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Ethnic disparities in maternal obesity and weight gain during pregnancy. The Generation R Study

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      To examine ethnic disparities in maternal prepregnancy obesity and gestational weight gain, and to examine to which extent these differences can be explained by socio-demographic, lifestyle and pregnancy related characteristics.


      In a multi-ethnic population-based prospective cohort study among 6,444 pregnant women in Rotterdam, the Netherlands, maternal anthropometrics were repeatedly measured throughout pregnancy. Ethnicity, socio-demographic, lifestyle and pregnancy related characteristics were assessed by physical examinations and questionnaires.


      The prevalence of prepregnancy overweight and obesity was 23.1% among Dutch-origin women. Statistically higher prevalences were observed among Dutch Antillean-origin (40.8%), Moroccan-origin (49.9%), Surinamese-Creole-origin (38.6%) and Turkish-origin (41.1%) women (all p-values <0.05). Only Dutch Antillean-origin, Moroccan-origin, Surinamese-Creole-origin and Turkish-origin women had higher risks of maternal prepregnancy overweight and obesity as compared to Dutch-origin women (p-values <0.05). Socio-demographic and lifestyle related characteristics explained up to 45% of the ethnic differences in body mass index. Compared to Dutch-origin women, total gestational weight gain was lower in all ethnic minority groups, except for Cape Verdean-origin and Surinamese-Creole-origin women (p-values <0.05). Lifestyle and pregnancy related characteristics explained up to 33% and 40% of these associations, respectively. The largest ethnic differences in gestational weight gain were observed in late pregnancy.


      We observed moderate ethnic differences in maternal prepregnancy overweight, obesity and gestational weight gain. Socio-demographic, lifestyle and pregnancy related characteristics partly explained these differences. Whether these differences also lead to ethnic differences in maternal and childhood outcomes should be further studied.

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      Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls

      Most studies have some missing data. Jonathan Sterne and colleagues describe the appropriate use and reporting of the multiple imputation approach to dealing with them
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        The Generation R Study: design and cohort update 2012.

        The Generation R Study is a population-based prospective cohort study from fetal life until adulthood. The study is designed to identify early environmental and genetic causes and causal pathways leading to normal and abnormal growth, development and health during fetal life, childhood and adulthood. The study focuses on six areas of research: (1) maternal health; (2) growth and physical development; (3) behavioural and cognitive development; (4) respiratory health and allergies; (5) diseases in childhood; and (6) health and healthcare for children and their parents. Main exposures of interest include environmental, endocrine, genetic and epigenetic, lifestyle related, nutritional and socio-demographic determinants. In total, n = 9,778 mothers with a delivery date from April 2002 until January 2006 were enrolled in the study. Response at baseline was 61 %, and general follow-up rates until the age of 6 years exceed 80 %. Data collection in mothers, fathers and children include questionnaires, detailed physical and ultrasound examinations, behavioural observations, and biological samples. A genome and epigenome wide association screen is available in the participating children. From the age of 5 years, regular detailed hands-on assessments are performed in a dedicated research center including advanced imaging facilities such as Magnetic Resonance Imaging. Eventually, results forthcoming from the Generation R Study contribute to the development of strategies for optimizing health and healthcare for pregnant women and children.
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          Does low participation in cohort studies induce bias?

          Participation rates in large cohort studies have decreased during the last 2 decades. The consequences of this trend for relative risk estimation are unknown. The impact of a low participation rate (30%) on the Danish National Birth Cohort was examined among 49,751 women from the source population, including 15,373 participants in the cohort study. On the basis of independent data collection, we estimated odds ratios (ORs) in the source population and among participants for 3 exposure-risk associations: (a) in vitro fertilization and preterm birth, (b) smoking during pregnancy and birth of a small-for-gestational-age infant, and (c) prepregnancy body mass index and antepartum stillbirth. The effect of nonparticipation was described by a relative odds ratio (ROR), calculated as the OR(participants)/OR(source population). Two methods for calculation of confidence intervals for the relative odds ratio also were assessed. The effect of nonparticipation on the selected ORs was small. The relative ORs were close to one and the bias was never larger than 16%, although some of the confidence intervals were wide. The 2 methods for calculation of confidence intervals gave very similar results and a small simulation study showed that the coverage probabilities were close to the 95% nominal level. For the 3 chosen associations, the ORs were not biased by nonparticipation. The results are reassuring for studies based on the Danish cohort and similar cohorts of pregnant women. The methodology used to compute confidence intervals for the relative odds ratios performed well in the scenarios considered.

            Author and article information

            [1 ]The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, the Netherlands
            [2 ]Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
            [3 ]Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, the Netherlands
            [4 ]Department of Public Health, Erasmus MC, University Medical Center Rotterdam, the Netherlands
            [5 ]Department of Health Sciences, section Prevention and Public Health, VU University Amsterdam, the Netherlands
            [6 ]Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
            Author notes
            Correspondence to: Vincent W.V. Jaddoe, MD, PhD. The Generation R Study Group (NA2915). Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands. ( v.jaddoe@ ).
            Eur J Obstet Gynecol Reprod Biol
            Eur. J. Obstet. Gynecol. Reprod. Biol.
            European journal of obstetrics, gynecology, and reproductive biology
            25 April 2017
            08 July 2015
            October 2015
            28 April 2017
            : 193
            : 51-60
            26232727 5408938 10.1016/j.ejogrb.2015.06.031 EMS66131

            This manuscript version is made available under the CC-BY-NC-ND 4.0 license



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