This study aimed to evaluate the nutritional knowledge levels of mothers of children aged 4-6 years attending pediatric outpatient clinics, analyze knowledge levels according to maternal age, education, and income, and investigate their relationship with children's anthropometric measurements. This cross-sectional study included 282 mothers of preschool-aged children who attended a pediatric outpatient clinic. Nutritional knowledge was assessed using the Nutritional Knowledge Level Scale for Adults, comprising Basic Nutritional Knowledge (BNK) and food preference (FP) subscales. Mothers also rated Nutrition-Health Awareness (NHA) and Dietary Adequacy Self-Assessment (DAS) on a 0-10 visual scale. Children's height-for-age (HAZ) and weight-for-age (WAZ) z-scores were calculated. Multiple linear regression and correlation analyses were performed. The median maternal age was 34 (interquartile range [IQR]: 29.25-40) years. Median BNK and FP scores were 58 (IQR: 51-69) and 35 (IQR: 30-40), respectively. Educational attainment was the strongest independent predictor of BNK (p=0.006) and DAS (p=0.033). Household income independently predicted FP (p=0.022) and NHA (p=0.026) after adjusting for age and education. Younger maternal age was associated with higher BNK scores. No statistically significant associations were found between maternal nutritional knowledge variables and children's HAZ or WAZ scores (all p>0.05). Most mothers demonstrated adequate BNK; however, this did not consistently translate into FP competence or healthy dietary self-perception. Maternal nutritional knowledge was not directly associated with children's growth outcomes in this cohort, suggesting the pathway from knowledge to child growth is indirect and multifactorial. Nutrition interventions should move beyond knowledge transfer to address practical dietary skills and socioeconomic determinants of eating behavior.
Background/Objectives: Chronic undernutrition in the first 1000 days continues to be a significant public health concern in Ecuador. This study examined associations between infant feeding practices, maternal supplementation, socioeconomic factors, and stunting in the first two years of life using explainable machine-learning methods. Methods: The analysis was based on 8613 eligible children aged 0-23 months from the Ecuadorian National Child Malnutrition Survey (Encuesta Nacional sobre Desnutrición Infantil, ENDI) 2023-2024, of whom 8344 had non-missing stunting status and were included in the final modelling sample. Results: Among the children included in the modelling sample, stunting was observed in 18.7%. Maternal iron and folic-acid supplementation were associated with lower stunting prevalence, while breastfeeding and complementary feeding indicators showed weak linear associations but contributed to model predictions in explainability analyses. SHapley Additive exPlanations (SHAP) additionally highlighted geographic and socioeconomic variation, with province, area of residence, and socioeconomic indicators ranking among the features contributing to model prediction. Predictive performance was modest to moderate across models, with area under the receiver operating characteristic curve (AUC) values ranging approximately from 0.62 to 0.66 across the main model specifications. Model performance remained stronger for the majority non-stunted class than for the minority stunted class, highlighting the challenge of detecting stunted children in an imbalanced analytic ENDI sample. Conclusions: Overall, the results suggest that stunting in the analytic sample was represented by multidimensional predictive patterns involving prenatal, nutritional, socioeconomic, and geographic factors, and illustrate the potential value of explainable machine learning for identifying multidimensional risk patterns in child nutrition research.
Overweight in childhood, adolescence and adulthood is now a world-wide epidemic. A variety of preventive and therapeutic measures are being developed with partial success. Since the pioneering studies of D.J. Barker linking maternal famine in pregnancy to long-term undesirable effects on the offspring-the "metabolic syndrome" that stems from long-lasting epigenetic changes, it became evident that there are many undesirable events which affect in-utero fetal growth and development. They often persist postnatally, through childhood and adulthood. The purpose of this review is to discuss the prenatal factors that may have long term effects on postnatal weight gain and obesity that are important contributors to the "obesity" epidemic. These prenatal undesired factors are pregestational and gestational diabetes, pre-pregnancy maternal obesity, excessive weight gain in pregnancy, placental dysfunction and maternal hormonal imbalances. They may affect fetal growth, generally causing excessive growth (macrosomia) and sometimes diminished growth (small for gestational age). These prenatal conditions are associated with epigenetic changes that may contribute to insulin resistance and subsequent metabolic alterations leading to increased food intake, overweight, and obesity. Studies also demonstrate that increased exposure in pregnancy to teratogens, like endocrine disruptors and cigarette smoking, may also affect prenatal and postnatal growth and adiposity. However, many the studies demonstrating the role of these factors are often weakened, as they mainly demonstrate associations and do not sufficiently consider possible confounding factors such as postnatal age, nutrition and lifestyle. Better understanding of these prenatal factors may support more effective prevention and management strategies for childhood overweight and obesity.
As co-existing forms of maternal malnutrition increase globally, understanding their impact on children's linear growth is vital. Examine the association between maternal pre-pregnancy malnutrition, both single and co-existent forms, and their offspring's linear growth across the first 24 months of life. This study is a secondary data analysis using data on mother-child pairs from the Women First Trial, a randomized controlled trial evaluating maternal nutrition supplementation conducted in the Democratic Republic of the Congo, Guatemala, India, and Pakistan. Using measured height and weight indicators, maternal pre-pregnancy malnutrition was classified as normal, underweight, short stature, overweight/obesity, underweight and short stature, or short stature and overweight/obesity. Latent class growth analysis was employed to identify offspring's linear growth trajectories using length-for-age z-score from birth to 24 months. Poisson regression assessed the association between maternal pre-pregnancy malnutrition and offspring growth trajectories. We analyzed data from 2,228 mother-child pairs. Pre-pregnancy, 63% of mothers presented malnutrition: 17% underweight, 22% short stature, 6% overweight/obesity, 6% underweight and short stature, and 11% short stature and overweight/obesity. Two offspring growth trajectories emerged: no/mild growth faltering (n=1,238) and severe growth faltering (n=990). Compared with children of mothers with a pre-pregnancy normal anthropometric status, those born to mothers with underweight (aRR: 1.09; 95%CI: 1.02, 1.15), short-stature (aRR: 1.17; 95%CI: 1.11, 1.24), underweight and short stature (aRR: 1.18; 95%CI: 1.09, 1.27), and short stature and overweight/obesity (aRR: 1.17; 95%CI: 1.08, 1.27) had higher risks of severe growth faltering. Maternal pre-pregnancy short stature, alone or combined with underweight or overweight/obesity, was associated with an increased risk of suboptimal linear growth in children during the first 24 months. These findings underscore the importance of addressing maternal nutritional status before pregnancy as part of broader efforts to improve child growth outcomes in low-resource settings. ClinicalTrials.gov: NCT01883193; https://clinicaltrials.gov/study/NCT01883193.
Children who suffer from undernutrition would grow rapidly to catch-up-growth after improvement in nutrition intake. However, this rapid growth during early life might have harmful effects on children's long-term health. Rapid growth, which is too fast, increases the risk of cardiovascular disease and obesity. To determine the prevalence and analyze the risk of rapid growth in children, particularly who experienced undernutrition in 1000 first days of life, compared to well-nourished children. This cohort study used data from the second and third waves of the Indonesia Family Life Survey (1997 and 2000). A total of 671 children aged 0 to 23 months in 1997 and 3 to 5 years in 2000 were included in this study. Rapid growth was determined as a change in length- or height-per-age and weight-per-age z-score greater than 0.67, based on WHO Child Growth Standard between years of follow-up. The anthropometric measurements were conducted by trained health workers. Children with history of low birth weight, stunting, underweight, and/or wasting were categorized as undernourished children. We used a logistic regression model to identify the risk of rapid growth in children among undernourished and well-nourished children, adjusted by characteristics of children, parents, and the household socioeconomic status. The prevalence of rapid growth in length/height and weight in undernourished children was 44.56% and 35.2%, respectively. The odds of undernourished children to grow rapidly in length/height compared to well-nourished children was 6.36 (95% CI 3.94,10.26; p = 0.000) after being controlled by socio-demographic characteristics. There was a higher odd 5.7 (95% CI 3.4, 9.5; p = 0.000) of rapid growth in weight in undernourished children. The odds of rapid growth in height increased significantly in children aged 12 to 23 months and children with mothers who had lower education levels. Furthermore, the odds of rapid growth in weight-for-age increased significantly in all children whose fathers had lower education levels. This study adds to the evidence that there is an increased risk for rapid growth in length/height and weight in undernourished children and the risk was higher among older children aged 12 to 23 months. The study also found that maternal education was related to the risk of rapid growth in height and paternal education was strongly related to the risk for rapid growth in weight.
Growth failure in the first 1000 days of life can have a major impact on a child's health. Therefore, catching up on growth in early childhood is essential to prevent nutritional problems, especially stunting, as indicated by the height for age z-score (HAZ). Catch-up growth after a period of malnutrition in the first 1000 days of life can be measured as an improvement in linear growth using HAZ parameters. This study aimed to determine the factors that influence catch-up growth in early childhood based on the HAZ. This three-year cohort study used two waves of secondary data from the Indonesian Family Life Survey (IFLS). Baseline data of the study were taken in 1997 when the children were 0 to 23 months old, then followed up in 2000 (at 3 to 5 years old). The study included 537 children aged 0 to 23 months in 1997. The dependent variable was catch-up growth. The independent variables were: children-related, parent-related, and household factors. We collected secondary data from the IFLS annual report book. Bivariate data analysis was performed using the Chi-squared test, while multivariate analysis was performed using multinomial logistic regression. There were four groups in this study: not stunted (reference group), stunted catch-up, stunted non-catch-up, and late incident stunted. Bivariate analysis showed that catch-up growth, based on HAZ, was significantly influenced by birth weight (normal birth weight), head circumference (normal head circumference), maternal nutritional status (normal), and maternal height (p <0.05). After controlling for potentially confounding factors, sex (p = 0.003; 95% CI:1.43-5.93) and maternal nutritional status (p = 0.011; 95% CI:0.19-0.81) were the most influential factors on catch-up growth in early childhood. Children with stunting and catch-up growth are more common among males, and poor maternal nutritional status was associated with stunting and failure to achieve catch-up growth. The determining factors for the late incident and stunted non-catch-up groups include head circumference, breastfeeding status, maternal height, and maternal nutritional status. The stunted non-catch-up group is also influenced by small gestational age (SGA). Therefore, it is important to regularly monitor the growth and development of children in early childhood.
Intimate partner violence (IPV) and childhood undernutrition represent co-occurring public health challenges in Madhya Pradesh (MP), India. This study examined the association between maternal IPV exposure and child health outcomes, including stunting, wasting, and underweight, using data from the National Family Health Survey-5 (NFHS-5), 2019-21. A cross-sectional secondary data analysis was conducted using NFHS-5 Individual Recode and Children's Recode files for MP. The files were merged at the household level, yielding 1,820 mother-child pairs. IPV was assessed using the validated domestic violence (DV) module (n=4,519 women in the 50% subsample). Child outcomes were defined using WHO anthropometric Z-scores. Multivariable binary logistic regression estimated adjusted odds ratios (aOR) with 95% confidence intervals (CIs), adjusting for exogenous sociodemographic confounders, including place of residence, maternal education, wealth index, and maternal age. Demographic and Health Surveys (DHS) sampling weights were applied throughout. IPV prevalence was 28.3% among the DV subsample. Stunting, wasting, and underweight were observed in 36.4%, 18.7%, and 33.4% of children, respectively. After adjustment, IPV was not independently associated with stunting (aOR=1.071, 95% CI: 0.833-1.376, p=0.592), wasting (aOR=0.825, 95% CI: 0.601-1.132, p=0.234), or underweight (aOR=0.912, 95% CI: 0.708-1.174, p=0.475). The household wealth index emerged as the dominant, strongly protective independent predictor across all child health metrics (stunting and underweight: p<0.001; wasting: p=0.017). IPV and pediatric malnutrition represent concurrent, intersecting vulnerabilities within MP, but structural poverty is the primary independent predictor of anthropometric failure. Effective policy responses must shift beyond isolated vertical programmes, integrating gender-based violence prevention within maternal and child health platforms alongside robust household economic empowerment.
Childhood overweight and obesity are growing public health concerns in Malaysia. Increasing evidence suggests that early-life factors, including maternal gestational weight gain (GWG) and nutritional status, contribute to long-term child health outcomes. The Gestational Weight Gain and Child Nutritional Outcomes in East Coast Malaysia study is a 10-year prospective cohort established to investigate the intergenerational effects of maternal GWG on the nutritional and metabolic health of their respective offspring living in the East Coast of Peninsular Malaysia. This study follows up a cohort of mother-child pairs (n=499) initially recruited during pregnancy in 2014 from maternal and child health clinics in Kota Bharu, Kelantan and Kuala Terengganu, Terengganu, Malaysia. At the 10-year follow-up scheduled for 2026, anthropometric assessments, body composition and dietary intake will be collected from both mothers and their children. GWG classifications will be made in accordance with the Institute of Medicine guidelines. Multivariate regression models will be used to evaluate the relationship between GWG and childhood outcomes, including body mass index-for-age, mothers' nutritional status and other metabolic risk indicators. Ethical approval of this study was obtained from the Medical Research Ethics Committee of the Ministry of Health Malaysia (NMRR-12-1256-13141). Apart from that, human ethical approval (FWA Reg. No: 00007718; IRB Reg. No: 00004494) was obtained from the Human Research Ethics Committee Universiti Sains Malaysia. Findings will be disseminated through academic and professional conferences and peer-reviewed literature. Additionally, findings and analyses will be disseminated to the Ministry of Health (MoH) through regular presentations. The investigators also plan a public-facing podcast of the study findings and related topics to disseminate results to participants, the MoH and the general public.
Background/Objectives: Optimal birth spacing plays an important role in supporting children's growth and nutritional outcomes. However, evidence on the long-term effects of short birth intervals on stunting from childhood to adolescence in Indonesia is limited. This retrospective cohort study used longitudinal data from waves 3, 4, and 5 of the Indonesian Family Life Survey (IFLS) (2000, 2007, 2014) to examine the association between short birth intervals and stunting trajectories among Indonesian children. Methods: We analyzed 1401 children aged 0-59 months with complete anthropometric data using longitudinal data from IFLS waves 3, 4, and 5 (2000, 2007, 2014). Stunting was defined as a height-for-age z-score (HAZ) below -2 standard deviations (SDs) according to the WHO Child Growth Standards (2006) for children under five years and the WHO Growth Reference (2007) for children and adolescents. The impact of short birth intervals on stunting status was evaluated using multilevel binary logistic regression. Results: Stunting distribution showed significant improvement between 2000 and 2014. In 2000, 37.7% of children were stunted, which decreased to 33.9% in 2007 and nearly 25% in 2014. The majority of mothers (77.7%) gave birth between 20 and 35 years of age, while 12.7% gave birth too early (<20 years) and 9.6% gave birth too late (>35 years). In addition, 16.2% of parents had too many children (parity ≥ 4), and 6.8% had too close birth intervals (<24 months). Multilevel logistic analysis revealed that short birth intervals (odds ratio (OR) = 1.60-1.63) were significantly associated with stunting after adjusting for child, household, socioeconomic, and environmental factors. However, maternal age and parity were not significantly associated with stunted growth. Conclusions: Birth spacing is a critical risk factor for stunting in early childhood and remains significant as children age. Longitudinal analyses highlight the importance of sustained interventions targeting maternal health, education, and child nutrition to address stunting in Indonesia.
Iron-deficiency anemia (IDA) is common in young children in developing countries, where recurrent infections (RIs) are also endemic. It was evaluated whether RI is an independent determinant of IDA using inflammation-adjusted serum ferritin (ISF), rather than viewing IDA as purely nutritional. A prospective case-control study of children aged 6-59 months was conducted. Iron-deficiency anemia (IDA) was defined by anemia and iron deficiency using ISF derived from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) approach; controls had normal hematology and ISF. Recurrent infection (RI) within the previous 12 months was ascertained from medical records. Multivariable regression estimated adjusted odds ratios (aORs) for IDA, controlling for nutritional and social covariates; model performance was assessed by discrimination, calibration, and comparative fit. Three hundred children were analyzed (100 with IDA, 200 controls). In multivariable analysis, RI remained independently associated with IDA (aOR=2.29), alongside delayed complementary feeding (aOR=7.12), non-maternal caregiving (aOR=21.02), and low-iron diet (aOR=2.69). A dose-response with infection breadth was observed: infections at ≥2 sites tripled the odds of IDA (P-trend= .007). In phenotype-specific models, recurrent respiratory and gastrointestinal infections were independently associated with IDA (aOR: 2.26 and 2.22, respectively). Adding RI slightly increased discrimination (AUC=0.902; ΔAUC=+0.008) but significantly improved model fit versus the model without RI (likelihood-ratio χ2(1) = 5.14; P=.023; DeLong P = .26). Recurrent infection (RI) was an independent, dose-related determinant of childhood IDA beyond inflammation and nutrition, supporting a dual nutrition-inflammation framework and the inclusion of infection control in anemia strategies.
Australian children of South Asian ethnicity are underrepresented in research on physical activity and sedentary behavior. Understanding the factors that shape these behaviors is essential for developing culturally responsive interventions. This Australian qualitative study explored South Asian children's and mothers' perceptions of these behaviors and their preferences for child-focused intervention programs. Online interviews were conducted with 10 mother-child dyads (children aged 10-12 y) and 14 additional mothers with children aged 2-12 years. Interviews were conducted in English and lasted between 15 and 60 minutes. Data were analyzed using reflexive thematic analysis in NVivo 15. Children and mothers offered complementary perspectives that provided a nuanced understanding of children's physical activity and sedentary behavior. Key themes related to physical activity included child-related factors (such as interest, perceived benefits), parental role as facilitators and gatekeepers, supportive home environment, role of school and peers, neighborhood environment and opportunities, and cultural norms. Key themes related to sedentary behavior included perceptions about screen use, access to personal digital devices, screen time practices at home, and the role of siblings and peers. Children and mothers preferred an in-person activity-oriented physical activity program, delivered in English by friendly instructors and involving parents, siblings, and school friends. Mothers emphasized tailoring programs by age and providing additional support for girls. A range of factors shape South Asian children's physical activity and sedentary behavior. Barriers unique to this group stem from cultural and gender norms that influence parents' (especially mothers') confidence and skills to support children's physical activity.
Previous studies have suggested that obesity during pregnancy is associated with changes in child neurodevelopmental outcomes, indicating in utero effects of maternal obesity on offspring brain development. This study aims to evaluate whether there are associations between maternal body fat mass percentage (a direct measure of adiposity) at different stages of pregnancy and neonatal cortical brain development. 169 mother/newborn dyads (79 boys and 90 girls) were included in this longitudinal and prospective study. Maternal fat mass percentage was assessed using air displacement plethysmography methodology at 12 and 36 weeks of pregnancy. At ∼2 weeks of postnatal age, the neonates underwent a brain MRI during natural sleep without sedation using high-resolution 3D T1- and T2-weighted imaging. Multiple linear regression models, controlling for appropriate covariates, were used to evaluate associations between maternal fat mass percentage and neonatal cortical features (volume, thickness, and surface area), as well as to test for interaction effects between neonatal sex and maternal fat mass percentage on these outcomes. Maternal fat mass percentage at 12 weeks of pregnancy negatively associated with neonatal cortical volume of left entorhinal cortex (ꞵ = -1.36, t = -3.53, P = 0.04), and left parahippocampal gyrus (ꞵ = -1.50, t = -3.31, P = 0.04); maternal fat mass percentage at 36 weeks of pregnancy negatively associated with neonatal cortical volume of left entorhinal cortex (ꞵ = -1.76, t = -3.25, P = 0.04), left parahippocampal gyrus (ꞵ = -2.26, t = -3.53, P = 0.04), and right temporal pole (ꞵ = -2.24, t = -3.19, P = 0.04), Sex interaction with maternal fat mass percentage at 12 weeks significantly associated with cortical volume in left pars triangularis (ꞵ = -8.28, t = -3.46, P = 0.05). Significant relationships were identified between maternal body fat mass percentage during pregnancy and neonatal cortical volume, suggesting potential in utero and sex-specific impacts of increased maternal adiposity on offspring brain development.
Climate change has significantly contributed to rising malnutrition rates, particularly in low- and middle-income countries. However, evidence linking heat stress to child nutritional status remains limited. This study estimated the association between heat stress exposure and severe stunting, wasting and underweight among rural children across areas with varying vegetation density. We used data from Ethiopia's Food and Nutrition Strategy Baseline Survey, a population-based cross-sectional study conducted between 2021 and 2023. Our study population included a total of 7166 children aged 0-59 months. We estimated environmental exposures to heat stress and green areas using satellite-based data on Universal Thermal Climate Index (UTCI) and the Normalized Difference Vegetation Index (NDVI). We used multilevel logistic regression models to assess associations between heat stress and severe stunting, wasting and underweight, adjusting for child age, maternal education, family size, and household wealth. About 23% of children (n = 1541) were severely stunted, 5.4% (n = 443) were identified with severe wasting and 8.4% (n = 761) with severe underweight. Among children living in low-vegetation areas (NDVI < 0.44), exposure to heat stress was associated with higher odds of severe wasting (AOR = 1.63, 95% CI = 1.06-2.51) and severe underweight (AOR = 1.63, 95% CI = 1.20-2.22) compared with children not exposed to thermal heat stress conditions. Conversely, in areas of moderate-to-high vegetation covers (NDVI ≥ 0.44), heat stress was associated with a 28% decrease in odds of severe stunting (AOR = 0.72, 95% CI = 0.52-0.99). Our findings call on policymakers to implement climate-resilient agriculture, and enhance social protection to safeguard livelihoods and food systems in vulnerable, low-resource settings.
Ultra-processed foods (UPFs) are increasingly prevalent in global diets and have been consistently associated with adverse health outcomes. Their consumption during sensitive life stages, such as pregnancy and early childhood, raises significant public health concerns due to potential intergenerational effects. This narrative review critically examines the impact of UPF consumption during pregnancy and early life, with a focus on maternal and child health outcomes, including alterations in gut microbiota composition. Accumulating evidence indicates that UPF consumption is linked to increased risks of obesity, type 2 diabetes, cardiovascular disease, and all-cause mortality. During pregnancy, high UPF intake is associated with poorer diet quality, excessive gestational weight gain, increased inflammation, and unfavorable neonatal outcomes, including altered microbiota transmission and impaired neurodevelopment. In early childhood, UPFs were linked to microbiota dysbiosis, obesity, micronutrient deficiencies, and allergic conditions. Notably, maternal dietary pattern strongly influences the early and sustained incorporation of UPFs into children's diets. Overall, UPF consumption during pregnancy and early childhood represents a modifiable risk factor with far-reaching health implications. A deeper understanding of the dietary-microbiome-health axis is essential for developing effective nutritional strategies to optimize maternal and child health outcomes and reduce long-term disease risks.
Bedtime routines established before the age of 5 are one of the most beneficial practices for children's sleep and are often used in interventions and recommended by pediatricians. However, for parents experiencing poverty, maintaining a bedtime routine can be challenging due to employment constraints and other factors. Using the Future of Families and Child Wellbeing Study, the present study assessed maternal nonstandard employment (i.e., night, weekend, variable shifts), child externalizing behavior, and maternal social capital as predictors and moderators of bedtime routine use and activities (i.e., physical contact, communication, hygiene, and nutrition) at age 3. The sample included 1,364 children (52.5% boys; Mage = 35.66 months, SD = 2.40 months) and their mothers (Mage = 28.69 years, SD = 6.07 years; 50.04% non-Hispanic Black, 23.88% non-Hispanic White, and 22.26% Hispanic, 3.82% "other"). Results showed that maternal nonstandard employment was associated with a lower probability of using a bedtime routine and communication activities. Higher social capital was also associated with a higher probability of using bedtime routines, hygiene, and communication activities. Mothers with children who show higher levels of externalizing behavior were more likely to have bedtime routines and use hygiene and nutrition activities. Higher levels of social capital eliminated the difference in the probability of using a bedtime routine by employment type. Finally, the positive association between externalizing behavior and communication activity use was only significant for mothers in standard employment. Results illustrate the importance of considering a family's social context when designing bedtime routine interventions and bedtime activities. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Early childhood is an important period when growth and adiposity patterns emerge and may persist into later childhood. Children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) face elevated obesity risk. We characterized BMI-for-age z-score (BMIz) trajectories from 24 to 60 months and their child-, caregiver-, and household-level correlates. This was a secondary analysis of the WIC Infant and Toddler Feeding Practices Study-2 (ITFPS-2) public-use dataset. We analyzed 5,583 BMIz observations from 2,247 dyads; adjusted models used 4,314 observations from 1,738 children. Linear mixed-effects models tested individual, interpersonal, and household predictors. Restriction and pressure-to-eat were lagged, time-varying exposures. Mean BMIz was elevated at all waves (0.46 to 0.56). Obesity prevalence rose from 15.4% to 18.5%. Unconditionally, BMIz was stable from 24 to 48 months and rose by 60 months. Adjusted models linked higher BMIz to higher birth weight, Hispanic or Latino ethnicity, birth complications, maternal overweight or obesity, paternal overweight, prenatal smoking, adolescent maternal age, and lower maternal education. Male sex was associated with lower BMIz. Prior-wave restriction was associated with higher, and pressure to eat with modestly lower, subsequent BMIz. Household indicators showed no independent association. Caregiver and perinatal characteristics and feeding practices were the most consistent modifiable correlates of late-preschool BMIz. These observational, complete-case findings warrant caution. The 48-60-month window may be a promising period to target for WIC-based obesity prevention.
This study explores the relationship between breastfeeding self-efficacy, childbirth experience, family intimacy, and postpartum lactation yield in 168 mothers who gave birth at Hefei Maternal and Child Health Hospital. Participants were divided into high and low self-efficacy groups based on their scores on the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). Data on childbirth experience, family intimacy, and lactation yield were collected. Correlation and logistic regression analyses revealed that breastfeeding self-efficacy positively correlated with childbirth experience, family intimacy, and lactation yield. The high self-efficacy group showed significantly better childbirth experiences, stronger family intimacy, and higher lactation yield compared with the low self-efficacy group. Primiparity, childbirth experience, family intimacy, and postpartum lactation yield were identified as independent factors influencing breastfeeding self-efficacy. These findings highlight the importance of improving childbirth experiences, enhancing family intimacy, and supporting lactation yield to boost maternal self-efficacy in breastfeeding, ultimately contributing to higher breastfeeding success rates. Cette étude explore la relation entre l’auto-efficacité de l’allaitement maternel, l’expérience de l’accouchement, l’intimité familiale et la production lactée post-partum chez 168 mères ayant accouché à l’Hôpital Maternel et Infantile de Hefei. Les participantes ont été réparties en groupes à auto-efficacité élevée et faible selon leurs scores à l’échelle abrégée d’auto-efficacité de l’allaitement maternel (Breastfeeding Self-Efficacy Scale–Short Form, BSES-SF). Des données concernant l’expérience de l’accouchement, l’intimité familiale et la production lactée ont été recueillies.Les analyses de corrélation et de régression logistique ont montré que l’auto-efficacité de l’allaitement maternel était positivement corrélée à l’expérience de l’accouchement, à l’intimité familiale et à la production lactée post-partum. Le groupe à auto-efficacité élevée présentait une expérience de l’accouchement significativement meilleure, une intimité familiale plus forte et une production lactée plus importante que le groupe à faible auto-efficacité.La primiparité, l’expérience de l’accouchement, l’intimité familiale et la production lactée post-partum ont été identifiées comme des facteurs indépendants influençant l’auto-efficacité de l’allaitement maternel. Ces résultats soulignent l’importance d’améliorer l’expérience de l’accouchement, de renforcer l’intimité familiale et de soutenir la production lactée afin d’accroître l’auto-efficacité maternelle en matière d’allaitement, contribuant ainsi à augmenter les taux de réussite de l’allaitement maternel.
Socioeconomic inequalities in children's emotional and behavioural problems are already present at school entry. We examined associations between early-life socioeconomic conditions and children's externalising and internalising problems and assessed whether early-life risk factors mediated these associations. We analysed harmonised individual participant data from eight birth cohorts within the EU Child Cohort Network. Maternal educational level during pregnancy was used as an indicator of early-life socioeconomic conditions (SECs). Scores of children's externalising and internalising problems around school entry age were used as the outcome variables. Inequalities were quantified using the Slope Index of Inequality which captures the difference in prevalence of problems between children from highest and lowest SECs. Mediation analysis was used to assess the mediating role of five early-life risk factors: maternal smoking during pregnancy, gestational age, small for gestational age, postpartum depression and breastfeeding. Inequalities in externalising and internalising problems by SECs were consistent across cohorts: Children of mothers with low educational level had on average a 12 and 11 percentage point increased prevalence of externalising and internalising problems respectively. Early-life factors explained around 8% (DNBC, Denmark) to 54% (INMA, Spain) of the inequality in externalising problems and 7% (ELFE, France) to 25% (ALSPAC, UK) in internalising problems. Children from lower SECs consistently had a higher prevalence of both externalising and internalising problems around school entry age. These inequalities were partly mediated by early-life factors. Public health interventions in pregnancy and the preschool period are critical to address the early emergence of inequalities in children's mental health.
Background: Maternal nutrition during pregnancy is increasingly recognized as an important determinant of offspring neurodevelopment. The Mediterranean diet has been associated with favorable cognitive and behavioral outcomes in children; however, evidence regarding autism-related traits remains limited, particularly during late childhood and adolescence. Objective: To investigate the association between maternal adherence to the Mediterranean diet during pregnancy and autism-related traits in preadolescent offspring in the KLOTHO birth cohort. Methods: This exploratory analysis included 96 adolescents (49 boys and 47 girls) from the KLOTHO birth cohort. Maternal adherence to the Mediterranean diet during pregnancy was assessed using a Mediterranean Diet Score derived from a food frequency questionnaire administered during gestation. Autism-related traits were evaluated during preadolescence using a parent-completed questionnaire that assessed social and emotional abilities, communication skills, cognitive characteristics, special interests, and motor skills. Associations were examined using Spearman's correlation analyses and sex-stratified linear regression models adjusted for offspring body mass index, sleep duration, and physical activity, all assessed during the preadolescent follow-up examination. Results: Boys exhibited higher communication (3.92 ± 3.90 vs. 1.70 ± 2.89, p = 0.026), cognitive (5.76 ± 3.80 vs. 3.33 ± 2.99, p = 0.014), special-interest (2.64 ± 3.29 vs. 1.04 ± 2.16, p = 0.046), and overall autism-related trait scores (19.08 ± 13.92 vs. 10.15 ± 8.57, p = 0.009) compared with girls. In the overall cohort, maternal Mediterranean Diet Score was not associated with autism-related traits. Among boys, higher maternal Mediterranean Diet Scores were associated with lower communication-related trait scores (ρ = -0.442, p = 0.027). In multivariable analyses, the inverse association remained consistent in direction but did not retain statistical significance after adjustment for body mass index, sleep duration, and physical activity. Sensitivity analyses incorporating offspring KIDMED scores yielded similar findings. Conclusions: Higher maternal adherence to the Mediterranean diet during pregnancy was associated with lower communication-related trait scores in male offspring. These findings should be considered exploratory and require confirmation in larger prospective cohorts.
Anemia among children under five remains a major public health problem in the Democratic Republic of Congo (DRC), affecting growth, cognitive development, and overall child health. We estimated the prevalence, spatial distribution, and determinants of anemia and identified high-risk geographic areas using multilevel and spatial analyses. We analyzed data from 11,393 children aged 6-59 months from the 2023-24 Democratic Republic of Congo Demographic and Health Survey (DHS). Weighted prevalence estimates were calculated, and multilevel mixed-effects logistic regression was used to assess individual- and community-level determinants of anemia. We applied Moran's I, hotspot detection, Kriging interpolation, and SaTScan analyses to identify high-risk areas. Model performance was evaluated using AIC, BIC, and log-likelihood ratio tests to ensure the results were reliable. Overall, 51.7% of children (95% CI: 49.5%-53.9%) were anemic, most cases were mild (25.6%) or moderate (25.0%), while severe anemia was rare (1.1%). Prevalence was highest among infants 0-5 months (56.2%) and boys (52.5%) than girls (50.8%). Key risk factors for anemia included wasting (AOR = 1.29), malaria infection (AOR = 1.21), high community malaria risk (AOR = 1.42), and low altitude (AOR = 1.39). Children were less likely to be anemic if their mothers were overweight (AOR = 0.66), if they came from wealthier households (AOR = 0.77), or if they lived in moderately sized families (AOR = 0.84). Spatial analysis revealed high-prevalence areas in Haut-Lomami, Maniema, and Tshuapa, whereas lower prevalence was seen in Haut-Uele and Nord Ubangi. Anemia among under-five children in the DRC is geographically clustered and influenced by both individual- and community-level factors. Targeted and integrated interventions focusing on malaria prevention, nutrition, and maternal health are needed in high-burden areas.