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1.  Impact of singlehood during pregnancy on dietary intake and birth outcomes- a study in the Norwegian Mother and Child Cohort Study 
Background
Little attention has been given to the impact of singlehood during pregnancy. The aim of this study was to examine the impact of marital status on diet during pregnancy and pregnancy outcome.
Methods
The study population comprised 62,773 women participating in the Norwegian Mother and Child Cohort Study. Marital status was categorised into singles living alone, singles living with parents and married/cohabiting (reference group). Participants answered a general health questionnaire in gestational week 15–17 and a food frequency questionnaire in gestational week 22. We used nonparametric tests to compare dietary intakes by marital status, and multiple logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for infants being small for gestational age (SGA), large for gestational age (LGA), and preterm delivery (defined as delivery before gestational week 37).
Results
Single women living with parents had lower intakes of fruits and vegetables, higher intake of total energy, higher proportion of energy from added sugar, and lower intake of fibre than the reference group. Singles living alone also had a higher intake of added sugar. In both of the single groups, daily smoking was more prevalent than in women living with a partner. In analyses adjusted for maternal age, pre-pregnancy BMI, energy intake, energy contributed by protein, education, income, parity and nausea, single women living alone had increased risk of SGA with OR = 1.27 (95% CI: 1.05, 1.55). When smoking was included among the confounding variables, the association was no longer significant. Likewise, singles living alone had increased risk of preterm delivery, with OR = 1.32 (95% CI: 1.01, 1.72) in a partly adjusted model, but the association did not remain significant in a model fully adjusted for confounding variables.
Conclusions
Single mothers had lower dietary quality and included more smokers than women who lived with a partner. Single mothers living alone had higher prevalence of SGA and preterm delivery, but the associations with adverse pregnancy outcomes were confounded by other variables. This study shows that single mothers should be given special attention during antenatal care and counselling.
doi:10.1186/s12884-014-0396-9
PMCID: PMC4268900  PMID: 25475509
Marital status; Singlehood; The Norwegian Mother and Child Cohort Study; MoBa; Food frequency questionnaire
2.  Folic acid supplementation, dietary folate intake during pregnancy and risk for spontaneous preterm delivery: a prospective observational cohort study 
Background
Health authorities in numerous countries recommend periconceptional folic acid supplementation to prevent neural tube defects. The objective of this study was to examine the association of dietary folate intake and folic acid supplementation during different periods of pregnancy with the risk of spontaneous preterm delivery (PTD).
Methods
The Norwegian Mother and Child Cohort Study is a population-based prospective cohort study. A total of 66,014 women with singleton pregnancies resulting in live births in 2002–2009 were included. Folic acid supplementation was self-reported from 26 weeks before pregnancy until pregnancy week 24. At gestational week 22, the women completed a food frequency questionnaire, which allowed the calculation of their average total folate intake from foods and supplements for the first 4–5 months of pregnancy. Spontaneous PTD was defined as the spontaneous onset of delivery between weeks 22+0 and 36+6 (n = 1,755).
Results
The median total folate intake was 313 μg/d (interquartile range IQR 167–558) in the overall population and 530 μg/d (IQR 355–636) in the supplement users. Eighty-five percent reported any folic acid supplementation from <8 weeks before to 24 weeks after conception while only 44% initiated folic acid supplementation before pregnancy. Cox regression analysis showed that the amount of dietary folate intake (hazard ratio HR 1.00; confidence interval 95% CI 0.61-1.65) and supplemental folate intake (HR 1.00; CI 1.00-1.00) was not significantly associated with the risk of PTD. The initiation of folic acid supplementation more than 8 weeks before conception was associated with an increased risk for spontaneous PTD (HR 1.18; CI 1.05-1.32) compared to no folic acid supplementation preconception. There was no significant association with PTD when supplementation was initiated within 8 weeks preconception (HR 0.99; CI 0.87-1.13). All analyses were adjusted for maternal characteristics and socioeconomic, health and dietary variables.
Conclusions
Our findings do not support a protective effect of dietary folate intake or folic acid supplementation on spontaneous PTD. Preconceptional folic acid supplementation starting more than 8 weeks before conception was associated with an increased risk of spontaneous PTD. These results require further investigation before discussing an expansion of folic acid supplementation guidelines.
Electronic supplementary material
The online version of this article (doi:10.1186/s12884-014-0375-1) contains supplementary material, which is available to authorized users.
doi:10.1186/s12884-014-0375-1
PMCID: PMC4240839  PMID: 25361626
Pregnancy; Preterm delivery; Preterm birth; Gestational length; Folate; Folic acid supplementation
4.  Associations of pre-pregnancy body mass index and gestational weight gain with pregnancy outcome and postpartum weight retention: a prospective observational cohort study 
Background
Excessive gestational weight gain (GWG) is associated with pregnancy complications, and Norwegian Health Authorities have adopted the GWG recommendations of the US Institute of Medicine and National Research Council (IOM). The aim of this study was to evaluate if a GWG outside the IOM recommendation in a Norwegian population is associated with increased risk of pregnancy complications like hypertension, low and high birth weight, preeclampsia, emergency caesarean delivery, and maternal post-partum weight retention (PPWR) at 6 and 18 months.
Methods
This study was performed in 56 101 pregnant women included in the prospective national Norwegian Mother and Child Cohort Study (MoBa) in the years 1999 to 2008. Women who delivered a singleton live born child during gestational week 37 to 42 were included. Maternal prepregnant and postpartum weight was collected from questionnaires at 17th week of gestation and 6 and 18 months postpartum.
Results
A weight gain less than the IOM recommendations (GWG < IOM rec.) increased the risk for giving birth to a low weight baby among normal weight nulliparous women. A weight gain higher than the IOM recommendations (GWG > IOM rec.) significantly increased the risk of pregnancy hypertension, a high birth weight baby, preeclampsia and emergency cesarean delivery in both nulliparous and parous normal weight women. Similar results were found for overweight women except for no increased risk for gestational hypertension in parous women with GWG > IOM rec. Seventy-four percent of the overweight nulliparous women and 66% of the obese women had a GWG > IOM rec. A GWG > IOM rec. resulted in increased risk of PPWR > 2 kg in all weight classes, but most women attained their prepregnant weight class by 18 months post-partum.
Conclusions
For prepregnant normal weight and overweight women a GWG > IOM rec. increased the risk for unfavorable birth outcomes in both nulliparous and parous women. A GWG > IOM rec. increased the risk of a PPWR > 2 kg at 18 months in all weight classes. This large study supports the Norwegian Health authorities’ recommendations for normal weight and overweight women to comply with the IOM rec.
doi:10.1186/1471-2393-14-201
PMCID: PMC4062904  PMID: 24917037
MoBa; Body mass index; Prepregnant; Gestational weight gain; Birth outcome; Postpartum weight gain
5.  Adherence of pregnant women to Nordic dietary guidelines in relation to postpartum weight retention: results from the Norwegian Mother and Child Cohort Study 
BMC Public Health  2014;14:75.
Background
Pregnancy is a major life event for women and often connected with changes in diet and lifestyle and natural gestational weight gain. However, excessive weight gain during pregnancy may lead to postpartum weight retention and add to the burden of increasing obesity prevalence. Therefore, it is of interest to examine whether adherence to nutrient recommendations or food-based guidelines is associated with postpartum weight retention 6 months after birth.
Methods
This analysis is based on data from the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. Diet during the first 4-5 months of pregnancy was assessed by a food-frequency questionnaire and maternal weight before pregnancy as well as in the postpartum period was assessed by questionnaires. Two Healthy Eating Index (HEI) scores were applied to measure compliance with either the official Norwegian food-based guidelines (HEI-NFG) or the Nordic Nutrition Recommendations (HEI-NNR) during pregnancy. The considered outcome, i.e. weight retention 6 months after birth, was modelled in two ways: continuously (in kg) and categorically (risk of substantial postpartum weight retention, i.e. ≥ 5% gain to pre-pregnancy weight). Associations between the HEI-NFG and HEI-NNR score with postpartum weight retention on the continuous scale were estimated by linear regression models. Relationships of both HEI scores with the categorical outcome variable were evaluated using logistic regression.
Results
In the continuous model without adjustment for gestational weight gain (GWG), the HEI-NFG score but not the HEI-NNR score was inversely related to postpartum weight retention. However, after additional adjustment for GWG as potential intermediate the HEI-NFG score was marginally inversely and the HEI-NNR score was inversely associated with postpartum weight retention. In the categorical model, both HEI scores were inversely related with risk of substantial postpartum weight retention, independent of adjustment for GWG.
Conclusions
Higher adherence to either the official Norwegian food guidelines or possibly also to Nordic Nutrition Recommendations during pregnancy appears to be associated with lower postpartum weight retention.
doi:10.1186/1471-2458-14-75
PMCID: PMC3908932  PMID: 24456804
Moba; The Norwegian Mother and Child Cohort Study; Diet; Dietary guidelines; Pregnancy; Postpartum weight retention
6.  Changes and tracking of fruit, vegetables and sugar-sweetened beverages intake from 18 months to 7 years in the Norwegian mother and child cohort study 
BMC Public Health  2013;13:793.
Background
A few studies have investigated tracking of dietary patterns or nutrient intake in pre-school children, but no studies have been identified examining tracking of sugar-sweetened beverages (SSB), fruit and vegetable intakes in early childhood (1–7 year olds). The purpose of this study was to investigate changes and tracking of intakes of fruit, vegetables and SSB, and association between maternal education and dietary tracking, from 18 months to 7 years of age.
Methods
Longitudinal data from the nation-wide Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health were used, including 9 025 children participating at three time points (18 months, 36 months and 7 years). Frequencies of fruit, vegetables and SSB were assessed by questionnaire. Slightly different questions were used at each time point to collect information about intake. Maternal education was categorized into ≤ 12 years, 13–16 years, ≥ 17 years. Cross-tabulation, Spearman’s rho and multinomial logistic regression were used for assessing change, tracking and differences by maternal education.
Results
Analyses by gender indicated largest changes for intake of fruit and SSB from age 18 months to 7 years. Fair to moderate tracking coefficients (Spearman’s rho = 0.23-0.46) for intake of fruit, vegetables and SSB were found and children assigned to low, medium and high frequency of consumption at 18 months continued to be in the same group at age 36 months and 7 years. Children of mothers with low education consumed fruit and vegetables less often and SSB more often compared to children of mothers with high education at 18 months of age. Children with higher educated mothers had lower odds for increasing fruit intake or decreasing SSB intake, compared to children with lower educated mothers showing a stable intake.
Conclusions
The tracking coefficients for intakes were fair to moderate and differences in intakes according to maternal education were found already at age 18 months. This suggests that promotion of healthy dietary behaviours at an early age is important to prevent unfavourable dietary behaviours later in childhood. Moreover, it seems important to target mothers in nutrition interventions for improving dietary habits among children.
doi:10.1186/1471-2458-13-793
PMCID: PMC3765981  PMID: 24103398
Children; Tracking; Diet; MoBa
7.  Folic acid supplementation, dietary folate intake during pregnancy and risk for spontaneous preterm delivery: a prospective observational cohort study 
Background
Health authorities in numerous countries recommend periconceptional folic acid to pregnant women to prevent neural tube defects. The objective of this study was to examine the association of folic acid supplementation during different periods of pregnancy and of dietary folate intake with the risk of spontaneous preterm delivery (PTD).
Methods
The Norwegian Mother and Child Cohort Study is a population-based prospective cohort study. A total of 65,668 women with singleton pregnancies resulting in live births in 1999–2009 were included. Folic acid supplementation was self-reported from 26 weeks before pregnancy until week 24 during pregnancy. At gestational week 22, the women completed a food frequency questionnaire, which allowed the calculation of their average total folate intake from foods and supplements for the first 4–5 months of pregnancy. Spontaneous PTD was defined as the spontaneous onset of delivery between weeks 22+0 and 36+6 (n = 1,628).
Results
The median total folate intake was 266 μg/d (interquartile range IQR 154–543) in the overall population and 540 μg/d (IQR 369–651) in the supplement users. Eighty-three percent reported any folic acid supplementation from <8 weeks before to 24 weeks after conception while 42% initiated folic acid supplementation before their pregnancy. Cox regression analysis showed that the amount of folate intake from the diet (hazard ratio HR 1.16; confidence interval CI 0.65-2.08) and from the folic acid supplements (HR 1.04; CI 0.95-1.13) was not significantly associated with the risk of PTD. The initiation of folic acid supplementation more than 8 weeks before conception was associated with an increased risk for PTD (HR 1.19; CI 1.05-1.34) compared to no folic acid supplementation pre-conception. There was no significant association with PTD when supplementation was initiated within 8 weeks pre-conception (HR 1.01; CI 0.88-1.16). All analyses were adjusted for maternal characteristics and socioeconomic, health and dietary variables.
Conclusions
Our findings do not support a protective effect of dietary folate intake or folic acid supplementation on spontaneous PTD. Pre-conceptional folic acid supplementation starting more than 8 weeks before conception was associated with an increased risk of PTD. These results require further investigation before discussing an expansion of folic acid supplementation guidelines.
doi:10.1186/1471-2393-13-160
PMCID: PMC3751653  PMID: 23937678
Pregnancy; Preterm delivery; Preterm birth; Gestational length; Folate; Folic acid supplementation
8.  Maternal caffeine intake during pregnancy is associated with birth weight but not with gestational length: results from a large prospective observational cohort study 
BMC Medicine  2013;11:42.
Background
Pregnant women consume caffeine daily. The aim of this study was to examine the association between maternal caffeine intake from different sources and (a) gestational length, particularly the risk for spontaneous preterm delivery (PTD), and (b) birth weight (BW) and the baby being small for gestational age (SGA).
Methods
This study is based on the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health. A total of 59,123 women with uncomplicated pregnancies giving birth to a live singleton were identified. Caffeine intake from different sources was self-reported at gestational weeks 17, 22 and 30. Spontaneous PTD was defined as spontaneous onset of delivery between 22+0 and 36+6 weeks (n = 1,451). As there is no consensus, SGA was defined according to ultrasound-based (Marsal, n = 856), population-based (Skjaerven, n = 4,503) and customized (Gardosi, n = 4,733) growth curves.
Results
The main caffeine source was coffee, but tea and chocolate were the main sources in women with low caffeine intake. Median pre-pregnancy caffeine intake was 126 mg/day (IQR 40 to 254), 44 mg/day (13 to 104) at gestational week 17 and 62 mg/day (21 to 130) at gestational week 30. Coffee caffeine, but not caffeine from other sources, was associated with prolonged gestation (8 h/100 mg/day, P <10-7). Neither total nor coffee caffeine was associated with spontaneous PTD risk. Caffeine intake from different sources, measured repeatedly during pregnancy, was associated with lower BW (Marsal-28 g, Skjaerven-25 g, Gardosi-21 g per 100 mg/day additional total caffeine for a baby with expected BW 3,600 g, P <10-25). Caffeine intake of 200 to 300 mg/day increased the odds for SGA (OR Marsal 1.62, Skjaerven 1.44, Gardosi 1.27, P <0.05), compared to 0 to 50 mg/day.
Conclusions
Coffee, but not caffeine, consumption was associated with marginally increased gestational length but not with spontaneous PTD risk. Caffeine intake was consistently associated with decreased BW and increased odds of SGA. The association was strengthened by concordant results for caffeine sources, time of survey and different SGA definitions. This might have clinical implications as even caffeine consumption below the recommended maximum (200 mg/day in the Nordic countries and USA, 300 mg/day according to the World Health Organization (WHO)) was associated with increased risk for SGA.
doi:10.1186/1741-7015-11-42
PMCID: PMC3606471  PMID: 23421532
preterm delivery; gestational length; small for gestational age; birth weight; growth curve; intrauterine growth restriction; caffeine; coffee; tea; soft drinks
9.  Risk of Suboptimal Iodine Intake in Pregnant Norwegian Women 
Nutrients  2013;5(2):424-440.
Pregnant women and infants are exceptionally vulnerable to iodine deficiency. The aims of the present study were to estimate iodine intake, to investigate sources of iodine, to identify predictors of low or suboptimal iodine intake (defined as intakes below 100 μg/day and 150 μg/day) in a large population of pregnant Norwegian women and to evaluate iodine status in a sub-population. Iodine intake was calculated based on a validated Food Frequency Questionnaire in the Norwegian Mother and Child Cohort. The median iodine intake was 141 μg/day from food and 166 μg/day from food and supplements. Use of iodine-containing supplements was reported by 31.6%. The main source of iodine from food was dairy products, contributing 67% and 43% in non-supplement and iodine-supplement users, respectively. Of 61,904 women, 16.1% had iodine intake below 100 μg/day, 42.0% had iodine intake below 150 μg/day and only 21.7% reached the WHO/UNICEF/ICCIDD recommendation of 250 μg/day. Dietary behaviors associated with increased risk of low and suboptimal iodine intake were: no use of iodine-containing supplements and low intake of milk/yogurt, seafood and eggs. The median urinary iodine concentration measured in 119 participants (69 μg/L) confirmed insufficient iodine intake. Public health strategies are needed to improve and secure the iodine status of pregnant women in Norway.
doi:10.3390/nu5020424
PMCID: PMC3635203  PMID: 23389302
iodine; pregnancy; prospective cohort; food frequency questionnaire; the Norwegian Mother and Child Cohort Study (MoBa)
10.  Food patterns and dietary quality associated with organic food consumption during pregnancy; data from a large cohort of pregnant women in Norway 
BMC Public Health  2012;12:612.
Background
Little is known about the consumption of organic food during pregnancy. The aim of this study was to describe dietary characteristics associated with frequent consumption of organic food among pregnant women participating in the Norwegian Mother and Child Cohort Study (MoBa).
Methods
The present study includes 63 808 women who during the years 2002–2007 answered two questionnaires, a general health questionnaire at gestational weeks 15 and a food frequency questionnaire at weeks 17-22. The exploration of food patterns by Principal component analyses (PCA) was followed by ANOVA analyses investigating how these food patterns as well as intake of selected food groups were associated with consumption of organic food.
Results
The first principal component (PC1) identified by PCA, accounting for 12% of the variation, was interpreted as a ‘health and sustainability component’, with high positive loadings for vegetables, fruit and berries, cooking oil, whole grain bread and cereal products and negative loadings for meat, including processed meat, white bread, and cakes and sweets. Frequent consumption of organic food, which was reported among 9.1% of participants (n = 5786), was associated with increased scores on the ‘health and sustainability component’ (p < 0.001). The increase in score represented approximately 1/10 of the total variation and was independent of sociodemographic and lifestyle characteristics. Participants with frequent consumption of organic food had a diet with higher density of fiber and most nutrients such as folate, beta-carotene and vitamin C, and lower density of sodium compared to participants with no or low organic consumption.
Conclusion
The present study showed that pregnant Norwegian women reporting frequent consumption of organically produced food had dietary pattern and quality more in line with public advice for healthy and sustainable diets. A methodological implication is that the overall diet needs to be included in future studies of potential health outcomes related to consumption of organic food during pregnancy.
doi:10.1186/1471-2458-12-612
PMCID: PMC3490940  PMID: 22862737
11.  Characteristics associated with organic food consumption during pregnancy; data from a large cohort of pregnant women in Norway 
BMC Public Health  2010;10:775.
Background
Little is known about the use of organic food during pregnancy. The aim of this study was to describe characteristics associated with the use of organic food among pregnant women participating in the Norwegian Mother and Child Cohort Study (MoBa).
Methods
The present study includes 63,561 women who during the years 2002-2007 answered two questionnaires, a general health questionnaire at gestational week 15 and a food frequency questionnaire at weeks 17-22. We used linear binomial regression with frequent versus rare use of organic food as outcome variable and characteristics of the respondent as independent variables. The outcome variable was derived from self-reported frequency of organic food use in six main food groups (milk/dairy, bread/cereal, eggs, vegetables, fruit and meat).
Results
Organic eggs and vegetables were the food items which were most frequently reported to be used "often" or "mostly". The proportion of women reporting frequent intake of organic food was 9.1% (n = 5754). This group included more women in the lower (<25 years) and higher (>40 years) age-groups, with normal or low body mass index, who were vegetarians, exercised regularly (3+times weekly), consumed alcohol and smoked cigarettes during pregnancy (p < 0.001 for all, except alcohol: p=0.044). Further, participants with frequent organic consumption included more women in the lower (≤12 years) or higher (17 years +) category of educational attainment, women who were students or had a partner being a student, who belonged to the lowest household income group (both respondent and her partner earned <300 000 NOK), who entered the study 2005-2007, and who lived in an urban area (p < 0.001 for all).
Conclusions
The socio-economic characteristics of pregnant Norwegian women with frequent organic consumption did not unambiguously follow those typically associated with better health, such as higher levels of education and income. Rather, lower household income, and both lowest and highest levels of education were associated with a higher prevalence of frequent organic consumption. The results indicate that personal and socio-economic characteristics are important covariates and need to be included in future studies of potential health outcomes related to organic food consumption during pregnancy.
doi:10.1186/1471-2458-10-775
PMCID: PMC3022851  PMID: 21172040
12.  Reduced risk of pre-eclampsia with organic vegetable consumption: results from the prospective Norwegian Mother and Child Cohort Study 
BMJ Open  2014;4(9):e006143.
Objective
Little is known about the potential health effects of eating organic food either in the general population or during pregnancy. The aim of this study was to examine associations between organic food consumption during pregnancy and the risk of pre-eclampsia among nulliparous Norwegian women.
Design
Prospective cohort study.
Setting
Norway, years 2002–2008.
Participants
28 192 pregnant women (nulliparous, answered food frequency questionnaire and general health questionnaire in mid-pregnancy and no missing information on height, body weight or gestational weight gain).
Main outcome measure
Relative risk was estimated as ORs by performing binary logistic regression with pre-eclampsia as the outcome and organic food consumption as the exposure.
Results
The prevalence of pre-eclampsia in the study sample was 5.3% (n=1491). Women who reported to have eaten organic vegetables ‘often’ or ‘mostly’ (n=2493, 8.8%) had lower risk of pre-eclampsia than those who reported ‘never/rarely’ or ‘sometimes’ (crude OR=0.76, 95% CI 0.61 to 0.96; adjusted OR=0.79, 95% CI 0.62 to 0.99). The lower risk associated with high organic vegetable consumption was evident also when adjusting for overall dietary quality, assessed as scores on a healthy food pattern derived by principal component analysis. No associations with pre-eclampsia were found for high intake of organic fruit, cereals, eggs or milk, or a combined index reflecting organic consumption.
Conclusions
These results show that choosing organically grown vegetables during pregnancy was associated with reduced risk of pre-eclampsia. Possible explanations for an association between pre-eclampsia and use of organic vegetables could be that organic vegetables may change the exposure to pesticides, secondary plant metabolites and/or influence the composition of the gut microbiota.
doi:10.1136/bmjopen-2014-006143
PMCID: PMC4160835  PMID: 25208850
Organic food; preeclampsia; prospective cohort stuy; MoBa
13.  The Human Early-Life Exposome (HELIX): Project Rationale and Design 
Environmental Health Perspectives  2014;122(6):535-544.
Background: Developmental periods in early life may be particularly vulnerable to impacts of environmental exposures. Human research on this topic has generally focused on single exposure–health effect relationships. The “exposome” concept encompasses the totality of exposures from conception onward, complementing the genome.
Objectives: The Human Early-Life Exposome (HELIX) project is a new collaborative research project that aims to implement novel exposure assessment and biomarker methods to characterize early-life exposure to multiple environmental factors and associate these with omics biomarkers and child health outcomes, thus characterizing the “early-life exposome.” Here we describe the general design of the project.
Methods: In six existing birth cohort studies in Europe, HELIX will estimate prenatal and postnatal exposure to a broad range of chemical and physical exposures. Exposure models will be developed for the full cohorts totaling 32,000 mother–child pairs, and biomarkers will be measured in a subset of 1,200 mother–child pairs. Nested repeat-sampling panel studies (n = 150) will collect data on biomarker variability, use smartphones to assess mobility and physical activity, and perform personal exposure monitoring. Omics techniques will determine molecular profiles (metabolome, proteome, transcriptome, epigenome) associated with exposures. Statistical methods for multiple exposures will provide exposure–response estimates for fetal and child growth, obesity, neurodevelopment, and respiratory outcomes. A health impact assessment exercise will evaluate risks and benefits of combined exposures.
Conclusions: HELIX is one of the first attempts to describe the early-life exposome of European populations and unravel its relation to omics markers and health in childhood. As proof of concept, it will form an important first step toward the life-course exposome.
Citation: Vrijheid M, Slama R, Robinson O, Chatzi L, Coen M, van den Hazel P, Thomsen C, Wright J, Athersuch TJ, Avellana N, Basagaña X, Brochot C, Bucchini L, Bustamante M, Carracedo A, Casas M, Estivill X, Fairley L, van Gent D, Gonzalez JR, Granum B, Gražulevičienė R, Gutzkow KB, Julvez J, Keun HC, Kogevinas M, McEachan RR, Meltzer HM, Sabidó E, Schwarze PE, Siroux V, Sunyer J, Want EJ, Zeman F, Nieuwenhuijsen MJ. 2014. The Human Early-Life Exposome (HELIX): project rationale and design. Environ Health Perspect 122:535–544; http://dx.doi.org/10.1289/ehp.1307204
doi:10.1289/ehp.1307204
PMCID: PMC4048258  PMID: 24610234
14.  Levels of metabolites of organophosphate pesticides, phthalates, and bisphenol A in pooled urine specimens from pregnant women participating in the Norwegian Mother and Child Cohort Study (MoBa) 
Concerns about reproductive and developmental health risks of exposure to organophosphate (OP) pesticides, phthalates, and bisphenol A (BPA) among the general population are increasing. Six dialkyl phosphate (DAP) metabolites, 3,5,6-trichloro-2-pyridinol (TCPy), BPA, and fourteen phthalate metabolites were measured in 10 pooled urine samples representing 110 pregnant women who participated in the Norwegian Mother and Child Birth Cohort (MoBa) study in 2004. Daily intakes were estimated from urinary data and compared with reference doses (RfDs) and daily tolerable intakes (TDIs). The MoBa women had a higher mean BPA concentration (4.50 μg/L) than the pregnant women in the Generation R Study (Generation R) in the Netherlands and the National Health and Nutrition Examination Survey (NHANES) in the United States. The mean concentration of total DAP metabolites (24.20 μg/L) in MoBa women was higher than that in NHANES women but lower than that in Generation R women. The diethyl phthalate metabolite mono-ethyl phthalate (MEP) was the dominant phthalate metabolite in all three studies, with the mean concentrations of greater than 300 μg/L. The MoBa and Generation R women had higher mean concentrations of mono-n-butyl phthalate (MnBP) and mono-isobutyl phthalate (MiBP) than the NHANES women. The estimated average daily intakes of BPA, chlorpyrifos/chlorpyrfios-methyl and phthalates in MoBa (and the other two studies) were below the RfDs and TDIs. The higher levels of metabolites in the MoBa participants may have been from intake via pesticide residues in food (organophosphates), consumption of canned food, especially fish/seafood (BPA), and use of personal care products (selected phthalates).
doi:10.1016/j.ijheh.2009.03.004
PMCID: PMC3756471  PMID: 19394271
Organophosphate (OP) pesticides; Bisphenol A (BPA); Phthalates; Biological monitoring; Environmental Exposure
15.  Dietary Acrylamide Intake during Pregnancy and Fetal Growth—Results from the Norwegian Mother and Child Cohort Study (MoBa) 
Environmental Health Perspectives  2012;121(3):374-379.
Background: Acrylamide has shown developmental and reproductive toxicity in animals, as well as neurotoxic effects in humans with occupational exposures. Because it is widespread in food and can pass through the human placenta, concerns have been raised about potential developmental effects of dietary exposures in humans.
Objectives: We assessed associations of prenatal exposure to dietary acrylamide with small for gestational age (SGA) and birth weight.
Methods: This study included 50,651 women in the Norwegian Mother and Child Cohort Study (MoBa). Acrylamide exposure assessment was based on intake estimates obtained from a food frequency questionnaire (FFQ), which were compared with hemoglobin (Hb) adduct measurements reflecting acrylamide exposure in a subset of samples (n = 79). Data on infant birth weight and gestational age were obtained from the Medical Birth Registry of Norway. Multivariable regression was used to estimate associations between prenatal acrylamide and birth outcomes.
Results: Acrylamide intake during pregnancy was negatively associated with fetal growth. When women in the highest quartile of acrylamide intake were compared with women in the lowest quartile, the multivariable-adjusted odds ratio (OR) for SGA was 1.11 (95% CI: 1.02, 1.21) and the coefficient for birth weight was –25.7 g (95% CI: –35.9, –15.4). Results were similar after excluding mothers who smoked during pregnancy. Maternal acrylamide– and glycidamide–Hb adduct levels were correlated with estimated dietary acrylamide intakes (Spearman correlations = 0.24; 95% CI: 0.02, 0.44; and 0.48; 95% CI: 0.29, 0.63, respectively).
Conclusions: Lowering dietary acrylamide intake during pregnancy may improve fetal growth.
doi:10.1289/ehp.1205396
PMCID: PMC3621181  PMID: 23204292
acrylamide; birth weight; diet; Hb adducts; MoBa; pregnancy; small for gestational age
16.  Intake of Probiotic Food and Risk of Preeclampsia in Primiparous Women 
American Journal of Epidemiology  2011;174(7):807-815.
Probiotics have been suggested to modify placental trophoblast inflammation, systemic inflammation, and blood pressure, all potentially interesting aspects of preeclampsia. The authors examined the association between consumption of milk-based probiotic products in pregnancy and development of preeclampsia and its subtypes. The study was performed in the Norwegian Mother and Child Cohort Study by using a prospective design in 33,399 primiparous women in the years 2002–2008. The intake of milk-based products containing probiotic lactobacilli was estimated from a self-reported food frequency questionnaire. Preeclampsia diagnoses were obtained from the Norwegian Medical Birth Registry. Intake of probiotic milk products was associated with reduced risk of preeclampsia. The association was most prominent in severe preeclampsia (adjusted odds ratio (OR) = 0.79, 95% confidence interval (CI): 0.66, 0.96). With probiotic intakes divided into categories representing no, monthly, weekly, or daily intake, a lower risk for preeclampsia (all subtypes) was observed for daily probiotic intake (OR = 0.80, 95% CI: 0.66, 0.96). Lower risks for severe preeclampsia were observed for weekly (OR = 0.75, 95% CI: 0.57, 0.98) and daily (OR = 0.61, 95% CI: 0.43, 0.89) intakes. These results suggest that regular consumption of milk-based probiotics could be associated with lower risk of preeclampsia in primiparous women.
doi:10.1093/aje/kwr168
PMCID: PMC3203379  PMID: 21821542
cohort studies; pre-eclampsia; pregnancy; primiparity; probiotics
17.  Mothers’ Negative Affectivity During Pregnancy and Food Choices for Their Infants 
Objective
To investigate whether maternal negative affectivity assessed in pregnancy is related to subsequent infant food choices.
Design
Cohort study.
Subjects
Mothers (N = 37, 919) and their infants participating in the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health.
Measurements
Maternal negative affectivity assessed pre-partum (SCL-5 at week 17 and 30 of pregnancy), introduction of solid foods by month 3, and feeding of sweet drinks by month 6 (by mothers’ reports).
Results
Mothers with higher negative affectivity were 64% more likely (95% CI 1.5–1.8) to feed sweet drinks by month 6, and 79% more likely (95% CI 1.6–2.0) to introduce solid foods by month 3. These odds decreased to 41% and 30%, respectively, after adjusting for mother’s age, body mass index, and education.
Conclusion
The maternal trait of negative affectivity is an independent predictor of infant feeding practices that may be related to childhood weight gain, overweight, and obesity.
doi:10.1038/ijo.2009.230
PMCID: PMC2822132  PMID: 19918247
maternal feeding practices; negative affectivity; solid foods; sweet drinks
18.  Dietary Supplements Contribute Substantially to the Total Nutrient Intake in Pregnant Norwegian Women 
Annals of Nutrition & Metabolism  2008;52(4):272-280.
Background
Use of dietary supplements during pregnancy may give an important contribution to nutrient intake, and for nutrients like folate and vitamin D supplements are recommended. Our objective was to study use and contribution of dietary supplement to nutrient intake among women participating in the Norwegian Mother and Child Cohort Study (MoBa).
Methods
This study is based on 40,108 women participating in MoBa which is conducted by the Norwegian Institute of Public Health. The women had filled inversion 2 of the food frequency questionnaire in MoBa between February 2002 and February 2005.
Results
81% reported use of one or more dietary supplements. The most commonly used category was cod liver oil/fish oil supplements (59%) followed by singular folic acid supplements (36%) and multivitamin/multimineral supplements (31%). The nutrient contribution of the dietary supplements varied from 65% for folate and vitamin D to 1% for potassium among supplement users. The dietary intake of vitamin D, folate, iodine and iron did not reach the Nordic Recommendations for pregnant women.
Conclusions
Use of supplements improved the intake of folate, iron and vitamin D, but not sufficiently to reach the recommended amounts.
doi:10.1159/000146274
PMCID: PMC2813797  PMID: 18645244
Dietary supplements; Pregnancy; Nutrient intake; Multivitamins; Minerals; Fatty acids; Vitamin D; Folate; Iodine
19.  Maternal dietary patterns and preterm delivery: results from large prospective cohort study 
Objective To examine whether an association exists between maternal dietary patterns and risk of preterm delivery.
Design Prospective cohort study.
Setting Norway, between 2002 and 2008.
Participants 66 000 pregnant women (singletons, answered food frequency questionnaire, no missing information about parity or previously preterm delivery, pregnancy duration between 22+0 and 41+6 gestational weeks, no diabetes, first enrolment pregnancy).
Main outcome measure Hazard ratio for preterm delivery according to level of adherence to three distinct dietary patterns interpreted as “prudent” (for example, vegetables, fruits, oils, water as beverage, whole grain cereals, fibre rich bread), “Western” (salty and sweet snacks, white bread, desserts, processed meat products), and “traditional” (potatoes, fish).
Results After adjustment for covariates, high scores on the “prudent” pattern were associated with significantly reduced risk of preterm delivery hazard ratio for the highest versus the lowest third (0.88, 95% confidence interval 0.80 to 0.97). The prudent pattern was also associated with a significantly lower risk of late and spontaneous preterm delivery. No independent association with preterm delivery was found for the “Western” pattern. The “traditional” pattern was associated with reduced risk of preterm delivery for the highest versus the lowest third (hazard ratio 0.91, 0.83 to 0.99).
Conclusion This study showed that women adhering to a “prudent” or a “traditional” dietary pattern during pregnancy were at lower risk of preterm delivery compared with other women. Although these findings cannot establish causality, they support dietary advice to pregnant women to eat a balanced diet including vegetables, fruit, whole grains, and fish and to drink water. Our results indicate that increasing the intake of foods associated with a prudent dietary pattern is more important than totally excluding processed food, fast food, junk food, and snacks.
doi:10.1136/bmj.g1446
PMCID: PMC3942565  PMID: 24609054

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