Publications by authors named "Marc Isabelle"

62 Publications

The 3D-Transition Study: Objectives, Methods, and Implementation of an Innovative Planned Missing Data Design.

Am J Epidemiol 2021 May 12. Epub 2021 May 12.

CHU Ste-Justine Research Centre, Montréal, Québec, Canada.

The prevalence of mental health problems represents a significant burden on school and community health resources as early as preschool. Reducing this burden requires a better understanding of the developmental mechanisms linking children's early vulnerabilities with mental health after the transition to formal schooling. The 3D-Transition study (2017-2021; ClinicalTrials.org ID: NCT04873518) follows 939 participants from a pregnancy cohort in Québec (Canada) as they transition to kindergarten and first grade to examine these mechanisms. Biannual assessments include questionnaires from two parents as well as teachers, parent-child observations, anthropometric measurements, and age-sensitive cognitive assessments. Salivary cortisol is also collected on 11 days over a 16-month period in a subsample of 384 participants to examine possible changes in child salivary cortisol levels across the school transition, and their role in difficulties observed during the transition. A combination of planned missing data designs is implemented to reduce participant burden, where incomplete data is collected without introducing bias after the use of multiple imputation. The 3D-Transition study will contribute to an evidence-based developmental framework of child mental health from pregnancy to school age. In turn, this framework can help inform prevention programs delivered in health care settings during pregnancy, childcare centers, preschools, and schools.
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http://dx.doi.org/10.1093/aje/kwab141DOI Listing
May 2021

Caregivers' perceptions, challenges and service needs related to tackling childhood overweight and obesity: a qualitative study in three districts of Shanghai, China.

BMC Public Health 2021 Apr 21;21(1):768. Epub 2021 Apr 21.

School of Public Health, Key Laboratory of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai, 200032, China.

Background: Childhood overweight and obesity (OWO) has become a major public concern worldwide including in Shanghai, one of the most developed areas of China. Understanding perceptions and challenges of tackling childhood OWO among caregivers of children is critical to provide services in need.

Methods: A qualitative descriptive study including in-depth interviews with seven parents and six focus group discussions with a total of 32 parents or grandparents of children zero to 6 years of age. Participants lived in three districts of Shanghai and indexed children included both those with OWO or non-OWO children. Data were analyzed using qualitative thematic analysis.

Results: Caregivers tended to underestimate children's weight status, and to regard chubby children as a sign of good parental care. Some caregivers even suggested that there were positive effects of childhood overweight. Caregivers identified a number of challenges to prevention of OWO in children, including difficulties in controlling dietary intake or increasing children's physical activities; discordant views between parents and grandparents, and barriers to accessing professional guidance. Caregivers desired more detailed advice regarding children's nutrition intake and physical activity, and preferred online approaches.

Conclusions: Misconceptions regarding childhood overweight were found in caregivers of children in Shanghai. Professional guidance on childhood weight control for caregivers is desired via digital applications such as mobile phone applications and social media.
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http://dx.doi.org/10.1186/s12889-021-10744-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8061052PMC
April 2021

Study protocol for the Sino-Canadian Healthy Life Trajectories Initiative (SCHeLTI): a multicentre, cluster-randomised, parallel-group, superiority trial of a multifaceted community-family-mother-child intervention to prevent childhood overweight and obesity.

BMJ Open 2021 Apr 1;11(4):e045192. Epub 2021 Apr 1.

Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.

Introduction: Childhood overweight and obesity (OWO) is a primary global health challenge. Childhood OWO prevention is now a public health priority in China. The Sino-Canadian Healthy Life Trajectories Initiative (SCHeLTI), one of four trials being undertaken by the international HeLTI consortium, aims to evaluate the effectiveness of a multifaceted, community-family-mother-child intervention on childhood OWO and non-communicable diseases risk.

Methods And Analysis: This is a multicentre, cluster-randomised, controlled trial conducted in Shanghai, China. The unit of randomisation is the service area of Maternal Child Health Units (N=36). We will recruit 4500 women/partners/families in maternity and district level hospitals. Participants in the intervention group will receive a multifaceted, integrated package of health promotion interventions beginning in preconception or in the first trimester of pregnancy, continuing into infancy and early childhood. The intervention, which is centred on a modified motivational interviewing approach, will target early-life maternal and child risk factors for adiposity. Through the development of a biological specimen bank, we will study potential mechanisms underlying the effects of the intervention. The primary outcome for the trial is childhood OWO (body mass index for age ≥85th percentile) at 5 years of age, based on WHO sex-specific standards. The study has a power of 0.8 (α=0.05) to detect a 30% risk reduction in the proportion of children with OWO at 5 years of age, from 24.4% in the control group to 17% in the intervention group. Recruitment was launched on 30 August 2018 for the pilot study and 10 January 2019 for the formal study.

Ethics And Dissemination: The study has been approved by the Medical Research Ethics Committee of the International Peace Maternity and Child Health Hospital in Shanghai, China, and the Research Ethics Board of the Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie-CHUS in Sherbrooke, Canada. Data sharing policies are consistent with the governance policy of the HeLTI consortium and government legislation.

Trial Registration Number: ChiCTR1800017773.

Protocol Version: November 11, 2020 (Version #5).
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http://dx.doi.org/10.1136/bmjopen-2020-045192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021741PMC
April 2021

Cord blood IGF-I, proinsulin, leptin, HMW adiponectin and ghrelin in short or skinny small-for-gestational-age infants.

J Clin Endocrinol Metab 2021 Mar 19. Epub 2021 Mar 19.

Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Department of Behavioral Pediatrics and Child Primary Care, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.

Context: Small-for-gestational-age (SGA) is an indicator of poor fetal growth "programming" an elevated risk of type 2 diabetes in adulthood. Little is known about early life endocrine characteristics in SGA subtypes. Stunting (short) and wasting (skinny) are considered distinct SGA phenotypes in neonatal prognosis.

Objectives: To assess whether SGA infants with stunting or wasting have similar alterations in neonatal endocrine metabolic health biomarkers.

Design: A nested case-control study.

Setting: The 3D (Design, Develop and Discover) birth cohort in Canada.

Participants: 146 SGA (birth weight <10 th percentile) and 155 optimal for gestational age (OGA, 25 th-75 th percentiles) infants. Stunting was defined as birth length <10 th percentile, and wasting as body mass index <10 th percentile for sex and gestational age, respectively.

Main Outcomes: Cord plasma concentrations of insulin-like growth factor I (IGF-I), proinsulin, leptin, high-molecular-weight (HMW) adiponectin and ghrelin.

Results: Comparing to OGA infants adjusted for maternal and neonatal characteristics, SGA infants with either stunting only or wasting only had lower cord plasma IGF-I and leptin concentrations. HMW adiponectin concentrations were lower in SGA infants with wasting only (P=0.004), but similar in SGA infants with stunting only (P=0.816). Only SGA infants with both stunting and wasting had substantially lower proinsulin (P<0.001) and higher ghrelin concentrations (P<0.001) than OGA infants.

Conclusions: The study is the first to demonstrate that SGA infants with wasting only are characterized by low HMW adiponectin concentrations, while those with stunting only are not. SGA with both stunting and wasting are characterized by low proinsulin and high ghrelin concentrations.
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http://dx.doi.org/10.1210/clinem/dgab178DOI Listing
March 2021

Breastfeeding and growth trajectory from birth to 5 years among children exposed and unexposed to gestational diabetes mellitus in utero.

J Perinatol 2021 May 28;41(5):1033-1042. Epub 2021 Jan 28.

Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, QC, Canada.

Objectives: This study aims to evaluate the association between exposure to gestational diabetes mellitus and growth trajectory from birth to 5 years and to test whether breastfeeding influences this association among children exposed and unexposed to gestational diabetes.

Study Design: Weight at 0, 6, 12, and 18 months and 2, 3, 4, and 5 years were retrospectively collected for 103 children exposed and 63 children unexposed to gestational diabetes. Weight-for-age z-score was calculated. Mixed linear model for repeated measurements were computed to test whether breastfeeding was associated differently with weight-for-age z-score of children exposed or unexposed to diabetes.

Results: Children exposed to gestational diabetes had greater z-score values at 6 months and 4 and 5 years (p < 0.10). Breastfeeding duration was not associated with weight-for-age z-score trajectory in any children.

Conclusion: Children exposed to gestational diabetes had a different growth trajectory in early life, but breastfeeding duration did not seem to influence this association.
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http://dx.doi.org/10.1038/s41372-021-00932-yDOI Listing
May 2021

Maternal Docosahexaenoic Acid Supplementation and Bronchopulmonary Dysplasia in Infants-Reply.

JAMA 2020 11;324(20):2105

Division of Neonatology, University of British Columbia, Vancouver, Canada.

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http://dx.doi.org/10.1001/jama.2020.19410DOI Listing
November 2020

Effect of Maternal Docosahexaenoic Acid Supplementation on Bronchopulmonary Dysplasia-Free Survival in Breastfed Preterm Infants: A Randomized Clinical Trial.

JAMA 2020 07;324(2):157-167

Department of Pediatrics, Division of Neonatology, University of British Columbia, Vancouver, Canada.

Importance: Maternal docosahexaenoic acid (DHA) supplementation may prevent bronchopulmonary dysplasia, but evidence remains inconclusive.

Objective: To determine whether maternal DHA supplementation during the neonatal period improves bronchopulmonary dysplasia-free survival in breastfed infants born before 29 weeks of gestation.

Design, Setting, And Participants: Superiority, placebo-controlled randomized clinical trial at 16 Canadian neonatal intensive care units (June 2015-April 2018 with last infant follow-up in July 2018). Lactating women who delivered before 29 weeks of gestation were enrolled within 72 hours of delivery. The trial intended to enroll 800 mothers, but was stopped earlier.

Interventions: There were 232 mothers (273 infants) assigned to oral capsules providing 1.2 g/d of DHA from randomization to 36 weeks' postmenstrual age and 229 mothers (255 infants) assigned to placebo capsules.

Main Outcomes And Measures: The primary outcome was bronchopulmonary dysplasia-free survival in infants at 36 weeks' postmenstrual age. There were 22 secondary outcomes, including mortality and bronchopulmonary dysplasia.

Results: Enrollment was stopped early due to concern for harm based on interim data from this trial and from another trial that was published during the course of this study. Among 461 mothers and their 528 infants (mean gestational age, 26.6 weeks [SD, 1.6 weeks]; 253 [47.9%] females), 375 mothers (81.3%) and 523 infants (99.1%) completed the trial. Overall, 147 of 268 infants (54.9%) in the DHA group vs 157 of 255 infants (61.6%) in the placebo group survived without bronchopulmonary dysplasia (absolute difference, -5.0% [95% CI, -11.6% to 2.6%]; relative risk, 0.91 [95% CI, 0.80 to 1.04], P = .18). Mortality occurred in 6.0% of infants in the DHA group vs 10.2% of infants in the placebo group (absolute difference, -3.9% [95% CI, -6.8% to 1.4%]; relative risk, 0.61 [95% CI, 0.33 to 1.13], P = .12). Bronchopulmonary dysplasia occurred in 41.7% of surviving infants in the DHA group vs 31.4% in the placebo group (absolute difference, 11.5% [95% CI, 2.3% to 23.2%]; relative risk, 1.36 [95% CI, 1.07 to 1.73], P = .01). Of 22 prespecified secondary outcomes, 19 were not significantly different.

Conclusions And Relevance: Among breastfed preterm infants born before 29 weeks of gestation, maternal docosahexaenoic acid supplementation during the neonatal period did not significantly improve bronchopulmonary dysplasia-free survival at 36 weeks' postmenstrual age compared with placebo. Study interpretation is limited by early trial termination.

Trial Registration: ClinicalTrials.gov Identifier: NCT02371460.
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http://dx.doi.org/10.1001/jama.2020.8896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361648PMC
July 2020

Cord blood S100B: reference ranges and interest for early identification of newborns with brain injury.

Clin Chem Lab Med 2020 01;58(2):285-293

Centre de recherche du CHU de Québec-Université Laval, Québec City, Canada.

Background Neurological complications are common in the premature and full-term neonates admitted to the intensive care unit, but the diagnosis of these complications is often difficult to make. S100B protein, measured in cord blood, may represent a valuable tool to better identify patients at risk of brain injury. Methods As a first step, we established S100B cord blood serum reference intervals from 183 preterm and 200 full-term neonates. We then measured cord blood serum S100B to identify neurological complications in 272 neonates hospitalized at the neonatal intensive care unit (NICU). Diagnosis of brain injury relied on imaging examination. Results The 95th percentiles of S100B concentration in cord blood were established as 1.21 μg/L for the 383 neonates, 0.96 μg/L for full-term neonates and 1.36 μg/L for premature neonates. Among the 272 neonates hospitalized at the NICU, 11 presented neurological complications. Using 1.27 μg/L as the optimal sensitivity/specificity threshold, S100B differentiate neonates with and without neurological complications with a sensitivity of 45.5% (95% confidence intervals [CI]: 16.7-76.6) and a specificity of 88.9% (95% CI: 84.4-92.4) (p = 0.006). In combination with arterial pH (<7.25), sensitivity increased to 90.9% (95% CI: 58.7-99.8), while specificity was 51.2% (95% CI: 44.8-57.7). The sensitivity is significantly (p = 0.03) increased in comparison to S100B alone. The specificity is significantly higher with S100B only than with pH + S100B (p < 0.001). Conclusions Cord blood S100B protein, in combination with arterial cord blood pH, has the potential to help clinicians to detect at birth neurological complications in neonates hospitalized in an NCIU.
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http://dx.doi.org/10.1515/cclm-2019-0737DOI Listing
January 2020

Association between lifestyle habits and adiposity values among children exposed and unexposed to gestational diabetes mellitus in utero.

Diabetes Metab Syndr 2019 Sep - Oct;13(5):2947-2952. Epub 2019 Aug 6.

School of Nutrition, Laval University, Québec, Québec, Canada; Institute of Nutrition and Functional Foods (INAF), Laval University, Québec, Québec, Canada; Endocrinology and Nephrology Axis, CHU de Quebec Research Center, Québec, Québec, Canada. Electronic address:

Aims: The objectives of this study were to assess the profile of lifestyle habits among children exposed (GDM+) or unexposed (GDM-) to GDM and to assess whether a healthy lifestyle profile is associated with lower adiposity values among these children.

Methods: A total of 105 GDM+ and 38 GDM- children aged 2-14 years were included. Vegetables and fruit intakes were collected using two 24-h dietary recalls. Physical activity and sedentary time were measured with accelerometers. Screen and sleep time were assessed using questionnaires. Weight, height and waist circumference were measured. Body composition was assessed by absorptiometry.

Results: GDM+ children had lower moderate-to-vigorous physical activity practice (p = 0.043) and fruit intake (p = 0.020) than GDM- children. Among children with an unhealthy lifestyle (meeting 0-2 lifestyle recommendations), GDM+ children had greater percentage of fat mass (p = 0.021) and android fat mass (p = 0.020) than GDM- children. Moreover, among GDM+ children, children with a healthy lifestyle (meeting 3-4 lifestyle recommendations) tended to have lower percentage of fat mass (p = 0.053) and android fat mass (p = 0.071) than those with an unhealthy lifestyle.

Conclusion: Improving lifestyle habits among GDM+ children could represent a promising approach to prevent deteriorated adiposity values.
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http://dx.doi.org/10.1016/j.dsx.2019.07.053DOI Listing
February 2020

Physical fitness is associated with prostaglandin F isomers during pregnancy.

Prostaglandins Leukot Essent Fatty Acids 2019 06 2;145:7-14. Epub 2019 May 2.

Research Center of the CHU de Québec-Université Laval, Reproduction, Mother and Child Health axis, 2705 Boulevard Laurier, Quebec, PQ, G1V 4G2, Canada; Laval University, Faculty of medicine, Department of pediatrics, 1050 Avenue de la Médecine, Quebec, PQ G1V 0A6, Canada. Electronic address:

Introduction: Pregnancy and physical activity are associated with oxidative stress and immune changes. We hypothesized that pregnant women physically more active in early pregnancy will display a better oxidative stress management and inflammatory response later in pregnancy compared with less active pregnant women.

Material And Methods: Maternal physical activity using accelerometry monitors for 1 week and cardiorespiratory fitness (VO at anaerobic threshold) were assessed at 14-18 weeks in 58 pregnant women. Plasma and erythrocytes membrane samples were obtained from maternal blood samples at 14-18 and 34-37 weeks of pregnancy. Pro-inflammatory prostaglandin (PG) F and oxidative stress-derived F-isoprostanes were measured by high-performance liquid chromatography coupled to tandem mass spectrometry.

Results: Higher physical activity levels at 14-18 weeks measured by mean counts per minute, >30 min/d of moderate to vigorous activity or >6500 steps/d at 14-18 weeks of pregnancy were associated with lower levels of total plasmatic PGF later in pregnancy. Concentrations of 5 F-isomers in erythrocyte membranes in late pregnancy were significantly higher in the third (17.5-19.5 mL kg min) and/or fourth (19.6-27.7 mL kg min) quartiles of cardio-respiratory fitness compared to the first quartile (13.9-15.9 mL kg min).

Conclusions: Overall, higher cardio-respiratory fitness in early pregnancy is associated with enhanced erythrocyte membranes oxidation at 34-37 weeks reflecting a higher oxygen transfer capacity. Also, the most active women experienced lower circulating levels of pro-inflammatory PGF in plasma at 34-37 weeks, a marker associated with adverse antenatal inflammation-associated conditions. These results support the practice of physical activity by pregnant women.
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http://dx.doi.org/10.1016/j.plefa.2019.05.001DOI Listing
June 2019

Chronic NO Restriction in Hypertensive Rats Increases Abdominal but Not Thoracic Aortic Intrinsic Stiffness via an Augmentation in Profibrotic Materials.

Int J Hypertens 2019 19;2019:8070198. Epub 2019 Mar 19.

Servier Research Institute, Cardiovascular Discovery Research Unit Suresnes, France.

The spontaneously hypertensive rat model with reduced NO synthesis (SHRLN) shares features with aging and hypertension in humans, among other a severe aortic stiffening. The present study aimed to compare thoracic (TA) and abdominal (AA) aortic stiffness in the SHRLN (treated 5 weeks with L-NAME), SHR, and normotensive Wistar Kyoto (WKY). Dynamic properties of TA and AA were measured in the same rats, using echotracking recording of aortic diameter coupled with blood pressure (BP). Measurements were performed first at operating BP and then after BP reduction in hypertensive rats, thus in isobaric conditions. Histological staining and immunohistochemistry were used for structural analysis at both sites. At operating pressure, BP and pulse pressure (PP) were higher in SHRLN compared with SHR. Stiffness index was also increased and distensibility decreased in both TA and AA in SHRLN. At WKY-matched blood pressure, isobaric AA parameters remained specifically altered in SHRLN, whereas TA recovered to values identical to WKYs. Collagen, fibronectin, 5-selectin, and FAK were increased in SHRLN compared with SHR or WKY. Nevertheless, only the strong accumulations of fibronectin and collagen at the AA site in SHRLN were associated with intrinsic stiffening. In conclusion, we confirm that NO restriction associated with hypertension induces a severe pathological phenotype and shows that L-NAME induced stiffening is more pronounced in AA than in TA as a result of greater fibrosis.
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http://dx.doi.org/10.1155/2019/8070198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6444237PMC
March 2019

Is A Healthy Diet Associated with Lower Anthropometric and Glycemic Alterations in Predisposed Children Born from Mothers with Gestational Diabetes Mellitus?

Nutrients 2019 Mar 7;11(3). Epub 2019 Mar 7.

School of Nutrition, Laval University, 2425 rue de l'Agriculture, Quebec City, QC G1V 0A6, Canada.

Children born from mothers with gestational diabetes mellitus (GDM) are at high-risk of obesity and type 2 diabetes. To date, there is a lack of effective strategies to prevent these complications. The aim of this study was to evaluate the association between diet quality and anthropometric and glycemic profiles of children exposed (GDM+) and unexposed (GDM⁻) to GDM. A total of 104 GDM+ and 38 GDM⁻ children were included. Two 24-h dietary recall questionnaires were used to assess dietary intakes. The Healthy Eating Index adapted for the Canadian population (HEI-C) was used to assess diet quality. Spearman correlations adjusted for children's age and sex were computed. Mean age was 6.0 ± 2.5 and 6.8 ± 2.3 years for GDM+ and GDM⁻, respectively ( = 0.03). Total HEI-C score was negatively associated with the android-to-gynoid fat mass ratio ( = -0.29, = 0.03) and homeostasis model assessment for insulin resistance (HOMA-IR) index ( = -0.22, = 0.04) in GDM+ children only. The prevalence of being overweight or obese during childhood was 4-fold higher among GDM+ children with a HEI-C score ≤70 compared to GDM+ children with a HEI-C score >70. Results of this study show that a healthy diet is associated with a better cardiometabolic health profile in GDM+ children, including a lower risk of being overweight or obese.
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http://dx.doi.org/10.3390/nu11030570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6470518PMC
March 2019

Prenatal determinants of childhood obesity: a review of risk factors .

Can J Physiol Pharmacol 2019 Mar 19;97(3):147-154. Epub 2019 Jan 19.

b Centre de recherche de Centre Hospitalier Universitaire de Sherbrooke (CRCHUS) and Department of Obstetrics and Gynecology, Université de Sherbrooke, Quebec, QC J1H 5N4, Canada.

Childhood obesity is a predictor of adult obesity and has its roots in the pre-pregnancy or pregnancy period. This review presents an overview of the prenatal risk factors for childhood obesity, which were categorized into 2 groups: biological risk factors (maternal pre-pregnancy body mass index, gestational weight gain, diabetes in pregnancy, and caesarean section), and environmental and behavioural risk factors (maternal smoking and exposure to obesogens, maternal dietary patterns, maternal intestinal microbiome and antibiotics exposure, and maternal psychosocial stress). Identifying modifiable predisposing prenatal factors for obesity will inform further development of inventions to prevent obesity over the life course, and future directions for research and intervention are discussed.
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http://dx.doi.org/10.1139/cjpp-2018-0403DOI Listing
March 2019

Association between early introduction of fruit juice during infancy and childhood consumption of sweet-tasting foods and beverages among children exposed and unexposed to gestational diabetes mellitus in utero.

Appetite 2019 01 29;132:190-195. Epub 2018 Aug 29.

School of Nutrition, Laval University, 2425 rue de l'Agriculture, Quebec City, G1V 0A6, Canada; Institute of Nutrition and Functional Foods (INAF), Laval University, 2440 Boulevard Hochelaga, Quebec City, G1V 0A6, Canada; Endocrinology and Nephrology Axis, CHU de Québec Research Center, 2705 boulevard Laurier, Quebec City, G1V 4G2, Canada. Electronic address:

Background: Children exposed to gestational diabetes mellitus (GDM) in utero are at high-risk of obesity. Given that nutritional habits can track from infancy to childhood, the aim of this study was to evaluate the association between the timing of fruit juice introduction in infancy and later consumption of sweet-tasting foods and beverages among children exposed (GDM+) and unexposed (GDM-) to GDM.

Methods: A total of 107 GDM+ and 59 GDM- participated in the project. Data on the timing of fruit juice introduction during infancy were retrospectively collected for 62 GDM+ and 32 GDM- children. Current dietary intakes were collected with two 24-hour dietary recall questionnaires. Children were divided into groups according to the median timing of juice introduction (9 months).

Results: Mean age of children was 6.3 ± 2.6 and 7.6 ± 3.7 years for GDM+ and GDM- children, respectively (p = 0.08). Mean age of fruit juice introduction was similar between groups (p > 0.05). Consuming >1 serving of fruit juice per day was 2.72 times more prevalent among GDM+ children introduced to fruit juice <9 months, compared to GDM+ children introduced ≥9 months (CI: 1.19-6.20). This association was not observed in the GDM- group. The timing of fruit juice introduction was not associated with later consumption of sweets, desserts and sweet-tasting beverages when adjustment for children's age was made among GDM+ and GDM- children.

Conclusion: Early introduction of fruit juice in infant diet is associated with higher prevalence of consumption of >1 serving of fruit juice per day in GDM+ children.
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http://dx.doi.org/10.1016/j.appet.2018.08.033DOI Listing
January 2019

Body Weight Status and Sleep Disturbances During Pregnancy: Does Adherence to Gestational Weight Gain Guidelines Matter?

J Womens Health (Larchmt) 2019 04 1;28(4):535-543. Epub 2018 Aug 1.

2 Department of Pediatrics, Research Center of CHUQ, Laval University, Quebec, Canada.

Background: To determine the effect of preconception body mass index (BMI) and/or gestational weight gain (GWG) on the occurrence of sleep disorders over the whole pregnancy.

Methods: A sample of 2,366 pregnant women, recruited in their 1st trimester (TM), was evaluated until delivery for their sleeping characteristics, using the Pittsburgh Sleep Quality Index (PSQI). Mixed or multinomial logistic modeling was applied, as appropriate.

Results: When compared with TM 1, PSQI score was the lowest at TM 2 (β = -1.03; 95% CI: -1.17 to -0.89) and highest in TM 3 (β = 0.27; 95% CI: 0.10-0.45). Obese (β = 0.48; 95% CI: 0.17-0.78) and overweight women (β = 0.24; 95% CI: 0.00-0.48) exhibited an overall greater PSQI than normal-weight women over the whole pregnancy. When sociodemographic factors were accounted for, the effect size was reduced by 25% among obese women (β = 0.36; 95% CI: 0.06-0.68), but was no more not significant in overweight women (β = 0.06; 95% CI: -0.17 to 0.30). Both obese and overweight women still exhibited, although at a lower extend, a greater PSQI than normal-weight women. Further adjustment for GWG had no effect on these observations. Obese women almost had a four-fold increased risk (OR = 3.89; 95% CI: 2.50-6.06) of being snorers in the three TMs. While GWG had only a minor effect (aOR = 3.83; 95% CI: 2.43-6.03), sociodemographic factors increased the odds of being habitual snorer (aOR = 4.04; 95% CI: 2.57-6.35).

Conclusions: High prepregnancy BMI together with sociodemographic correlates appear as the most critical for sleep disturbances across pregnancy. GWG is of marginal importance, especially regarding snoring. These findings confirm the importance of considering the initial body weight status of women in tailoring sleep hygiene advises irrespective of the recommendations for weight gain during pregnancy. The results also underscore the need to providing as early as possible during a pregnancy, supportive tools to ethnic minorities, multiparous, and women from deprived socioeconomic neighborhoods.
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http://dx.doi.org/10.1089/jwh.2017.6892DOI Listing
April 2019

Accelerometry to measure physical activity in toddlers: Determination of wear time requirements for a reliable estimate of physical activity.

J Sports Sci 2019 Feb 14;37(3):298-305. Epub 2018 Jul 14.

a Department of Pediatrics , Centre hospitalier universitaire (CHU) de Québec, Université Laval , Québec City , Province of Québec , Canada.

Accelerometry is widely used to evaluate physical activity in toddlers however recommendations regarding wear time are needed to understand physical activity behaviours in this age group. This study aimed to determine the minimum wear time to reliably evaluate physical activity in toddlers. Children from the 3D Birth Cohort (n = 255, 49.8% boys, 2.1 ± 0.2 years) were asked to wear an accelerometer (GT3X+, ActiGraph) for 7 days. Physical activity was expressed in active time (min/day) and counts per minute (CPM). Single day intraclass correlation coefficients (ICCs) were calculated to assess the effect of varying minimal wear time on reliability estimates. The Spearman-Brown formula was used to determine wear time required to achieve reliability levels of 70%, 80% and 90%. For active time, a reliability of 72.1% was achieved with wearing the accelerometer for ≥ 4 days of ≥ 6 h, which comprised 85.9% of the sample. For CPM, ≥ 4 days of ≥ 6 h provided a reliability of 74.7% and comprised 85.9% of the children. Results differed slightly when girls and boys were analysed separately, but restricting analyses to children with a weekend day did not. In summary, a minimum of 4 days with ≥ 6 h of accelerometry data provides a reliable estimate of physical activity in 2-year toddlers.
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http://dx.doi.org/10.1080/02640414.2018.1499391DOI Listing
February 2019

Maternal Circulating Placental Growth Factor and Neonatal Metabolic Health Biomarkers in Small for Gestational Age Infants.

Front Endocrinol (Lausanne) 2018 25;9:198. Epub 2018 Apr 25.

Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, QC, Canada.

Small for gestational age (SGA) infants are at increased risk of type 2 diabetes in adulthood. It is unknown whether any prenatal biomarkers are helpful for identifying SGA infants with altered metabolic health profile at birth or later life. In a nested study of 162 SGA (birth weight < 10th percentile) and 161 optimal birth weight (25th-75th percentiles) control infants in the 3D (design, develop and discover) birth cohort in Canada, we assessed whether maternal circulating placental growth factor (PlGF), a biomarker of placental function, is associated with metabolic health biomarkers in SGA infants. Main outcomes were cord plasma insulin, proinsulin, insulin-like growth factor-I (IGF-I), leptin, and high-molecular weight (HMW) adiponectin concentrations. Maternal PlGF concentrations at 32-35 weeks of gestation were substantially lower in SGA versus control infants ( < 0.001), so as were cord plasma proinsulin ( = 0.005), IGF-I ( < 0.001), leptin ( < 0.001), and HMW adiponectin ( = 0.002) concentrations. In SGA infants with both low (<25th percentile) and normal maternal PlGF concentrations, cord plasma IGF-I and leptin concentrations were lower than control infants, but the decreases were to a greater extent in SGA infants with low maternal PlGF. Cord blood leptin levels were lower comparing SGA infants with low vs. normal maternal PlGF levels ( = 0.01). SGA infants with low maternal circulating PlGF levels at late gestation were characterized by greater decreases in cord blood IGF-I and leptin concentrations. Maternal circulating PlGF appears to be associated with neonatal metabolic health profile in SGA infants.
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http://dx.doi.org/10.3389/fendo.2018.00198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5996905PMC
April 2018

Changes in endothelial function, arterial stiffness and blood pressure in pregnant women after consumption of high-flavanol and high-theobromine chocolate: a double blind randomized clinical trial.

Hypertens Pregnancy 2018 May 16;37(2):68-80. Epub 2018 Apr 16.

a Research center , Centre hospitalier universitaire de Québec , Québec , Canada.

Objectives: The aim of this 2-group, parallel, double blind single-centre RCT was to evaluate the acute and chronic impacts of high flavanol high theobromine (HFHT) chocolate consumption on endothelial function, arterial stiffness and blood pressure (BP) in women at risk of preeclampsia.

Methods: 131 pregnant women considered at risk of preeclampsia based on uterine artery Doppler ultrasound were divided into two groups (HFHT or low flavanol and theobromine chocolate (LFLT). Acute changes in plasma flavanol and theobromine, peripheral arterial tonometry and BP were evaluated at randomization (0, 60 and 120 min after a single 40-g dose of chocolate) and again 6 and 12 weeks after daily 30-g chocolate intake. The EndoPAT 2000 provided reactive hyperemia index (RHI) and adjusted augmentation index (AIx) as markers for endothelial function and arterial stiffness, respectively.

Results: Compared with LFLT, acute HFHT intake significantly increased plasma epicatechin and theobromine (p < 0.0001), decreased AIx (p < 0.0001) and increased diastolic BP (3.49 ± 3.40 mmHg increase in HFHT group vs 1.55 ± 2.59 mmHg increase in LFLT group, p = 0.0008). Chronic HFHT compared with LFLT intake significantly increased plasma theobromine (p < 0.0001). No other significant within group or between group changes were observed.

Conclusions: Acute consumption of HFHT, compared to LFLT, increased plasma epicatechin and theobromine concentrations and decreased arterial stiffness, with no effect on endothelial function and a marginal increase in diastolic BP. Chronic HFHT intake increased plasma theobromine, though it did not have positive impacts on endothelial function, arterial stiffness or BP when compared to LFLT in pregnant women at risk of PE.
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http://dx.doi.org/10.1080/10641955.2018.1446977DOI Listing
May 2018

Early life nutrition, glycemic and anthropometric profiles of children exposed to gestational diabetes mellitus in utero.

Early Hum Dev 2018 03 20;118:37-41. Epub 2018 Feb 20.

School of Nutrition, Laval University, 2425 rue de l'Agriculture, Quebec City G1V 0A6, Canada; Institute of Nutrition and Functional Foods (INAF), Laval University, 2440 Boulevard Hochelaga, Quebec City G1V 0A6, Canada; Endocrinology and Nephrology Axis, CHU de Québec Research Center, 2705 boulevard Laurier, Quebec City G1V 4G2, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.earlhumdev.2018.02.004DOI Listing
March 2018

Short sleep duration and hyperglycemia in pregnancy: Aggregate and individual patient data meta-analysis.

Sleep Med Rev 2018 08 5;40:31-42. Epub 2017 Oct 5.

Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Short sleep duration has been linked to maternal hyperglycemia. Systematic review and meta-analysis were performed to evaluate the relationship between sleep duration and hyperglycemia in pregnancy or gestational diabetes (GDM). MEDLINE and Scopus were searched until July 2017. Studies that assessed sleep duration and had objective measurements of hyperglycemia during pregnancy were eligible. Aggregate data were available from eight studies, n = 17,308 (seven with self-reported and one with objectively measured sleep duration). Meta-analysis was applied for pooling aggregate data using a random-effects model. Identified authors provided individual patient data (IPD) from four studies with objectively measured sleep duration, n = 287. A one-stage approach with a hierarchical mixed-effect logit model was applied to pool IPD across studies. Aggregate data analysis revealed that women with short sleep duration (<6-7 h) were more likely to have GDM than women without short sleep duration, odds ratio 1.70 (95% CI: 1.24, 2.33). IPD analysis demonstrated that, compared to sleeping >6.25 h, women who slept ≤6.25 h had higher 1-h glucose levels after 50-g oral glucose tolerance testing by 0.65 mmol/L (0.18, 1.13) and an increased risk of GDM, adjusted odds ratio 2.84 (1.25, 6.44). In conclusion, short sleep duration in pregnancy, both self-reported and objectively measured, is associated with hyperglycemia and an increased GDM risk.
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http://dx.doi.org/10.1016/j.smrv.2017.09.003DOI Listing
August 2018

Millisecond infrared laser pulses depolarize and elicit action potentials on dorsal root ganglion neurons.

Biomed Opt Express 2017 Oct 19;8(10):4568-4578. Epub 2017 Sep 19.

Institut d'Electronique et des Systèmes, CNRS UMR5214, Université de Montpellier, Montpellier, France.

This work focuses on the optical stimulation of dorsal root ganglion (DRG) neurons through infrared laser light stimulation. We show that a few millisecond laser pulse at 1875 nm induces a membrane depolarization, which was observed by the patch-clamp technique. This stimulation led to action potentials firing on a minority of neurons beyond an energy threshold. A depolarization without action potential was observed for the majority of DRG neurons, even beyond the action potential energy threshold. The use of ruthenium red, a thermal channel blocker, stops the action potential generation, but has no effects on membrane depolarization. Local temperature measurements reveal that the depolarization amplitude is sensitive to the amplitude of the temperature rise as well as to the time rate of change of temperature, but in a way which may not fully follow a photothermal capacitive mechanism, suggesting that more complex mechanisms are involved.
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http://dx.doi.org/10.1364/BOE.8.004568DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654800PMC
October 2017

Postnatal Prevention of Childhood Obesity in Offspring Prenatally Exposed to Gestational Diabetes mellitus: Where Are We Now?

Obes Facts 2017 23;10(4):396-406. Epub 2017 Aug 23.

Children exposed to gestational diabetes mellitus (GDM) in utero are at high risk of developing many health problems such as obesity. There is an urgent need to find new strategies to prevent obesity development among high-risk populations such as those children. Accordingly, the aim of this review was to summarize current knowledge on the postnatal prevention of childhood obesity in offspring born from mothers with GDM. Specifically, this review addresses the impact of breastfeeding, complementary feeding practices as well as dietary intake and physical activity during childhood on obesity risk of children exposed to GDM in utero. Furthermore, breast milk composition of diabetic mothers and its potential impact on growth is discussed. According to the available literature, breastfeeding may reduce obesity risk in children exposed to GDM in utero but a longer duration seems necessary to achieve its protective effect against obesity. Detailed analysis of breast milk composition of mothers with GDM will be necessary to fully understand the relationship between breastfeeding and obesity in this specific population. This review highlights the need for more studies addressing the impact of complementary feeding practices and lifestyle habits during childhood on obesity risk of children exposed to GDM in utero.
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http://dx.doi.org/10.1159/000477407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644967PMC
February 2018

Physical activity during pregnancy and infant's birth weight: results from the 3D Birth Cohort.

BMJ Open Sport Exerc Med 2017 19;3(1):e000242. Epub 2017 Jun 19.

Department of Pediatrics, CHU de Qubec, Québec City, Canada.

Aim: To evaluate the association between maternal physical activity and infant's birth weight or risk of inappropriate weight for gestational age (GA), and whether this association differs by infant's sex, maternal body mass index (BMI) or pregnancy complications in a prospective cohort study.

Methods: 1913 pregnant women from the 3D Birth Cohort (Québec, Canada) completed the Pregnancy Physical Activity Questionnaire at each trimester. Energy expenditure (metabolic equivalent of task (MET)*hours/week) for total activity, sports and exercise and vigorous intensity activities was calculated. The associations with birth weight and risk of inappropriate weight for GA were evaluated by regression modelling. Interactions were tested with infant's sex, maternal prepregnancy BMI, gestational diabetes, hypertensive disorders and prematurity.

Results: Each 1 MET/hours/week increase in sports and exercise in the first trimester was associated with a 2.5 g reduction in infant's birth weight (95% CI -4.8 to -0.3) but was not associated with the risk of small weight for GA. In contrast, although not significant, a 17% reduction in the risk of large weight for GA was observed with increasing sports and exercise. Furthermore, in women with subsequent pre-eclampsia (but not normotensive or hypertensive women), each 1 MET/hours/week increment spent in any vigorous exercise in the first trimester reduced the infant's birth weight by 19.8 g (95% CI -35.2 to -4.3).

Conclusions: Pregnant women with higher sports and exercise levels in the first trimester delivered infants with a lower birth weight. The risk of reducing infant's birth weight with vigorous exercise in women who develop pre-eclampsia later in pregnancy requires evaluation.
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http://dx.doi.org/10.1136/bmjsem-2017-000242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5530125PMC
June 2017

The Efficacy of Cardiac Anti-miR-208a Therapy Is Stress Dependent.

Mol Ther 2017 03 12;25(3):694-704. Epub 2017 Feb 12.

Hubrecht Institute, KNAW and University Medical Center Utrecht, 3584CT Utrecht, the Netherlands; Department of Cardiology, University Medical Center Utrecht, 3584CT Utrecht, the Netherlands. Electronic address:

MicroRNAs (miRNAs) are important regulators of biology and disease. Recent animal efficacy studies validate the therapeutic benefit of miRNA modulation and underscore the therapeutic value of miRNA-targeting oligonucleotides. However, whether disease conditions (stress) influence the pharmacological effects of an anti-miR is currently unknown. To study the effect of disease on target regulation after anti-miR treatment, we injected animals with anti-miR-208a, a synthetic oligonucleotide that inhibits the cardiomyocyte-specific miR-208a. Our data indicate that the presence of stress increases the number of regulated miR-208a targets, and that higher stress levels correlate with stronger target derepression. Additionally, the type of stress also influences which targets are regulated upon miR-208a inhibition. Studies in a large animal model indicate a similar stress-dependent anti-miR effect. Subsequent in vitro studies suggest that the influence of stress on anti-miR efficacy depends at least in part on increased cellular anti-miR uptake. These data indicate that the pharmacological effect of anti-miRs is stronger under disease conditions, and that both the type and severity of disease determine the therapeutic outcome. These facts will be important for assessing the therapeutic dose and predicting the therapeutic outcome when applying anti-miRs in a clinical setting.
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http://dx.doi.org/10.1016/j.ymthe.2017.01.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5363185PMC
March 2017

Could High Volume of Physical Activities in Early Pregnancy Interfere with Deep Placentation?

AJP Rep 2016 Oct;6(4):e421-e423

Department of Obstetrics and Gynecology, Université Laval, Québec City, Quebec, Canada; Centre de recherche du CHU de Québec, Mother, Child and Reproductive Health, Université Laval, Quebec City, Quebec, Canada.

 The impact of physical activity (PA) during pregnancy on obstetrical outcomes remains controversial. We followed pregnant women who reported more than 3 hours of sustained PA per week during the first trimester of pregnancy.  Total five eligible women were followed. We observed small placenta from the first trimester (median: 0.68; interquartile [IQ]: 0.62-0.97 multiples of median [MoM]) to delivery (median: 0.82; IQ: 0.71-0.94 MoM), high uterine artery pulsatility index in the first (median: 1.82; IQ: 1.68-1.99 MoM) and second trimesters (median: 1.33; IQ: 1.11-1.56 MoM) of pregnancy. Placenta pathology revealed deep vasculopathy in three (60%) cases. However, all participants delivered at term and none of them experienced preeclampsia.  This small case series suggest that high PA volume in first trimester could interfere with deep placentation.
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http://dx.doi.org/10.1055/s-0036-1597264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5138070PMC
October 2016

Body Composition in Very Preterm Infants: Role of Neonatal Characteristics and Nutrition in Achieving Growth Similar to Term Infants.

Neonatology 2017 19;111(3):214-221. Epub 2016 Nov 19.

Pediatrics, King Edward Memorial and Princess Margaret Hospitals, Subiaco, W.A., Australia.

Background: The identification of factors involved in the postnatal growth of preterm infants will help achieve growth similar to that of term infants.

Objectives: As per protocol: to compare body composition in very preterm infants at term-corrected age (TCA) with that in term infants, and to explore relationships between neonatal characteristics and body composition in preterm infants.

Methods: Anthropometry, nutritional characteristics, and neonatal outcomes were prospectively collected in 26 preterm (<29 weeks) and 33 term (37-40 weeks) infants. Body composition using dual-energy X-ray absorptiometry (DXA) was measured at TCA in preterm infants and between days 7 and 10 in term infants.

Results: Parenteral nutrition in preterm infants provided a mean of 2.9 ± 0.2 and 2.1 ± 0.5 g/kg/day of intravenous amino acids and lipids, respectively, during the first week of life. The mean weight gain velocity from birth to DXA assessment was 12.1 ± 1.4 g/kg/day. Compared with term infants, preterm infants at TCA were shorter and lighter, with a smaller head circumference, a lower weight estimated by DXA (2,960 ± 552 vs. 3,843 ± 377 g), and increased skinfold thicknesses. Fat mass percent (13.9 ± 5.4%) and lean mass percent (84.7 ± 5.6%) in preterm infants were similar to those in term infants (14.7 ± 3.5 and 83.5 ± 3.6%, respectively). Neonatal weight gain velocity in preterm infants was positively associated with lean mass (grams).

Conclusion: Subcutaneous fat is increased in preterm infants. Higher protein intake in preterm infants might increase weight gain velocity and achieve a lean mass comparable to that of term infants.
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http://dx.doi.org/10.1159/000450882DOI Listing
December 2017

Consequences of maternal omega-3 polyunsaturated fatty acid supplementation on respiratory function in rat pups.

J Physiol 2017 03 16;595(5):1637-1655. Epub 2016 Dec 16.

Department of Pediatrics, Université Laval, Centre de Recherche du CHU de Québec, Québec, QC, Canada.

Key Points: Incomplete development of the neural circuits that control breathing contributes to respiratory disorders in pre-term infants. Manifestations include respiratory instability, prolonged apnoeas and poor ventilatory responses to stimuli. Based on evidence suggesting that omega-3 polyunsaturated fatty acids (n-3 PUFA) improves brain development, we determined whether n-3 PUFA supplementation (via the maternal diet) improves respiratory function in 10-11-day-old rat pups. n-3 PUFA treatment prolonged apnoea duration but augmented the relative pulmonary surface area and the ventilatory response to hypoxia. During hypoxia, the drop in body temperature measured in treated pups was 1 °C less than in controls. n-3 PUFA treatment also reduced microglia cell density in the brainstem. Although heterogeneous, the results obtained in rat pups constitute a proof of concept that n-3 PUFA supplementation can have positive effects on neonatal respiration. This includes a more sustained hypoxic ventilatory response and a decreased respiratory inhibition during laryngeal chemoreflex.

Abstract: Most pre-term infants present respiratory instabilities and apnoeas as a result of incomplete development of the neural circuits that control breathing. Because omega-3 polyunsaturated fatty acids (n-3 PUFA) benefit brain development, we hypothesized that n-3 PUFA supplementation (via the maternal diet) improves respiratory function in rat pups. Pups received n-3 PUFA supplementation from an enriched diet (13 g kg of n-3 PUFA) administered to the mother from birth until the experiments were performed (postnatal days 10-11). Controls received a standard diet (0.3 g kg of n-3 PUFA). Breathing was measured in intact pups at rest and during hypoxia (FiO  = 0.12; 20 min) using whole body plethysmography. The duration of apnoeas induced by stimulating the laryngeal chemoreflex (LCR) was measured under anaesthesia. Lung morphology was compared between groups. Maternal n-3 PUFA supplementation effectively raised n-3 PUFA levels above control levels both in the blood and brainstem of pups. In intact, resting pups, n-3 PUFA increased the frequency and duration of apnoeas, especially in females. During hypoxia, n-3 PUFA supplemented pups hyperventilated 23% more than controls; their anapyrexic response was 1 °C less than controls. In anaesthetized pups, n-3 PUFA shortened the duration of LCR-induced apnoeas by 32%. The relative pulmonary surface area of n-3 PUFA supplemented pups was 12% higher than controls. Although n-3 PUFA supplementation augments apnoeas, there is no clear evidence of deleterious consequences on these pups. Based on the improved lung architecture and responses to respiratory challenges, this neonatal treatment appears to be beneficial to the offspring. However, further experiments are necessary to establish its overall safety.
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http://dx.doi.org/10.1113/JP273471DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426158PMC
March 2017

3D Cohort Study: The Integrated Research Network in Perinatology of Quebec and Eastern Ontario.

Paediatr Perinat Epidemiol 2016 11 25;30(6):623-632. Epub 2016 Oct 25.

Université de Montréal, Montreal, QC, Canada.

Background: The 3D Cohort Study (Design, Develop, Discover) was established to help bridge knowledge gaps about the links between various adverse exposures during pregnancy with birth outcomes and later health outcomes in children.

Methods: Pregnant women and their partners were recruited during the first trimester from nine sites in Quebec and followed along with their children through to 2 years of age. Questionnaires were administered during pregnancy and post-delivery to collect information on demographics, mental health and life style, medical history, psychosocial measures, diet, infant growth, and neurodevelopment. Information on the delivery and newborn outcomes were abstracted from medical charts. Biological specimens were collected from mothers during each trimester, fathers (once during the pregnancy), and infants (at delivery and 2 years of age) for storage in a biological specimen bank.

Results: Of the 9864 women screened, 6348 met the eligibility criteria and 2366 women participated in the study (37% of eligible women). Among women in the 3D cohort, 1721 of their partners (1704 biological fathers) agreed to participate (73%). Two thousand two hundred and nineteen participants had a live singleton birth (94%). Prenatal blood and urine samples as well as vaginal secretions were collected for ≥98% of participants, cord blood for 81% of livebirths, and placental tissue for 89% of livebirths.

Conclusions: The 3D Cohort Study combines a rich bank of multiple biological specimens with extensive clinical, life style, and psychosocial data. This data set is a valuable resource for studying the developmental etiology of birth and early childhood neurodevelopmental outcomes.
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http://dx.doi.org/10.1111/ppe.12320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5113695PMC
November 2016

High-flavanol and high-theobromine versus low-flavanol and low-theobromine chocolate to improve uterine artery pulsatility index: a double blind randomized clinical trial.

J Matern Fetal Neonatal Med 2017 Sep 3;30(17):2062-2067. Epub 2016 Oct 3.

a Research Center, Center Hospitalier Universitaire de Québec , Québec , Canada.

Objective: To evaluate the impact of high-flavanol and high-theobromine (HFHT) chocolate in women at risk of preeclampsia (PE).

Study Design: We conducted a single-center randomized controlled trial including women with singleton pregnancy between 11 and 14 weeks gestation who had bilateral abnormal uterine artery (UtA) waveforms (notching) and elevated pulsatility index (PI). Participants were randomized to either HFHT or low-flavanol and low-theobromine (LFLT) chocolate (30 grams daily for a total of 12 weeks). UtA PI, reported as multiple of medians (MoM) adjusted for gestational age, was assessed at baseline and 12 weeks after randomization.

Results: One hundred thirty-one women were randomized with mean gestational age of 12.4 ± 0.6 weeks and a mean UtA PI of 1.39 ± 0.31 MoM. UtA PI adjusted for gestational age significantly decreased from baseline to the second visit (12 weeks later) in the two groups (p < 0.0001) but no significant difference was observed between the groups (p = 0.16).

Conclusions: Compared with LFLT chocolate, daily intake of HFHT chocolate was not associated with significant changes of UtA PI. Nevertheless, the improvement observed in both groups suggests that chocolate could improve placental function independently of flavanol and/or theobromine content.
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http://dx.doi.org/10.1080/14767058.2016.1236250DOI Listing
September 2017

Physical Activity Volumes during Pregnancy: A Systematic Review and Meta-Analysis of Observational Studies Assessing the Association with Infant's Birth Weight.

AJP Rep 2016 Apr;6(2):e170-97

Department of Pediatrics, Centre Hospitalier Universitaire de Québec (CHU de Québec), Université Laval, Quebec, Canada.

Objective This study aims to examine the association between different maternal physical activity exposures during pregnancy and infant's birth weight, body composition, and risk of inadequate weight. Methods Two reviewers (M.B. and J.L.G.) identified observational studies reporting total or leisure time activity during pregnancy and birth weight outcomes. Pooled analyses were performed to summarize the risk associated with high or moderate volumes of physical activity on birth weight. Results A total of 54 studies among 4,080 reported the association between physical activity and birth weight (37 studies) or risks of small or large birth weight. The association between physical activity and birth weight was evaluated by physical activity levels (low, moderate, or high). Despite heterogeneity, pooled results (23 studies) suggested that moderate levels of activity are associated with an increased birth weight (mean difference: 61.5 g, 95% confidence interval [CI]: 16.6, 106.5, 15 studies), while high levels were associated with lower birth weight (mean difference: -69.9 g, 95% CI: -114.8, -25.0, 15 studies). Data were insufficient to provide robust estimates for other outcomes. Conclusions The results of observational studies suggest an inverted u-shaped association between physical activity and birth weight, despite methodological variability. These results could help refining physical activity guidelines for pregnancy and provide guidance for future research.
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http://dx.doi.org/10.1055/s-0036-1583169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848034PMC
April 2016