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Influence of maternal preconception and early-pregnancy health on pregnancy and offspring outcomes. From risk selection to interventions in multi-ethnic populations

Projectomschrijving

Generation R Next: Invloed van preconceptiezorg op zwangerschap en geboorte uitkomsten

Vraagstuk

Het vroege leven is al zeer belangrijk voor onze gezondheid later in het leven. Steeds meer onderzoek laat zien dat de vroege zwangerschap, en zelfs al de preconceptieperiode, belangrijke perioden zijn voor geboorte-uitkomsten en latere gezondheid.

Onderzoek en verwachte uitkomst

Dit project is gericht op de ontwikkeling van preventiestrategieën gericht op het verbeteren van de leefstijl en het verminderen van stress van toekomstige ouders, al vanaf de preconceptieperiode, om het verloop van de zwangerschap, geboorte-uitkomsten en de gezondheid van hun kinderen te verbeteren. Dit project zal worden uitgevoerd binnen het Generation R Next onderzoek, een groot onderzoek in Rotterdam vanaf de preconceptieperiode gericht op toekomstige ouders en hun kinderen. Voor het project zullen we nauw samenwerken met het Rotterdams Centrum voor Zwangerschap & Kind, het ZonMw Regionaal Consortium Zwangerschap & Geboorte Zuidwest Nederland en de gemeente Rotterdam.

Meer over preconceptiezorg

Producten

Titel: High maternal early-pregnancy blood glucose levels are associated with altered fetal growth and increased risk of adverse birth outcomes
Auteur: Geurtsen ML, van Soest EEL, Voerman E, Steegers EAP, Jaddoe VWV, Gaillard R
Magazine: Diabetologia
Titel: Associations of maternal early-pregnancy dietary glycemic index with childhood general, abdominal and ectopic fat accumulation.
Auteur: Wahab RJ, Jaddoe VWV, Gaillard R.
Magazine: Clinical Nutrition
Titel: Changes in parental smoking during pregnancy and risks of adverse birth outcomes and childhood overweight in Europe and North America: An individual participant data meta-analysis of 229,000 singleton births
Auteur: Elise M Philips , Susana Santos, Leonardo Trasande, Juan J Aurrekoetxea, Henrique Barros, Andrea von Berg, Anna Bergström, Philippa K Bird, Sonia Brescianini, Carol Ní Chaoimh, Marie-Aline Charles, Leda Chatzi, Cécile Chevrier, George P Chrousos, Nathalie Costet, Rachel Criswell, Sarah Crozier, Merete Eggesbø, Maria Pia Fantini, Sara Farchi, Francesco Forastiere, Marleen M H J van Gelder, Vagelis Georgiu, Keith M Godfrey, Davide Gori, Wojciech Hanke, Barbara Heude, Daniel Hryhorczuk, Carmen
Magazine: PLoS Medicine
Titel: Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes
Auteur: LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group; Ellis Voerman, Susana Santos, Hazel Inskip, Pilar Amiano, Henrique Barros, Marie-Aline Charles, Leda Chatzi, George P Chrousos, Eva Corpeleijn, Sarah Crozier, Myriam Doyon, Merete Eggesbø, Maria Pia Fantini, Sara Farchi, Francesco Forastiere, Vagelis Georgiu, Davide Gori, Wojciech Hanke, Irva Hertz-Picciotto, Barbara Heude, Marie-France Hivert, Daniel Hryhorczuk, Carmen Iñiguez, Anne M Karvonen, Leanne K Küpers, Hanna Lags
Magazine: JAMA Network Open
Titel: Associations of maternal metabolic profile with placental and fetal cerebral and cardiac hemodynamics
Auteur: Kooijman MN, Jaddoe VWV, Steegers EAP, Gaillard R
Magazine: European Journal of Obstetrics & Gynecology and Reproductive Biology
Titel: Maternal vomiting during early pregnancy and cardiovascular risk factors at school age: the Generation R Study
Auteur: Poeran-Bahadoer S, Jaddoe VWV, Gishti O, Grooten IJ, Franco OH, Hofman A, Steegers EAP, Gaillard R
Magazine: Journal of Developmental Origin of Health and Disease
Titel: Maternal body mass index, early-pregnancy metabolite profile and birthweight.
Auteur: Wahab RJ, Jaddoe VWV, Voerman E, Ruijter GJG, Felix JF, Marchioro L, Uhl O, Shokry E, Koletzko B, Gaillard R.
Magazine: Journal of Clinical Endocrinology & Metabolism
Titel: Associations Between Intake of Sugar-Containing Beverages in Infancy With Liver Fat Accumulation at School Age
Auteur: Geurtsen ML, Santos S, Gaillard R, Felix JF, Jaddoe VWV.
Magazine: Hepatology
Titel: Associations of Maternal Glycemia in the First Half of Pregnancy With Alterations in Cardiac Structure and Function in Childhood
Auteur: Rama J Wahab, Vincent W V Jaddoe, Arno A W Roest, Liza Toemen, Romy Gaillard
Magazine: Diabetes Care
Titel: Associations of maternal age at the start of pregnancy with placental function throughout pregnancy: The Generation R Study.
Auteur: Erkamp JS, Jaddoe VWV, Mulders AGMGJ, Duijts L, Reiss IKM, Steegers EAP, Gaillard R.
Magazine: European Journal of Obstetrics & Gynecology and Reproductive Biology
Titel: Associations of maternal caffeine intake during pregnancy with abdominal and liver fat deposition in childhood
Auteur: Voerman E, Jaddoe VW, Hulst ME, Oei EH, Gaillard R
Magazine: International Journal of Pediatric Obesity
Titel: Prediction of healthy pregnancy outcomes in women with overweight and obesity: The role of maternal early-pregnancy metabolites
Auteur: Rama J Wahab, Vincent W V Jaddoe, Romy Gaillard
Magazine: Metabolites
Titel: Maternal early pregnancy dietary glycemic index and load, fetal growth, and the risk of adverse birth outcomes
Auteur: Rama J Wahab, Judith M Scholing, Romy Gaillard
Magazine: European Journal of Nutricion
Titel: Maternal First-Trimester Cow-Milk Intake Is Positively Associated with Childhood General and Abdominal Visceral Fat Mass and Lean Mass but Not with Other Cardiometabolic Risk Factors at the Age of 10 Years
Auteur: Voerman E, Gaillard R, Geurtsen ML, Jaddoe VWV.
Magazine: Journal of Nutrition
Titel: Influence of genetic variants for birth weight on fetal growth and placental haemodynamics
Auteur: Vermeulen MJ, Gaillard R, Miliku K, Reiss I, Steegers EAP, Jaddoe V, Felix J.
Magazine: Archives of Disease in Childhood - Fetal and Neonatal Edition
Titel: Maternal Iron Status in Early Pregnancy and Blood Pressure Throughout Pregnancy, Placental Hemodynamics and the Risk of Gestational Hypertensive Disorders
Auteur: Taeubert MJ, Wiertsema CJ, Vermeulen MJ, Quezada-Pinedo HG, Reiss IK, Muckenthaler MU, Gaillard R.
Magazine: Journal of Nutrition
Titel: Population screening for gestational hypertensive disorders using maternal, fetal and placental characteristics: A population-based prospective cohort study
Auteur: Jan S Erkamp, Vincent W V Jaddoe, Liesbeth Duijts, Irwin K M Reiss, Annemarie G M G J Mulders, Eric A P Steegers, Romy Gaillard
Magazine: Prenatal Diagnosis
Titel: Associations of fetal and infant growth patterns with early markers of arterial health in school-aged children.
Auteur: Gonçalves, R., Wiertsema, C.J., Silva, C.C.V., Monasso, G.S., Gaillard, R., Steegers, E.A.P., Santos, S., Jaddoe, V.W.V.
Magazine: JAMA Network Open
Titel: Smoking cessation in early-pregnancy, gestational weight gain and subsequent risks of pregnancy complications.
Auteur: Al-Hassany L, Wahab RJ, Steegers EAP, Jaddoe VWV, Gaillard
Magazine: European Journal of Obstetrics & Gynecology and Reproductive Biology
Titel: Associations of dietary glycemic index and load during pregnancy with blood pressure, placental hemodynamic parameters and the risk of gestational hypertensive disorders
Auteur: Wiertsema CJ, Wahab RJ, Mulders AGMGJ, Gaillard R.
Magazine: European Journal of Nutricion
Titel: Customized versus population birth weight charts for identification of newborns at risk of long-term adverse cardio-metabolic and respiratory outcomes: a population-based prospective cohort study
Auteur: Jan S Erkamp, Vincent W V Jaddoe, Annemarie G M G J Mulders, Eric A P Steegers, Irwin K M Reiss, Liesbeth Duijts, Romy Gaillard
Magazine: BMC Medicine
Titel: Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes
Auteur: LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group; Ellis Voerman, Susana Santos, Hazel Inskip, Pilar Amiano, Henrique Barros, Marie-Aline Charles, Leda Chatzi, George P Chrousos, Eva Corpeleijn, Sarah Crozier, Myriam Doyon, Merete Eggesbø, Maria Pia Fantini, Sara Farchi, Francesco Forastiere, Vagelis Georgiu, Davide Gori, Wojciech Hanke, Irva Hertz-Picciotto, Barbara Heude, Marie-France Hivert, Daniel Hryhorczuk, Carmen Iñiguez, Anne M Karvonen, Leanne K Küpers, Hanna Lags
Magazine: JAMA
Titel: Associations of maternal Angiogenic factors during pregnancy with childhood carotid intimamedia thickness and blood pressure.
Auteur: Meddy N Bongers-Karmaoui, Vincent W V Jaddoe, Romy Gaillard
Magazine: Atherosclerosis
Titel: Associations of Maternal Early-Pregnancy Glucose Concentrations With Placental Hemodynamics, Blood Pressure, and Gestational Hypertensive Disorders
Auteur: Erkamp JS, Geurtsen ML, Duijts L, Reiss IKM, Mulders AGMGJ, Steegers EAP, Gaillard R, Jaddoe VWV
Magazine: American Journal of Hypertension
Titel: Associations of maternal and infant metabolite profiles with foetal growth and the odds of adverse birth outcomes.
Auteur: Voerman E, Jaddoe VWV, Shokry E, Ruijter GJG, Felix JF, Koletzko B, Gaillard R
Magazine: International Journal of Pediatric Obesity
Titel: The Cardiovascular Stress Response as Early Life Marker of Cardiovascular Health: Applications in Population-Based Pediatric Studies-A Narrative Review
Auteur: Meddy N Bongers-Karmaoui, Vincent W V Jaddoe, Arno A W Roest, Romy Gaillard
Magazine: Pediatric cardiology
Titel: Maternal dietary quality, inflammatory potential and childhood adiposity: an individual participant data pooled analysis of seven European cohorts in the ALPHABET consortium.
Auteur: Chen LW, Aubert AM, Shivappa N, Bernard JY, Mensink-Bout SM, Geraghty AA, Mehegan J, Suderman M, Polanska K, Hanke W, Jankowska A, Relton CL, Crozier SR, Harvey NC, Cooper C, Hanson M, Godfrey KM, Gaillard R, Duijts L, Heude B, Hébert JR, McAuliffe FM, Kelleher CC, Phillips CM.
Magazine: BMC Medicine
Titel: Vitamin B12, folate and homocysteine concentrations during pregnancy and early signs of atherosclerosis at school-age.
Auteur: Monasso GS, Felix JF, Heil SG, de Rijke YB, Gaillard R, Jaddoe VWV
Magazine: Clinical Nutrition
Titel: Ethnic differences in childhood right and left cardiac structure and function assessed by cardiac magnetic resonance imaging.
Auteur: van Genuchten WJ, Toemen L, Roest AAW, Vernooij MW, Gaillard R, Helbing WA, Jaddoe VWV
Magazine: European Journal of Pediatrics
Titel: Maternal Early-Pregnancy Glucose Concentrations and Liver Fat Among School-Age Children.
Auteur: Geurtsen ML, Wahab RJ, Felix JF, Gaillard R, Jaddoe VWV
Magazine: Hepatology
Titel: Second and third trimester fetal ultrasound population screening for risks of preterm birth and small-size and large-size for gestational age at birth: a population-based prospective cohort study
Auteur: Jan S Erkamp, Ellis Voerman, Eric A P Steegers, Annemarie G M G J Mulders, Irwin K M Reiss, Liesbeth Duijts, Vincent W V Jaddoe, Romy Gaillard
Magazine: BMC Medicine
Titel: Maternal Phthalate and Bisphenol Urine Concentrations during Pregnancy and Early Markers of Arterial Health in Children
Auteur: Blaauwendraad SM, Gaillard R, Santos S, Sol CM, Kannan K, Trasande L, Jaddoe VWV.
Magazine: Environmental Health Perspectives
Titel: Associations of maternal bisphenol urine concentrations during pregnancy with neonatal metabolomic profiles.
Auteur: Blaauwendraad SM, Voerman E, Trasande L, Kannan K, Santos S, Ruijter GJG, Sol CM, Marchioro L, Shokry E, Koletzko B, Jaddoe VWV, Gaillard R
Magazine: Metabolomics
Titel: Associations of DASH Diet in Pregnancy With Blood Pressure Patterns, Placental Hemodynamics, and Gestational Hypertensive Disorders.
Auteur: Wiertsema CJ, Mensink-Bout SM, Duijts L, Mulders AGMGJ, Jaddoe VWV, Gaillard R
Magazine: Journal of the American Heart Association
Titel: Maternal Glucose Concentrations in Early Pregnancy and Cardiometabolic Risk Factors in Childhood
Auteur: Rama J Wahab, Ellis Voerman, Pauline W Jansen, Edwin H G Oei, Eric A P Steegers, Vincent W V Jaddoe, Romy Gaillard
Magazine: Obesity

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Samenvatting van de aanvraag

A suboptimal start of life has long-term health consequences. Children born preterm or with a small or large size at birth have increased risks of common diseases across the full lifecourse, including obesity, cardio-metabolic diseases, asthma and mental health disorders. Recent observational studies, of which many financially supported by the first “ZonMw Zwangerschap en Geboorte” call, suggest that specifically early-pregnancy, and even the preconception period, are important potential windows of opportunity for new prevention strategies focused on a better start of life and lower risks of common chronic diseases throughout the lifecourse in future generations. Findings from observational studies have shown that maternal overweight, high-fat high-sugar diet, smoking, alcohol consumption and stress, are among the most common and modifiable maternal lifestyle factors before and during pregnancy, leading to a suboptimal in-utero environment predisposing offspring to increased risks of short and long-term adverse health outcomes. Knowledge from these observational studies needs to be urgently translated into improved health care practices for populations. The main hypothesis for our project is that preventive strategies from preconception onwards focused on the main adverse maternal lifestyle factors including high BMI, high-fat high-sugar diet, smoking, alcohol consumption and stress, induce better placental and embryonic development and lead to improved pregnancy outcomes and offspring growth, adiposity and behavioral development. We will use an integrated translational approach with a population intervention study embedded within the Generation R Next Study from preconception onwards. First, we will construct a risk score of maternal preconception characteristics for identification of women at risk of adverse pregnancy and offspring outcomes based on previous findings from the Generation R Study. We will focus on maternal socio-demographic and lifestyle factors as risk factors and birth outcomes as outcomes. Second, we will set-up and perform a population lifestyle intervention study from preconception onwards (n=2000 women) to assess the influence of optimizing maternal lifestyle from preconception onwards on maternal and fetal pregnancy outcomes and offspring long-term health outcomes. We will use a 2x2 factorial trial design with cluster randomization by (planned) midwife practice. Participants at risk for adverse outcomes based on the developed risk score will be randomly assigned by (planned) midwife practice to one of 4 trial arms: Control group: regular Dutch antenatal advice; Intervention group 1: regular Dutch antenatal advice + dietary advice; Intervention group 2: regular Dutch antenatal advice + mind-body therapy; Intervention group 3: regular Dutch antenatal advice + dietary advice + mind-body therapy. All women will receive regular Dutch antenatal advice, with emphasis on no smoking and no alcohol consumption in pregnancy. The first intervention is additional advice on healthy dietary intake, focused on stimulating a low-glycemic index diet, optimizing polyunsaturated fatty acids intake and no alcohol consumption. The second intervention is mind-body therapy for stress reduction and reduction of risk behaviors including smoking, alcohol consumption and unhealthy diet. The intervention will be delivered in the preconception period as a group educational session and be reinforced at 8-13 weeks gestation by a research nurse. The primary outcome is a composite outcome of preterm birth (birth<37 weeks of gestation) or SGA (gestational-age-adjusted birth weight<10th percentile) or low Apgar score 5 minutes after birth (APGAR score<7) or LGA (gestational-age-adjusted birth weight>90th percentile) based on the definition of ZonMw Big4-disorders. Secondary outcomes are maternal adherence to lifestyle advice, pregnancy complications, postpartum psychological distress and weight retention, and offspring growth, adiposity and behavior at age 1 year. Independent and interactive effects of the interventions will be assessed. Secondary subgroup analyses focused on ethnic background and socio-economic status will be performed. The intervention study will be designed in detail based on findings from previous studies, including the Generation R Studies, an expert meeting with leading experts on maternal health during pregnancy and a client panel, including the parents-child group of the Generation R Study and the client panel of the ZonMw Regional Consortium Pregnancy & Childbirth Southwest of the Netherlands. This multidisciplinary project is embedded in this regional consortium and the Rotterdam Academic Center for Pregnancy & Childhood, in which the Municipality, health care professionals for mothers and children and the university work closely together. Results from this project will contribute to the development and implementation of new preventive strategies focused on future parents and their children.

Onderwerpen

Kenmerken

Projectnummer:
543003109
Looptijd: 100%
Looptijd: 100 %
2018
2023
Onderdeel van programma:
Gerelateerde subsidieronde:
Projectleider en penvoerder:
dr. R. Gaillard MD PhD
Verantwoordelijke organisatie:
Erasmus Medisch Centrum