The Chilean Maternal-Infant Cohort Study-II in the COVID-19 Era: A Study Protocol

María F Mujica-Coopman, Camila Corvalán, Marcela Flores, María Luisa Garmendia, María F Mujica-Coopman, Camila Corvalán, Marcela Flores, María Luisa Garmendia

Abstract

Background: Pregnancy is a critical developmental window in which optimal maternal nutrition and health are key for pregnancy and infant development. The COVID-19 pandemic is considered as a "natural experiment" in which maternal and infant nutrition and health challenges were faced especially in developing countries. Therefore, understanding the health consequences for mothers and infants living in the COVID-19 era is key to revisit public health measures focused on maternal and infant health. The current work aims to describe the design, methods, and descriptive information at recruitment and preliminary findings of the Chilean Maternal & Infant Cohort Study II (CHiMINCs-II) cohort.

Methods: The CHiMINCs-II is an ongoing cohort that is part of the Chilean Maternal and Infant Nutrition Observatory of the South-East area of Santiago, Chile. In total, 1954 pregnant women beneficiaries of the public health systems and their offspring were recruited before 15 weeks of gestation and are followed across pregnancy (<15, 26-28, and 35-37 weeks of gestation) and up to 2 years of age in their offspring. Two studies are currently nested within the CHiMINCs-II cohort: (1) Breast Cancer Risk Assessment in Mothers (BRECAM) study, and (2) the CHiMINCs-COVID study. The primary objective of BRECAM study is to test the association between maternal metabolic indicators (i.e., insulin, glucose, insulin growth factor 1, and hemoglobin A1c concentrations) at early pregnancy (i.e., <15 and 26-28 weeks of gestation) and breast density 3 months after the cessation of lactation. For this purpose, we collect maternal obstetric, lifestyle, dietary intake, anthropometric, and biochemical information. The aim of the CHiMINCs-COVID study is to assess maternal dietary intake and mental health problems derived from the COVID-19 pandemic and their association with maternal and infant's health and nutrition. Thus, we collected detailed information on dietary behaviors, mental health, and COVID-related information at each trimester, along with neonatal and infant nutritional information.

Discussion: The findings of this study will provide novel and critical information to better understand maternal nutritional status, mental health, as well as infant growth and nutrition during the COVID-19 era.

Clinical trial registration: BRECAM study registration number NCT03920098 and CHiMINCs-COVID study registration number NCT01916603.

Keywords: COVID-19; dietary intake; infant growth; infant health; maternal health; mental health; nutrition; pregnancy.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Mujica-Coopman, Corvalán, Flores and Garmendia.

Figures

Figure 1
Figure 1
Timeline of the CHiMINCs-II cohort.

References

    1. Ursin G, Bernstein L, Wang Y, Lord SJ, Deapen D, Liff JM, et al. . Reproductive factors and risk of breast carcinoma in a study of White and African-American women. Cancer. (2004) 101:353–62. 10.1002/cncr.20373
    1. Wu G, Bazer FW, Cudd T, Meininger CJ, Spencer TE. Maternal nutrition and fetal development. J Nutr. (2004) 134:2169–72. 10.1093/jn/134.9.2169
    1. Hoffman DJ, Reynolds RM, Hardy DB. Developmental origins of health and disease: current knowledge and potential mechanisms. Nutr Rev. (2017) 75:951–70. 10.1093/nutrit/nux053
    1. McKerracher L, Moffat T, Barker M, McConnell M, Atkinson SA, Murray-Davis B, et al. . Knowledge about the Developmental Origins of Health and Disease is independently associated with variation in diet quality during pregnancy. Matern Child Nutr. (2020) 16:1–13. 10.1111/mcn.12891
    1. Godfrey KM, Reynolds RM, Prescott S, Nyirenda M, Jaddoe VW, Eriksson JG, et al. . Influence of maternal obesity on the long-term health of offspring. Lancet Diabetes Endocrinol. (2017) 5:53–64. 10.1016/S2213-8587(16)30107-3
    1. Hanson M, Barker M, Dodd J, Kumanyika SK, Norris S, Steegers E, et al. . Interventions to prevent maternal obesity before conception, during pregnancy, and post partum. Lancet Diabetes Endocrinol. (2017) 5:65–76. 10.1016/S2213-8587(16)30108-5
    1. Garmendia ML, Corvalan C, Araya M, Casanello P, Kusanovic JP, Uauy R. Effectiveness of a normative nutrition intervention in Chilean pregnant women on maternal and neonatal outcomes: the CHiMINCs study. Am J Clin Nutr. (2020) 112:991–1001. 10.1093/ajcn/nqaa185
    1. Azamjah N, Soltan-Zadeh Y, Zayeri F. Global trend of breast cancer mortality rate: a 25-year study. Asian Pacific J Cancer Prev. (2019) 20:2015–20. 10.31557/APJCP.2019.20.7.2015
    1. Rice MS, Rosner BA, Tamimi RM. Percent mammographic density prediction: development of a model in the nurses' health studies. Cancer Causes Control. (2017) 28:677–84. 10.1007/s10552-017-0898-7
    1. Butler LM, Gold EB, Greendale GA, Crandall CJ, Modugno F, Oestreicher N, et al. . Menstrual and reproductive factors in relation to mammographic density: the Study of Women's Health Across the Nation (SWAN). Breast Cancer Res Treat. (2009) 112:165–74. 10.1007/s10549-007-9840-0
    1. Britt K, Ashworth A, Smalley M. Pregnancy and the risk of breast cancer. Endocr Relat Cancer. (2007) 14:907–33. 10.1677/ERC-07-0137
    1. Beral V, Bull D, Doll R, Peto R, Reeves G. Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50 302 women with breast cancer and 96 973 women without the disease. Lancet. (2002) 360:187–95. 10.1016/S0140-6736(02)09454-0
    1. Loehberg CR, Heusinger K, Jud SM, Haeberle L, Hein A, Rauh C, et al. . Assessment of mammographic density before and after first full-term pregnancy. Eur J Cancer Prev. (2010) 19:405–12. 10.1097/CEJ.0b013e32833ca1f4
    1. Husby A, Wohlfahrt J, Øyen N, Melbye M. Pregnancy duration and breast cancer risk. Nat Commun. (2018) 9:4255. 10.1038/s41467-018-06748-3
    1. Thurlow J. COVID-19 Lockdowns Are Imposing Substantial Economic Costs on Countries in Africa. (2020). Available online at: (accessed June 20, 2022).
    1. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. . The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. (2020) 395:912–20. 10.1016/S0140-6736(20)30460-8
    1. Wolfson JA, Leung CW. Food insecurity and COVID-19: disparities in early effects for us adults. Nutrients. (2020) 12:1–13. 10.3390/nu12061648
    1. Niles MT, Bertmann F, Belarmino EH, Wentworth T, Biehl E, Neff R. The early food insecurity impacts of covid-19. Nutrients. (2020) 12:1–23. 10.3390/nu12072096
    1. Harding R, Bocking AD. Fetal Growth and Development. Cambridge; New York, NY: Cambridge University Press; (2001).
    1. Chen LW, Aris IM, Bernard JY, Tint MT, Colega M, Gluckman PD, et al. . Associations of maternal macronutrient intake during pregnancy with infant BMI peak characteristics and childhood BMI. Am J Clin Nutr. (2017) 105:705–13. 10.3945/ajcn.116.148270
    1. Villamor E, Rifas-Shiman SL, Gillman MW, Oken E. Maternal intake of methyl-donor nutrients and child cognition at 3 years of age. Paediatr Perinat Epidemiol. (2012) 26:328–35. 10.1111/j.1365-3016.2012.01264.x
    1. Henrichs J, Schenk JJ, Roza SJ, Van Den Berg MP, Schmidt HG, Steegers EAP, et al. . Maternal psychological distress and fetal growth trajectories: the generation R study. Psychol Med. (2010) 40:633–43. 10.1017/S0033291709990894
    1. Dole N, Savitz DA, Siega-Riz AM, Hertz-Picciotto I, McMahon MJ, Buekens P. Psychosocial factors and preterm birth among African American and white women in central North Carolina. Am J Public Health. (2004) 94:1358–65. 10.2105/AJPH.94.8.1358
    1. Lindsay KL, Buss C, Wadhwa PD, Entringer S. The interplay between maternal nutrition and stress during pregnancy: issues and considerations. Ann Nutr Metab. (2017) 70:191–200. 10.1159/000457136
    1. Sparling TM, Cheng B, Deeney M, Santoso M V., Pfeiffer E, Emerson JA, et al. . Global mental health and nutrition: moving toward a convergent research agenda. Front Public Heal. (2021) 9:1–7. 10.3389/fpubh.2021.722290
    1. Osendarp S, Akuoku JK, Black RE, Headey D, Ruel M, Scott N, et al. . The COVID-19 crisis will exacerbate maternal and child undernutrition and child mortality in low- and middle-income countries. Nat Food. (2021) 2:476–84. 10.1038/s43016-021-00319-4
    1. Liu X, Zhu M, Zhang R, Zhang J, Zhang C, Liu P, et al. . Public mental health problems during COVID-19 pandemic: a large-scale meta-analysis of the evidence. Transl Psychiatry. (2021) 11:1–10. 10.1038/s41398-021-01501-9
    1. GBD 2015 Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. (2017) 377:13–27. 10.1056/NEJMoa1614362
    1. Garmendia, Corvalan C, Araya M, Casanello P, Kusanovic JP, Uauy R. Effectiveness of a normative nutrition intervention (diet, physical activity and breastfeeding) on maternal nutrition and offspring growth: the Chilean maternal and infant nutrition cohort study (CHiMINCs). BMC Preg Childbirth. (2015) 15:1–6. 10.1186/s12884-015-0605-1
    1. Garmendia M, Corvalán C, Casanello P, Araya M, Flores M, Bravo A, et al. . Effectiveness on maternal and offspring metabolic control of a home-based dietary counseling intervention and DHA supplementation in obese/overweight pregnant women (MIGHT study): a randomized controlled trial—Study protocol. Contemp Clin Trials. (2018) 70:35–40. 10.1016/j.cct.2018.05.007
    1. Ministry of Health Control . Chilean Ministry of Health Departamento Ciclo Vital División Prevención y Control de Enfermedades Subsecretaría de Salud Pública. Manual de atención personalizada en el proceso reproductivo. Santiago (2008).
    1. Borrescio-Higa F, Valdés N. Publicly insured caesarean sections in private hospitals: a repeated cross-sectional analysis in Chile. BMJ Open. (2019) 9:1–7. 10.1136/bmjopen-2018-024241
    1. Conway JM, Ingwersen LA, Moshfegh AJ. Accuracy of dietary recall using the USDA five-step multiple-pass method in men: an observational validation study. J Am Diet Assoc. (2004) 104:595–603. 10.1016/j.jada.2004.01.007
    1. USDA . Agricultural Research Service USDA National Nutrient Database for Standard Reference, Release 24. Nutrient Data Laboratory. (2011). Available online at:
    1. Schmidt-Hebbel H, Pennacchiotti I, Masson L MM. Chilean Table of Foods Chemical Composition. Santiago: Facultad de Ciencias Quimicas y Farmaceuticas, Universidad de Chile; (1992).
    1. Hawkes C, Jewell J, Allen K. A food policy package for healthy diets and the prevention of obesity and diet-related non-communicable diseases: the NOURISHING framework. Obes Rev. (2013) 14:159–68. 10.1111/obr.12098
    1. Kanter R, Reyes M, Corvalań C. Photographic methods for measuring packaged food and beverage products in supermarkets. Curr Dev Nutr. (2017) 1:e001016. 10.3945/cdn.117.001016
    1. Oxford U. of Co-SPACE study Parent & Adolescent Survey Items. Oxford: University of Oxford; (2020).
    1. World Health Organization . Regional Office for Europe. Survey Tool and Guidance: Rapid, Simple, Flexible Behavioural Insights on COVID-19. Copenhagen: (2020).
    1. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry. (1987) 150:782–6. 10.1192/bjp.150.6.782
    1. Shulman HB, D'Angelo D V, Harrison L, Smith RA, Warner L. The pregnancy risk assessment monitoring system (PRAMS): overview of design and methodology. Am J Public Health. (2018) 108:1305–13. 10.2105/AJPH.2018.304563
    1. Nord M. Introduction to Item Response Theory applied to Food Security Measurement: Basic Concepts, Parameters, and Statistics. Rome: FAO; (2014).
    1. Ellis KJ, Yao M, Shypailo RJ, Urlando A, Wong WW, Heird WC. Body-composition assessment in infancy: air-displacement plethysmography compared with a reference 4-compartment model. Am J Clin Nutr. (2007) 85:90–5. 10.1093/ajcn/85.1.90
    1. WHO UNICEF . Indicators for Assessing Infant and Young Child Feeding Practices. Vol. WHA55 A55/, World Health Organization and the United Nations Children's Fund (UNICEF) (2021). 19 p. Available online at: (accessed June 20, 2022).
    1. Shepherd JA, Herve L, Landau J, Fan B, Kerlikowske K, Cummings SR. Clinical comparison of a novel breast DXA technique to mammographic density. Med Phys. (2006) 33:1490–8. 10.1118/1.2193691
    1. Pereira A, Garmendia ML, Uauy R, Neira P, Lopez-Arana S, Malkov S, et al. . Determinants of volumetric breast density in Chilean premenopausal women. Breast Cancer Res Treat. (2017) 162:343–52. 10.1007/s10549-017-4126-7

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever