one year and two years of age. Results Keeping a dog at home before and during pregnancy (every trimester) decreased the risk of food allergy in the first year of life. On the other hand, keeping any animal other than a dog (cat, hamster, guinea pig, rabbit) before pregnancy and during each trimester separately increased the risk of food allergy in the first year of life of children. Keeping a guinea pig in the first trimester of pregnancy increased the risk of wheezing in the first year of life. The analysis did not show any significant associations between keeping animals at home before and during pregnancy and the occurrence of atopic dermatitis in the second year of life. Conclusions Keeping a dog at home before and during pregnancy decreased the risk of food allergy in 1-year-old children. This effect was eliminated in case of having a cat, hamster, guinea pig, or rabbit.

Background Bisphenol A (BPA) is an industrial chemical mostly used in the manufacture of plastics, resins and thermal paper. Several studies have reported adverse health effects with BPA exposures, namely metabolic disorders and altered neurodevelopment in children, among others. The aim of this study was to explore BPA exposure, its socio-demographic and life-style related determinants, and its association with neurodevelopmental outcomes in early school age children from Poland. Methods A total of 250 urine samples of 7 year-old children from the Polish Mother and Child Cohort Study (REPRO_PL) were analyzed for BPA concentrations using high performance liquid chromatography with online sample clean-up coupled to tandem mass spectrometry (online-SPE-LC-MS/MS). Socio-demographic and lifestyle-related data was collected by questionnaires or additional biomarker measurements. Emotional and behavioral symptoms in children were assessed using mother-reported Strengths and Difficulties Questionnaire (SDQ). Cognitive and psychomotor development was evaluated by Polish adaptation of the Intelligence and Development Scales (IDS) performed by trained psychologists. Results Urinary BPA concentrations and back-calculated daily intakes (medians of 1.8 μg/l and 46.3 ng/kg bw/day, respectively) were similar to other European studies. Urinary cotinine levels and body mass index, together with maternal educational level and socio-economic status, were the main determinants of BPA levels in Polish children. After adjusting for confounding factors, BPA has been found to be positively associated with emotional symptoms (β: 0.14, 95% CI: 0.022; 0.27). Cognitive and psychomotor development were not found to be related to BPA levels. Conclusions This study represents the first report of BPA levels and their determinants in school age children in Poland. The exposure level was found to be related to child emotional condition, which can have long-term consequences including social functioning and scholastic achievements. Further monitoring of this population in terms of overall chemical exposure is required.

Exposure to environmental factors, such as neurotoxic metals and micronutrients, during critical periods of development can contribute to long-term consequences in offspring's health, including neurodevelopmental outcomes. The aim of this study was to evaluate the association between simultaneous prenatal exposure to metals [lead (Pb), cadmium (Cd), mercury (Hg)] and micronutrients [selenium (Se), zinc (Zn), copper (Cu)] and neurodevelopmental outcomes in school-age children from the Polish Mother and Child Cohort (REPRO_PL). Metals and micronutrients concentrations were measured in cord blood (Pb, Cd, Se, Zn, Cu) and in maternal hair (Hg) collected during the 3rd trimester of pregnancy. Behavioral and emotional problems, as well as children's cognitive and psychomotor development, were assessed in 436 school-age children using the Strengths and Difficulties Questionnaire (SDQ, filled in by the mothers) and the Polish adaptation of the Intelligence and Development Scales (IDS, administered by trained psychologists). Multivariate regression models were applied after imputation of missing values, using two approaches: (i) a joint analysis taking into account all metals and micronutrients simultaneously, and (ii) an ExWAS study (single-exposure model). In the SDQ, Hyperactivity/Inattention problems and Total difficulties were associated with higher Hg concentrations in maternal hair (0.18, 95% CI: 0.05; 0.3; and 0.14, 95% CI: 0.01; 0.3, respectively), whereas Emotional symptoms were inversely associated with Se and Zn levels in cord blood (−0.13, 95% CI: −0.3; 0.004; and −0.10, 95% CI: −0.2; 0.02, respectively). In the IDS, cord blood Pb levels were found to be negatively associated with Fluid and Crystallized IQ (−0.12, 95% CI: −0.3; 0.02; and −0.14, 95% CI: −0.3; 0.007, respectively) as well as Mathematical skills (−0.15, 95% CI: −0.3; 0.01). The current research has been able to simultaneously assess the exposure to various interacting chemicals during the prenatal period. We demonstrate that prenatal co-exposures to Pb, Hg, Zn and Se have long-term influences on the neuropsychological outcome of school-age children.

The aim of the current study was to assess the perceived treatment effectiveness and beliefs with respect to the best advisor who could conduct smoking cessation treatment or counseling among socially disadvantaged light and heavy smokers. This could be crucial for implementation of a successful smoking cessation intervention among this vulnerable population.The current assessments were based on the data collected during the second wave of a cross-sectional study performed in the Piotrkowski District among 1668 adults aged 18-59, entitled to social aid from welfare institutions. Face-to-face interviews were conducted to collect the relevant data.The current daily smoking status was declared by 31% of the participants. About 23% of the study sample (74% of daily smokers) admitted to being heavy smokers with a meaningful difference between men and women (p0.05). About 29% of the daily smokers indicated that medications/pharmacotherapy could be a good method for giving up the habit. Fifteen percent of the participants shared the opinion that a smoking cessation specialist is the best advisor for counseling, and only about 7% would choose a general practitioner or pharmacist, and even fewer a nurse, as a person who could provide help to smokers. There were no statistically significant differences in any of the evaluated perceptions between the light and heavy smokers (p0.05).A high share of heavy smokers among socially disadvantaged people, and their perception that medications/pharmacotherapy would be a good solution to quit smoking, underline the need for stronger support for this method, including relevant financing resources and training. However, this method should be applied along with behavioral counseling. Int J Occup Med Environ Health. 2019;32(4):527-36.

OBJECTIVES: This study aimed at assessment of the perceived barriers and motivators to smoking cessation among socially-disadvantaged populations in Poland. It is hypothesized that different factors can be considered depending on the level of smoking addiction. Therefore, a comparison between light and heavy smokers was performed. MATERIAL AND METHODS: Data collected during the second wave of a cross-sectional study carried out in the Piotrkowski District in October 2016 - February 2017 among 1668 socio-economically disadvantaged persons constituted the source of information for the present study. Barriers and motivators to smoking cessation among daily smokers were identified via face-to face interviews. RESULTS: About one-third of the studied population admitted to being current daily smokers, almost 75% of whom were heavy smokers. The most common barriers to quitting smoking were related to difficulties in quitting (62%), the lack of willingness to quit (56%), as well as addiction and withdrawal symptoms (craving cigarettes [65%], habit [56%], stress and mood swings [55%]). A significantly higher proportion of such barriers was noted among heavy smokers compared to light smokers (p < 0.05). The following motivations to quit were pointed out by the respondents: available pharmacotherapy (47%), access to a free-of-charge cessation clinic (40%), and encouragement and support provided by their doctor (30%), with no differences between various levels of smoking addiction (p > 0.05). CONCLUSIONS: Developing effective interventions targeted at unique deprived populations requires understanding the barriers and motivators to quitting smoking. Social support and financial issues, including free-of-charge pharmacotherapy and cessation clinics, as well as doctor's encouragement and support, are crucial for successful smoking cessation in this vulnerable population

Objectives The objective of this study was to evaluate the association between breastfeeding duration and child neurodevelopment based on the Polish Mother and Child Cohort Study. Material and Methods The current analysis included 501 mother–child pairs. The analysis evaluating the association between the length of breastfeeding and child neurodevelopment considered the following variables: maternal age and body mass index, weight gain during pregnancy, parental level of education, marital status, socioeconomic status, child gender, birthweight, type of delivery, preterm delivery, pre- and postnatal exposure to tobacco constituents and child day care attendance. Psychomotor development was assessed in 1-year-olds on the Bayley Scales of Infant and Toddler Development . Results The length of breastfeeding correlated positively with maternal age at delivery (ρ = 0.13), maternal and paternal level of education (ρ = 0.2 and ρ = 0.14 respectively), birthweight (ρ = 0.1) and marital status (ρ = 0.16) (p < 0.05). A negative correlation between the length of breastfeeding and maternal smoking status during the first year after delivery (ρ = –0.19) and weight gain during pregnancy (r = –0.1) was observed (p < 0.05). The association between the duration of breastfeeding and child development was not statistically significant in the model with the inclusion of confounding variables. A significant association between language development and maternal level of education (p = 0.004), gender of the child (p = 0.0007) and maternal weight gain during pregnancy (p = 0.01) was found. A negative association between cognitive development and maternal salivary cotinine during pregnancy (p = 0.03) and a negative association between motor development and maternal smoking status during the first year after delivery (p = 0.007) were also found. Conclusions This study found no significant association between the duration of breastfeeding and child development after adjustment for confounders. Int J Occup Med Environ Health. 2019;32(2):175–84

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: I2 = 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.Tweetable abstract: In an individual participant meta‐analysis, late pregnancy moderate to vigorous physical activity modestly reduced birth size outcomes.

The study objective was to identify determinants of essential elements and vitamins intake, and microelements and vitamins concentration in blood among pregnant women from Poland. Based on the data from food frequency questionnaires and information about supplements taken (n = 1252), daily supply of six elements (calcium, magnesium, iron, zinc, copper, selenium) and nine vitamins (folate, vitamins A, E, C, B1, B2, B3, B6, B12) was calculated. Zinc, copper, selenium (n = 340), vitamin A and E (n = 358) concentration was determined in blood collected during pregnancy. Most of the women did not meet the demand for essential elements and vitamins with a diet. About 94% of the respondents declared supplements use. The women with higher education, indicating leisure-time, physical activity and multiparity had a higher chance of meeting the average demand for the majority of the analyzed nutrients. On the other hand, factors such as BMI &lt, 18.5kg/m2, a higher level of stress, and late first medical-care visit were associated with a lower chance of meeting the recommendations. Higher socio-economic status was a determinant of a higher selenium concentration in plasma (β = 3.1, 95%CI: 0.2–5.9), whereas BMI ≥ 25 kg/m2, and multiparity of a higher copper concentration in plasma (β = 0.2, 95%CI: 0.03-0.4, β = 0.2, 95%CI: 0.1–0.4). Higher plasma concentration of vitamin E was noted among women older than 30 years of age comparing to those who were 30 or younger (β = 1.5, 95%CI: 0.6–2.4). Although more studies are required, especially such based on laboratory measures, our results indicate target groups for dietary interventions during pregnancy for children’s optimal health and development.

Background Mounting evidence suggests that maternal diet influences pregnancy and birth outcomes, but its contribution to the global epidemic of childhood obesity has not as yet been definitively characterized. We investigated whether maternal whole diet quality and inflammatory potential influence childhood adiposity. Methods We harmonized and pooled individual participant data from 16,295 mother-child pairs in seven European birth cohorts. Maternal pre-, early-, late-, and whole-pregnancy (any time during pregnancy) dietary quality and inflammatory potential assessed with the Dietary Approaches to Stop Hypertension (DASH) score and the energy-adjusted Dietary Inflammatory Index (E-DII™) score, respectively. Primary outcome was childhood overweight and obesity (OWOB) (age-and-sex-specific BMI z-score > 85th percentile). Secondary outcomes were sum of skinfold thickness (SST), fat mass index (FMI) and fat-free mass index (FFMI). We used multivariable regression analyses (adjusting for maternal lifestyle and sociodemographic factors) to assess the associations of maternal DASH and E-DII scores with offspring adiposity outcomes in cohort-specific analyses, with subsequent random-effect meta-analyses. Results The study mothers had a mean (SD) age of 30.2 (4.6) years and a mean BMI of 23.4 (4.2) kg/m2. Higher early-pregnancy E-DII scores (more pro-inflammatory diet) tended to be associated with a higher odds of late-childhood [10.6 (1.2) years] OWOB [OR (95% CI) 1.09 (1.00, 1.19) per 1-SD E-DII score increase], whereas an inverse association was observed for late-pregnancy E-DII score and early-childhood [2.8 (0.3) years] OWOB [0.91 (0.83, 1.00)]. Higher maternal whole pregnancy DASH score (higher dietary quality) was associated with a lower odds of late-childhood OWOB [OR (95% CI) 0.92 (0.87, 0.98) per 1-SD DASH score increase]; associations were of similar magnitude for early and late-pregnancy [0.86 (0.72, 1.04) and 0.91 (0.85, 0.98), respectively]. These associations were robust in several sensitivity analyses and further adjustment for birth weight and childhood diet did not meaningfully alter the associations and conclusions. In two cohorts with available data, a higher whole pregnancy E-DII and lower DASH scores were associated with a lower late-childhood FFMI in males and a higher mid-childhood FMI in females (P interactions Conclusions A pro-inflammatory, low-quality maternal antenatal diet may adversely influence offspring body composition and OWOB risk, especially during late-childhood. Promoting an overall healthy and anti-inflammatory maternal dietary pattern may contribute to the prevention of childhood obesity, a complex health issue requiring multifaceted strategy.

It has been proven that outdoor and indoor air pollutants can cause adverse health effects and are able to promote the onset of atopic diseases. The current manuscript is focused on methodological issues. The aim of the study is to determine the effect of air pollution, urban environment, and urban heat islands (UHIs) on the occurrence of respiratory diseases including allergic rhinitis, asthma and wheezing in preschool children. The study group consists of 276 five-year-old children attending randomly selected kindergartens in the urban and rural areas of the Łódź Voivodeship. The questionnaire including data on the child’s state of health and socio-economic data will be filled by the caregivers. The children will undergo skin prick testing and the measurement of volatile organic compounds in exhaled breath. The key components of air pollution – particulate matter (PM) will be measured by personal meters. The PM sampling planned in the study will take 12 h for PM 2.5 and for PM 10 alike. Data on the level of outdoor air pollution will be collected based on the results obtained from air monitoring stations. The impact of air pollution, UHIs and the environment on the respiratory system and the presence of allergies in children, including chronic respiratory diseases, will be assessed. The project results will provide a scientific basis for the development of preventive programs in the population of children in the Łódź Voivodeship, adapted to the real health needs of society. Int J Occup Med Environ Health. 2021;34(4):453–60

Background Adverse birth outcomes are major causes of morbidity and mortality during childhood and associate with a higher risk of noncommunicable diseases in adult life. Maternal periconception and antenatal nutrition, mostly focusing on single nutrients or foods, has been shown to influence infant birth outcomes. However, evidence on whole diet that considers complex nutrient and food interaction is rare and conflicting. We aim to elucidate the influence of whole-diet maternal dietary inflammatory potential and quality during periconceptional and antenatal periods on birth outcomes. Methods and findings We harmonized and pooled individual participant data (IPD) from up to 24,861 mother–child pairs in 7 European mother–offspring cohorts [cohort name, country (recruitment dates): ALSPAC, UK (1 April 1991 to 31 December 1992); EDEN, France (27 January 2003 to 6 March 2006); Generation R, the Netherlands (1 April 2002 to 31 January 2006); Lifeways, Ireland (2 October 2001 to 4 April 2003); REPRO_PL, Poland (18 September 2007 to 16 December 2011); ROLO, Ireland (1 January 2007 to 1 January 2011); SWS, United Kingdom (6 April 1998 to 17 December 2002)]. Maternal diets were assessed preconceptionally (n = 2 cohorts) and antenatally (n = 7 cohorts). Maternal dietary inflammatory potential and quality were ranked using the energy-adjusted Dietary Inflammatory Index (E-DII) and Dietary Approaches to Stop Hypertension (DASH) index, respectively. Primary outcomes were birth weight and gestational age at birth. Adverse birth outcomes, i.e., low birth weight (LBW), macrosomia, small-for-gestational-age (SGA), large-for-gestational-age (LGA), preterm and postterm births were defined according to standard clinical cutoffs. Associations of maternal E-DII and DASH scores with infant birth outcomes were assessed using cohort-specific multivariable regression analyses (adjusted for confounders including maternal education, ethnicity, prepregnancy body mass index (BMI), maternal height, parity, cigarettes smoking, and alcohol consumption), with subsequent random-effects meta-analyses. Overall, the study mothers had a mean ± SD age of 29.5 ± 4.9 y at delivery and a mean BMI of 23.3 ± 4.2 kg/m2. Higher pregnancy DASH score (higher dietary quality) was associated with higher birth weight [β(95% CI) = 18.5(5.7, 31.3) g per 1-SD higher DASH score; P value = 0.005] and head circumference [0.03(0.01, 0.06) cm; P value = 0.004], longer birth length [0.05(0.01, 0.10) cm; P value = 0.010], and lower risk of delivering LBW [odds ratio (OR) (95% CI) = 0.89(0.82, 0.95); P value = 0.001] and SGA [0.87(0.82, 0.94); P value < 0.001] infants. Higher maternal prepregnancy E-DII score (more pro-inflammatory diet) was associated with lower birth weight [β(95% CI) = −18.7(−34.8, −2.6) g per 1-SD higher E-DII score; P value = 0.023] and shorter birth length [−0.07(−0.14, −0.01) cm; P value = 0.031], whereas higher pregnancy E-DII score was associated with a shorter birth length [−0.06(−0.10, −0.01) cm; P value = 0.026] and higher risk of SGA [OR(95% CI) = 1.18(1.11, 1.26); P value < 0.001]. In male, but not female, infants higher maternal prepregnancy E-DII was associated with lower birth weight and head circumference, shorter birth length, and higher risk of SGA (P-for-sex-interaction = 0.029, 0.059, 0.104, and 0.075, respectively). No consistent associations were observed for maternal E-DII and DASH scores with gestational age, preterm and postterm birth, or macrosomia and LGA. Limitations of this study were that self-reported dietary data might have increased nondifferential measurement error and that causality cannot be claimed definitely with observational design. Conclusions In this cohort study, we observed that maternal diet that is of low quality and high inflammatory potential is associated with lower offspring birth size and higher risk of offspring being born SGA in this multicenter meta-analysis using harmonized IPD. Improving overall maternal dietary pattern based on predefined criteria may optimize fetal growth and avert substantial healthcare burden associated with adverse birth outcomes., In this cohort analysis, Ling-Wei Chen and colleagues explore associations of maternal dietary patterns with offspring birth outcomes., Author summary Why was this study done? Adverse birth outcomes are associated with higher morbidity and mortality during childhood and a higher risk of noncommunicable diseases in adult life. The Developmental Origins of Health and Diseases (DOHaD) theory posits that maternal periconceptional and intrauterine nutrition can alter the health trajectory of the offspring. Although individual maternal dietary factors have been studied widely, evidence on the impact of whole-diet maternal dietary inflammatory potential and quality on birth outcomes is scarce and conflicting. What did the researchers do and find? We investigated whether maternal prepregnancy and antenatal dietary quality and inflammatory potential are associated with birth outcomes in a consortium of 7 European cohorts in 5 countries using harmonized individual participant data from up to 24,861 mother–child pairs. After adjusting for confounders, we found that a low-quality and pro-inflammatory maternal diet during pregnancy is significantly associated with lower offspring birth weight and higher risk of offspring being born small-for-gestational-age (SGA). In male, but not female, infants higher maternal prepregnancy energy-adjusted Dietary Inflammatory Index (E-DII) score was associated with lower birth weight and head circumference, shorter birth length, and higher risk of SGA. What do these findings mean? Improving overall maternal dietary quality and reducing dietary inflammatory potential may optimize fetal growth and avert substantial healthcare burden associated with adverse birth outcomes. Policies to ensure availability of affordable healthy foods and programmatic efforts to inform and support women of reproductive age, such as raising awareness of the importance of maternal diet and prenatal and antenatal counseling would help women achieve a healthier diet.

Background: The impact of maternal diet during pregnancy on child neurodevelopment is of public health and clinical relevance. We evaluated the associations of dietary quality based on the Dietary Approaches to Stop Hypertension (DASH) score and dietary inflammatory potential based on the energy-adjusted Dietary Inflammatory Index (E-DII) score during pregnancy with emotional and behavioral symptoms of offspring at 7 to 10 years of age. Methods: Individual participant data for 11,870 mother-child pairs from four European cohorts participating in the ALPHABET project were analyzed. Maternal antenatal DASH and E-DII scores were generated from self-completed food frequency questionnaires. Symptoms of depression and anxiety, aggressive behavior, and attention-deficit/hyperactivity disorder in children were assessed using mother-reported tests and classified within the normal or borderline/clinical ranges using validated cutoffs. Adjusted odds ratios were determined by multivariable logistic regression models and aggregated by the two-level individual participant data meta-analysis method. Results: Higher maternal DASH scores (indicating better dietary quality) were associated with lower risk of depressive and anxiety symptoms, aggressive behavior symptoms, and attention-deficit/hyperactivity disorder symptoms within the borderline/clinical ranges: odds ratio [OR] 0.97, 95% confidence interval [CI], 0.95-0.99; OR 0.97, 95% CI, 0.94-0.99; OR 0.97, 95% CI, 0.95-0.98, per one-unit DASH score increase, respectively. For depression and anxiety, aggressive behavior, and attention-deficit/hyperactivity disorder symptoms, a one-unit increase in E-DII scores (a more proinflammatory diet) was associated with a 7% increased risk of all three analyzed emotional and behavioral symptoms: OR 1.07, 95% CI, 1.03-1.11; OR 1.07, 95% CI, 1.02-1.13; OR 1.07, 95% CI, 1.01-1.13, respectively. Conclusions: Our findings suggest that a maternal low-quality and proinflammatory diet may increase the risk of emotional and behavioral symptoms in children. This work was supported by an award from the European Union’s Horizon 2020 research and innovation programme under the ERA-Net Cofund of the Joint Programming Initiative Healthy Diet for Healthy Life (JPI-HDHL) (http://www.healthydietforhealthylife.eu) action number 696295 (Biomarkers for Nutrition and Health). Cofunding was provided by Science Foundation Ireland, Ireland (Grant No. SFI/16/ERA-HDHL/3360 [to CMP]), the UK Biotechnology and Biological Sciences Research Council (ERA-HDHL Biomarkers: BBSRC BB/P028187/1 [to CR]), the Polish National Centre for Research and Development (ERA-HDHL/01/ALPHABET/1/2017 [to KP]), the ZonMw The Netherlands (Grant No. 529051014; 2017) ALPHABET project (Grant No. 696295; 2017 [to LD]) and the French National Agency of Research (reference AnrR16227KK [to BH]). ALSPAC: This work was supported by the UK Medical Research Council and Wellcome (Grant No. 102215/2/13/2) and the University of Bristol. This publication is the work of the authors and Matthew Suderman will serve as guarantors for the contents of this paper. EDEN: This work was supported by the Foundation for Medical Research (FRM), National Agency for Research (ANR), National Institute for Research in Public health (IRESP: TGIR Cohorte Santé 2008 program), French Ministry of Health (DGS), French Ministry of Research, INSERM Bone and Joint Diseases National Research (PRO-A), and Human Nutrition National Research Programs, Paris-Sud University, Nestlé, French National Institute for Population Health Surveillance (InVS), French National Institute for Health Education (INPES), the European Union FP7 programmes (FP7/2007-2013, HELIX, ESCAPE, ENRIECO, Medall projects), Diabetes National Research Program (through a collaboration with the French Association of Diabetic Patients), French Agency for Environmental Health Safety (now ANSES), Mutuelle Générale de l’Education Nationale, a complementary health insurance (MGEN), French National Agency for Food Security, French-speaking Association for the Study of Diabetes and Metabolism (ALFEDIAM). Generation R: This work was supported by the Erasmus Medical Centre, Rotterdam, the Erasmus University Rotterdam and the Netherlands Organization for Health Research and Development. Dr Liesbeth Duijts received funding from the European Union's Horizon 2020 cofunded programme ERA-Net on Biomarkers for Nutrition and Health (ERA HDHL) (ALPHABET project (Grant No. 696295; 2017), ZonMW The Netherlands (Grant No. 529051014; 2017). Dr. Hanan El Marroun was supported by Stichting Volksbond Rotterdam, the Dutch Brain Foundation (De Hersenstichting, project number GH2016.2.01), and NARSAD Young Investigator Grant No. 27853 from the Brain & Behavior Research Foundation. The project received funding from the European Union’s Horizon 2020 Research and Innovation Programme (LIFECYCLE project, Grant No. 733206; 2016). REPRO_PL: This work was supported by the Ministry of Science and Higher Education, Poland (PBZ-MEiN-/8/2//2006; Contract No. K140/P01/2007/1.3.1.1); by the grant PNRF-218-AI-1/07 from Norway through the Norwegian Financial Mechanism within the Polish-Norwegian Research Fund, National Science Centre under the call of JPI HDHL Nutrition and Cognitive Function (2015/17/Z/NZ7/04273), and the National Science Centre, Poland (DEC-2014/15/B/NZ7/00998). Mònica Guxens (CPII18/00018) and Maribel Casas (CP16/00128) are funded by a Miguel Servet fellowship (from the Spanish Institute of Health Carlos III). We acknowledge support from the Spanish Ministry of Science and Innovation through the “Centro de Excelencia Severo Ochoa 2019–2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Programme.

In this study, the exposome paradigm has been applied on a mother-child cohort adopting an optimised untargeted metabolomics approach for human urine followed by advanced bioinformatics analysis. Exposome-wide association algorithms were used to draw links between in utero co-exposure to metals and phthalates, metabolic pathways deregulation, and clinically observed phenotypes of neurodevelopmental disorders such as problems in linguistic, motor development and cognitive capacity. Children (n = 148) were tested at the first and second year of their life using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Their mothers had been exposed to metals and phthalates during the pregnancy, according to human biomonitoring results from previously performed studies. Untargeted metabolomics analysis of biobanked urine samples from the mothers was performed using a combination of the high throughput analytical methods liquid chromatography-high resolution mass spectrometry (LC-HRMS) and nuclear magnetic resonance (NMR). Most perturbed metabolic pathways from co-exposure heavy metals and phthalates were pathways related to the tricarboxylic acid cycle (TCA cycle) and oxidative phosphorylation, indicating the possibility of disruption of mitochondrial respiration. Overproduction of reactive oxygen species (ROS); the presence of glutathione peroxidase 3 (GPx3) during pregnancy and presence of glutathione peroxidase 1 (GPx1) in the umbilical cord were linked to verbal development problems. Another finding of the study is that in real life, adverse outcomes occur as a combination of environmental and social factors, all of them acting synergistically towards the deployment of an observed phenotype. Finally, the two-steps association process (exposure to pathways and pathways to adverse outcomes) was able to (a) provide associations that are not evident by directly associating exposure to outcomes and (b) provides additional insides on the mechanisms of environmental disease.

The objective of this study was to evaluate compliance with the ban on tobacco and e-cigarette products advertising at point of sale (POS) before and after amendment of the Polish Tobacco Control Act. Data were collected, using an observation checklist, between March and October 2014 (n = 1450 POS) and between March and October 2019 (n = 1320 POS). Ban on tobacco and e-cigarette advertising at POS is commonly violated in Poland. In all POS, at least one form (including tobacco products display) of tobacco advertising was found in 2014 and in 2019. The most common types of tobacco advertising in 2014 were change and counter mats (61%, 42%), posters (38%) and illuminated banners (37%). In 2019, a decrease in promoting tobacco products in the form of mats (p ≤ 0.001), posters and boards (p &lt, 0.001) but an increase in video screens were observed (from 8% in 2014 to 30% in 2019, p &lt, 0.001). A significant increase in the presence of any e-cigarette ads, including e-cigarette displays, illuminated banners and video screens, was observed in 2019 as compared to 2014 (90% vs. 30%, 89% vs. 20%, 31% vs. 2%, 31% vs. 0.5%, 0.001). The minimum age or a no-sale-to-minors signs for tobacco and e-cigarettes were not sufficiently placed in POS to comply with the Act. Poor enforcement of the ban on tobacco and e-cigarette ads at POS provides the tobacco industry with an opportunity to promote their products using unlawful ways. There is a need to educate the public, retailers and civil society with respect to their legal responsibilities and roles.

Alcohol consumption at a level exceeding existing recommendations is one of the leading risk factors for death and disability worldwide. The aim of the study was to identify correlates of alcohol drinking among a socially-disadvantaged population in Poland. The cross-sectional study covered 1644 adult social assistance beneficiaries from the Piotrkowski district (rural area in central Poland). A detailed questionnaire filled in during a face-to-face interview allowed for the collection of socio-demographic, lifestyle-related (including alcohol consumption) and health status data. About 42% of the participants, including 67% of the men and 30% of the women, exceeded the recommended level of alcohol consumption. In the adjusted model, the men tended not to follow recommendations for alcohol consumption more frequently than the women (OR = 4.5, p &lt, 0.001). The higher odds of not following alcohol-related recommendations were also observed for the subjects declaring having a permanent or temporary job compared to the unemployed participants (OR = 1.2, p = 0.04). A lower healthy lifestyle index (indicating an unhealthy lifestyle related to a diet, body mass index (BMI), physical activity, and tobacco smoking) was associated with not following recommendations for alcohol consumption (OR = 1.1, p = 0.04). Our study indicates that being men, having a permanent or a temporary job, and coexistence of other unfavorable lifestyle-related factors are important correlates of not following recommendations for alcohol consumption among the beneficiaries of government welfare assistance.

Background: Fetal exposure to a suboptimal maternal diet might affect respiratory health later in life. We tested the hypothesis that a pro-inflammatory or low-quality maternal diet in pregnancy was associated with child’s respiratory health. Methods: We performed an individual participant meta-analysis among 18,326 children and their mothers, participating in seven European birth cohorts. Maternal pro-inflammatory diet during pregnancy was estimated by the energy-adjusted Dietary Inflammatory Index score (E-DIITM), and low quality diet by the Dietary Approaches to Stop Hypertension (DASH) score. Child’s preschool wheezing and school-age asthma and lung function were measured by questionnaires and spirometry. We used multilevel regression models with a random intercept at cohort level to study the associations. Results: After adjustment for lifestyle and sociodemographic factors, we observed no consistent associations of a high E-DII score (>90th percentile) with respiratory outcomes, but a low DASH score ( Conclusion: A low quality maternal diet in pregnancy might have a modest adverse effect on respiratory health in childhood.

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], P value = 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], P value = 0.012), small size for gestational age (OR 2.15 [95% CI 2.07–2.23], P value < 0.001), and childhood overweight (OR 1.42 [95% CI 1.35–1.48], P value < 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 ≤4 cigarettes/day; OR 2.79 [95% CI 2.39–3.25] and OR 1.93 [95% CI 1.46–2.57] instead of OR 2.95 [95% CI 2.75–3.15] when reducing from ≥10 to 5–9 and ≤4 cigarettes/day, respectively [P values < 0.001]). Reducing the number of cigarettes during pregnancy did not affect the risks of preterm birth and childhood overweight. Among nonsmoking mothers, paternal smoking was associated with childhood overweight (OR 1.21 [95% CI 1.16–1.27], P value < 0.001) but not with adverse birth outcomes. Limitations of this study include the self-report of parental smoking information and the possibility of residual confounding. As this study only included participants from Europe and North America, results need to be carefully interpreted regarding other populations. Conclusions We observed that as compared to nonsmoking during pregnancy, quitting smoking in the first trimester is associated with the same risk of preterm birth and small size for gestational age, but with a higher risk of childhood overweight. Reducing the number of cigarettes, without quitting, has limited beneficial effects. Paternal smoking seems to be associated, independently of maternal smoking, with the risk of childhood overweight. Population strategies should focus on parental smoking prevention before or at the start, rather than during, pregnancy., Elise Philips and co-workers investigate parental smoking and associated birth and child outcomes., Author summary Why 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.

As part of cardiovascular disease prevention, the performance of BMI determination, blood pressure measurement, biochemical tests, as well as a lifestyle-related risk assessment are recommended. The aim of this study was to evaluate the correlates of blood pressure and cholesterol level testing among a socially-disadvantaged population in Poland. This cross-sectional study was performed between 2015 and 2016 among 1710 beneficiaries of government welfare assistance. Face-to-face interviews conducted by trained staff at each participant&rsquo, s place of residence allowed for completion of questionnaires that covered socio-demographic, health and lifestyle-related information. Sixty-five percent of the participants declared a blood pressure and 27% of them cholesterol level testing at least once within the year proceeding the study. A higher chance of having blood pressure testing was observed among the women (OR = 1.5, p = 0.002) and people with high blood pressure (OR = 3.9, p &lt, 0.001). The women (OR = 1.4, p = 0.04) and older people (OR = 1.9, p = 0.02, OR = 2.6, 0.001, OR = 2.7, p = 0.002, for the following age groups: 30-39, 40-49, 50-59 years respectively), the respondents who declared health problems such as heart attack (OR = 3.0, p = 0.04), high blood pressure (OR = 2.3, 0.001) and type 2 diabetes (OR = 3.3, p = 0.004) and those with a family history of chronic diseases (OR = 1.5, p = 0.03) had a higher chance of cholesterol level checking. Higher healthy lifestyle index, indicating that the study participants have followed almost all of the studied lifestyle-related recommendations, was a significant correlate of cholesterol level testing (OR = 1.7, p = 0.006). Actions that promote lifestyle changes, blood pressure, and cholesterol level testing should take into account the needs of the disadvantaged population and should especially target men, people with existing chronic diseases, and those with unfavorable lifestyle characteristics. With respect to the socially-disadvantaged population, the social assistance institutions and outpatient clinics are the best places to conduct activities promoting a healthy lifestyle. The most commonly applied strategies to promote lifestyle changes can cover risk assessment, increasing awareness, emotional support and encouragement, as well as a referral to specialists.

Purpose: Based on the available data, alterations of the antioxidant defense as well as the vitamin status in mothers may affect the prenatal process of lung and immune system development as a pathophysiological background of increased prevalence of allergic diseases. The primary aim of the current study was to assess the associations among cord blood concentrations of zinc (Zn); copper (Cu); selenium (Se); β-carotene; and vitamin A, E, and D, and the occurrence of atopic dermatitis, food allergy, allergic rhinitis, and asthma in early school-age children. Methods: We evaluated 211 children, 7‐9 years old, from the Polish Mother and Child Cohort Study. the women were interviewed during pregnancy to collect demographic and socioeconomic data, and the medical and reproductive history. At delivery, umbilical cord blood plasma was sampled. Seven to nine years after the birth, the child's exposure and health status (including skin-prick test and spirometry for allergy assessment and urine sample for cotinine level) were examined. In the analyses, a multivariable model was applied. Results: Statistically significant relationships were found among Zn; Cu; Se; and vitamin A, E, and D concentrations in cord blood; and the prevalence of food allergy, allergic rhinitis, atopic dermatitis, and asthma in children ages 7‐9 years after adjustment for several confounders. Conclusion: We showed an imbalance in the antioxidant defense system in cord blood, which may lead to the occurrence of allergic diseases later in life. The maternal diet may have substantial potential to modify immune tolerance and, consequently, the development of allergic disease in the offspring.Clinical trial NCT01861548, www.clinicaltrials.gov

Background: Trihalomethanes (THMs) are widespread disinfection by-products (DBPs) in drinking water, and long-term exposure has been consistently associated with increased bladder cancer risk. Objective: We assessed THM levels in drinking water in the European Union as a marker of DBP exposure and estimated the attributable burden of bladder cancer. Methods: We collected recent annual mean THM levels in municipal drinking water in 28 European countries (EU28) from routine monitoring records. We estimated a linear exposure-response function for average residential THM levels and bladder cancer by pooling data from studies included in the largest international pooled analysis published to date in order to estimate odds ratios (ORs) for bladder cancer associated with the mean THM level in each country (relative to no exposure), population-attributable fraction (PAF), and number of attributable bladder cancer cases in different scenarios using incidence rates and population from the Global Burden of Disease study of 2016. Results: We obtained 2005-2018 THM data from EU26, covering 75% of the population. Data coverage and accuracy were heterogeneous among countries. The estimated population-weighted mean THM level was 11.7 μg/L [standard deviation (SD) of 11.2]. The estimated bladder cancer PAF was 4.9% [95% confidence interval (CI): 2.5, 7.1] overall (range: 0-23%), accounting for 6,561 (95% CI: 3,389, 9,537) bladder cancer cases per year. Denmark and the Netherlands had the lowest PAF (0.0% each), while Cyprus (23.2%), Malta (17.9%), and Ireland (17.2%) had the highest among EU26. In the scenario where no country would exceed the current EU mean, 2,868 (95% CI: 1,522, 4,060; 43%) annual attributable bladder cancer cases could potentially be avoided. Discussion: Efforts have been made to reduce THM levels in the European Union. However, assuming a causal association, current levels in certain countries still could lead to a considerable burden of bladder cancer that could potentially be avoided by optimizing water treatment, disinfection, and distribution practices, among other possible measures. https://doi.org/10.1289/EHP4495. This work was funded by the EU Seventh Framework Programme EXPOsOMICS Project (grant agreement no. 308610), Human Genetics Foundation agreement 17-080 ISG, and CIBER Epidemiología y Salud Pública (CIBERESP). ISGlobal is a member of the Centres de Recerca de Catalunya (CERCA) Programme, Generalitat de Catalunya. We would like to thank the members of the European Programme for Intervention Epidemiology Training (EPIET) Alumni Network (EAN) for their assistance in identifying appropriate national focal points in specific countries. We would also like to thank the people from the national and local authorities and universities for the provision of THM data: Sofie Dewaele (Leefmilieu Brussel-BIM/Bruxelles Environnement–IBGE Afd. Inspectie en verontreinigde bodems, Dpt. Geïntegreerde controles, Brussels, Belgium), Steven Vanderwaeren (Team Watervoorziening-en gebruik, Vlaamse Milieumaatschappij, Afdeling Operationeel Waterbeheer, Brussels, Belgium), Jurica Štiglić (Croatian National Institute of Public Health, Zagreb, Croatia), Outi Zacheus (National Institute for Health and Welfare, Kuopio, Finland), Carmelo Massimo Maida (University of Palermo, Italy), Anna Norata (Agenzia di Tutela della Salute Citta’ Metropolitana Milano, Italy), Marco Chiesa (Agenzia di Tutela della Salute della Val Padana-Sede Territoriale di Mantova, Italy), Vincenzo Clasadonte (Agenzia di Tutela della Salute della Val Padana-Sede Territoriale Cremona, Italy), Emilia Guberti (Local Health Authority, Bologna, Italy), Cinzia Govoni (Local Health Authority, Ferrara, Italy), Paolo Pagliai (Local Health Authority Romagna, Italy), Daniela de Vita (Local Health Authority, Reggio Emilia, Italy), Danila Tortorici (Regional Health and Social Agency, Emilia Romagna, Italy), Marco Schintu (University of Cagliari, Italy), Paolo Montuori (University of Napoli Federico II, Italy), Audrius Dedele (Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, Kaunas, Lithuania), Stefan Cachia (Water Services Corporation, Malta), Roel C.H. Vermuelen (Institute of Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands), the Chief Sanitary Inspectorate (Poland), Luís Simas (Water Quality Department, Entidade Reguladora, Dos Serviços De Águas e Resíduos, Lisboa, Portugal), and Christina Forslund (Food Control Department, National Food Agency, Uppsala, Sweden). Finally, we would like to thank Charles F. Lynch (University of Iowa, USA), Sylvaine Cordier (Université de Rennes, Inserm, École des hautes études en santé Publique (EHESP), Rennes, France), Will D. King (Queen’s University, Kingston, Ontario, Canada), and Kenneth P. Cantor (National Cancer Institute, National Institutes of Health, Bethesda, USA) for allowing us to use the dose–exposure data from their study. We are grateful to Xavier Basagaña (ISGlobal) for statistical assistance.

IntroductionThe foetal programming hypothesis posits that optimising early life factors e.g. maternal diets can help avert the burden of adverse childhood outcomes e.g. childhood obesity. To improve applicability to public health messaging, we investigated whether maternal whole diet quality and inflammatory potential influence childhood adiposity in a large consortium.MethodsWe harmonized and pooled individual participant data from up to 8,769 mother-child pairs in 7 European mother-offspring cohorts. Maternal early-, late-, and whole-pregnancy dietary quality and inflammatory potential were assessed with Dietary Approaches to Stop Hypertension (DASH) and energy-adjusted Dietary Inflammatory Index (E-DII), respectively. Primary outcome was childhood overweight and obesity (OWOB), defined as age- and sex-specific body-mass-index-z score (BMIz) > 85th percentile based on WHO growth standard. Secondary outcomes were sum-of-skinfold-thickness (SST), fat-mass-index (FMI) and fat-free-mass-index (FFMI) in available cohorts. Outcomes were assessed in early- [mean (SD) age: 2.8 (0.3) y], mid- [6.2 (0.6) y], and late-childhood [10.6 (1.2) y]. We used multivariable regression analyses to assess the associations of maternal E-DII and DASH with offspring adiposity outcomes in cohort-specific analyses, with subsequent random-effects meta-analyses. Analyses were adjusted for maternal age, pre-pregnancy BMI, parity, lifestyle factors, energy intake, educational attainment, offspring age and sex.ResultsA more pro-inflammatory maternal diet, indicated by higher E-DII, was associated with a higher risk of offspring late-childhood OWOB [pooled-OR (95% CI) comparing highest vs. lowest E-DII quartiles: 1.22 (1.01,1.47) for whole-pregnancy and 1.38 (1.05,1.83) for early-pregnancy; both P < 0.05]. Moreover, higher late-pregnancy E-DII was associated with higher mid-childhood FMI [pooled-β (95% CI): 0.11 (0.003,0.22) kg/m2; P < 0.05]; trending association was observed for whole-pregnancy E-DII [0.12 (-0.01,0.25) kg/m2; P = 0.07]. A higher maternal dietary quality, indicated by higher DASH score, showed a trending inverse association with late-childhood OWOB (pooled-OR (95% CI) comparing highest vs. lowest DASH quartiles: 0.58 (0.32,1.02; P = 0.06). Higher early-pregnancy DASH was associated with lower late-childhood SST [pooled-β (95% CI): -1.9 (-3.6,-0.1) cm; P < 0.05] and tended to be associated with lower late-childhood FMI [-0.34 (-0.71,0.04) kg/m2; P = 0.08]. Higher whole-pregnancy DASH tended to associate with lower early-childhood SST [-0.33 (-0.72,0.06) cm; P = 0.10]. Results were similar when modelling DASH and E-DII continuously.DiscussionAnalysis of pooled data suggests that pro-inflammatory, low-quality maternal antenatal diets may influence offspring body composition and obesity risk, especially during mid- or late-childhood. Due to variation of data availability at each timepoint, our results should be interpreted with caution. Because most associations were observed at mid-childhood or later, future studies will benefit from a longer follow-up.

Micronutrients status during pregnancy is recognized as one of the environmental factors that can have an impact on maternal and children’s health. The study aims at evaluating sociodemographic, lifestyle, environmental, and pregnancy-related determinants of maternal micronutrients status during pregnancy. The analysis was based on data from the Polish Mother and Child Cohort (REPRO_PL). During the second trimester of pregnancy, 1306 women filled in a modified version of the validated food frequency questionnaire (FFQ) based on which the intake of the following micronutrients was estimated: calcium, magnesium, zinc, copper, selenium, folate, vitamin D, vitamin A and vitamin E. In addition, copper, zinc and selenium levels were measured in the blood collected during the second trimester of pregnancy. About 95% of the women took dietary supplements during pregnancy. Despite such supplementation in the case of a high proportion of the women the intake of majority of the analyzed micronutrients was below recommendations for the pregnancy period (based on the Estimated Average Requirement). The mean plasma zinc, copper and selenium concentrations were 0.9±0.3 mg/l, 2.0±0.6 mg/l and 48.4±10.5 ug/l, respectively. The chance to reach the recommended intake for vitamin A, vitamin D and selenium was higher among the multiparous women (OR = 1.53 p = 0.007; OR = 1.44 p = 0.02; OR = 1.48 p = 0.009) and for zinc among the women with a higher socio-economic status (SES) (OR = 1.43 p = 0.04). For other variables the results were not statistically significant. A higher selenium level in the plasma was observed among the older women (p = 0.01) and those with a higher SES (p = 0.03). The current study presents evidence on specific factors influencing the micronutrients intake. They need to be accounted for in educational programs and interventions that focus on healthy diet recommendations during pregnancy. Key messages In the case of a high proportion of the women the intake of majority of the analyzed micronutrients was below recommendations for the pregnancy period. More effort should be taken to educational programs and interventions that focus on healthy diet recommendations during pregnancy.

The aim of the study was to assess whether general practitioners (GPs) monitor and evaluate the health behavior of their patients in the field of a diet, physical activity, and weight control, and whether they provide appropriate counselling as part of this evaluation. Predictors of those activities among physicians were also determined. The cross-sectional study was conducted in the Piotrkowski district among 200 GPs. The questionnaire covered socio-demographic data and lifestyle characteristics of the physicians, their role as healthy lifestyle providers, and whether they assess lifestyle characteristics of their patients and perform healthy lifestyle counselling. More than 60% of the GPs did not evaluate lifestyle features during their patients&rsquo, examination. In total, 56% of the GPs provided healthy lifestyle recommendations among patients who have not been diagnosed with chronic lifestyle-related diseases but who do not follow healthy recommendations, and 73% of GPs provided recommendations to patients with chronic diseases related to lifestyle. The study showed that the chance to assess lifestyle characteristics of the patients was significantly higher for the GPs who believed that they were obliged to do so (OR = 6.5, p = 0.002). The chance to recommend a healthy lifestyle among patients who have not been diagnosed with chronic lifestyle-related diseases but who do not follow healthy recommendations was 5.9 times higher among the GPs working in the public sector (p &lt, 0.001) and 16.3 times higher for these who believed that they had sufficient knowledge to provide the advice (p = 0.02). The following predictors of providing a healthy lifestyle counselling among patients with diagnosed chronic lifestyle-related diseases were identified: conviction that a GPs is obligated to provide it (OR = 4.4, p = 0.02), sufficient knowledge (OR = 8.7, p = 0.01), and following health recommendations by themselves (OR = 3.9, p = 0.04). Conclusions: The identified predictors are crucial for the development of appropriate strategies aiming at increasing GPs&rsquo, involvement in preventive measures and consequently at improving the population&rsquo, s health.

Aim A growing body of literature documents associations between maternal stress in pregnancy and child development, but findings across studies are often inconsistent. The aim of this study was to estimate the association between exposure to different kinds of prenatal stress and child psychomotor development. Methods The study population consisted of 372 mother-child pairs from Polish Mother and Child Cohort. The analysis was restricted to the women who worked at least 1 month during pregnancy period. Maternal psychological stress during pregnancy was assessed based on: the Subjective Work Characteristics Questionnaire, Perceived Stress Scale and Social Readjustment Rating Scale. The level of satisfaction with family functioning and support was evaluated by APGAR Family Scale. Child psychomotor development was assessed at the 12th and 24th months of age by Bayley Scales of Infant and Toddler Development. Results Negative impact on child cognitive development at the age of two was observed for the Perceived Stress Scale (β = −0.8; P = 0.01) and the Social Readjustment Rating Scale (β = −0.4; P = 0.03) after adjusting for the variety of confounders. Occupational stress, as well as satisfaction with family functioning, was not significantly associated with child psychomotor development (P > 0.05). Conclusions The study supports the findings that prenatal exposure to maternal stress is significantly associated with decreased child cognitive functions. In order to further understand and quantify the effects of prenatal stress on child neurodevelopment further studies are needed. This will be important for developing interventions that provide more assistance to pregnant women, including emotional support or help to manage psychological stress.

Background: This study was based on data from the Polish Mother and Child Cohort Study. Objective: The aim was to study associations between home environment factors and allergic diseases at 1 year of life and new onset and remission of children's allergy diagnosis at ages 7-9 years. Methods: Children's health status was assessed at ∼12 months of age and then at ages between 7-9 years by using a questionnaire administered to the mothers. Children were assessed by pediatrician/allergists. The patients, who were 7-9 years old, underwent skin-prick tests. Exposure to tobacco smoke was evaluated with a questionnaire addressed to parents and/or caregivers and cotinine measurements were taken of mother's saliva during pregnancy and in children's urine at ages 7-9 years. Incidence and remission were calculated by comparing symptoms in the first year of life with symptoms at 7-9 years. We studied the associations among demographic data, home environment, and new onset and remission of food allergy, atopic dermatitis, and asthma and allergic rhinitis in logistic regression analysis. All associations were adjusted for independent risk factors of dependent variables. Results: Data from 211 participants were included in the analysis. During the first year of life, food allergy was the most common symptom (39%), followed by atopic dermatitis (35%) and asthma (12%). When comparing diagnoses at ages 7-9 years with the first year of life, food allergy had decreased by as much as 18.6%, atopic dermatitis decreased by as much as 23.8%, and asthma decreased by as much as 8%, whereas asthma and allergic rhinitis had increased from 6% to 14.8%. More frequent house cleaning negatively correlated with the new onset of atopic dermatitis and of asthma and allergic rhinitis. Hypersensitivity to seasonal allergens and mites and to any other allergen positively correlated with new onset of food allergy, atopic dermatitis, and asthma and allergic rhinitis. Parental atopy positively correlated with the new onset of asthma and negatively correlated with asthma remission. Conclusion: Analysis of our findings indicated that new onset and/or remission of allergic diseases was linked with hypersensitivity to house-dust mites in children who were polysensitized and with parental atopy. In addition, children who had food allergy, allergic rhinitis, or atopic dermatitis at the age of 1 year had more of a chance developing other atopic disease (except asthma) at ages 7-9 years and less of a chance of having a remission of the disease.

Phthalates are among the most frequently investigated environmental chemicals influencing children's health and particularly their neuropsychological development. However, the reported effects of these compounds on child behavior, cognitive and psychomotor outcomes are not fully consistent. The aim of this study is to evaluate the associations between prenatal and early postnatal phthalate exposures and child neurodevelopment at age of 7 years. A total of 134 mother-child pairs from Polish Mother and Child Cohort (REPRO_PL) constitute the basis for current analysis. Eleven phthalate metabolites were measured in urine samples collected from mothers in the 3rd trimester of pregnancy and from children at the age of 2 years. Child neuropsychological development at early school age (7 years) was assessed by both the Strengths and Difficulties Questionnaire (SDQ) filled by mothers and the Polish adaptation of the Intelligence and Development Scales (IDS) performed by psychologists. Mono-ethyl phthalate (MEP) concentration during pregnancy was significantly associated with increased risk of peer relationship problems in SDQ (OR = 2.7, p = 0.03). The results of the IDS analyses focused on child's cognitive and psychomotor development are not fully conclusive. Negative associations were evident between some phthalates in early childhood period and fluid intelligence and cognition (MEP: β = −5.2; p = 0.006; β = −4.2; p = 0.006; mono-n-butyl phthalate (MnBP): β = −4.9; p = 0.03; β = −4.0; p = 0.03; respectively), while positive associations have been found in the prenatal period (mono-2-ethyl-5-oxo-hexyl phthalate (oxo-MEHP): β = 3.6; p = 0.03 for fluid intelligence; β = 2.9; p = 0.03 for cognition). Further studies are required in order to elucidate which are the most critical periods of phthalate exposure on children's neurodevelopmental outcomes.

Characterization of the exposome, the totality of all environmental factors that one is exposed to from conception onwards, has been recommended to better evaluate the role of environmental influences on developmental programming and life- course vulnerability to major chronic diseases. In the framework of the Health and Environment- wide Associations based on Large population Surveys (HEALS) project we considered the pregnancy exposome exploiting two databases (PRIME and REPRO PL) that include birth cohorts from three EU countries (Croatia, Slovenia and Poland). The databases contained information on several chemical exposures, socio-demographic, lifestyle and health related factors from conception to child birth, and neuropsychological scores assessed by the Bayley Scales of Infant and Toddler Development in the first two years of life. Our main goal was to assess consistency of environmental influences on neurodevelopment, if any, across European countries differing for geographical, socio-demographic characteristics and levels of chemical exposures to metals such as lead (Pb), mercury (Hg), cadmium (Cd) and trace elements, including micronutrients such as zinc (Zn) and selenium (Se). To this aim, we first selected variables common to the different databases, then applied univariate and multivariate regression analyses to identify factors linked to neurodevelopment, and finally performed meta-analysis to detect potential heterogeneity among cohorts and pooled estimates. Significant differences in exposure levels among the three sub-cohorts were observed as for Hg and Se ; exposure levels under study were relatively low and within the range described in existing EU biomonitoring studies. The univariate analyses did not show any common pattern of association as only in the Polish cohort chemical exposure had an impact on neuropsychological outcome. In the meta-analysis, some consistent trends were evident, relative to the adverse influence of Pb on children's language and cognition and the positive influence of Se on language abilities. The effects of the neurotoxic metal Hg positively influenced the motor scores in the Polish cohorts, while it decreased the motor scores in the Slovenia and Croatian sub-cohorts. The only socio-demographic factor consistently associated to the outcome among cohorts was child's sex, with females performing better than males on cognitive and language scores. These findings point to the need of harmonizing existing cohorts or creating prospective study designs that facilitate comparisons in the exposome over time, places and kind of environmental exposures.

Phthalates are a group of widely used chemicals and humans are exposed to them in their daily life. Some phthalates may affect the hormonal balance in both children and adults. The aim of this study was to assess the phthalate exposure and its determinants among children at age of 7 years from the Polish Mother and Child Cohort Study (REPRO_PL). 250 urine samples collected in 2014–2015 were analysed for 21 metabolites of 11 parent phthalates using on-line high performance liquid chromatography coupled to tandem mass spectrometry (HPLC-MS/MS). This represents the most extensive set of phthalate metabolites ever determined for Poland. Ten metabolites were quantifiable in 100% of the samples, another eight in >90%. The highest median concentrations were found for the primary monoester metabolites of di-iso-butyl (MiBP, 72.4 μg/l), di-n-butyl (MnBP, 56.3 μg/l) and diethyl (MEP, 42.0 μg/l) phthalate, followed by the sum of di-2-ethylhexyl (ΣDEHP, 89.3 μg/l) and di-iso-nonyl (ΣDiNP, 21.9 μg/l) phthalate metabolites. Metabolite concentrations were higher in children at 7 years than in the same children at age 2 or in their mothers during pregnancy. Generally, phthalate exposures in this study were much higher than exposures reported in other European populations. Multivariate regression models showed that body mass index, place of residence, breastfeeding duration, socio-economic status and parental education were associated with the metabolite levels in the 7-year old children. Daily intake and hazard index calculations revealed that a small percentage of children (around 3–10%) exceeded the tolerable daily intakes established by international institutions such as EFSA and U.S. EPA indicating that these children might be at risk of anti-androgenic effects from the individual and cumulative exposure to phthalates. Thus, further monitoring of this population, by educational programs and follow-up interventions, is required. Keywords: Birth cohort, Children, Daily intake, Hazard risk, Phthalate metabolites, Poland

Background: Characterization of dietary patterns represents a valid and meaningful measure of overall diet quality and nutrient intake. The study aims at evaluating the sociodemographic, lifestyle, environmental, and pregnancy-related determinants of maternal dietary patterns during pregnancy. Methods: The analysis was conducted on a group of pregnant women from the Polish Mother and Child Cohort (REPRO_PL). During the second trimester of pregnancy, 1306 women filled in a modified version of the validated food frequency questionnaire (FFQ). Dietary patterns were estimated using an exploratory factor analysis. Potential dietary determinants were assessed via a questionnaire or biomarker measurements (saliva cotinine level). Results: Two dietary patterns were identified. The Prudent dietary pattern was characterized by high consumption of fruit, vegetables, legumes, whole grains, poultry, and low-fat dairy products, while the Western dietary pattern included high intake of refined grains, processed meat, potatoes, and very low intake of whole grains. Clear sociodemographic, environmental, lifestyle, and pregnancy-related determinants of diet quality were established. Older age (&beta, = 0.2, p &lt, 0.01), higher educational level (&beta, = 0.3, 0.01), and socioeconomic status (SES) (&beta, 0.01), overweight/obesity before (&beta, 0.01), as well as physical activity during pregnancy (&beta, p = 0.01) were positive determinants of a healthier diet (increasing Prudent&ndash, Western difference in dietary pattern scores). On the other hand, parity (&beta, = &minus, 0.2, p = 0.04) and living in small cities (&beta, 0.3, p = 0.02) were significantly related to a rather Western dietary pattern. Conclusions: The current study presents evidence on specific factors influencing dietary patterns. They need to be accounted for in educational programs and interventions focused on healthy diet recommendations during pregnancy.

There are over 1,000,000 publications on diet and health and over 480,000 references on inflammation in the National Library of Medicine database. In addition, there have now been over 30,000 peer-reviewed articles published on the relationship between diet, inflammation, and health outcomes. Based on this voluminous literature, it is now recognized that low-grade, chronic systemic inflammation is associated with most non-communicable diseases (NCDs), including diabetes, obesity, cardiovascular disease, cancers, respiratory and musculoskeletal disorders, as well as impaired neurodevelopment and adverse mental health outcomes. Dietary components modulate inflammatory status. In recent years, the Dietary Inflammatory Index (DII®), a literature-derived dietary index, was developed to characterize the inflammatory potential of habitual diet. Subsequently, a large and rapidly growing body of research investigating associations between dietary inflammatory potential, determined by the DII, and risk of a wide range of NCDs has emerged. In this narrative review, we examine the current state of the science regarding relationships between the DII and cancer, cardiometabolic, respiratory and musculoskeletal diseases, neurodevelopment, and adverse mental health outcomes. We synthesize the findings from recent studies, discuss potential underlying mechanisms, and look to the future regarding novel applications of the adult and children’s DII (C-DII) scores and new avenues of investigation in this field of nutritional research.