The Mother and Child Cohort in Crete, Rhea Study

Study design & key findings Leda Chatzi, MD, PhD Department of Social Medicine, Faculty of Medicine,

University of Crete, Heraklion, Greece

Brussels, October 2011

Study protocol: pregnancy- 2 years of age

Mother

Child Cord blood

FFQ Q2

+urine sample

EPDS

Q4

(parents)

Q5

(parents)

12w – 24w Pregnancy

Delivery 9th month 18th month

Q3

+ blood sample

Neurodevelopment

Q 1

+ blood + urine

sample

25w – 36w Pregnancy

EPDS

STAI-T

EPQ

S. Capital

1st month 4th year

The Mother & Child Cohort in Crete, Rhea Study

Study protocol: 4 years

Questionnaires

Clinical Exams

FFQ

Physical activity Q

AD/HD Quest.

Neurodevelopment

(McCarthy)

Q6 (Clinical Questionnaire)

4th year

Urine & Blood

samples

Clinical Examination

(+ spirometry)

Strengths & Difficulties Quest. (SDQ)

Parenting Stress Index (PSI-SF)

The Mother & Child Cohort in Crete, Rhea Study

Diet assessment in pregnancy

Dietary habits in mid pregnancy: FFQ on 250 items, completed by personal interview

Dietary changes during pregnancy: FFQ in 3rd trimester, 100 items, completed by personal interview

Supplement use: specific questions in mid, late pregnancy for supplement use, brand names, dosages.

Nutrient analysis: Based on the UK Nutrient Databank (McCance and Widdowson's, 6th edition 2002).

The Mother & Child Cohort in Crete, Rhea Study

Diet assessment in childhood

Breastfeeding practices: Questionnaire 9th month

Introduction of solid foods: Questionnaire 9th month

Dietary habits at 4 years: FFQ, 100 items, personal interview with the parents

Nutrient analysis: Based on the UK Nutrient Databank (McCance and Widdowson's, 6th edition 2002).

The Mother & Child Cohort in Crete, Rhea Study

• Biological samples, Clinical Measurements related to Maternal Obesity in pregnancy

Serum 10-14th week of gestation: Fasting glucose, TG,

LDL, HDL, Tchol, insulin Cord Blood at birth: Leptin Maternal anthropometry: BMI pre-pregnancy; BMI-

first trimester, weight gain during pregnancy Blood pressure measurement: Standard protocol, 10-

14th week of gestation Definition of Metabolic syndrome: NCEP III criteria

with some adaptations to our study population of pregnant women

The Greek Mother & Child Cohort Study The Mother & Child Cohort in Crete, Rhea Study

The Mother & Child Cohort in Crete, Rhea Study

Metabolic Syndrome in Early Pregnancy and Risk of Preterm birth and Fetal growth restriction

Leda Chatzi, Estel Plana, Vasiliki Daraki, Polyxeni Karakosta, Dimitris Alegkakis, Christos Tsatsanis, Antonis Kafatos, Antonis Koutis, and Manolis Kogevinas Am J Epidemiol, 2009

The Mother & Child Cohort in Crete, Rhea Study

Metabolic Syndrome

No (N=603) Yes (N=22) P-Value

Mean (SD) Mean (SD)

Systolic blood pressure,

mm Hg

106.1 (9.6) 117.9 (11.0) <0.001

Diastolic blood pressure,

mm Hg

69.8 (9.6) 80.3 (12.6) <0.001

Glucose, mg/dL 76.0 (12.7) 83.4 (21.8) 0.011

Homeostasis model assessment ª

2.10 (3.6) 4.54 (5.6) 0.005

Insulin, mU/mL 10.5 (16.4) 31.7 (62.5) <0.001

ª Calculated as glucose (mg/dL) * insulin (mU/mL/405)

Abbreviations: HDL, high density lipoprotein; LDL, low density lipoprotein; SD, standard deviation.

Distribution of the Components of Metabolic Syndrome in Early Pregnancy

Chatzi et al, 2009; Am J Epidemiol

The Mother & Child Cohort in Crete, Rhea Study

Preterm Births

All Preterm (N=74) Neonates With Fetal Weight Growth

Restriction (N=52)

Relative Riskª

95% Confidence Interval

Relative Riskª

95% Confidence Interval

Metabolic syndrome (n=22)

2.93* 1.53, 5.58 1.23 0.41, 3.67

Maternal body mass index prepregnancy, >30 (n=76)

0.93 0.48, 1.79 1.12 0.55, 2.29

Triglycerides, ≥150 mg/dL (n=145)

1.26 0.74, 2.15 0.85 0.43, 1.69

HDL cholesterol, <50 mg/dL (n=145)

1.27 0.79, 2.05 1.70 1.00, 2.89

Blood pressure, ≥130/≥85 mm Hg (n=40)

2.32* 1.28, 4.20 1.92 0.88, 4.16

Fasting glucose, ≥100 mg/dL (n=8)

0.88 0.23, 3.42 1.64 0.47, 5.69

No. of metabolic syndrome components

1.22 0.96, 1.54 1.21 0.92, 1.59

Association of Metabolic Syndrome in Early Pregnancy With Preterm Birth and Fetal Weight Growth Restriction

ª Adjusted for maternal age, maternal education and maternal smoking during pregnancy. * Confidence interval does not include 1,00.

Chatzi et al, 2009 Am J Epidemiol

The Mother & Child Cohort in Crete, Rhea Study

Preterm Births

Spontaneous Preterm (N=45)

Medically Indicated Preterm (N=29)

Relative Riskª

95% Confidence Interval

Relative Riskª

95% Confidence Interval

Metabolic syndrome (n=22) 2.24 0.75, 6.68 5.13* 1.97, 13.38

Maternal body mass index prepregnancy, >30 (n=76)

0.97 0.42, 2.21 0.85 0.26, 2.79

Triglycerides, ≥150 mg/dL (n=145)

1.09 0.52, 2.29 1.64 0.71, 3.80

HDL cholesterol, <50 mg/dL (n=145)

1.54 0.84, 2.82 0.93 0.38, 2.24

Blood pressure, ≥130/≥85 mm Hg (n=40)

1.87 0.78, 4.52 3.92* 1.57, 9.77

Fasting glucose, ≥100 mg/dL (n=8)

2.21 0.53, 9.14

No. of metabolic syndrome components

1.17 0.85, 1.63 1.34 0.90, 1.97

Association of Metabolic Syndrome in Early Pregnancy With Preterm Births

ª Adjusted for maternal age, maternal education and maternal smoking during pregnancy. * Confidence interval does not include 1,00.

Chatzi et al, 2009 Am J Epidemiol

Is Mediterranean Diet during pregnancy protective for

fetal growth restriction? Results from two prospective

cohort studies in Spain and Greece

Leda Chatzi, Michelle Mendez, Raquel Garcia, Theano

Roumeliotaki, Jesús Ibarluzea, Adonina Tardón, Pilar Amiano,

Aitana Lertxundi, Carmen Iñiguez, Jesus Vioque, Manolis

Kogevinas, Jordi Sunyer

On behalf of the INMA and the RHEA birth cohorts study groups,

British Journal of Nutrition 2011

Mediterranean Diet Score during pregnancy

The INMA and Rhea Mother & Child Cohort Studies

3.35

3.45

3.55

3.65

3.75

3.85

3.95

4.05

4.15

4.25 M

ean (9

5%

C.I.)

0

5

10

15

20

25

30

35

40

45

50

Fre

quency %

Diet Score

of 0-3

Diet Score

of 4-5

Diet Score

of 6-8

INMA

Atlantic

INMA Mediterranean

RHEA

INMA Atlantic INMA Mediterranean RHEA

All models were adjusted for gender, gestational age, maternal smoking during pregnancy, maternal age and total energy intake using linear regression models. a P values for values for each component from the regression model b Also adjusted for: INMA Atlantic: parity, maternal BMI, paternal education and parental social class; INMA Mediterranean: parity, parental BMI, and maternal social class;

RHEA: maternal BMI and education.

c Also adjusted for: INMA Atlantic: parity, maternal BMI, paternal age and maternal social class; INMA Mediterranean: parity, maternal BMI, and maternal social class;

RHEA: maternal height and education.

d Also adjusted for: INMA Atlantic: parity, maternal BMI and education; INMA Mediterranean: parity, maternal BMI, maternal education and alcohol intake; RHEA: maternal

BMI and education.

* Mediteranean Diet score, Low: 0-3; Medium: 4-5; High: 6-8

Associations between Mediterranean Diet Score in pregnancy with anthropometric measurements at birth

The INMA and Rhea Mother & Child Cohort Studies

INMA Atlantic INMA Mediterranean RHEA

β SE Pa β SE Pa β SE Pa

Weightb

MD score, Low Ref. Ref. Ref.

MD score, Medium -26·46 26·03 0·310 55·20 23·52 0·019 -33·67 31·78 0·290

MD score, High -82·85 47·67 0·082 87·78 33·40 0·009 -20·42 42·33 0·630

Lengthc

MD score, Low Ref. Ref. Ref.

MD score, Medium -0·16 0·12 0·185 0·13 0·10 0·203 -0·43 0·18 0·077

MD score, High -0·25 0·22 0·245 0·30 0·15 0·040 -0·06 0·24 0·794

Head circumferenced

MD score, Low Ref. Ref. Ref.

MD score, Medium 0·03 0·09 0·770 0·03 0·07 0·647 -0·23 0·12 0·049

MD score, High -0·06 0·16 0·711 0·16 0·10 0·121 -0·20 0·16 0·214

Adjusted means of birth weight by Mediterranean Diet Score and maternal smoking during pregnancy

The INMA and Rhea Mother & Child Cohort Studies

2950

3000

3050

3100

3150

3200

3250

MedDiet 0-3 MedDiet 4-6 MedDiet 6-8

Weig

ht (g

r)

INMA-Atlantic: Non Smokers (○), Smokers (●); INMA-Mediterannean: Non Smokers (□), Smokers (■); RHEA: Non Smokers (), Smokers

(). All models were adjusted for maternal age and total energy intake, gender and gestational age. Models for weight were also adjusted for:

INMA-Atlantic: parity, maternal BMI, paternal education and parental social class; INMA-Mediterannean: parity, parental BMI, and maternal

social class; RHEA: maternal BMI and education.

Adjusted means of head circumference by Mediterranean Diet Score and maternal smoking during pregnancy

The INMA and Rhea Mother & Child Cohort Studies

33.2

33.4

33.6

33.8

34.0

34.2

34.4

MedDiet 0-3 MedDiet 4-6 MedDiet 6-8

He

ad

circu

mfe

rence

(cm

)

INMA-Atlantic: Non Smokers (○), Smokers (●); INMA-Mediterannean: Non Smokers (□), Smokers (■); RHEA: Non Smokers (), Smokers

(). All models were adjusted for maternal age and total energy intake, gender and gestational age. Models for head circumference were also

adjusted: INMA-Atlantic: parity, maternal BMI and education; INMA-Mediterranean: parity, maternal BMI, maternal education and alcohol

intake; RHEA: maternal BMI and education.

The Mother & Child Cohort in Crete, Rhea Study

Future research

Maternal obesity and gestational weight gain

Metabolic syndrome in pregnancy

Leptin in cord blood

Dietary patterns in pregnancy

POSTNATAL GROWTH AND OBESITY RISK

Coordination Leda Chatzi

Maria Vassilaki Antonis Koutis

RHEA STUDY

Biobank Eleni Fthenou Georgia Chalkiadaki Polly Karakosta Maria Sarri

Epidemiology

Theano Roumeliotaki Katerina Sarri Vaggelis Georgiou Manolis Bagkeris Vicky Patelarou Constantinos Vardavas Vicky Lebentakou

PIs Manolis Kogevinas Leda Chatzi

Field Study S.Matalliotaki, D. Pagiataki, Μ. Karachaliou Κ. Koutra V.Lebentakou

Chemistry Evripides Stephanou

The Greek Mother & Child Cohort Study The Greek Mother & Child Cohort Study

to be continued ……………

Thank you…