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The article provides an update on the Project Viva study. The study was a pre-birth cohort that began in 1999-2002 in Massachusetts and aimed to examine the long-term health outcomes of women and their offspring. The study collected data on various aspects of women's health, behavior, and environment through questionnaires, in-person measurements, blood tests, and genetic analysis. The study produced numerous publications and was recently focused on analyzing data from the Mid-Life Visit, Year 19 questionnaire, and annual survey. The study's strengths include the collection of exposure and outcome measures using research standard procedures, but limitations include loss to follow-up and limited generalizability. [Extracted from the article]

Objectives: This study aims at identifying associations between therapeutics used during labor and the occurrence of postpartum preeclampsia (PPPE), a poorly understood entity.Study Design and Main Outcome Measures: This is a case-control study of women who received an ICD-9 code for PPPE (cases) during the years 2009-2011, compared to women with a normotensive term pregnancy, delivery and postpartum period until discharge (controls), matched on age (±1year) and delivery date (±3months). Cases were defined as women having a normotensive term pregnancy, delivery and initial postpartum period (48h post-delivery) but developing hypertension between 48h and 6weeks postpartum. Single variable and multiple variable models were used to determine significant risk factors.Results: Forty-three women with PPPE were compared to 86 controls. Use of vasopressors and oxytocin did not differ between cases and controls, but rate of fluids administered during labor (OR=1.68 per 100cc/h; 95% CI: 1.09-2.59, p=0.02) and an elevated pre-pregnancy/first trimester BMI (OR=1.18 per kg/m2, 95% CI: 1.07-1.3, p=0.001) were identified as significant risk factors in multivariate analysis.Conclusions: We identified two potentially modifiable risk factors for PPPE; further studies are needed to better define the role of these two variables in the development of PPPE. [ABSTRACT FROM AUTHOR]

Background: We designed and tested the validity of a questionnaire to characterize maternal recall of pregnancy complications associated with increased future cardiovascular disease risk, based on the 2011 American Heart Association (AHA) guidelines. Methods: A maternal recall questionnaire of pregnancy history was administered to 971 patients who had participated in a previous cohort study of 1,608 pregnant women. Medical records from the study pregnancy served as the gold standard. Prevalence, sensitivity (sens), specificity (spec), positive predictive value (PPV), negative predictive value (NPV), and/or Spearman's correlation coefficients ( r) were calculated for each question. Results: A total of 526 (54%) individuals recontacted responded. Respondents were more likely to be older, white, educated, and nulliparous and were less likely to deliver low-birthweight infants in the study pregnancy than were individuals who did not respond. Mean length of recall was 4.35 years (standard deviation [SD] 0.46) postpartum. Maternal recall was most accurate for gestational diabetes (sens: 92%, spec: 98%, PPV: 79%, NPV: 99%), infant birthweight ( r=0.95), and gestation length ( r=0.85). Maternal recall was modest for preeclampsia (sens: 79%, spec: 97%, PPV: 68%, NPV: 98%) and pregnancy-associated hypertension, including preeclampsia or gestational hypertension (sens: 60%, spec: 95%, PPV: 64%, NPV: 94%). Conclusions: This validation study demonstrated that the majority of women could accurately recall a history of gestational diabetes, infant birthweight, and gestational age at delivery, 4 years postpartum on average. Recall of preeclampsia and pregnancy-associated hypertension overall was modest. Maternal report of these pregnancy conditions may help clinicians identify women at increased risk for cardiovascular disease. [ABSTRACT FROM AUTHOR]

Background: We examined associations of material hardship with prepregnancy body mass index (BMI), gestational weight gain (GWG), and substantial postpartum weight retention (SPPWR; ≥5 kg at 1 year). Methods: We studied 2128 women in Project Viva, a Boston-area cohort with recruitment during1999-2002. At recruitment, women reported whether they experienced material hardship, defined as having ever received public assistance, welfare, or lacked basic necessities (food, rent, or medical care) during childhood, in adulthood before pregnancy, and/or in pregnancy. We used multivariable logistic models adjusted for age, race/ethnicity, and parity (and prepregnancy BMI for GWG and SPPWR) to examine associations of material hardship with the three weight-related outcomes (BMI, GWG, and SPPWR). Results: Mean age was 31.8 (standard deviation, 5.2) years; 66% of women were white, 16% were obese (prepregnancy BMI ≥30.0 kg/m2), 50% experienced excessive GWG, and 17% experienced SPPWR. Material hardship was most common during childhood ( n=192, 9%), followed by adulthood (102, 5%), and pregnancy (41, 2%). Hardship in adulthood was associated with prepregnancy obesity (BMI ≥30 kg/m2 vs. 18.5 to <25.0 kg/m2), odds ratio ([OR] 2.35, 95% confidence interval [CI] 1.29, 4.31), but hardship in childhood was not (OR 1.26, 95% CI 0.80, 1.98). Hardship in childhood was associated with excess GWG (OR 1.45, 95% CI 0.99, 2.14), but hardship in adulthood or during pregnancy was not. We saw trends among hardship in each of the periods and associations with SPPWR, but all confidence intervals included the null. Conclusion: The timing of hardship exposure may differently influence weight before, during, and after pregnancy. [ABSTRACT FROM AUTHOR]

Background: Hypertensive disorders in pregnancy are risk markers for future maternal coronary heart disease (CHD). Clinical assessment of a woman's history of pregnancy complications relies on self-report, but the predictive value of maternal recall is unclear. A systematic review was conducted to comprehensively review and critically assess the available literature on maternal recall of hypertensive disorders in pregnancy. Methods: The PubMed, EMBASE, and Web of Science databases were searched through August 2012. We included original research articles comparing maternal recall of hypertensive disorders in pregnancy with medical records. Results: Ten studies met eligibility criteria for qualitative analysis and were independently reviewed by two investigators. Recall periods ranged from 48 hours to 30 years. Length of recall did not appear to uniformly affect recall quality. Sensitivity was generally lower and less consistent for gestational hypertension than for preeclampsia. Specificity was >90% for all hypertensive disorders. Determinants of recall accuracy included maternal education and parity. Conclusions: Although maternal recall of hypertensive disorders of pregnancy is specific, low sensitivity and predictive values may limit the clinical utility of asking mothers to recall their history of hypertensive pregnancy complications. Future research on maternal recall of pregnancy complications should be designed to yield predictive values and test recall of disorder subtypes, recurrent complications, and changing recall over time in the same population. The utility of gestation length and offspring birth weight for clinical identification of women whose pregnancy history puts them at increased CHD risk should also be explored. [ABSTRACT FROM AUTHOR]

Objectives: To examine the public health burden of major depressive disorder (MDD) among mothers: its prevalence and sociodemographic patterns; associated functioning, comorbidities, and adversities; and racial/ethnic disparities. Methods: This was a cross-sectional analysis of 8916 mothers in the National Epidemiologic Survey of Alcohol and Related Conditions, a nationally representative survey of the civilian U.S. population in 2001-2002. Past-year MDD was assessed with a structured interview protocol. Results: Ten percent of mothers experienced depression in the past year. White and Native American women, those with low education or income, and those not married had high rates of depression. Depression was not strongly patterned by number of or age of children. Depressed mothers experienced more adversities (poverty, separation or divorce, unemployment, financial difficulties) and had worse functioning. Half of depressed mothers received services for their depression. Black and Hispanic depressed mothers were more likely to experience multiple adversities and less likely to receive services than white depressed mothers. Conclusions: Maternal depression is a major public health problem in the United States, with an estimated 1 in 10 children experiencing a depressed mother in any given year. Professionals who work with mothers and children should be aware of its prevalence and its detrimental effects. [ABSTRACT FROM AUTHOR]

Background: To investigate lifetime history of interpersonal abuse and risk of pre-natal depression in socio-economically distinct populations in the same city.Methods: We examined associations of physical and sexual abuse with the risk of pre-natal depression in two cohorts in the Boston area, including 2128 participants recruited from a large urban- and suburban-managed care organization (Project Viva) and 1509 participants recruited primarily from urban community health centres (Project ACCESS). Protocols for the studies were designed in parallel to allow us to merge data to enhance ethnic and socio-economic diversity in the combined sample. In mid-pregnancy, the Personal Safety Questionnaire and Edinburgh Postnatal Depression Scale (EPDS) were administered in both cohorts. An EPDS score ≥ 13 indicated probable pre-natal depression. Logistic regression was used to estimate the odds ratio (OR) of pre-natal depression associated with lifetime abuse history.Results: Project ACCESS participants were twice as likely as Project Viva participants to report symptoms consistent with pre-natal depression: 22% of Project ACCESS participants had EPDS scores ≥ 13, compared with 11% of Project Viva participants. Fifty-seven percent of women in ACCESS and 46% in Viva reported lifetime physical and/or sexual abuse. In merged analysis, women reporting lifetime physical or sexual abuse had an OR for mid-pregnancy depression of 1.63 [95% confidence interval (95% CI): 1.29-2.07], adjusted for age and race/ethnicity. Lifetime histories of physical abuse [OR 1.48 (95% CI 1.15-1.90)] and sexual abuse [OR 1.68 (95% CI 1.24-2.28)] were independently associated with pre-natal depression. When child/teen, pre-pregnancy adult and pregnancy life periods were considered simultaneously, abuse in childhood was independently associated with an OR of 1.23 (95% CI 1.00-1.59), pre-pregnancy adult abuse with an OR of 1.70 (95% CI 1.31-2.21) and abuse during pregnancy with an OR of 1.77 (95% CI 1.14-2.74). Further adjustment for childhood socio-economic position made no material difference, and there were no clear interactions between abuse and adult socio-economic position.Conclusions: Physical and sexual abuse histories were positively associated with pre-natal depression in two economically and ethnically distinct populations. Stronger associations with recent abuse may indicate that the association of abuse with depression wanes with time or may result from less accurate recall of remote events. [ABSTRACT FROM AUTHOR]

The article presents a study that examined the probability of overweight at age three years for different combinations of four modifiable risk factors occurring prenatally and during the first year of life. Pregnant women in eastern Massachusetts served as subjects in this study. The risk factors include smoking during pregnancy, gestational weight gain, breastfeeding duration, and daily sleep during infancy. Logistic regression models were used in this study. Results showed that the probability of overweight in childhood varied from six to 29%.

The article presents the results of a study on the association of postpartum depression with weight retention 1 year after childbirth conducted in Massachusetts between 1999 and 2002. About 13% of the subjects had an Edinburgh Postnatal Depression Scale (EPDS) score of >12 during and/or after pregnancy. At 1 year, 27% of the 37% women with new-onset postpartum depression demonstrated postpartum weight retention. Some of the factors that caused postpartum weight retention are lack of sleep, physical inactivity, race, income and marital status.

Systemic maternal infections have been associated with preterm delivery. The authors examined the association of C-reactive protein (CRP), a marker of inflammation, with preterm delivery. This nested case-control study was conducted within Project Viva in Massachusetts between 1999 and 2002. Subjects were 117 women who delivered preterm (<37 weeks' gestation) and 117 controls (term deliveries) matched on age, race/ethnicity, and smoking status. High-sensitivity CRP assays were performed on early-pregnancy (5.3–19.3 weeks' gestation) plasma samples. Odds ratios and 95% confidence intervals were estimated by using conditional logistic regression adjusted for matching factors, gestational age at blood collection, and prepregnancy body mass index. Median concentration of CRP was 3.2 mg/liter in cases versus 2.4 mg/liter in controls. No significant association was found between quartiles of CRP and preterm delivery. However, CRP levels exceeding the threshold defined in the literature were associated with increased risk of preterm delivery (odds ratio = 2.55, 95% confidence interval: 1.05, 6.02 for CRP ≥8 mg/liter). The association was stronger among cases who experienced spontaneous delivery (odds ratio = 4.64, 95% confidence interval: 0.94, 22.96) versus indicated delivery (odds ratio = 1.42, 95% confidence interval: 0.44, 4.61). These findings suggest that very high CRP levels in early pregnancy are associated with preterm delivery. [ABSTRACT FROM AUTHOR]

Background: We hypothesized that stress induced by the terrorist attacks of September 11, 2001 might shorten pregnancy. To test this hypothesis, we compared gestational duration and risk of preterm delivery among women who were pregnant on September 11 with women who had delivered before that date.Study Design: We conducted a matched cohort study among pregnant women enrolled in the Boston-based cohort study Project Viva between 1999 and 2001. Each of 606 participants, pregnant on September 11, 2001, was matched to 1 or 2 participants who delivered before that date.Results: Compared with women who delivered before September 11th, women who were pregnant on September 11th had mean gestation length that was 0.13 weeks longer (95% confidence interval = -0.05 to 0.30) and an odds ratio for preterm delivery before 37 weeks' gestation of 0.60 (0.36 to 0.98). Only women exposed in the first trimester had longer gestation.Conclusions: Contrary to expectation, Boston-area women who were pregnant on September 11th had a lower risk of preterm delivery than women who delivered before that date. Although the interpretation of this finding is difficult, it is clear that the acute psychologic stress documented nationwide after the terrorist attacks did not increase the risk of preterm delivery in this population at some distance from the attacks. [ABSTRACT FROM AUTHOR]

Objective To determine the impact of immigration status as well as race/ethnicity and social and economic factors on breastfeeding initiation. Design Cohort. Setting Multisite group practice in eastern Massachusetts. Participants One thousand eight hundred twenty-nine pregnant women prospectively followed up in Project Viva. Main Outcome Measure Whether the participant breastfed her infant. Results The overall breastfeeding initiation rate was 83%. In multivariate models that included race/ethnicity and social, economic, and demographic factors, foreign-born women were more likely to initiate breastfeeding than US-born women (odds ratio [OR], 3.2 [95% confidence interval (CI), 2.0-5.2]). In models stratified by both race/ethnicity and immigration status, and further adjusted for whether the mother herself was breastfed as an infant and the mother’s parents’ immigration status, US-born and foreign-born black and Hispanic women initiated breastfeeding at rates at least as high as US-born white women (US-born black vs US-born white women, OR, 1.2 [95% CI, 0.8-1.9], US-born Hispanic vs US-born white women, OR, 1.1 [95% CI, 0.6-1.9], foreign-born black vs US-born white women, OR, 2.6 [95% CI, 1.1-6.0], and foreign-born Hispanic vs US-born white women, OR, 1.8 [95% CI, 0.7-4.8]). Calculations of predicted prevalences showed that, for example, the 2.6-fold increase in odds for the foreign-born black vs US-born white women translated to an increase in probability of approximately 1.4. Higher maternal education and household income also predicted higher initiation rates. Conclusions Immigration status was strongly associated with increased breastfeeding initiation in this cohort, implying that cultural factors are important in the decision to breastfeed. Immigrants of all races/ethnicities initiated breastfeeding more often than their US-born counterparts. In addition, US-born minority groups initiated breastfeeding at rates at least as high as their white counterparts, likely due in part to high levels of education and income as well as to access to a medical care system that explicitly supports breastfeeding. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: In a prospective prenatal cohort study, we examined associations of second trimester and cord plasma 25-hydroxyvitamin D (25[OH]D) with small-for-gestational age (SGA) and the extent to which vitamin D might explain black/white differences in SGA. Methods: We studied 1067 white and 236 black mother-infant pairs recruited from eight obstetrical offices early in pregnancy in Massachusetts. We analyzed 25(OH)D levels using an immunoassay and performed multivariable logistic models to estimate the odds of SGA by category of 25(OH)D level. Results: Mean (SD) second trimester 25(OH)D level was 60 nmol/L (SD, 21) and was lower for black (46 nmol/L [SD, 22]) than white (62 nmol/L [SD, 20]) women. Fifty-nine infants were SGA (4.5%), and more black than white infants were SGA (8.5% vs. 3.7%). The odds of SGA were higher with maternal 25(OH)D levels less than 25 versus 25 nmol/L or greater (adjusted odds ratio, 3.17; 95% confidence interval, 1.16–8.63). The increased odds of SGA among black versus white participants decreased from an odds ratio of 2.04(1.04, 4.04) to 1.68(0.82, 3.46) after adjusting for 25(OH)D. Conclusions: Second trimester 25(OH)D levels less than 25 nmol/L were associated with higher odds of SGA. Our data raise the possibility that vitamin D status may contribute to racial disparities in SGA. [Copyright &y& Elsevier]

Background: Few studies document longitudinal changes in physical activity from prepregnancy to the postpartum period. Methods: This study estimated change in self-reported leisure-time physical activity in 1442 women before pregnancy, during the second trimester, and at 6 months postpartum. In addition, it also examined predictors of becoming insufficiently active during or after pregnancy. Results: The mean (SD) age was 32.5 (4.5) years, 34% of the women were overweight or obese prepregnancy (body mass index equal to or greater than 25 kg/m2), and 76% were white. Before pregnancy, the mean total leisure physical activity was 9.6 hours per week. The reported decrease in total activity between prepregnancy and 6 months postpartum was –1.4 (95% CI=–1.0 to –1.9) hours per week, accounted for by decreases in moderate and vigorous physical activity but not walking. Prevalence of insufficiently active lifestyle (less than 150 minutes per week of total activity) increased from 12.6% before pregnancy to 21.7% during the postpartum period. The OR for becoming insufficiently active during pregnancy was 1.58 (95% CI=1.07–2.32) in women with at least one child compared with no children. Predictors of becoming insufficiently active postpartum included postpartum weight retention (OR=1.31; 95% CI=1.05–1.58 for each 5-kg increment); working longer hours in the first trimester (e.g., OR=5.12; 95% CI=1.96–13.4 for 45+ vs 0 hours); and reporting that lack of child care was a barrier to physical activity (OR=1.73; 95% CI=0.99–3.02). Conclusions: Women reported decreases in moderate and vigorous physical activity during pregnancy that persisted at 6 months postpartum. Levels of walking did not decline. Children in the home, longer work hours, and lack of child care were predictors of becoming insufficiently active during or after pregnancy. [Copyright &y& Elsevier]

Background: For many women, pregnancy begets long-term weight gain. Modifiable behaviors that contribute to postpartum weight retention have not been well studied. Methods: Prospective cohort study of 902 women enrolled in Project Viva, examining associations of postpartum television viewing, walking, and trans fat intake with weight retention equal to or greater than 5 kg at 12 months postpartum. Data were collected in 1999–2003 and analyzed in 2005–2006. Results: At 6 months postpartum, women reported a mean (SD) of 1.7 (1.3) hours of television viewing, 0.7 (0.7) hours of walking, and 1.1% (0.5) of energy intake from trans fat per day. At 1 year, participants retained a mean of 0.6 kg (range: −17.3 to 25.5), and 12% retained at least 5 kg. In multivariate logistic regression models, adjusting for maternal sociodemographics, parity, prepregnancy body mass index, gestational weight gain, breastfeeding, and smoking, the odds ratio of retaining at least 5 kg was 1.24 (95% confidence interval [CI]: 1.06–1.46) per daily hour of television viewing, 0.66 (95% CI: 0.46–0.94) per daily hour of walking, and 1.33 (95% CI: 1.09–1.62) per 0.5% increment in daily energy intake from trans fat. Women who watched less than 2 hours of television, walked at least 30 minutes, and consumed trans fat below the median had an odds ratio of 0.23 (95% CI: 0.08–0.66) of retaining at least 5 kg. Conclusions: Postpartum television viewing, walking, and trans fat intake were associated with weight retention. Interventions to modify these behaviors may help reduce excess postpartum weight gain and prevent obesity among women. [Copyright &y& Elsevier]

Background: Preterm delivery (PTD) includes three main presenting subtypes: spontaneous preterm labour (sPTL), preterm premature rupture of membranes (pPROM) and clinician-initiated preterm delivery (ciPTD). PTD subtype data are rarely available from birth registries and are onerous to derive from medical records., Objectives: To develop and test the validity of a questionnaire to classify PTD subtype based on birthing parent recall of labour and delivery events., Methods: The questionnaire was sent in 2022 to 581 patients with PTD history documented in the LIFECODES study, a hospital-based birth cohort in Boston, Massachusetts. Eighty-two respondents reported 94 PTDs that could be linked to medical records. Data on PTD subtype were extracted from medical records as the reference standard., Results: Medical records indicated 47 spontaneous (24 sPTL, 23 pPROM) and 47 ciPTD deliveries occurring a median eight years earlier. The sensitivity and specificity of the recall questionnaire were 88% (95% confidence interval: 68, 97%) and 89% (79, 95%) for sPTL; 96% (78, 100%) and 94% (86, 98%) for pPROM; and 83% (69, 92%) and 100% (92, 100%) for ciPTD, respectively. Greater time since pregnancy did not degrade the sensitivity or specificity of the parental recall questionnaire., Conclusions: Although derived from a modest sample, the moderate-to-high sensitivity and specificity of the parental recall questionnaire to classify sPTL, pPROM and ciPTD demonstrates its potential for large studies of PTD and for correction of misclassification bias. Future studies are required to test the questionnaire in a variety of populations., (© 2023 The Authors. Paediatric and Perinatal Epidemiology published by John Wiley & Sons Ltd.)

Objective: To examine the association of maternal lifetime experiences of racial discrimination with infant sleep duration over the first 2 years of life., Design: Prebirth cohort study., Setting: Massachusetts, USA (baseline: 1999-2002)., Participants: 552 mother-infant dyads in Project Viva, for whom the mother self-identified as being a woman of color., Measurements: During pregnancy, mothers completed the Experiences of Discrimination survey that measured lifetime experiences of racial discrimination in eight domains. The main outcome was a weighted average of their infants' 24-hour sleep duration from 6 months to 2 years., Results: 30% reported 0 domains of racial discrimination, 35% 1-2 domains, and 34% ≥3 domains. Any racial discrimination (≥1 vs. 0 domains) was higher among black (80%) versus Hispanic (58%) or Asian (53%) mothers and the United States versus foreign-born mothers (79% vs. 58%) and was associated with higher mean prepregnancy BMI (26.8 vs. 24.5 kg/m 2 ). Children whose mothers reported ≥3 domains versus 0 domains had shorter sleep duration from 6 months to 2 years in unadjusted analysis (β -18.6 min/d; 95% CI -37.3, 0.0), which was attenuated after adjusting for maternal race/ethnicity and nativity (-13.6 min/d; -33.7, 6.5). We found stronger associations of racial discrimination with offspring sleep at 6 months (-49.3 min/d; -85.3, -13.2) than for sleep at 1 year (-13.5 min/d; -47.2, 20.3) or 2 years (4.2 min/d; -21.5, 29.9)., Conclusions: Maternal lifetime experiences of racial discrimination was associated with shorter offspring sleep duration at 6 months, but not with infant's sleep at 1 and 2 years of age., (Copyright © 2020 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

We established Project Viva to examine prenatal diet and other factors in relation to maternal and child health. We recruited pregnant women at their initial prenatal visit in eastern Massachusetts between 1999 and 2002. Exclusion criteria included multiple gestation, inability to answer questions in English, gestational age ≥22 weeks at recruitment and plans to move away before delivery. We completed in-person visits with mothers during pregnancy in the late first (median 9.9 weeks of gestation) and second (median 27.9 weeks) trimesters. We saw mothers and children in the hospital during the delivery admission and during infancy (median age 6.3 months), early childhood (median 3.2 years) and mid-childhood (median 7.7 years). We collected information from mothers via interviews and questionnaires, performed anthropometric and neurodevelopmental assessments and collected biosamples. We have collected additional information from medical records and from mailed questionnaires sent annually to mothers between in-person visits and to children beginning at age 9 years. From 2341 eligible women, there were 2128 live births; 1279 mother-child pairs provided data at the mid-childhood visit. Primary study outcomes include pregnancy outcomes, maternal mental and cardiometabolic health and child neurodevelopment, asthma/atopy and obesity/cardiometabolic health. Investigators interested in learning more about how to obtain Project Viva data can contact Project&#95;Viva@hphc.org., (© The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.)

Background: Previous studies have suggested that violence victimization is prevalent among women with premenstrual syndrome (PMS). However, it is unclear whether early life abuse contributes directly to PMS or whether associations are explained by the high prevalence of PMS risk factors including smoking and obesity among women reporting childhood abuse., Methods: We have assessed the relation of early life abuse and the incidence of moderate-to-severe PMS in a study nested within the prospective Nurses' Health Study 2. Participants were aged 27-44 years and free from PMS at baseline, including 1,018 cases developing PMS over 14 years and 2,277 comparison women experiencing minimal menstrual symptoms. History of early life emotional, physical, and sexual abuse was self-reported in 2001., Results: After adjustment for obesity, smoking, and other factors, emotional abuse was strongly related to PMS (pTrend<0.0001); women reporting the highest level of emotional abuse had 2.6 times the risk of PMS as those reporting no emotional abuse (95% confidence interval, 1.7-3.9). Women reporting severe childhood physical abuse had an odds ratio of 2.1 (95% confidence interval, 1.5-2.9; pTrend<0.001) compared with those reporting no physical abuse. Sexual abuse was less strongly associated with risk. Adjustment for childhood social support minimally affected findings., Conclusions: Findings from this large prospective study suggest that early life emotional and physical abuse increase the risk of PMS in the middle-to-late reproductive years. The persistence of associations after control for potential confounders and mediators supports the hypothesis that early life abuse is importantly related to PMS.

Objective: To examine the associations of upward crossing of major percentiles in weight-for-length in the first 24 months of life with the prevalence of obesity at ages 5 and 10 years., Design: Longitudinal study., Setting: Multisite clinical practice., Participants: We included 44 622 children aged from 1 month to less than 11 years with 122 214 length/height and weight measurements from January 1, 1980, through December 31, 2008., Main Exposure: The number of major weight-for-length percentiles crossed during each of four 6-month intervals, that is, 1 to 6 months, 6 to 12 months, 12 to 18 months, and 18 to 24 months., Main Outcome Measures: Odds and observed prevalence of obesity (body mass index [calculated as weight in kilograms divided by height in meters squared] ≥95th percentile) at ages 5 and 10 years., Results: Crossing upwards 2 or more weight-for-length percentiles was common in the first 6 months of life (43%) and less common during later age intervals. Crossing upwards 2 or more weight-for-length percentiles in the first 24 months was associated with elevated odds of obesity at ages 5 years (odds ratio, 2.08; 95% CI, 1.84-2.34) and 10 years (1.75; 1.53-2.00) compared with crossing less than 2 major percentiles. Obesity prevalence at ages 5 and 10 was highest among children who crossed upwards 2 or more weight-for-length percentiles in the first 6 months of life., Conclusions: Crossing upwards 2 or more major weight-for-length percentiles in the first 24 months of life is associated with later obesity. Upward crossing of 2 weight-for-length percentiles in the first 6 months is associated with the highest prevalence of obesity 5 and 10 years later. Efforts to curb excess weight gain in infancy may be useful in preventing later obesity.

Background: Infancy is a critical period for brain development. Few studies have examined the extent to which infant weight gain is associated with later neurodevelopmental outcomes in healthy populations., Objective: The purpose of this work was to examine associations of infant weight gain from birth to 6 months with child cognitive and visual-motor skills at 3 years of age., Patients and Methods: We studied 872 participants in Project Viva, an ongoing prospective, longitudinal, prebirth cohort. We abstracted birth weight from the medical chart and weighed infants at 6 months of age. We used the 2000 Centers for Disease Control and Prevention growth charts to derive weight-for-age z scores. Our primary predictor was infant weight gain, defined as the weight-for-age z score at 6 months adjusted for the weight-for-age z score at birth. At 3 years of age, we measured child cognition with the Peabody Picture Vocabulary Test III and visual-motor skills with the Wide Range Assessment of Visual Motor Abilities., Results: Mean Peabody Picture Vocabulary Test III score was 104.2, and mean Wide Range Assessment of Visual Motor Abilities test score was 102.8. Mean birth weight z score was 0.21, and mean 6-month weight z score was 0.39. In multiple linear regression adjusted for child age, gender, gestational age, breastfeeding duration, primary language, and race/ethnicity; maternal age, parity, smoking status, and cognition; and parental education and income level, we found no association of infant weight gain with child Peabody Picture Vocabulary Test III score (-0.4 points per z score weight gain increment, 95% confidence interval -1.3, 0.6) or total Wide Range Assessment of Visual Motor Abilities standard score (-0.4 points, 95% confidence interval -1.2, 0.5)., Conclusions: Slower infant weight gain was not associated with poorer neurodevelopmental outcomes in healthy, term-born 3-year-old children. These results should aid in determining optimal growth patterns in infants to balance risks and benefits of health outcomes through the life course.

Background: Animal data show that decreased activity of placental 11-beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD2), which potently inactivates glucocorticoids (e.g. cortisol) to inert forms (cortisone), allows increased access of maternal glucocorticoids to the fetus and 'programs' hypertension. Data in humans are limited. We examined in humans the association between venous umbilical cord blood glucocorticoids, a potential marker for placental 11beta-HSD2 enzyme activity, and blood pressure at age 3 years., Methods: Among 286 newborns in Project Viva, a prospective pre-birth cohort study based in eastern Massachusetts, we measured cortisol (F) and cortisone (E) in venous cord blood and used the ratio of F/E as a marker for placental 11beta-HSD2 activity. We measured blood pressure (BP) when the offspring reached age 3 years. Using mixed effects regression models to control for BP measurement conditions, maternal and child characteristics, we examined the association between the F/E ratio and child BP., Results: At age 3 years, each unit increase in the F/E ratio was associated with a 1.6 mm Hg increase in systolic BP (95% CI 0.0 to 3.1). The F/E ratio was not associated with diastolic blood pressure or birth weight for gestational age z-score., Conclusion: A higher F/E ratio in umbilical venous cord blood, likely reflecting reduced placental 11beta-HSD2 activity, was associated with higher systolic blood pressure at age 3 years. Our data suggest that increased fetal exposure to active maternal glucocorticoids may program later systolic blood pressure.

Purpose: We examined the association between severity, accumulation, and timing of abuse in childhood and adolescence and smoking status among young women., Methods: Retrospective self-reported childhood abuse was ascertained with the modified Conflict Tactics Scale from 91,286 Nurses Health Study II participants in 2001 (68,505 returned; 75.0% response rate). Childhood abuse was categorized by severity (mile/moderate/severe), type (physical/sexual), and timing (childhood/adolescence). Smoking status during adolescence was reported at baseline (1989). Logistic regression was used to predict smoking initiation by age 14 and smoking status between the ages of 15 and 19., Results: A graded association between severity of abuse and early initiation of smoking (by age 14 years) was demonstrated (odds ratio [OR] = 1.9, 95% confidence interval [CI] = 1.7-2.1 for severe physical violence). Young women with both physical and sexual abuse were two times more likely to start smoking by age 14 than were those reporting no abuse (OR = 2.0, 95% CI = 1.8-2.3). Although abuse during childhood increased risk for adolescent smoking (OR = 1.7, 95% CI = 1.8-2.1) for those with childhood physical and sexual abuse, inclusion of adolescent physical and sexual abuse (OR = 2.2, 95% CI 2.1-2.4) diminished the impact of childhood abuse (OR = 1.1, 95% CI 1.1-1.2). The degree of familial emotional support was protective against smoking, and reduced the impact of abuse by 40% among those with high emotional support versus those without (p < .0001)., Conclusions: A strong and graded association was observed between both severity and accumulation of abuse and the risk of early initiation of smoking among girls. Smoking status during late adolescence was more strongly associated with adolescent abuse than childhood abuse. Early smoking onset is associated with both heightened risk for disease in adolescence but also increased morbidity and mortality in adulthood. Identifying and intervening in potentially modifiable risk factors for smoking onset in young women, such as early-life physical and sexual abuse, and building familial strengths, such as emotional support, may have significant public health implications.

Shorter sleep duration is linked to obesity, coronary artery disease, and diabetes. Whether sleep deprivation during the postpartum period affects maternal postpartum weight retention remains unknown. This study examined the association of sleep at 6 months postpartum with substantial postpartum weight retention (SPPWR), defined as 5 kg or more above pregravid weight at 1 year postpartum. The authors selected 940 participants in Project Viva who enrolled during early pregnancy from 1999 to 2002. Logistic regression models estimated odds ratios of SPPWR for sleep categories, controlling for sociodemographic, prenatal, and behavioral attributes. Of the 940 women, 124 (13%) developed SPPWR. Sleep distributions were as follows: 114 (12%) women slept < or =5 hours/day, 280 (30%) slept 6 hours/day, 321 (34%) slept 7 hours/day, and 225 (24%) slept > or =8 hours/day. Adjusted odds ratios of SPPWR were 3.13 (95% confidence interval (CI): 1.42, 6.94) for < or =5 hours/day, 0.99 (95% CI: 0.50, 1.97) for 6 hours/day, and 0.94 (95% CI: 0.50, 1.78) for > or =8 hours/day versus 7 hours/day (p = 0.012). The adjusted odds ratio for SPPWR of 2.05 (95% CI: 1.11, 3.78) was twofold greater (p = 0.02) for a decrease in versus no change in sleep at 1 year postpartum. Sleeping < or =5 hours/day at 6 months postpartum was strongly associated with retaining > or =5 kg at 1 year postpartum. Interventions to prevent postpartum obesity should consider strategies to attain optimal maternal sleep duration.

Purpose: We sought to examine associations of first-trimester intake of calcium, n-3 and n-6 fatty acids, trans fatty acids, magnesium, folate, and vitamins C, D, and E with preeclampsia (PE) and gestational hypertension (GH)., Methods: We studied associations of diet with PE or GH among 1718 women in the prospective cohort study Project Viva, using logistic regression and adjusting for maternal age, prepregnancy body mass index, first trimester systolic blood pressure, race/ethnicity, education, and parity. We assessed first-trimester diet using a validated semiquantitative food frequency questionnaire., Results: A total of 59 (3%) women developed PE, and 119 developed (7%) GH. We found a somewhat-lower risk of PE associated with higher intake of the elongated n-3 fatty acids docosahexaenoic and eicosapentaenoic acids (odds ratio [OR] 0.84, 95% confidence interval [95% CI]: 0.69-1.03 per 100 mg/day), fish (OR 0.91, 95% CI 0.75-1.09 per serving/day), and the ratio of docosahexaenoic + eicosapentaenoic to arachadonic acid (OR 0.82, 95% CI 0.66-1.01). We did not observe a lower risk of GH or PE with a greater intake of calcium; vitamin C, D, or E; milk; magnesium; folate; or with lower intake of n-6 or trans fatty acids., Conclusions: Our results support a potential benefit for elongated n-3 fatty acids in preventing preeclampsia.

Context: An important indicator of nutritional status within a pediatric population is the anemia prevalence rate. Limited national data are available regarding trends in anemia prevalence among non-low-income children., Objective: To determine the prevalence of anemia over time among children enrolled in a health maintenance organization (HMO)., Design: Trend analysis, adjusted for clinical site, age group, sex, race/ethnicity, Medicaid insurance, and testing frequency within each year, and accounting for repeated observations of individual children across different years., Setting: Massachusetts HMO., Participants: 72,729 children aged 6-59.9 months seen at 126,695 well-child visits from 1987 to 2001., Main Outcome: Anemia prevalence by hemoglobin level., Results: The observed prevalence of anemia was 8.9%, and was higher among younger children, blacks, boys, and those with Medicaid insurance. While the unadjusted anemia rate among children tested increased from 9.9% in 1987 to 11% in 2001, the proportion of children who were tested for anemia declined from 55% to 45% during the study period. After adjustment for demographics and testing frequency, the odds of anemia decreased over time (odds ratio 0.84, 95% confidence interval 0.76-0.93, per decade). Predicted anemia prevalence among those tested decreased from 8.9% in 1987 to 7.1% in 2001., Conclusions: Anemia was less prevalent in this HMO population than has been reported in low-income children. After adjustment for testing frequency, the odds of anemia declined over time. As testing practices change to target children at higher risk, trend analyses should account for differences in screening rates over time. The computerized medical records of large health systems may serve as a valuable tool for nutritional surveillance among non low-income populations.

Objective: To examine overweight trends over a 22-year period among preschool-aged children from primarily middle-income families enrolled in a health maintenance organization., Research Methods and Procedures: From well-child care visits to a Massachusetts health maintenance organization, we randomly selected one visit per child per calendar year, yielding a study sample of 120,680 children seen at 366,109 visits from 1980 through 2001. Using multivariate logistic regression models accounting for repeated observations of individual children across years, we estimated trends in prevalence of overweight (weight-for-length/height > or = 95th percentile) and at-risk-for-overweight (85th to 95th percentile)., Results: Over the 22-year study period, the observed prevalence of overweight increased from 6.3% to 10.0% and at-risk-for-overweight increased from 11.1% to 14.4%. These increases were evident among all groups of children including infants < 6 months of age. Overall, the adjusted odds ratios were 1.21 per decade (95% confidence interval, 1.17 to 1.25) for overweight and 1.06 per decade (95% confidence interval, 1.03 to 1.08) for at-risk-for-overweight., Discussion: Rates of overweight are increasing in very young children, even infants, from primarily middle-class families.

Previous studies, mainly among populations with high consumption of seafood, have suggested that increased marine n-3 polyunsaturated fatty acid (PUFA) intake during pregnancy promotes longer gestation and higher birth weight. Few studies have isolated the contribution of fetal growth to birth weight. Using data from 2,109 pregnant women in Massachusetts enrolled in Project Viva from 1999 to 2002, the authors examined associations of marine n-3 PUFA and seafood intake with birth weight and birth-weight-for-gestational-age z value (fetal growth) using linear regression; length of gestation using median regression; and low birth weight, preterm delivery, and being small for gestational age using logistic regression. After adjustment for maternal and child factors, birth weight was 94 (95% confidence interval: 23, 166) g lower and fetal growth z value 0.19 (95% confidence interval: 0.08, 0.31) units lower in the highest compared with the lowest quartile of first-trimester n-3 PUFA intake. Results for the second and third trimesters were similar, and findings for seafood paralleled those for n-3 PUFA. Elongated n-3 PUFA intake and seafood intake were not associated with length of gestation or risk of preterm birth. Results from this US cohort support the conclusion that seafood intake during pregnancy is associated with reduced fetal growth.