Impact of Maternal Vitamin D Insufficiency on Neonatal Bone and Fat Mass

Abstracts / Annals of Epidemiology 24 (2014) 682e702 695

CI, 77.3-79.9) for women 20-59, 28.9% (95% CI, 27.6-30.3) for men from 20-59and adults older than 59 had a prevalence of 68.6% (95% CI, 67.1-70.2). Northand central regions of the country had the highest frequency of centralobesity.Conclusions: Central obesity is an important public health problem inMexico. Our results show that Mexico has higher values of central obesitycompared to other countries and the problem is more important in women.Physical activity, nutrition and genetic factor should be taken into account tocreate health interventions programs according to Mexican population.

P54. Impact of Maternal Vitamin D Insufficiency on NeonatalBone and Fat Mass

Nansi Boghossian PhD, MPH, Winston Koo, Aiyi Liu PhD, Sunni Mumford,Kerri Kissell, James Mills, Edwina Yeung PhD. National Institute of ChildHealth and Human Development

Purpose: Conflicting evidence suggests that total maternal 25-hydrox-yvitamin D [25(OH)D] is associatedwith fetal bone and fat mass. Associationswith the more bioavailable, free 25(OH)D however, have not been inves-tigated. We examined the associations for total and free 25(OH)D withneonatal bone and adiposity by dual-energy x-ray absorptiometry (DXA).Methods: 252 newborns of nulliparous women from theMemphis site of theCalcium for Preeclampsia Prevention trial (1993-1995) underwent DXAwithin the first week of life. Maternal serum samples, collected 3 timesduring pregnancy, were measured for 25(OH)D, its binding protein, andalbumin fromwhich free 25(OH)D was calculated. Multiple linear regressionexamined whether maternal total and free 25(OH)D, averaged over preg-nancy, were associated with birthweight, neonatal total and lumbar bonemineral content (BMC), bone mineral density (BMD), and fat mass afteradjusting for maternal BMI, age, race, smoking status, caloric intake, andserum calcium levels.Results: 63(25%) of the women had Vitamin D insufficiency (<20 ng/ml).Means (SD) of total and free 25(OH)D were 26.5(8.8) ng/ml and 11.7(6.6) pg/ml, respectively. Total (Blacks: 25.2(8.2), Whites 35.0(8.2) ng/ml, p<0.001)and free (Blacks: 12.2(6.7), Whites 8.5(5.3) pg/ml, p¼0.003) 25(OH)D dif-fered significantly by race. Vitamin D insufficiency was associated with lowerbirthweight (-171.7g; 95% confidence interval (CI): -336.5, -6.97), BMD(-0.0095g/cm2, 95% CI: -0.017, -0.0023), and percent fat mass (-1.10%, 95% CI:-2.18, -0.009). No associations were found between free 25(OH)D andexamined neonatal DXA measures.Conclusions: Insufficient maternal total but not free 25(OH)D status wasassociated with lower neonatal bone and fat mass.

P55. Seasonality of Metabolic Syndrome Characteristics in theOld Order Amish

Jared A. Fisher MPH, Robin C. Puett PhD, Jeff D. Yanosky PhD, Mary PavlovichMPH, Robert M. Reed MD, James Hibbert MS, Braxton D. Mitchell PhD.University of Maryland

Purpose: Prior studies have found that Metabolic Syndrome (MetS) char-acteristics can vary by season. In order to test if these findings hold true in apredominantly rural/agricultural population, we examined the seasonality ofMetS characteristics in a cross-sectional sample of Old Order Amish fromLancaster County, Pennsylvania. This population is a genetically homoge-neous population of European ancestry with high levels of physical activity,limited medication use, and rates of obesity comparable to the nationalaverage.Methods: We used criteria from the U.S. National Cholesterol EducationProgram Adult Treatment Panel III (ATPIII) to define MetS as the presence ofat least three of the following factors: abdominal obesity, elevated bloodpressure, elevated fasting plasma glucose, high serum triglycerides, and lowhigh-density cholesterol (HDL) levels. We used analysis of covariance(ANCOVA) procedures to determine seasonal differences in means and pro-portions in MetS characteristics while adjusting for age and gender. Sig-nificance-level adjustments were made for post-hoc group comparisons.Results: The overall prevalence of MetS was 12.4% among 2,438 participantsrecruited from 1995-2007. While there were no differences in the prevalenceof MetS by season, both systolic (p¼0.004) and diastolic (p¼0.008) bloodpressure were higher in fall and winter compared to spring and summer. In

contrast, mean HDL levels were lowest in summer compared to all otherseasons (p<0.001).Conclusions: Though there was a relatively low prevalence of MetS in thispopulation, means and proportions of certain MetS characteristics varied byseason. These effects may be mediated by seasonal changes in physicalactivity.

P56. Obesity and Work-Site Injury: The National HealthInterview Survey (NHIS), 2004-2012

J.A.K. GU MSPH, Luenda E. Charles PhD, Claudia C. Ma MPH, Tara A. HartleyPhD, Michael E. Andrew PhD, John M. Violanti PhD, Cecil M. Burchfiel PhD.NIOSH/CDC

Purpose: To investigate the association between obesity and work-siteinjury.Methods: Self-reported weight, height, and injuries within the previousthreemonths were collected annually for US workers in the NHIS from 2004-2012. Participants were categorized as normal weight (BMI: 18.5 - <25 kg/m2), overweight (BMI: 25 - <30), obese I (BMI: 30 - <35), and obese II (BMI:�35). Prevalence ratios (PR) and 95% confidence intervals (CI) from the fittedlogistic regression model were used to assess relationships between obesityand injury.Results: Compared to normal weight workers, overweight and obeseworkers were more likely to experience work-site injuries (overweight:PR¼1.25, 95% CI¼1.04-1.52; obese I: 1.41 (1.14-1.74); obese II: 1.68 (1.32-2.14).These injuries were more likely to affect the lower extremities (overweight:PR¼1.48, 95% CI¼1.03-2.13; obese I: 1.70 (1.13-2.55); obese II: 2.91 (1.91-4.41)and more likely to be due to sprains/strains/twists (overweight: 1.73 (1.29-2.31); obese I: 2.24 (1.64-3.06); obese II: 2.95 (2.04-4.26).Conclusion: Among NHIS participants, overweight and obese workers were25% to 68% more likely to experience injuries than normal weight workers.Weight reduction policies and management programs may be effectivelytargeted towards overweight and obese groups to prevent or reduce work-site injuries.

P57. Association Between Prenatal Exposure to SecondhandSmoke and Risk of Postpartum Depressive Symptoms:Examination of Data from the North Carolina Pregnancy RiskAssessment and Monitoring System (2004-2008)

Shama Khan MSPH, Ahmed A. Arif PhD, James N. Laditka PhD,Elizabeth F. Racine DrPH. University at North Carolina at Charlotte

Purpose: The purpose of this study was to evaluate the association betweenresidential pre-natal secondhand smoke (SHS)exposure and the risk ofpostpartum depressive symptoms (PPDS).Methods: This study involved secondary data analysis of 6,884 women whoparticipated in the North Carolina Pregnancy Risk Assessment and Mon-itoring System (2004-2008). Data on both prenatal secondhand smoke andpostpartum depressive symptoms was obtained from self-reportedquestionnaires.Results: In the unadjusted analysis, women exposed to SHS had nearly twicethe odds of PPDS than the unexposed (OR¼1.90, 95%CI¼1.61-2.26). Afteradjusting for maternal race, income, Medicaid recipient status, physicalactivity during pregnancy, pregnancy-induced hypertension and timing ofentry into prenatal care, the association between PPDS and SHS was weak-ened but remained statistically significant (OR¼1.49, 95%CI¼1.23-1.80). Adose response relationship was not evident in the unadjusted and adjustedanalysis, because even though the odds of PPDS for women living with1smoker (OR¼1.83, 95%CI¼1.51-2.22 for unadjusted analysis; OR¼1.50, 95%CI¼1.22-1.85 for adjusted analysis) differed from the odds of PPDS for womenliving with 2 or more smokers (OR¼2.10, 95% CI:1.60,2.73 for unadjustedanalysis; OR¼1.46,95%CI:1.08,1.96 for adjusted analysis), their 95% con-fidence intervals overlapped substantially. When stratified by infant birthweight and maternal smoking during pregnancy, the adjusted odds ratio wasnot altered.Conclusions: The current study identified a strong, positive associationbetween SHS and PPDS; however, future research should include usingobjective clinical tests or standardized scales to measure the exposure andoutcome variables. Future studies should also include measuring SHSexposure at work or other public places in addition to residential exposure.