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Several studies reported an association between Caesarean section (CS) birth and childhood obesity. However, there are several limitations in the current literature. These include an inability to distinguish between planned and emergency CS, small study sample sizes and not adjusting for pre-pregnancy body-mass-index (BMI). We examined the association between CS delivery and childhood obesity using the United Kingdom Millennium Cohort Study (MCS). Mother-infant pairs were recruited into the MCS. Use of sampling weights ensured the sample was representative of the population. The exposure was categorised as normal vaginal delivery (VD) [reference], assisted VD, planned CS and emergency CS. Childhood obesity prevalence, at age three, five, seven, eleven and fourteen years was calculated using the International Obesity Taskforce criteria. Mixed-effects linear regression models were fitted with associations adjusted for several potential confounders like maternal age, pre-pregnancy BMI, education and infant macrosomia. Linear regression models were fitted evaluating body fat percentage (BF%), at age seven and fourteen years. Of the 18,116 infants, 3872 (21.4%) were delivered by CS; 9.2% by planned CS. Obesity prevalence was 5.4%, 5.7%, 6.5%, 7.1% and 7.6% at age three, five, seven, eleven and fourteen years respectively. The mixed-effects linear regression model showed no association between planned (adjusted mean difference = 0.00; [95% confidence interval (CI) -0.10; 0.10], p-value = 0.97) or emergency CS (adjusted mean difference = 0.08; [95% CI -0.01; 0.17], p-value = 0.09) and child BMI. At age seven years, there was no association between planned CS and BF% (adjusted mean difference = 0.13; [95% CI -0.23; 0.49]); there was no association at age fourteen years. Infants born by planned CS did not have a significantly higher BMI or BF% compared to those born by normal VD. This may suggest that the association, described in the literature, could be due to the indications/reasons for CS birth or residual confounding.

Background Longitudinal cohort studies are pivotal to understand how socioeconomic, environmental, biological, and lifestyle factors influence health and disease. The added value of cohort studies increases as they accumulate life course data and expand across generations. Ensuring that participants stay motivated to contribute over decades of follow-up is, however, challenging. Participant engagement and involvement (PEI) aims to secure the long-term commitment of participants and promote researcher-participant interaction. This study explored PEI practices in a selection of pregnancy and birth, twin, and family-based population cohort studies. Methods Purposive sampling was used to identify cohorts in Europe, Australia and New Zealand. Fourteen semi-structured digital interviews were conducted with cohort study representatives to explore strategies for participant recruitment, informed consent, communication of general and individual information to participants, data collection, and participant involvement. Experiences, resources allocated to PEI, and reflections on future PEI, were discussed. The interview data were analyzed using a content analysis approach and summary results were reviewed and discussed by the representatives. Results The cohort studies used various strategies to recruit participants including support from health professionals and organizations combined with information on the studies’ web sites and social media. New approaches such as intra-cohort recruitment, were being investigated. Most cohorts transitioned from paper-based to digital solutions to collect the participants’ consent and data. While digital solutions increased efficiency, they also brought new challenges. The studies experimented with the use of participant advisory panels and focus groups to involve participants in making decisions, although their success varied across age and socio-economic background. Most representatives reported PEI resources to be limited and called for more human, technical, educational and financial resources to maximize the positive effects of PEI. Conclusions This study of PEI among well-established cohort studies underscores the importance of PEI for project sustainability and highlights key factors to consider in developing PEI. Our analysis shows that knowledge gaps exist regarding which approaches have highest impact on retention rates and are best suited for different participant groups. Research is needed to support the development of best practices for PEI as well as knowledge exchange between cohorts through network building.

Caesarean section (CS) rates are increasing globally and exceed 50% in some countries. Childhood obesity has been linked to CS via lack of exposure to vaginal microflora although the literature is inconsistent. We investigated the association between CS birth and the risk of childhood obesity using the nationally representative Growing-Up-in-Ireland (GUI) cohort. The GUI study recruited randomly 11134 infants. The exposure was categorised into normal vaginal birth (VD) [reference], assisted VD, elective (planned) CS and emergency (unplanned) CS. The primary outcome measure was obesity defined according to the International Obesity Taskforce criteria. Statistical analysis included multinomial logistic regression with adjustment for potential confounders. Infants delivered by elective CS had an adjusted relative risk ratio (aRRR) = 1.32; [95% confidence interval (CI) 1.01–1.74] of being obese at age three years. This association was attenuated when macrosomic children were excluded (aRRR = 0.99; [95% CI 0.67–1.45]). Infants delivered by emergency CS had an increased risk of obesity aRRR = 1.56; [95% CI 1.20–2.03]; this association remained after excluding macrosomic children. We found insufficient evidence to support a causal relationship between elective CS and childhood obesity. An increased risk of obesity in children born by emergency CS, but not elective, suggests that there is no causal effect due to vaginal microflora.

BACKGROUND The burgeoning global multi-ethnic population, in conjunction with the importance of accurate ethnic group counts for research and policy purposes, make classification of multiple ethnic responses a complex but important issue. There are numerous possible classification approaches, differing in ethical implications and ease of statistical application. OBJECTIVE This study empirically examines the validity and consistency of three comparatively accessible ethnic classification methods (total response, administrative-prioritisation, and self-prioritisation) in increasingly ethnically diverse age cohorts (adults, adolescents, and children). METHOD We utilised secondary data from two large-scale studies in Aotearoa/New Zealand which asked children (N = 6,149; responded via mother proxy), adolescents (N = 8,464), and adults (N = 11,210) to select (1) all the ethnicities they identified with, and (2) their main ethnicity. The data were coded, then analysed using descriptive statistics and z-tests for proportional differences. RESULTS The majority of multi-ethnic participants were able to select a main ethnic group when required, but around 20% could not or refused to do so, and there was over 60% discrepancy between self-prioritised ethnicity and administrative-prioritised ethnicity. Differences by age group and ethnic combination were apparent. Comparison of overall ethnic group proportions outputted by the three classification methods revealed within-group variation, particularly where there were higher rates of multi-ethnic identification. CONTRIBUTION This study empirically demonstrates that researchers' choice of ethnic classification method can have a strong influence on ethnic group proportions. Researchers should therefore select the classification method most appropriate for their research question and clearly report the method employed.

Objectives Antenatal and postnatal depression can lead to poor outcomes for women and their children. The aim of this study was to explore whether risk factors differ for depression symptoms that are present during pregnancy and/or after childbirth. Methods An ethnically and socioeconomically diverse sample of 5301 women completed interviews during the third trimester of pregnancy and 9 months after childbirth. Depression symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS). Depression symptoms (defined as EPDS >12) among participants and associations with pre-pregnancy and pregnancy maternal characteristics were explored using logistic regression. Results The rate of antenatal depression symptoms (ADS) only was 8.5, 5% of women had depression symptoms at 9 months postpartum (PDS) only and 3% experienced depression symptoms at both time points. Perceived stress and Pacific or Asian ethnicity were risk factors for ADS and PDS. Anxiety during and before pregnancy was a risk factor for ADS only while having a pre-pregnancy diagnosis of depression was a risk factor for PDS only. Having ADS increased the odds ratio of PDS by 1.5 (95% CI 1.01–2.30). Conclusions The results supported evidence from previous longitudinal studies that depression symptoms appear to be higher during pregnancy than in the first year following childbirth. The study found that PDS may often be a continuation or recurrence of ADS.

Notes that while prediction models can estimate an infant’s risk of developing obesity at a later point in early childhood, caregiver receptiveness to such information is largely unknown. Aims to assess the acceptability of these models to New Zealand caregivers. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.

Several early childhood obesity prediction models have been developed, but none for New Zealand's diverse population. We aimed to develop and validate a model for predicting obesity in 4–5-year-old New Zealand children, using parental and infant data from the Growing Up in New Zealand (GUiNZ) cohort. Obesity was defined as body mass index (BMI) for age and sex ≥ 95th percentile. Data on GUiNZ children were used for derivation (n = 1731) and internal validation (n = 713). External validation was performed using data from the Prevention of Overweight in Infancy Study (POI, n = 383) and Pacific Islands Families Study (PIF, n = 135) cohorts. The final model included: birth weight, maternal smoking during pregnancy, maternal pre-pregnancy BMI, paternal BMI, and infant weight gain. Discrimination accuracy was adequate [AUROC = 0.74 (0.71–0.77)], remained so when validated internally [AUROC = 0.73 (0.68–0.78)] and externally on PIF [AUROC = 0.74 [0.66–0.82)] and POI [AUROC = 0.80 (0.71–0.90)]. Positive predictive values were variable but low across the risk threshold range (GUiNZ derivation 19–54%; GUiNZ validation 19–48%; and POI 8–24%), although more consistent in the PIF cohort (52–61%), all indicating high rates of false positives. Although this early childhood obesity prediction model could inform early obesity prevention, high rates of false positives might create unwarranted anxiety for families.

The objective of this study was to derive a factor structure of the measures of the National Institutes of Health (NIH) Toolbox Cognition Battery (CB) that is representative of cognitive abilities in a large ethnically diverse cohort of 8-year-old children in Aotearoa New Zealand. Our sample comprised of 4298 8-year-old children from the Growing Up in New Zealand study. We conducted exploratory and confirmatory factor analysis for the NIH Toolbox CB measures to discover the best-fitting factor structure in our sample. Measurement invariance of the identified model was tested across child's gender, socio-economic status (SES), and ethnicity. A three-dimensional factor structure was identified, with one factor of Crystallised Cognition (Reading and Vocabulary), and two distinguished factors of fluid cognition: Fluid Cognition I (Attention/Inhibitory Control, Processing Speed, and Cognitive Flexibility) and Fluid Cognition II (Working Memory, Episodic Memory). The results demonstrate excellent model fit, but reliability of the factors was low. Measurement invariance was confirmed for child's gender. We found configural, but neither metric nor scalar, invariance across SES and the four major ethnic groups: European, Māori, Pacific Peoples, and Asian. Our findings show that, at the age of 8 years, fluid abilities are more strongly associated with one another than with crystallised abilities and that fluid abilities need to be further differentiated. This dimensional structure allows for comparisons across child's gender, but evaluations across SES and ethnicity within the Aotearoa New Zealand context must be conducted with caution. We recommend using raw scores of the individual NIH Toolbox CB measures in future research.

Background Behavioural problems and psychopathology can present from as early as the preschool period. However there is evidence that behavioural difficulties may not be stable over this period. Therefore, the current study was interested in evaluating the persistence and change in clinically relevant behavioural problems during early childhood in a population-based New Zealand birth cohort. Methods Behaviour was assessed in 5896 children when they were aged 2 and 4.5 years using the Strengths and Difficulties Questionnaire (SDQ). Correlations and mean differences in subscale and total difficulties scores were examined. Scores were then dichotomised into normal/borderline and abnormal ranges to evaluate the persistence and change in significant behavioural problems. Chi-square analyses and ANOVAs were used to determine the association between sociodemographic and birth variables, and preschool behavioural stability. Results Raw scores at ages 2 and 4.5 years were moderately correlated, with most measures showing a small but significant decrease in mean scores over time. The majority of children who showed abnormal behaviour at 2 years improved at 4.5 years (57.9% for total difficulties). However, a notable proportion persisted in their difficulties from 2 to 4.5 years (42.1% for total difficulties). There was a small percentage of children who were categorised as abnormal only at 4.5 years. Children with difficulties at one or both time points had a greater proportion who were the result of an unplanned pregnancy, lived in highly deprived urban areas, and had mothers who were younger, of Māori and Pacific ethnicity and were less educated. Conclusions Not all children who show early behavioural difficulties persist in these difficulties. Those whose difficulties persist were more likely to experience risk factors for vulnerability relative to children with no difficulties. Results suggest that repeated screening for early childhood behavioural difficulties is important.

Abdominal aortic aneurysm (AAA) rupture is an important cause of death in older adults. In clinical practice, the most established predictor of AAA rupture is maximum AAA diameter. Aortic diameter is commonly used to assess AAA severity in mouse models studies. AAA rupture occurs when the stress (force per unit area) on the aneurysm wall exceeds wall strength. Previous research suggests that aortic wall structure and strength, biomechanical forces on the aorta and cellular and proteolytic composition of the AAA wall influence the risk of AAA rupture. Mouse models offer an opportunity to study the association of these factors with AAA rupture in a way not currently possible in patients. Such studies could provide data to support the use of novel surrogate markers of AAA rupture in patients. In this review, the currently available mouse models of AAA and their relevance to the study of AAA rupture are discussed. The review highlights the limitations of mouse models and suggests novel approaches that could be incorporated in future experimental AAA studies to generate clinically relevant results.