Foregut cysts are uncommon, mucosa-lined congenital lesions that may occur anywhere along the gastrointestinal or respiratory tract and typically present within the first year of life. Although infrequent, these cysts may generate feeding or respiratory difficulties depending on the size and location of the lesion. Foregut cysts of the oral cavity are rarely seen and of those cases localized to the tongue are even more uncommon. We describe a 4-month-old girl with a foregut cyst involving the floor of mouth and anterior tongue. Subsequent histologic analysis demonstrated a cyst lined with both gastric and respiratory epithelia. This case represents an extremely rare finding of both gastric and respiratory epithelia lined within a single cystic structure in the tongue. Although a very rare finding, a foregut cyst should be on the differential diagnosis of any lesion involving the floor of mouth or tongue in an infant or child. Cysts of foregut origin may localize anywhere along the gastrointestinal tract from the oral cavity to the anus although they are most commonly found in the ileum . The vasAn infant girl presented with a cystic mass on the floor of the mouth at 6 weeks of age. The slowly growing mass which was present at birth measured approximately 2 cm in diameter on initial examination. At the time of presentation, the patient weighed 4.075 kg, corresponding to the 11th percentile for her age. However, the patient showed no distress and the parents did not report any feeding or breathing difficulties. The family history was unremarkable and there was no history of any other anomalies. Two months later, a magnetic resonance imaging (MRI) was obtained and demonstrated a 1.8 × 2.0 × 1.9 cm T2 hyperintense and mildly T1 hyperintense nonenhancing cystic mass localized to the tongue and sublingual space in the midline with extension to the left of the midline. No fluid-fluid levels were noted. There was no indication that the cyst was arising from the sublingual or submandibular glands and no evidence of extension into the submandibular space . The difThree weeks after the imaging study was performed, the cystic mass was resected in its entirety using bipolar electrocautery. The cyst was not opened during the procedure. Gross examination of the mass showed a cystic structure measuring 2.5 × 2.1 × 1.8 cm. Sectioning revealed a unilocular cyst measuring 2.5 cm at the greatest dimension which was filled with opaque gelatinous material. Microscopic sections showed a cyst which is lined by respiratory-type ciliated pseudostratified columnar epithelium punctuated at multiple sites by short segments of gastric epithelium. The cyst wall was composed of a continuous layer of skeletal muscle and, to a lesser extent, fibroconnective tissue. Foci of acute and chronic inflammation were present. Several seromucous glands were embedded in the skeletal muscle and fibroconnective tissue. The lumen was filled with mucinous material . Given tThe pathogenesis of foregut cysts remains unclear owing to the variability of mucosal linings and locations across the reported cases. There is a general consensus that the often antenatal, neonatal, or infantile presentation of lingual cysts points to some early aberrant embryological event(s) leading to ectopic multipotent cells as the basis for cyst development. Even in the exceedingly rare adult cases, the examination and treatment typically arise from rapid recent changes in cysts observable since infancy or childhood , 19. The N-acetylgalactosamine, and galactosamine. These findings suggested a high degree of differentiation and varied from patterns seen in normal gastrointestinal epithelium, supporting an origin from undifferentiated endoderm subjected to inductive influence that could subsequently produce various cell types with varying degrees of differentiation [In 1970, Gorlin and Jirasek proposed that the heterotopic gastric mucosa seen in oral cysts may be the result of entrapped epithelium of the primitive stomach or stomatodeum . Daley entiation , 11, 27.ntiation .While a number of theories have been presented over the years, those proposed by Veeneklaas and Gorlin and Jirasek remain the most prominent. In any case, all explanations proposed thus far have failed to incorporate all locations and cell types described in the literature. These differences are readily apparent as the structural anomalies observed by Veeneklass and associated with intestinal foregut cysts, or any other abnormalities for that matter, are notably absent in most reports of lingual foregut cysts. Indeed, the variety of presentations suggests a number of different, albeit possibly similar, causes leading to the manifestation of the various clinical entities classified as foregut cysts or choristomas. It may therefore be impossible to reconcile the development of all cysts under a single theory.A variety of designations have been used to refer to these cysts in the literature including “lingual cyst,” “enteric duplication cyst,” “foregut cyst,” “lingual choristoma,” “gastrointestinal cyst of the tongue,” and “lingual alimentary cyst,” as well as combinations of the aforementioned terms. Given the confusion surrounding the nomenclature, the use of histologic descriptive terms endorsed by Manor et al. should be favored until these pathologies are better understood or distinguished . While tReview of reports of lingual cysts involving both gastric and respiratory epithelia suggests a male predilection  which haPatients are usually asymptomatic at the time of identification. Among the roughly one-third of cases reporting symptoms, at least half involved some period of observation following discovery and prior to presentation with complaints. Feeding and respiratory difficulties are usually the greatest cause of concern for lingual foregut cysts given the very young age of most patients at the time of presentation but the obstruction or mass effect produced by a cyst can also result in dysphagia, dysphonia, and pain or discomfort , 21–23.CT or MRI is often useful in defining the dimensions and anatomic involvement of a cyst and assists in preoperative planning for excision but the definitive diagnosis usually cannot be confirmed until the histopathologic analysis of the specimen. Surgery should be considered, even in the absence of symptoms or complaints, as evolution to malignancy in adults has been reported in previously untreated cysts , 19. Exc


Background and Objectives. Parents' birth weight acts as a predictor for the descendant birth weight, with the correlation more strongly transmitted through maternal line. The present research aims to study the correlation between the child's low or increased birth weight, the mother's birth weight, and maternal conditions. Methods. 773 mother-infant binomials were identified with information on both the baby's and the mother's birth weight recorded. Group studies were constituted, dividing the sample according to birth weight  and ≥3,500 grams (g)). The length at birth was also studied in children ≤47.5 cm (lower quartile). Chi2 test or Fisher's exact test, Spearman's Rho, and odds ratio were performed in order to investigate the relation between the children's weight and length at birth and the mothers' and children's variables. Results. The girls were heavier at birth than their mothers, with an average increase at birth weight between the generations of 79 g. The child's birth weight <2,500 g did not show any correlation with maternal birth weight <2,500 g  or with maternal stature below the lower quartile (<157 cm) . The child's low birth weight  was lightly correlated with drug use by the mother during pregnancy . The child's birth weight <2,500 g showed increased correlation with gestational age lower than 38 weeks and 3 days . The child's weight at birth ≥3,500 g showed strong correlation with maternal weight at birth ≥3,500 g . It was also revealed that the higher the maternal prepregnancy BMI, the stronger the correlation with child's birth weight ≥3,500 g  and ). The child's length at birth in the lower quartile (≤47.5 cm) showed strong correlation with drug use by the mother during pregnancy . Conclusions. The mother's increased weight at birth and the prenatal overweight or obesity were correlated with increased weight and length at birth of the newborn, coupled with the tendency of increasing birth weight between generations of mothers and daughters. Also, descendants with smaller length at birth are the children of women with the lowest statures. Intergenerational effect on birth weight studies has shown that the offspring's birth weight is related to the birth weight of both parents, with the correlation being more strongly transmitted through the maternal line , 2. WomeFetal growth is a critical part of the prenatal period and can affect the health of the child both in short term and in long term. Small or large newborns face an increased risk of infant mortality and a variety of latter health problems, including metabolic and cardiovascular diseases in adulthood .The possible mechanisms that explain the intergenerational effects on birth weight and linear growth are not mutually exclusives and include mechanical factors caused by reduced space for the fetus to grow, fetal programming of metabolic alterations, shared genetic characteristics, epigenetic effect, and sociocultural factors .One of the main determinants of birth weight is maternal height. Maternal height is correlated to the mother's own birth weight .The intergenerational cycle of growth failure is well known in developing countries. Children who suffered from malnutrition during gestational life and early childhood tend to have a shorter stature in adulthood and are more likely to have children with low birth weight. When these children who are born small are girls, they probably tend to perpetuate the malnutrition cycle .Adverse exposures during preconception and pregnancy periods  may also influence the duration of gestation period and the newborn's birth weight. This leads to an intergenerational transmission of altered birth weight .The intergenerational transmission of low or increased birth weight and its delayed effects later in life are a matter of concern throughout the nations. Women who were born small for gestational age have an increased risk of developing hypertension during pregnancy, which may lead to giving birth to low birth weight newborns. This leads to an inherited predisposition to low birth weight and to cardiovascular risk . Women wMaternal prepregnancy BMI (body mass index) is influenced by her own growth and development during intrauterine life and childhood. Maternal intrauterine life and childhood growth also have an impact on maternal stature, fat-free mass, placenta size, uterus and ovaries size, and maternal metabolism. All these variables affect female reproductive quality , 14.This paper analyzes the intergenerational transmission of birth weight in two successive generations. The correlation between altered birth weight with the mother's birth weight and other maternal conditions was studied in full-term newborns in the “Hospital Universitário” of the University of São Paulo.Mother-child binomials were only included as participants in this study if their birth weight was registered in their respective medical records. The following participants were excluded from this research: mothers who have given birth at home, subjects born from multiple gestation pregnancy, and also those who had congenital disorders. Stillborn babies were also excluded. Premature newborns  were excluded due to the multicausal origins involved in preterm birth. Furthermore, the previously mentioned intergenerational effect is not consistent among preterm births .The participants of this research were women who gave birth in the “Hospital Universitário” (HU) between January 2012 and March 2014. If the mother was also born in HU, their medical record was obtained using their birth date, full name, and their own mother's hospital record. Maternal birth weight was obtained either through the medical records found in HU or through the medical records located in the two biggest maternity hospitals from the area of HU.558 mother-child binomials were formed. If the children born between January 2012 and March 2014 were not their mothers' first child, their older siblings were also included in this study in case they were also born in HU. Therefore, 773 mother-child binomials were obtained from the initial 558 women who gave birth between January 2012 and March 2014 in HU.For analytical purposes, the collected data was analyzed according to three different parameters. For each one of these parameters, a group with two categories was formed. Firstly, the sample was sorted according to the criteria of low birth weight (Group I): those born with a birth weight lower than 2,500 grams (g) formed one category, while the rest formed another. Medical literature describes low birth weight as any weight <2,500 g . In anotSociodemographic data, maternal anthropometry during pregnancy, and gestational history were obtained through the medical records. Other information about gestational risk factors and the delivery was also obtained that way. Capurro method. The sample was sorted according to the gestational age and the newborns were placed in one of these three categories: preterm pregnancy (GA <37 weeks), full-term pregnancy (between 37 weeks and 41 weeks and 6 days), and postterm pregnancy (GA >42 weeks) [The gestational age (GA) was calculated using the2 weeks) , 17.The women were sorted according to their ages in three different groups: (a) those who were 19 years old or younger, (b) those who were between 20 and 35 years old, and (c) those who were older than 35 years old –20. TheyThey were also sorted according to parity: they were sorted into different categories if they had previously already given birth to other children or not and, if so, how many. They were sorted according to their history of prenatal care as well: those who did not receive any prenatal care formed one group, while the ones who received prenatal care formed another. Smoking, drinking, and drug use during pregnancy were also taken into consideration. Pregnancy related diseases  were also assessed.Maternal stature during pregnancy was also obtained. The women in the lower quartile (<157 cm) were compared to the ones who were taller than 157 cm.2 (low weight); BMI between 18.5 and 24.9 Kg/m2 ; BMI between 25.0 and 29.9 Kg/m2 (overweight); and BMI ≥30.0 Kg/m2 (obesity) [The participants were also sorted according to their prepregnancy body mass index (BMI). They were divided in the following categories: BMI <18.5 Kg/mobesity) , 22.The weight gain during pregnancy was estimated from prepregnancy or early prenatal nutritional statuses. Adequate weight gain during pregnancy varies according to maternal prepregnancy weight. Weight gain should be (a) between 12.5 and 18.0 kg in women with low prepregnancy weight; (b) between 11.5 and 16.0 kg in women with adequate prepregnancy weight; (c) between 7.0 and 11.5 kg in overweight women; and (d) between 5.0 and 9.0 kg in obese women .We also compared female newborns with male newborns. The newborns whose birth length was in the lower quartile (≤47.5 cm) were compared to the others. Parturition was classified as being either vaginal or by surgical cesarean section. Pearson's Chi-square test or Fisher's exact test were performed [ Spearman's Rho test and the analysis of odds ratio were performed [Descriptive statistical analyses of the parametrical variables were performed by calculating the average, standard deviation, and standard error. The results were expressed according to these parameters. In order to test the homogeneity of the groups in relation to their proportions,erformed , 25. In erformed .This Research Project was approved by the Research Ethics Committee from the “Hospital Universitário” of the University of São Paulo.94.0% of the mothers were born in the city of São Paulo, 83.8% of which were born in “Hospital Universitário.” Average maternal birth weight was 3,110 g, with a standard deviation (SD) of 463 g. Information about maternal gestational age was only available for 29% of the women who participated in this research, of which 95.1% were full-term newborns, 8.0% had low birth weight , and 18.6% had increased birth weight . Maternal age at birth varied from 12 to 40 years old and 29% of the women were 19 years old or younger at birth. 40.3% of them had finished high school  by the time of the delivery and 2.0% of them had been to college.15.2% of participants smoked during pregnancy and 3.0% of them also consumed alcohol and/or other drugs during pregnancy. 58.7% of the 773 mother-child binomials were primiparous and the abortion prevalence reached 14.0%.n = 763) did not receive prenatal care. 28.9% had urinary tract infection during pregnancy, 21.1% had leukorrhea during pregnancy, and 7.2% had other kinds of infectious diseases (n = 762). 14.7% had other kinds of diseases, such as asthma, bronchitis, and allergic rhinitis (n = 764).9 mothers (n = 752) were shorter than 157 cm (lower quartile) and 21.7% were taller than 166 cm (upper quartile). Average prepregnancy BMI (n = 628) was 24.1 Kg/m2 with a standard deviation of 4.5% Kg/m2. 5.3% of the mothers had a BMI <18.5 Kg/m2, 59.4% had a BMI between 18.5 Kg/m2 and 24.9 Kg/m2, and 24.4% of them had a BMI between 25.9 Kg/m2 and 29.9 Kg/m2. 11% of them had a BMI ≥30 Kg/m2. The weight gain during pregnancy (n = 610) was inadequate in 69.0% of them: 39.6% showed insufficient weight gain and 29.4% of them gained excessive weight during pregnancy.29.4% of the mothers , 70.0% weighted between 2,500 g and 3,500 g, and 26.5% had an increased birth weight . Average birth weight was 3,242 g, with a standard deviation (SD) of 421 g. Fisher 0*; Spearman's Rho 0.287; OR 28.6 and OR lower 8.5. Low birth weight had also a significant correlation with shorter full-term gestational age. If the child is born 10 to 14 days after completion of 37 weeks of gestational age, he/she will be born with a significantly higher birth weight .Chi2 sig 0.025; Spearman's Rho 0.081; OR 2.6 and OR lower 1.1), and also with drug use during pregnancy .Low birth weight  had a slight correlation with noncommunicable diseases, such as asthma, bronchitis, and allergic rhinitis  and surgical cesarean section .2 ; BMI ≥ 25.0 Kg/m2 ; and BMI ≥ 30.0 .Increased birth weight  also had a strong correlation with inadequate maternal prepregnancy BMI: BMI < 18.5 Kg/mSpearman's Rho 0.210). This correlation was more pronounced in newborns with birth weight >2,500 g.Chi2 sig 0; Spearman's Rho 0.134; OR 2.0 and OR lower 1.4). Length at birth in the lower quartile also had a strong correlation with illicit drug use during pregnancy .Chi2 sig 0.012; Spearman's Rho 0.091; OR 1.6 and OR lower 1.1) and with smoking during pregnancy .Length at birth in the lower quartile (≤47.5 cm) had a slight correlation with maternal height in the lower quartile (<157 cm)  was higher than maternal average birth weight . Both average birth weights were very similar to those found by Monteiro et al. in São Paulo, Brazil,  and alsoFemale newborns weighted on average 79 g more at birth than their mothers. Veena et al. also observed a birth weight increase between generations of women in southern India: in that study, the daughters' birth weight was on average 104 g heavier than their mothers' birth weight , EuropeaMale newborns weighted on average 109 g more than female newborns. This result is very similar to the evidence given by Lubchenco et al.  and AlexLow birth weight  was not correlated with low maternal birth weight. This differs from the results of other studies that showed an intergenerational transmission of low birth weight , 35, 45.Newborn low birth weight <2,500 g) and newborn birth length in the lower quartile ≤47.5 cm) had a correlation with drug use by the mother during pregnancy. Newborn birth length in the lower quartile also had a slight correlation with smoking during pregnancy. Several studies in medical literature demonstrate that smoking and illicit drug use during pregnancy are related to newborn low birth weight [.5 cm had0 g and nWe did not find any correlation between newborn low birth weight  and maternal height in the lower quartile (<157 cm). This differs from several studies that showed an increased risk of newborn low birth weight in women with short height when compared to reference height –55.A recent Brazilian study that analyzed 2,226 mother-child binomials found that maternal height in the lower quartile (≤152 cm) was related to an increased risk (42%) for having children with low birth weight when compared to mothers in the upper quartile for height (>160.4 cm) . HoweverNewborn increased birth weight ≥3,500 g) had a strong correlation with increased maternal birth weight. A similar result was observed in the study of Buffalo's birth cohort: Klebanoff et al. found that increased maternal birth weight was the best predictor for large newborns for gestational age after controlling for all confounding factors. Women who weighed more than 3,600 g at birth presented a higher risk of having a child large for their gestational age . In the 00 g had In the present study, newborn increased birth weight  also had a strong correlation with increased maternal prepregnancy BMI: the higher the mother's prepregnancy BMI was, the stronger the correlation with newborn increased birth weight was.A meta-analysis has showed an association between prepregnancy overweight or obesity with increased risk for newborns large for gestational age (LGA) and babies with weight >4,000 g or macrosomic . LGA babNewborn birth length in the lower quartile (≤47.5 cm) had a slight correlation with maternal height in the lower quartile <157 cm). Witter and Luke had a similar result: newborns whose mother's height varied from 150 to 157 cm were smaller than children born to taller women (between 168 cm and 175 cm) . Veena e57 cm. WiMedical literature shows that first-born children are usually lighter than their younger siblings –65. 58.7Studies have showed that maternal age is an important predictor for the size of the newborn: teenage mothers tend to have smaller babies . 29.0% oThis research provides two evidences for the intergenerational vicious cycle of high birth weight: (1) increased maternal birth weight and prepregnancy maternal overweight or obesity had a strong correlation with newborn high birth weight; (2) a tendency of daughters having a higher birth weight than their mothers was observed.Public policies may lead to important benefits for the next generations. Improving female health with a focus on preconception, maternal-fetal health, proper development of children, fight against obesity, and socioeconomic improvement may be a way of interruption of the intergenerational cycle of growth failure and the perpetuation of obesity in the world.Newborn low birth weight was not correlated to low maternal birth weight. However, newborn high birth weight (≥ 3.500 g) had a strong correlation with high maternal birth weight.2), with absence of smoking during pregnancy, and also with surgical cesarean section.Newborn low birth weight had a slight correlation with drug use during pregnancy. Increased birth weight had a strong correlation with increased maternal prepregnancy body mass index (BMI ≥ 25 mg/kgNewborn birth length in the lower quartile (≤47.5 cm) had a strong correlation with drug use during pregnancy and a mild correlation with maternal stature in the lower quartile (<157 cm) and with smoking during pregnancy.The results suggest that increased maternal birth weight (≥3.500 g) and maternal prepregnancy overweight or obesity is associated with newborn high birth weight. This points to a tendency of increasing weight across generations, which can result in an intergenerational cycle of obesity.


Maternal blood pressures in pregnancy is an important determinant of offspring size at birth. However, the relationship between maternal blood pressures and offspring’s size at birth is not consistent and may vary between ethnic groups. We examined the relationship between maternal peripheral and central blood pressures and offspring size at birth in an Asian multi-ethnic cohort, and effect modifications by maternal ethnicity and obesity.We used data from 713 participants in the Growing Up in Singapore Towards Healthy Outcomes study consisting of pregnant Chinese, Malay and Indian women recruited from two tertiary hospitals between 2009 to 2010. Peripheral systolic and diastolic blood pressures (SBP and DBP), and central SBP and pulse pressure (PP) were measured around 27 weeks of gestation. Biometric parameters at birth were collected from medical records.th percentile for gestational age adjusted birth weight). Maternal adiposity modified these associations, with stronger inverse associations in normal weight women. No significant interactions were found with ethnicity.After adjusting for maternal and fetal covariates, each 1-SD increase (10.0 mmHg) in central SBP was inversely associated with birth weight  -70.66 to −10.37), birth length , head circumference  and placental weight . A one-SD (11.1 mmHg) increase in peripheral SBP was also associated with lower birth weight . The inverse relations between other blood pressure measures and offspring size at birth were observed but not statistically significant. Higher peripheral SBP and DBP and central SBP were associated with increased odds of low birth weight (defined as weight <2500 g) and small for gestational age  contains supplementary material, which is available to authorized users. Birth weight is an important measure of intra-uterine growth. Various maternal and fetal factors are known to influence size at birth ,2. AmongSeveral studies have investigated the associations between offspring’s birth weight and maternal peripheral ,5-17 andThere is evidence that the relation between maternal blood pressures and offspring’s birth weight were found to be stronger in Asian Indians than white or black women , and wasTherefore, we aimed to simultaneously examine both maternal peripheral and central blood pressures in relation to size at birth, and to explore the possible effect modification by maternal ethnicity or adiposity in pregnancy in a Southeast Asian birth cohort of pregnant Chinese, Malay and Indian women.Growing Up in Singapore Towards Healthy Outcomes (GUSTO) study, a prospective early life cohort study comprising Chinese, Indian and Malay women  to measure maternal height and weight, as well as blood pressures using standard protocols . Depressfication . Rate ofStudy participants were rested for at least 10 minutes prior to the first blood pressure measurement. Peripheral systolic and diastolic blood pressures (SBP and DBP) were taken on the right brachial artery at the level of the heart. Using an oscillometric device , three blood pressure readings were taken consecutively at 30 to 60 seconds apart to obtain the average reading of SBP and DBP. The A-pulse tonometer  was then applied on the radial artery of the same arm for continuous sampling of radial artery waveforms for at least 60 seconds. Central SBP was estimated from the calibrated radial artery waveforms , and centh percentile for gestational age adjusted birth weight.Information on offspring size at birth  were extracted from medical records, which were measured by midwives according to standard hospital protocols. Gestational age adjusted standard deviation (SD) scores for birth weight, length, head circumference and placental weight were constructed for the GUSTO cohort. The binary outcome of low birth weight was defined as weight at birth <2500 g, and small for gestational age was defined as those who were below the 10Blood pressure values were converted into SD scores, whereby per 1-SD increase in peripheral SBP and DBP was equivalent to 11.1 and 8.3 mmHg, respectively, and central SBP and PP to 10.0 and 6.5 mmHg, respectively. Maternal characteristics were compared across blood pressures using analysis of variance. The relationship between blood pressures and size at birth were examined using multiple linear and logistic regression models for continuous and binary birth size outcomes, respectively. All analyses were adjusted for baby’s sex, gestation age at delivery in weeks, maternal age, ethnicity, education, parity, smoking history, height, BMI around 27 weeks gestation, coffee consumption and depression. No adjustment was made for chronic hypertension as there were only 13 (1.8%) women with this condition.We further evaluated the potential effect modification by maternal ethnicity  and BMI categories . Multiplicative interaction terms with blood pressures as continuous variable and ethnicity or BMI as a categorical variable were added to the final model, and the likelihood ratio test was used to evaluate significance. We also reported the results stratified by maternal ethnicity  and BMI category .We performed a series of sensitivity analyses to test the robustness of our results: (1) we additionally adjusted for gestational diabetes ; (2) we examined a subgroup of 705 women within normal range of blood pressures ; (3) we repeated our analysis using the imputed data (20 sets) for the missing information on blood pressures ; (4) we adjusted for pre-pregnancy BMI and rate of weight gain instead of BMI around 27 weeks of gestation (n = 678 due to 35 missing data for pre-pregnancy weight); (5) we used tertiles of BMI around 27 weeks gestation instead of the WHO classification to test for interaction between maternal adiposity and blood pressures; (6) lastly, we examined gestational age adjusted size at birth measures as the outcomes instead of actual values to better account for the effect of gestational duration on size at birth. All analyses were performed using Stata version 11.2 , with statistical significance at two-sided p value less than 0.05.< 0.01, Table Of the 713 women studied, 339 (55.9%) were Chinese, 196 (27.5%) were Indians and 118 (16.6%) were Malays. The mean age at enrolment was 30.5 (SD = 5.1) years. At the GUSTO study follow-up, 17.5% were obese at around 27 weeks of gestation , and the interaction between maternal BMI category and central PP was significant for low birth weight (p = 0.01). Again, the odds ratios were generally stronger in normal weight women compared to overweight/obese women (Table To further account for the influence from gestational age, we used gestational age adjusted SD scores of size at birth as the outcomes, and similar findings were observed (Additional file en Table .Table 5We found associations between higher maternal blood pressures and smaller offspring. Maternal adiposity modified the associations with stronger inverse associations in normal weight women than their overweight/obese counterparts. No significant effect modification by ethnicity were found, although Chinese women with higher blood pressures tended to have smaller offspring.Our finding of an inverse association between maternal blood pressures and offspring size at birth is consistent with previous studies -9,13-17.However, there are studies with conflicting results. For example, two previous studies measuring DBP from 34 weeks gestation onwards  and the Some studies have suggested that central blood pressures may be more relevant to size at birth than the conventional peripheral blood pressures, because blood pressure differences were more pronounced in central than peripheral measures ,14. HoweThe exact mechanisms linking higher maternal blood pressures and smaller offspring are unclear. Several studies have observed that women with preeclampsia and low birth weight offsprings share a common link in placental dysfunction -29. But A previous study by Lydakis et al.  found thOur finding on the effect modification by maternal obesity is consistent with literature that lean or normal weight women with higher blood pressures have smaller offspring compared to their obese counterparts . The effThere are several strengths of our study. The prospective design enabled the evaluation of a comprehensive information on offspring size at birth and a wide range of potential confounding factors. Peripheral blood pressure and radial pulse wave were measured in a detailed and standardized approach, thereby minimizing inter-rater measurement errors. Various sensitivity analyses suggested that our results were robust.We are aware of several limitations. First, we excluded 38.6% of the GUSTO participants due to missing information on the exposures and covariates. However, we deemed that the selection bias was unlikely to change our results based on the sensitivity analysis using imputed data (Additional file In conclusion, our results provide further evidence that higher second trimester blood pressures are associated with smaller offspring, with a stronger association among normal weight women. Therefore, routine antenatal monitoring of maternal blood pressures are clinically relevant and important practice, and may have a positive impact on offspring size at birth, particularly in normal weight women.


Thallium (Tl) is a highly toxic heavy metal widely present in the environment. Case reports have suggested that maternal exposure to high levels of Tl during pregnancy is associated with low birth weight (LBW), but epidemiological data are limited.This study was designed to evaluate whether prenatal Tl exposure is associated with an increased risk of LBW.This case–control study involving 816 study participants (204 LBW cases and 612 matched controls) was conducted in Hubei Province, China, in 2012–2014. Tl concentrations were measured in maternal urine collected at delivery, and associations with LBW were evaluated using conditional logistic regression.p for heterogeneity = 0.18) or household income (p for heterogeneity = 0.28).Higher maternal urinary Tl levels were significantly associated with increased risk of LBW , and the association was similarly elevated after adjustment for potential confounders . Stratified analyses showed slightly higher risk estimates for LBW associated with higher Tl levels for mothers < 28 years old and for mothers with lower household income; however, there was no statistical evidence of heterogeneity in risk according to maternal age (To our knowledge, ours is the first case–control study to investigate the association between prenatal Tl exposure and LBW. The results suggest that prenatal exposure to high levels of Tl may be associated with an increased risk of LBW.http://dx.doi.org/10.1289/ehp.1409202Xia W, Du X, Zheng T, Zhang B, Li Y, Bassig BA, Zhou A, Wang Y, Xiong C, Li Z, Yao Y, Hu J, Zhou Y, Liu J, Xue W, Ma Y, Pan X, Peng Y, Xu S. 2016. A case–control study of prenatal thallium exposure and low birth weight in China. Environ Health Perspect 124:164–169;  Thallium (Tl), a well-known toxic heavy metal, is present naturally in the earth’s crust and is now widely used in the manufacturing of optical lenses, semiconductors, scintillation counters, low-temperature thermometers, chemical catalysts, crystals, and imitation jewelry . Tl is rIncreased exposure to Tl in industrial workers and in the general population has raised concerns for human health . Of partLow birth weight (LBW), which is defined as a birth weight of < 2,500 g, is a main cause of morbidity and mortality in the neonatal period, and is one of the main risk factors of global disease burden, according to the World Health Organization . PreviouStudy design and study population. A nested case–control study design was used in this study. Both cases and controls were selected from the prospective Tongji birth cohort, which was conducted to explore the environmental and genetic factors that affect health and development. This ongoing cohort enrolls participants at three maternity hospitals in the cities of Wuhan, Ezhou, and Macheng, which are located in Hubei province in the central region of People’s Republic of China. The recruitment period started in November 2012 and will continue for 3 years. Pregnant women, who came for their first examination in the first trimester or gave birth at one of the three hospitals, have been asked to participate in the study. The eligibility criteria for participants are as follows: a) residence in the study areas at the time of the recruitment period with an expectation to reside continually in these areas for the foreseeable future, and b) ability to comprehend the Chinese language and complete the questionnaire. Participants were invited to provide blood and urine samples and participate in a face-to-face interview. Also, the participants will be contacted by telephone for follow-up. The participating children will be followed through the use of questionnaires and health examinations at 1 month, 6 months, 1 year, 3 years, 6 years, and 12 years of age. Between November 2012 and April 2014, 16,293 women were recruited from three hospitals , and the participation rate  was 78.7%. The research protocol was approved by the ethics committee of the Tongji Medical College, Huazhong University of Science and Technology, and the three study hospitals. All participants provided written informed consent at enrollment.In this study, cases were mothers who delivered a singleton live infant with birth weight < 2,500 g in one of the three hospitals. Controls were mothers who delivered a singleton live infant with normal birth weight between ≥ 2,500 g and < 4,000 g. Women with multiple pregnancies, without urine samples available for analysis, and those who gave birth to a stillborn infant or an infant with a birth defect were excluded. For each case, three individual controls were randomly selected from the birth cohort based on the matching variables by delivery hospital, infant sex, and maternal age at conception . If more than three potential controls met the matching criteria for an individual case, the three women whose maternal ages were closest to that of the case mother were selected. Controls were sampled from the cohort without replacement, so an individual control could be matched to one case only. A total of 204 cases and 612 controls were included in the analysis.Data collection. The face-to-face interviews were conducted by specially trained nurses in the hospitals with the participants after delivery. The interview collected a variety of information, including socioeconomic data  and lifestyle factors during pregnancy . Information about the mothers’ history of pregnancy outcomes, disease, and information concerning the infants’ birth date, sex, gestational age at birth, and birth weight were retrieved from medical records. Gestational age was estimated using the date of the last menstrual period. Birth weight of infants was measured within 1 hr after birth by experienced obstetric nurses using standardized procedures. The body mass index (BMI) of mothers was calculated using the self-reported weight before pregnancy and height, which was measured using a stadiometer.Urine sample collection and Tl measurement. The maternal urine samples were obtained during admission to the hospital as part of the preparation for delivery (within 3 days before delivery). All of the urine samples were collected in polypropylene tubes, and stored at –20°C until further analysis.3 was added to the final volume of 5 mL for overnight nitrification. The resulting sample was digested by ultrasound at 40°C for 1 hr and then analyzed for Tl by inductively coupled plasma mass spectrometry (ICP-MS) . The operation conditions of ICP-MS were RF power 1550 W, plasma gas flow 15.00 L/min, auxiliary gas flow 0.9 L/min, carrier gas flow 0.25 L/min, resolution (peak high 10%) 0.65 ~ 0.80 amu, improved quantity of samples 0.4 mL/min, unimodal residence time 0.1 sec.Before analysis, urine samples were thawed at room temperature, and 1 mL of urine from the supernatant was introduced in 15-mL Kirgen polypropylene conical centrifuge tubes. Next, 3% HNO3 blank was processed in each batch of samples to control for possible contamination. The limit of detection (LOD) for Tl was 0.02 μg/L. The recovery of the quality control standard by using this procedure was 103%. The intra-day coefficient of variation (CV) was 1.34%, and inter-day CV was 2.07%. The undetected samples (n = 5) were assigned a value of one-half the LOD. Lead, arsenic, and cadmium were also measured simultaneously, because previous studies have suggested that they are potentially associated with decreasing birth weight  was used as an external quality control in each batch to assess the instrument performance, and the concentrations measured were within the certified range recommended by the manufacturer (5%). If concentrations were significantly different from the certified value of SRM2670a, the instrument was recalibrated and the previous batch of samples was reanalyzed. A 3% HNOh weight . The recUrine creatinine concentrations were determined by a creatinine kit . Tl concentrations in urine (micrograms per liter) were adjusted for creatinine to account for variations in urine dilution in spot urine specimens, and results were expressed as μg/g creatinine.Statistical analysis. The distributions of Tl concentrations were tested by the Shapiro–Wilk normality test. Because Tl concentrations were highly skewed, the Wilcoxon matched pairs signed rank test was used to compare Tl concentrations between cases and controls. The Pearson chi-square test was used to evaluate the differences in the variables between cases and controls. The associations between the risk of LBW and maternal urinary Tl levels were evaluated by calculating matched odds ratios (OR) and 95% confidence intervals (CIs) using conditional logistic regression models. Models were fit using maternal urinary Tl concentrations as categorical variables, based on the tertile distribution of Tl concentrations in controls, and the lowest tertile was assigned as the referent group. In this study, the three variables that may represent socioeconomic status (SES) including household income , maternal education , and occupational status (employed or unemployed), were weakly correlated . The likelihood ratio test was used to assess model fit, and inclusion of all three SES variables  into the model did not significantly improve the model fit compared to addition of each individual variable into the model separately. We selected household income to adjust for SES in this study because its adjustment showed a larger impact on the ORs for the association between Tl and LBW than did the other two SES variables. Although gestational age (< 37 or ≥ 37 weeks), parity (1 or ≥ 2), maternal BMI , passive smoking (yes or no), and hypertension during pregnancy (yes or no) individually did not cause a change in the ORs by ≥ 10%, inclusion of all of these variables in the model together did result in a > 10% change in the ORs for Tl, and thus they were all included in the final model. The missing values were constructed as dummy variables in the regression model. We did not adjust for maternal smoking or alcohol consumption during pregnancy because these behaviors were reported by only one case (for smoking) and by two cases and one control  (umption) .We tested for linear trends by modeling the median values of tertiles of Tl as a continuous variable and evaluated the statistical significance of this predictor using the Wald test. The analyses were further stratified by infant sex and maternal age. The median age of the case mothers at delivery (28 years old) was used as the cut-point for these stratified analyses, regardless of the age of the matched controls (one matched control mother with an age of 29 years was distributed into the ≤ 28 year old stratum). We also performed sensitivity analyses that excluded maternal urine samples with creatinine < 0.3 g/L or > 3 g/L , pretermAll statistical analyses were performed using SAS . All statistical tests were considered to be significant at an alpha level of 0.05 for a two-tailed test.p > 0.05). Also, there were no significant differences in the Tl concentrations for different educational levels, occupational status, household income, or for other demographic characteristics.The detection rate for Tl in maternal urine was 99.4%. The creatinine-adjusted Tl concentrations ranged from below the LOD to 8.15 μg/g creatinine with a median of 0.64 μg/g creatinine in the mothers of LBW cases, and from below the LOD to 6.90 μg/g creatinine with a median of 0.55 μg/g creatinine in the control mothers . There was no significant difference in the median Tl concentrations between the two groups (p trend = 0.06). After adjustment for potential confounders, the positive association between LBW risk and maternal urinary Tl levels was similarly elevated with a significant trend  (p trend = 0.04). When 7 cases and 18 controls with creatinine concentrations < 0.3 g/L or > 3.0 g/L and their matched cases or controls were excluded (180 case–control sets included), we found the adjusted OR for LBW was essentially unchanged . In the analysis excluding preterm births (87 case/control sets included), an adjusted OR of 1.81  was observed for the highest tertile, which was slightly decreased due to the smaller sample size. We also performed an analysis that excluded the women with hypertension during pregnancy (178 case–control sets included), and found that the adjusted OR for LBW associated with Tl exposure was essentially unchanged .The unadjusted and adjusted ORs and 95% CIs for LBW according to the tertiles of creatinine-adjusted Tl concentrations in maternal urine are shown in p heterogeneity = 0.18). Associations were similar for male  and female infants  (p heterogeneity = 0.68).p for heterogeneity = 0.28). Also, there was no statistical evidence of heterogeneity in risk according to educational levels (p for heterogeneity = 0.62) or occupational status (p for heterogeneity = 0.89).We also performed unconditional analyses stratified by household income, maternal educational level, and occupational status, because of the differences between cases and controls in these variables . The highest tertile of Tl was positively associated with LBW among mothers who had lower household income , but not in those with higher household incomes . However, the differences between household income strata were not significant . The associations between higher levels of Tl and increased risk of LBW were largely unchanged  .To the best of our knowledge, this is the first case–control study to investigate the association of prenatal Tl exposure with the risk of LBW. The results of the present study suggest that prenatal exposure to the current levels of Tl encountered today in China may potentially increase the risk of delivering LBW infants.Tl was detected in almost all of the maternal urine samples, indicating that our study population is widely exposed to this heavy metal in daily life. A comparison of urinary Tl concentrations in pregnant women of the present study and previously published data from non-occupationally exposed populations worldwide is shown in A previous study showed that the children born in an industrial area with Tl contamination had higher levels of urinary Tl , and had about a 6-fold higher risk of congenital abnormalities compared with the unexposed children . HoffmanIn the stratified analysis, we found that the significant association between maternal urinary Tl levels and the risk of delivering a LBW infant was slightly more pronounced in younger mothers (< 28 years old) compared with older mothers (≥ 28 years old) and in the mothers who had lower household income compared with those who had higher household income, although no significant effect modification was apparent. Previous studies have reported that younger mothers and mothers with lower household income generally displayed greater risk of delivering a LBW infant , and a rAlthough there is currently limited understanding of the potential mechanism between maternal exposure to Tl and an increased risk of LBW infants, one possible mechanism is that Tl may exert toxicity by disturbing mitochondrial function . Tl crosOne of the strengths of our study is that the nested case–control design provided the opportunity to include all the LBW infants in the study. In addition, interviews conducted with all participants allowed us to adjust for other potential risk factors for LBW, such as gestational age, maternal BMI, household income, passive smoking, and hypertension during pregnancy.There are some limitations to this study. First, maternal urinary Tl levels were measured at only one spot time before delivery and may not be perfect surrogates for prenatal Tl levels, though urinary Tl is regarded to represent a steady-state condition with long-term exposure in the general population . A prospUsing a case–control study design, we found a positive association between maternal urinary Tl and LBW in Chinese women. Additional research is needed to confirm the association between prenatal exposure to Tl and LBW and develop strategies for reducing LBW related to developmental exposure to environmental pollutants, including Tl.Editor’s Note: The author lineup changed between advance and final publication. All authors of the article agreed to the changes. The correct author lineup is included in this article.(323 KB) PDFClick here for additional data file.


Mothers’ existential dimensions in the transition to motherhood have not been described thoroughly. They might experience disruption and new perspectives in existential ways and this may especially be the case in preterm birth. The aim of this study was twofold. First we investigated the existential dimension of motherhood transition in a secularized context, through practices of prayer and meditation. Second we described the relationship between time of birth (term/preterm) and the prayer/meditation practices of the mothers.nd pregnancy week (n = 255), and double the number of mothers who gave birth at full term (n = 658) in 2010 were included . The questionnaire consisted of 46 overall items categorized in seven sections, which independently cover important aspects of existential meaning-making related to becoming a mother. The respondent rate was 57 % (n = 517).Data were gathered from a nationwide questionnaire survey among first time mothers conducted during the summer 2011. All Danish women who gave birth before the 32n = 286) more than meditation (n = 89), p < 0,001. We did not observe differences in affirmative responses to prayer or meditation between mothers of full term or preterm born children, not even after controlling for perinatal or post partum loss, mode of birth, age, status of cohabiting or education.Moments of praying or meditation 6–18 months post partum were reported by 65 %, and mothers who responded affirmatively, practiced prayer (In this explorative study we found specific practices of existential meaning-making through prayer and/or meditation among first time mothers, living in a very secularized context. Yet we know only little about character or importance of these practices among mothers, and hardly anything about existential meaning-making among new fathers. Hence the implications of meaning-making practices related to other dimensions of health are difficult to address in a qualified way in care for new mothers and families. In recent decades there has been an increasing amount of research on the manifold forms of making meaning at the end of life among patients and relatives. Some of this research addresses existential, spiritual or religious considerations and needs, and suggests that they intensify when facing the end of life , 2. In sSpiritual ways of making meaning is a focus in the field of palliative care related to the end of life, but it is not addressed at all in maternity services in Denmark , 6. In r“…motherland” [“… a miracle” [“… a religious act” [“…a sacrament” [Motherhood as an existentially transformative process has been explored in psychological and anthropological research –11. A reherland”  “… a mirmiracle”  “… a relous act”  and evencrament” . In a socrament” , it may crament” . An intecrament” . Ausker crament” , p. 132.crament” .Giving birth preterm may be even more existentially transformative since the period of the beginning of life is potentially confronted with the end of life. Mothers of preterm born children may suffer from post-traumatic stress and anxiety , and somExistential meaning is a multidimensional construct explored in different ways. Whereas religion in an earlier European context was an obvious and normal socio-cultural source of meaning during illness, it seems to have lost its importance in western medicine today . The incMeditation practices have been studied in a randomized controlled trial among nulliparous women in Denmark, focusing on the effect of the practice of hypnosis during birth in relation to pain and the experience of childbirth. The study showed that overall, women randomized to hypnosis had a better childbirth experience than the two control groups . In anteEvery day to Never, the choices being dichotomized between Less often and Never. Of these answers, 55 % were in the “A few times a year” or “Less often than a few times a year” options. 48 % reported that they never prayed [Prayer and/or meditation practices have been studied among other groups in Denmark. 480 hospitalized people and their relatives at Copenhagen University Hospital  participated in a questionnaire survey about faith in 2006. Sixty-two percent replied affirmatively to the question: “Do you take some moments of prayer, meditation or contemplation or something like that?”  When askr prayed .1 When ar prayed . In a Dar prayed . There sMothers in other studies, based on data from primarily Western countries, giving birth is highlighted as something holy, a spiritual experience or blessed event , 16, 37.nd pregnancy week or death post partum, covering up till 100 days post partum) were also included. Mothers of twins, who lost one of them, were categorized as mothers of a living child. In the present paper, mothers who gave birth at full term will be called full term (FT) mothers), whereas mothers who gave birth before the 32nd pregnancy week go as preterm (PT) mothers. We included only first time mothers who had given birth in 2010, in order to reduce the risk of recall bias if the experience of becoming a mother was older than 18 months. The free of charge antenatal care in Denmark encompasses almost all pregnant women (99 %) [We used data from a cross sectional questionnaire survey among Danish first time mothers who gave birth in 2010. We retrieved information from the Danish Medical Birth Register about all mothers who gave birth before the 32nd week of gestation in Denmark and twice that number of women who gave birth at full term, randomly sampled. Mothers experiencing perinatal or post partum loss (stillbirth after the 22n (99 %) , which mIn July 2011, a postal questionnaire about existential meaning making in motherhood was sent to all participants along with a covering letter. Reminder letters were sent 10 weeks later . No inceexistential is the broader concept, encompassing both existential philosophical values and ideas without any transcendent foundation (secular), as well as meaning orientations related to spiritual and/or religious notions [knowing, doing and being to the three dimensions of secular, spiritual and religious meaning-making within a “matrix”, to explore consistency between the concepts of cognition, practice and importance. The three concepts of knowing (cognition), doing (practice) and being (importance) were introduced by the sociologist Fishman [The questionnaire consisted of 46 general items categorized in seven sections, which independently cover the most important aspects of existential meaning-making related to becoming a mother and the pregnancy, birth and post partum periods respectively. The questionnaire was structured to differentiate between different forms of meaning-making. Existential meaning-making is an overall concept linked to both secular, religious and spiritual orientations. Especially in Northern Europe it is also derived from more secular viewpoints . As expl notions . They pr Fishman  and have Fishman .The structure of the questionnaire was based on this “matrix”, as well as an underlying understanding of the pregnancy, birth and post partum periods as periods that may actualize existential reflections either partially or as a whole. In the interpretation of findings we also relied on this underlying understanding. As earlier mentioned, we focused in this particular study on those items in the questionnaire that concerned the practice dimension, in particular prayer and meditation.The items in the questionnaire were developed on the basis of a pilot study, a qualitative interview study among Danish mothers of preterm born children in 2008 , as wellIn this paper we focus on and differentiate the item “Do you take some moments of prayer, meditation or contemplation or something like that?” (See item 28 below). This item was designed to provide knowledge about religious and spiritual practices among Danish mothers. It has been used in the EVS 2008 and in a survey among hospitalized patients and their relatives at the Danish Rigshospitalet . In contt-test. P < 0.05 was considered statistically significant. Respondents answering, “don’t know” were included in all analyses, whereas missing or faulty answers were omitted in analyses [Data was analyzed using Stata version 13.0 . Categoranalyses .“at least once a month” and “several times a year”. Secondly, the biggest group of respondents, reporting prayer several times a year or less often than that, and thirdly, a group reporting “never”. We reduced the item concerning the idea of God (item 25) into four subgroups as well. The first three subgroups based on each of the first three possibilities of answers and the fourth subgroup based on a sum of the last three possibilities: first, one group of non-believers; second, a group of agnostics; third, (the biggest group) reporting belief in a higher power; and fourth, a group reporting belief in some kind of god.We reduced the item concerning prayer to God outside religious services (item 22) into four subgroups. Firstly, one group praying regularly, divided between n = 370), or caused by emigration or termination of pregnancy before the 10th week (n = 8). Research or address protection can be obtained easily in Denmark due to the Danish Act on Processing of Personal Data. Of the 913 mothers included, 517 responded, preterm mothers accounting for 26 % and full term mothers accounting for 74 %. See the dropout flow chart  or neonatal outcome (p = 0.12). Also there was no statistically significant difference related to time of birth (full term = 58 % vs. preterm = 53 %) (See Table p < 0.001).In relation to differences between respondents and non-respondents, no statistically significant difference was found related to marital/cohabitant status or mode of birth, defined by caesarean birth versus vaginal birth , and 33 % reported some kind of belief in God, when asked what their own idea of God was. Belief in some kind of higher power was reported by 37 %. Praying outside religious services once a month or more was reported by 21 % and 39 % reported prayer as rarely as less often than once a year. There were no statistical significant differences between FT and PT mothers in the three items concerning beliefs.More than half (56 %) of the mothers reported being a religious person (in the Danish version the wording is more similar to p = 0.05) which vanished when controlling for perinatal or post partum loss and mode of birth (p = 0.4). RR of prayer/meditation related to perinatal or post partum loss alone was 1.25 (data not shown). Of the mothers, 166 denied having prayed or meditated and 17 did not answer the question. The mothers practiced prayer rather than meditation  See Tables Of the 517 respondents, 334 (65 %) confirmed having prayed or meditated, with a difference between FT and PT mothers (p = 0.86) or meditation (p = 0.30) (data not shown). Respondents could choose several of the different forms of prayer or meditation. 11 did not choose any of the options, even though they had said that they prayed or meditated in the introductory question. Among the different forms of prayer, most mothers responded to the option of “prayer as an inner dialogue addressed to God” (46 %), followed by “prayer as an inner dialogue addressed to something greater than myself” (40 %). In relation to meditation, most mothers responded to the option “meditation as a means to maintaining or achieving good mental health” (19 %). We conducted sub-analyses by investigating every possibility of praying or meditation, and found no statistically significant differences in responses from FT and PT mothers in any the items. See Fig. When dichotomizing the options of prayer or meditation, we found no statistically significant differences between FT mothers and PT mothers in their choices of prayer  responded affirmatively to the same question . It is aThe respondents in this survey are mothers, not fathers, and perhaps mothers are more attuned to prayer and meditation? In 2012, the sociologists Trzebiatowska and Bruce proposed childbirth as one of the possible reasons for women being more religious than men . One aspWhen separating prayer and meditation, this individualism in a prayer- or meditation practice persists. The initial hypothesis of more mothers responding affirmatively to meditation than prayer, due for example to the focus on spiritually oriented practices in antenatal classes, was not supported. The majority of mothers reported having prayed (286 versus 89), and among them, most endorsed the statement of having addressed their prayer to a personal God. However, in the background question on prayer to God outside religious services, only 21 % agreed, which supports the notion that questions loaded with a conventional understanding of religiosity as church attendance lead to more reluctant responses.“I’m a believer – but I’ll be damned if I’m religious” (Rosen 2009:161). When asked about their idea of God (the knowing dimension), more mothers in this survey reported belief in a higher power (37 %) than belief in some kind of God (33 %). “A higher power” is seen as a spiritual dimension of existential meaning-making. This points to some inconsistency according to “the matrix” structure of the questionnaire, since most mothers at the same time affirmed some practice of prayer (the doing dimension), which is interpreted as a religious way of existential meaning-making. When most mothers report praying, this finding clashes to some extent with the expected widespread move from religious to more spiritual practices, including from prayer to meditation, predicted, for example, by two sociologists claiming a “spiritual revolution” on behalf of belief in a personal God [Andersen and Lüchau highlight the apparent paradox that religion has become more important to Danes, but individualized as well, when looking at religious data from the European Values Study. It seems that many contemporary Danes combine seeking answers in religion with doing this in their own individual way: there is a growing confidence in the church providing relevant answers to existential questions, but a receding belief in the church as a special authority . In lineonal God . After aonal God .relation to a God greater and beyond oneself may be a higher good than that gained in secular meditation practices, often characterized by contemplation within oneself [dimension (as in meditation), but also to a transcendent relation (as in praying to someone outside oneself) becomes important [One reason for the preference for praying rather than meditating among these new mothers may be that people in life transitions are emotionally dependent on strong relations. On the basis of neuroscientific research, Danish researchers argue, that improvised prayer is comparable to normal interpersonal interaction . In pray oneself . For themportant ?“something bigger than myself”. There seems to be a combination of the highly individualistic way of making existential meaning of life combined with a widespread use of religious and spiritual practice deriving from a conventional religiously affiliated way of making meaning.So - at the same time as conventional religious beliefs are decreasing, women in this survey seem to practice praying as an inner dialogue with either a personal God or We looked into prayer and meditation practices among first time mothers of both preterm and full term children. Research suggests that traumatic childbirth, for example giving birth preterm, may actualize existential reflections, including religious practices, which ought to be addressed clinically . TherefoIn relation to prayer/meditation, the impact of childbirth and becoming a mother seem to affect the mothers in this study to equal extents. Although we did not find any statistically significant differences between FT and PT mothers in the study, it is obviously still possible that they differ in underlying motivations. Prayer and meditation practices may be motivated by a variety of feelings and experiences. Feelings of grief, loss and betrayal are described among mothers of preterm born children , 68, andOf the 1291 mothers, only 71 % could be contacted, mainly due to address and research protection. The final respondent rate of 57 % may seem low, but is not unusual. The 2009 Views and Values Survey from the Danish Twin Registry had a respondent rate of 55 %, even though twins are usually willing participants . We sougThe apparently high proportion of respondents replying affirmatively to prayer and meditation, and the lack of differences between preterm and full term mothers, may be due to the time frame, since the mothers in this study gave birth 6–18 months prior to the survey. Answers might have differed if mothers had been asked earlier in the post partum period, assumedly increasing the difference between FT and PT mothers. The use of prayer and/or meditation has been investigated earlier in Denmark among other groups of people, but not the distinction between different kinds of religious activities, which renders a comparison of the data impossible. Due to the cross-sectional design, changes over time in answers cannot be compared either . We stil“prayer as an inner dialogue addressed to God” (46 %). Amongst the three meditation options, most mothers chose the option, “meditation as a means to maintaining or achieving good mental health” (19 %). Thirdly, we found no differences in the frequency of prayer or meditation between full term and preterm mothers when controlling for perinatal or post partum loss or mode of birth.Firstly, we found that 65 % of Danish first time mothers reported having had moments of prayer or meditation 6–18 months post partum. Secondly, when separating prayer and meditation in the core question, we found that mothers practiced prayer more than meditation. Amongst the five prayer options, most of the practicing mothers chose the option, It seems that specific practices of existential meaning-making, namely prayer and/or meditation, are indeed found among Danish first time mothers, and yet we know only little about the character or importance of these practices. To do so, qualitative research is needed to supplement this explorative overview. Also more research is needed to include attitudes and the nature of existential meaning-making among new fathers.


British alcohol consumption and abstinence rates have increased substantially in the last 3 decades. This study aims to disentangle age, period and birth cohort effects to improve our understanding of these trends and suggest groups for targeted interventions to reduce resultant harms.Age, period, cohort analysis of repeated cross-sectional surveys using separate logistic and negative binomial models for each gender.Great Britain 1984–2009.Annual nationally representative samples of approximately 20 000 adults (16+) within 13 000 households.Age (eight groups: 16–17 to 75+ years), period (six groups: 1980–84 to 2005–09) and birth cohorts (19 groups: 1900–04 to 1990–94). Outcome measures were abstinence and average weekly alcohol consumption. Controls were income, education, ethnicity and country.After accounting for period and cohort trends, 18–24-year-olds have the highest consumption levels (incident rate ratio = 1.18–1.15) and lower abstention rates (odds ratio = 0.67–0.87). Consumption generally decreases and abstention rates increase in later life. Until recently, successive birth cohorts' consumption levels were also increasing. However, for those born post-1985, abstention rates are increasing and male consumption is falling relative to preceding cohorts. In contrast, female drinking behaviours have polarized over the study period, with increasing abstention rates accompanying increases in drinkers' consumption levels.Rising female consumption of alcohol and progression of higher-consuming birth cohorts through the life course are key drivers of increased per capita alcohol consumption in the United Kingdom. Recent declines in alcohol consumption appear to be attributable to reduced consumption and increased abstinence rates among the most recent birth cohorts, especially males, and general increased rates of abstention across the study period. Rising UK alcohol consumption in the second half of the 20th century Paradoxically, rates of abstinence have also increased markedly Fig.  and, altPrevious studies of the origins of trends in population-level alcohol consumption can provide some insight into these questions. Lederman proposed that, on average, populations tend to change their behaviour in concert; ensuring regularity can be observed in the relationship between mean consumption and levels of harmful consumption over time Although useful, much of this literature does not consider different demographic components of change simultaneously. A small number of age, period and cohort (APC) studies using time–series of cross-sectional consumption survey data address this point. APC studies seek to separate the population trends into three types of demographic trend: (i) trends across the life-course (age effects); (ii) trends across the whole population over time (period effects) and (iii) trends across successive generations (cohort effects). Ideally, this is achieved through statistical modelling to isolate APC effects from each other; however, descriptive analyses are also possible. In the United Kingdom, Kemm descriptively analysed rates of low and heavy consumption within gender-specific birth cohorts from 1978 to 1998 and found that heavy consumption rates declined with age and rose in more recent birth cohorts This paper aims to build on these analyses by conducting an APC analysis of a 25-year time–series of cross-sectional surveys on alcohol consumption and abstinence in Great Britain. In particular, we seek to identify (i) whether an APC analysis indicates attributions of the UK population trend to rising female and youth consumption are justified and (ii) the demographic origins for recent increases in abstention. To facilitate attribution of effects to male and female trends, we separate our data to conduct gender-specific analyses.The General Lifestyle Survey  is an annual cross-sectional household survey of approximately 20 000 individuals living in around 13 000 private households in Great Britain conducted by the Office for National Statistics. A probability-stratified two-stage sample design is used to draw a representative sample of private households from the postal address file. Household members aged 18+ were asked to complete the drinking section during face-to-face interviews from the GLF 1978 onwards, and from 1988 onwards 16- and 17-year-olds responded using a self-completion form. We obtained the GLF 1978 to 2009 data sets from the UK Data Archive .The questions to establish whether respondents abstain from alcohol have remained consistent; these are: (i) whether the respondent ever drinks alcohol nowadays and (ii) if not, whether the respondent means that they never drink alcohol nowadays or they drink alcohol only very occasionally.Kemm The dependent variable in the abstention analysis is binary . The dependent variable in the consumption model is the drinker's average weekly consumption in units.The same set of independent variables was used for both the abstention and consumption analyses Table . These aA logistic regression model is used to model the odds ratio (OR) for abstention. We excluded the GLF 1978, 1980 and 1982 from the abstention (and the consumption) analyses because ethnicity was not recorded. The sample size for the abstention analysis was 291 683, covering the period 1984 to 2009.As in previous studies In both analyses the reference groups were 45–54-year-olds, the 2005–09 period and the 1960–64 birth cohort, as these represent the most recent period and an average age or cohort group. Reference categories for other variables are shown in Table The logistic and negative binomial models are fitted in Stata/SE version 10.1 software . The survey design was accounted for by using the commands for handling survey data in Stata. Survey weights were used for both the descriptive statistics and model fitting.The weighted means of the proportions of abstainers and average weekly consumption for drinkers by gender and APC are presented in Fig. Drinkers' average weekly units peaks at age 18–24 , falls by approximately 5 units and remains stable between ages 25–54, then declines into later life. By period, there are upward trends in drinkers' average consumption for both genders over the study period and the increase is greater for females. By cohort, we identify increasing consumption trends for male (from 7.1 units to 23.2 units) and female (from 2.4 units to 13.7 units) cohorts of drinkers up to those born before 1979 and 1989, respectively. Average consumption has declined in later birth cohorts, especially the most recent (1990–94) male cohort.The results from the logistic models are shown in Fig. Compared with the reference age group (45–54-year-olds), men aged 16–17 (OR = 1.55) and women aged 16–17 (OR = 1.48) or 55+ (OR = 1.23–1.44) are significantly more likely to be abstainers. Men aged 18–44 (OR = 0.67–0.82) and women aged 25–44 (OR = 0.86–0.86) are significantly less likely to be abstainers. The odds of alcohol abstention for men and women both decrease as people move from the 16–17- to the 18–24-year age group and the odds increase over their subsequent life-times.The odds of abstention have increased steadily from the 1985–89 period  to the reference period of 2005–09.U-shaped curves were identified for cohort effects on abstention. Both men and women in the early birth cohorts (born before 1930) have significantly higher odds of abstention compared with the reference 1960–65 cohort. These ORs have wider confidence intervals due to the smaller sample sizes. For those born post-1930, odds of abstention compared with the reference cohort are significantly higher for men born between 1970 and 1974 (OR = 1.19) and, more markedly, between 1985 and 1994 (OR = 1.81–2.36) and for women born between 1990 and 1994 (OR = 1.63).The results from the negative binomial models are shown in Fig. Male and female drinkers show very different period effects. No significant changes in consumption are identified for men, but successive significant increases are identified for women from 1990 to 1994 onwards (IRR = 0.77).Both male and female drinkers in the earliest birth cohorts (pre-1930) drink significantly less than the reference 1960–64 cohort. For those born post-1929, male drinkers born 1930–49 (IRR = 0.65–0.96) and 1990–94 (IRR = 0.91) drink significantly less than the reference cohort, while male drinkers born 1975–79 drink significantly more (IRR = 1.10). Female drinkers born 1930–49 drink significantly less (IRR = 0.68–0.92) and those born 1965–94 drink significantly more (IRR = 1.06–1.32) than the reference group, with the consumption level reaching its peak in the 1980–84 cohort. Following the generally upward trend in successive birth cohorts, there is a marked decrease of consumption level for male birth cohorts born post-1980, but the decrease is not significant for later female cohorts.Table An alternative definition of abstinence was tested in an SA where people who drink very occasionally are also classified as abstainers; however, the results (not shown) did not differ substantively from the base case model. A range of one-way SAs applying alternative groupings to APC variables was performed (e.g. combining the 16–17- and 18–24-year age groups to increase sample size and number of surveys covering the youngest cohorts). Again, the results (not shown) did not differ substantively from the base case and the increasing probability of being an abstainer and decreasing consumption level for drinkers among later birth cohorts were still identifiable. Finally, gender dummies and interactions between gender and APC groups were tested and did not yield substantively different results.The above results present a complex picture of the components of recent trends in UK alcohol consumption. Below we attempt to summarize the results by characterizing their contribution to the three broad components of the per capita consumption trend between 1986/87 and 2010/11 . Consumption among female drinkers continued a general rise during this period, although this effect was mitigated by ongoing increases in abstinence for both men and women.The process of replacing earlier low-consuming, high-abstinence cohorts at the end of their lives with high-consuming, low-abstinence cohorts was largely completed, and smaller differences in abstinence rates were seen between the 1940s–80s cohorts who composed the bulk of the population. Drinkers in the most recent birth cohorts, who were also at the highest consuming point in the life-course, had lower average consumption levels than preceding cohorts, and these new cohorts also contained more abstainers. Abstinence rates also continued to rise across the population during this period, although female drinkers, again, also continued to drink more on average.These findings suggest that recent UK per capita consumption trends are rooted in four phenomena. First, the United Kingdom appears to be moving progressively away from highly gendered drinking roles as changes in female drinking behaviour occur. Previous research has found similar shifts in some countries  but not others  Recent UK policy debate has focused on youth and female consumption. There is some justification for this, as our results show a clear spike in consumption in early adulthood and large increases in consumption among female drinkers. However, while early adulthood is associated with concerns regarding alcohol-related violence and disorder There are a number of limitations to this study. Drinking patterns are not covered by the data, and our analyses do not permit examination of changes in the distribution of consumption within population subgroups. Therefore, we present only a partial picture of the components of the population-level trends. The estimated effects for both late and early birth cohorts are based on a small number of surveys and cover relatively few age groups; therefore, these estimates are less reliable than those for other cohorts and the interactions between APC effects are more difficult to quantify. In common with other surveys, the GLF underestimates per capita consumption relative to sales data The above APC analysis suggests that rising female consumption and the progression of higher-consuming birth cohorts through the life-course are key drivers of increases in per capita alcohol consumption in the United Kingdom. In contrast, recent falls in consumption appear attributable to reduced consumption and increased abstinence rates among the most recent birth cohorts, especially recent male cohorts, and general increased rates of abstention across the study period. These results support the use of policy interventions with the potential to impact upon adults of all ages, not just younger drinkers, to reduce substantially the rising rates of alcohol-related disease.None.