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  • 1.
    Döring, Nora
    et al.
    Karolinska Institutet.
    Hansson, Lena M.
    Karolinska Institutet.
    Scheers Andersson, Elina
    Karolinska Institutet.
    Bohman, Benjamin
    Karolinska Institutet.
    Westin, Maria
    Karolinska Institutet.
    Magnusson, Margaretha
    Uppsala University.
    Larsson, Christel
    University of Gothenburg / Umeå University.
    Sundblom, Elinor
    Stockholm County Council.
    Willmer, Mikaela
    Karolinska Institutet.
    Blennow, Margareta
    Södersjukhuset.
    Heitmann, Berit L.
    Copenhagen University Hospital, Denmark / University of Sydney, Australia / University of Southern Denmark.
    Forsberg, Lars
    Karolinska Institutet.
    Wallin, Sanna
    Karolinska Institutet.
    Tynelius, Per
    Karolinska Institutet / Stockholm County Council.
    Ghaderi, Ata
    Karolinska Institutet.
    Rasmussen, Finn
    Karolinska Institutet / Stockholm County Council.
    Primary prevention of childhood obesity through counselling sessions at Swedish child health centres: design, methods and baseline sample characteristics of the PRIMROSE cluster-randomised trial2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, article id 335Article in journal (Refereed)
    Abstract [en]

    Background: Childhood obesity is a growing concern in Sweden. Children with overweight and obesity run a high risk of becoming obese as adults, and are likely to develop comorbidities. Despite the immense demand, there is still a lack of evidence-based comprehensive prevention programmes targeting pre-school children and their families in primary health care settings. The aims are to describe the design and methodology of the PRIMROSE cluster-randomised controlled trial, assess the relative validity of a food frequency questionnaire, and describe the baseline characteristics of the eligible young children and their mothers. Methods/Design: The PRIMROSE trial targets first-time parents and their children at Swedish child health centres (CHC) in eight counties in Sweden. Randomisation is conducted at the CHC unit level. CHC nurses employed at the participating CHC received training in carrying out the intervention alongside their provision of regular services. The intervention programme, starting when the child is 8-9 months of age and ending at age 4, is based on social cognitive theory and employs motivational interviewing. Primary outcomes are children's body mass index and waist circumference at four years. Secondary outcomes are children's and mothers' eating habits (assessed by a food frequency questionnaire), and children's and mothers' physical activity (measured by accelerometer and a validated questionnaire), and mothers' body mass index and waist circumference. Discussion: The on-going population-based PRIMROSE trial, which targets childhood obesity, is embedded in the regular national (routine) preventive child health services that are available free-of-charge to all young families in Sweden. Of the participants (n = 1369), 489 intervention and 550 control mothers (75.9%) responded to the validated physical activity and food frequency questionnaire at baseline (i.e., before the first intervention session, or, for children in the control group, before they reached 10 months of age). The food frequency questionnaire showed acceptable relative validity when compared with an 8-day food diary. We are not aware of any previous RCT, concerned with the primary prevention of childhood obesity through sessions at CHC that addresses healthy eating habits and physical activity in the context of a routine child health services programme.

  • 2.
    Scheers Andersson, Elina
    Karolinska Institutet.
    Pregnancy weight gain: family studies on the effects on offspring’s body size and blood pressure2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Increasing maternal weight gain during pregnancy, gestational weight gain (GWG), is associated with several adverse outcomes in the child, e.g. high birth weight, childhood overweight and obesity, as well as adult blood pressure (BP). Studies have also shown that specific periods of pregnancy might be more sensitive in terms of influencing these outcomes. However, the aforementioned associations could be explained by genetic and/or environmental factors which are shared between the mother and child. As far as we know, no studies have examined to what extent these genetic and environmental factors explain the variation in GWG.

    Aims: The overall aim of this PhD thesis was therefore to investigate the possible associations between GWG and the children’s birth weight and body mass index (BMI) during childhood (study 2), and BP during early adulthood (study 3), while taking environmental and genetic factors shared between the mother and child into account (within the twin/sibling pairs). The current thesis also aimed at exploring how much of the variation in GWG which is determined by genetic (the heritability) and both unique and common environmental factors (study 1).

    Methods and Results: Study 1 was a register-based twin study with Swedish female monozygotic (MZ) and dizygotic (DZ) twin pairs with children born 1982-1989 and 1992- 2010. Genetic factors accounted for 43% of the variation in GWG in the first pregnancy (N = 694 twin mother-pairs) and 26% in the second pregnancy (N = 465 twin mother-pairs). Unique environmental factors explained the remaining variation in GWG. Studies 2 and 3 were both prospective cohort studies, where study 2 was based on a data-collection of Swedish MZ twin mothers born 1962 to 1975 and their children (N = 82 twin mother-pairs), and study 3 was register-based and included Swedish male sibling pairs born 1982-1989 (N = 4908 brother pairs). In study 2, the results indicated that total, and possibly also second and third trimester weight gain, were associated with birth weight in the offspring within the twin pairs in the fully adjusted model. In terms of GWG and offspring weight and BMI during infancy and childhood, no associations were found. In study 3, no significant associations were found between GWG and systolic BP, or diastolic BP, or the offspring’s risk of hypertension, neither within nor between the sibling pairs.

    Conclusions: This thesis shows that the total GWG, and specifically weight gain during the second and third trimester, seem to be positively associated with offspring birth weight, but no effects were seen for BMI during infancy and childhood. However, due to the limited sample size, this requires further investigation. Moreover, no association was found between total GWG and the male sibling pairs’ BP at the age of 18 years. The variation in GWG seems to be largely explained by the mother’s unique environment during pregnancy and to a smaller degree by genetic factors.

  • 3.
    Scheers Andersson, Elina
    et al.
    Karolinska Institutet.
    Silventoinen, Karri
    Department of Social Research, Helsinki, Finland.
    Tynelius, Per
    Karolinska Institutet.
    Nohr, Ellen A
    University of Southern Denmark, Odense, Denmark.
    Sørensen, Thorkild I A
    University of Copenhagen, Copenhagen, Denmark / Bispebjerg and Frederiksberg Hospital, Copenhagen, The Capital Region, Denmark / Bristol University, Bristol, UK.
    Rasmussen, Finn
    Karolinska Institutet.
    Heritability of gestational weight gain--a Swedish register-based twin study2015In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 18, no 4, p. 410-8Article in journal (Refereed)
    Abstract [en]

    Gestational weight gain (GWG) is a complex trait involving intrauterine environmental, maternal environmental, and genetic factors. However, the extent to which these factors contribute to the total variation in GWG is unclear. We therefore examined the genetic and environmental influences on the variation in GWG in the first and second pregnancy in monozygotic (MZ) and dizygotic (DZ) twin mother-pairs. Further, we explored if any co-variance existed between factors influencing the variation in GWG of the mothers’ first and second pregnancies. By using Swedish nationwide record-linkage data, we identified 694 twin mother-pairs with complete data on their first pregnancy and 465 twin mother-pairs with complete data on their second pregnancy during 1982–2010. For a subanalysis, 143 twin mother-pairs had complete data on two consecutive pregnancies during the study period. We used structural equation modeling (SEM) to assess the contribution of genetic, shared, and unique environmental factors to the variation in GWG. A bivariate Cholesky decomposition model was used for the subanalysis. We found that genetic factors explained 43% (95% CI: 36–51%) of the variation in GWG in the first pregnancy and 26% (95% CI: 16–36%) in the second pregnancy. The remaining variance was explained by unique environmental factors. Both overlapping and distinct genetic and unique environmental factors influenced GWG in the first and the second pregnancy. This study showed that GWG has a moderate heritability, suggesting that a large part of the variation in the trait can be explained by unique environmental factors.

  • 4.
    Scheers Andersson, Elina
    et al.
    Karolinska Institutet.
    Silventoinen, Karri
    University of Helsinki, Helsinki, Finland.
    Tynelius, Per
    Karolinska Institutet / Stockholm County Council.
    Nohr, Ellen A
    University of Southern Denmark, Odense, Denmark.
    Sørensen, Thorkild I A
    University of Copenhagen, Copenhagen, Denmark / Bispebjerg and Frederiksberg Hospital, Copenhagen, The Capital Region, Denmark / Bristol University, Bristol, UK.
    Rasmussen, Finn
    Karolinska Institutet / Stockholm County Council.
    Total and Trimester-Specific Gestational Weight Gain and Offspring Birth and Early Childhood Weight: A Prospective Cohort Study on Monozygotic Twin Mothers and Their Offspring2016In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 19, no 4, p. 367-76Article in journal (Refereed)
    Abstract [en]

    Gestational weight gain (GWG) has in numerous studies been associated with offspring birth weight (BW) and childhood weight. However, these associations might be explained by genetic confounding as offspring inherit their mother's genetic potential to gain weight. Furthermore, little is known about whether particular periods of pregnancy could influence offspring body weight differently. We therefore aimed to explore total and trimester-specific effects of GWG in monozygotic (MZ) twin mother-pairs on their offspring's BW, weight at 1 year and body mass index (BMI) at 5 and 10 years. MZ twin mothers born 1962-1975 were identified in national Swedish registers, and data on exposure and outcome variables was collected from medical records. We analyzed associations within and between twin pairs. We had complete data on the mothers' GWG and offspring BW for 82 pairs. The results indicated that total, and possibly also second and third trimester GWG were associated with offspring BW within the twin pairs in the fully adjusted model (β = 0.08 z-score units, 95% CI: 0.001, 0.17; β = 1.32 z-score units, 95% CI: -0.29, 2.95; and β = 1.02 z-score units, 95% CI: -0.50, 2.54, respectively). Our findings, although statistically weak, suggested no associations between GWG and offspring weight or BMI during infancy or childhood. Our study suggests that total, and possibly also second and third trimester, GWG are associated with offspring BW when taking shared genetic and environmental factors within twin pairs into account. Larger family-based studies with long follow-up are needed to confirm our findings.

  • 5.
    Scheers Andersson, Elina
    et al.
    Karolinska Institutet.
    Tynelius, Per
    Karolinska Institutet.
    Nohr, Ellen Aagaard
    University of Southern Denmark, Odense, Denmark.
    Sørensen, Thorkild I A
    University of Copenhagen, Copenhagen, Denmark / Frederiksberg Hospital, Copenhagen, The Capital Region, Denmark / Bristol University, Bristol, United Kingdom.
    Rasmussen, Finn
    Karolinska Institutet.
    No association of maternal gestational weight gain with offspring blood pressure and hypertension at age 18 years in male sibling-pairs: a prospective register-based cohort study2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 3, article id e0121202Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Maternal gestational weight gain (GWG) is associated with birth weight, obesity, and possibly blood pressure (BP) and hypertension in the offspring. These associations may however be confounded by genetic and/or shared environmental factors. In contrast to previous studies based on non-siblings and self-reported data, we investigated whether GWG is associated with offspring BP and hypertension, in a register-based cohort of full brothers while controlling for fixed shared effects.

    METHODS: By using Swedish nation-wide record-linkage data, we identified women with at least two male children (full brothers) born 1982-1989. Their BP was obtained from the mandatory military conscription induction tests. We adopted linear and Poisson regression models with robust variance, using generalized estimating equations to analyze associations between GWG and BP, as well as with hypertension, within and between offspring sibling-pairs.

    RESULTS: Complete data on the mothers' GWG and offspring BP was obtained for 9,816 brothers (4,908 brother-pairs). Adjusted regression models showed no significant associations between GWG and SBP (β = 0.03 mmHg per 1-kg GWG difference, [95% CI -0.08, 0.14], or DBP (β = -0.03 mmHg per 1-kg GWG difference [95% CI -0.11, 0.05]), or between GWG and offspring's risk of hypertension (relative risk = 1.0 [95% CI 0.99, 1.02], neither within nor between siblings.

    CONCLUSIONS: In this large sibling-pair study, we did not find any significant association between GWG and offspring BP or the risk of hypertension at 18y, when taking genetic and environmental factors shared within sibling pairs into account. Further large sibling studies are required to confirm a null association between GWG and other cardiovascular risk factors.

1 - 5 of 5
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