Andrea L Deierlein
Andrea L. Deierlein
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Director of Public Health Nutrition
Associate Professor of Public Health Nutrition
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Professional overview
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Dr. Andrea Deierlein’s research focuses on examining how dietary, behavioral, and
environmental factors contribute to reproductive health outcomes and chronic-disease
development throughout the lifespan.Dr. Deierlein is trained as a nutritional epidemiologist. Much of her research has
examined predictors and outcomes of maternal metabolic health-related conditions during
pregnancy and the postpartum, specifically, excessive gestational weight gain,
hyperglycemia, and obesity. She contributed to a systematic evidence-based review
examining outcomes of weight gain during pregnancy at the Agency of Healthcare
Research and Quality. This review informed the development of the 2009 Institute of
Medicine Gestational Weight Gain Guidelines. Dr. Deierlein received the K99/R00
Pathway to Independence Award to expand her training to include the study of toxic
environmental chemicals and metals. She conducted research examining associations of
endocrine-disrupting toxicant exposures during childhood and changes in anthropometric
measurements through adolescence among girls. She also conducted a series of analyses
examining maternal prenatal exposures to phthalates with weight gain and biomarkers of
cardiometabolic health in women during pregnancy and throughout the postpartum.
Recently, Dr. Deierlein has expanded her research to include disability-related disparities
in nutrition and reproductive health. -
Education
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BS, Animal Science, Cornell University, Ithaca, NYMS, Health Nutrition, Columbia University, New York, NYMPH, Epidemiology, Columbia University, New York, NYPhD, Nutrition Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Honors and awards
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Travel Scholarship, Be Our Voice Childhood Obesity Prevention Advocacy Training, Robert Wood Johnson Foundation (2013)New York Academy of Sciences Education Fellowship (2012)Postdoctoral Fellowship in Pediatric Environmental Health, Icahn School of Medicine at Mount Sinai (2010)Travel Scholarship, Researching Women’s Environmental Health: Food, Nutrition, and Obesity, University of Rochester Medical Center (2010)Travel Scholarship, Childhood Obesity Symposium, University of Southern California (2010)
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Areas of research and study
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Environmental Public Health ServicesEpidemiologyMaternal and Child HealthNutritionWomen's Health
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Publications
Publications
Clinical interventions to increase vegetable intake in children
AbstractBeals, E., Deierlein, A., & Katzow, M. (n.d.).Publication year
2023Journal title
Current Opinion in PediatricsVolume
35Issue
1Page(s)
138-146AbstractPURPOSE OF REVIEW: Eating behaviors and dietary patterns begin in early childhood and persist into adolescence and adulthood, affecting lifelong acute and chronic disease risk. Vegetables provide a high density of necessary vitamins, minerals, and fiber. Dietary intake data show that children of all ages consume below the recommended range for vegetables. Pediatric providers are optimally positioned to promote vegetable intake in childhood. This review seeks to summarize lessons learned from behavioral interventions useful in the pediatric primary care setting to improve vegetable intake. RECENT FINDINGS: Ten published studies tested behavioral interventions in primary care to increase child vegetable intake. Strategies tested include teaching healthy eating behaviors and role modeling to parents of infants, and motivational interviewing paired with frequent office visits and reminders for families of older children and adolescents. Some strategies suggested positive change, despite study quality being limited by underpowered samples, heterogeneity of outcome measures, and statistical analytic approach. SUMMARY: Increased vegetable intake was achieved in infants through parental role-modeling when providers emphasized healthy dietary choices in parents. Older children increased their vegetable intake with motivational interviewing and frequent reminders from providers. Despite the high prevalence of inadequate vegetable intake among children, at present, there is only a modest body of literature to help guide pediatric providers in implementing practice-based interventions to improve vegetable intake in childhood, highlighting a need for high-quality research in this area.Concordance between Dash Diet and Hypertension: Results from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study
AbstractHussain, B. M., Deierlein, A. L., Kanaya, A. M., Talegawkar, S. A., O’Connor, J. A., Gadgil, M. D., Lin, Y., & Parekh, N. (n.d.).Publication year
2023Journal title
NutrientsVolume
15Issue
16AbstractHigh blood pressure is an important predictor of atherosclerotic cardiovascular disease (ASCVD), particularly among South Asians, who are at higher risk for ASCVD when compared to other population groups. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is established as the best proven nonpharmacological approach to preventing hypertension in adults. Using data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort, we calculated a DASH dietary score to examine the association between adherence to the DASH diet and its components, and prevalent and incident hypertension and systolic and diastolic blood pressure, after five years of follow-up. We found that the relative risk ratio (RRR) of incident hypertension was 67% lower among participants in the highest DASH diet score category (aRRR: 0.33; 95% CI: 0.13, 0.82; ptrend = 0.02) compared with those in the lowest DASH diet score category in fully adjusted models. These findings are consistent with previous clinical trials and large prospective cohort studies, adding to evidence that supports the diet-disease relationship established between DASH diet and hypertension. This study is the first to examine DASH diet adherence and hypertension among South Asian adults in the U.S.Diet quality, diet-related factors and disability status among male adults of reproductive age in the USA
AbstractDeierlein, A. L., Litvak, J., Liu, C., & Stein, C. R. (n.d.).Publication year
2023Journal title
Public Health NutritionVolume
26Issue
10Page(s)
1976-1985AbstractObjective: To examine diet quality and diet-related factors among male adults of reproductive age with and without disabilities. Design: Cross-sectional data from the National Health and Nutrition Examination Surveys, 2013-2018. Setting: Disability was reported as serious difficulty hearing, seeing, concentrating, walking, dressing and/or running errands due to physical, mental or emotional conditions. Diet quality was assessed by the Healthy Eating Index (HEI)-2015 and diet-related factors included self-rated diet healthfulness, food security and food assistance programmes. Multivariable linear regression estimated differences in HEI-2015 scores. Multivariable Poisson regression estimated adjusted prevalence ratios (aPR) and 95 % CI for diet-related factors. Participants: In total, 3249 males, 18-44 years; of whom, 441 (13·4 %) reported having disabilities. Results: Compared with males without disabilities, those with disabilities had a 2·69-point (95 % CI: -4·18, -1·20) lower mean total HEI-2015 score and approximately one-third to half of a point lower HEI-2015 component scores for greens and beans, total protein foods, seafood and plant proteins, fatty acids and added sugars. Males with any disabilities were more likely to have low food security (aPR = 1·57; 95 % CI: 1·28, 2·92); household participation in food assistance programmes (aPR = 1·61; 95 % CI: 1·34, 1·93) and consume fast food meals during the previous week (1-3 meals: aPR = 1·11; 95 % CI: 1·01-1·21 and 4 or more meals: aPR = 1·18; 95 % CI: 1·01-1·38) compared with males with no disabilities. Conclusions: Factors affecting diet and other modifiable health behaviours among male adults of reproductive age with disabilities require further investigation. Health promotion strategies that are adaptive to diverse populations within the disability community are needed.Dietary Quality and Diet-Related Factors Among Female Adults of Reproductive Age With and Without Disabilities Participating in the National Health and Nutrition Examination Surveys, 2013-2018
AbstractDeierlein, A. L., Litvak, J., & Stein, C. R. (n.d.).Publication year
2023Journal title
Journal of the Academy of Nutrition and DieteticsVolume
123Issue
2Page(s)
263-275AbstractBackground: Female adults of reproductive age (18 to 44 years) with disabilities have higher rates of health-risk behaviors and chronic conditions compared with their counterparts without disabilities; however, there is limited examination of diet. Objective: Our aim was to examine associations of self-reported disability status with diet quality and diet-related factors. Design: Cross-sectional data were from the National Health and Nutrition Examination Surveys, 2013-2018. Participants/setting: Female adults aged 18 through 44 years were included. Disability was defined as serious difficulty hearing, seeing, concentrating, walking, dressing, and/or running errands due to physical, mental, or emotional conditions. Main outcome measures: The Healthy Eating Index-2015 assessed diet quality. Diet-related factors included self-rated diet healthfulness, meal characteristics, food security, and food assistance programs. Statistical analysis: Multivariable linear regression estimated differences in Healthy Eating Index-2015 scores for a given day and multivariable Poisson regression estimated adjusted prevalence ratios and 95% CI of diet-related factors by disability status. Results: Of 3,579 female adults, 557 (16%) reported any disabilities, 207 (6%) of whom reported having 2 or more types of disabilities. Differences in mean Healthy Eating Index-2015 scores for a given day were one-third to one-half a point lower for fruits, total protein foods, and seafood and plant proteins among female adults with 2 or more types of disabilities compared with those without disabilities. Female adults with any disabilities were more likely to rate their diet as poor, have low food security, participate in food-assistance programs, and consume frozen foods or pizza, compared with those without disabilities (adjusted prevalence ratio ranged from 1.35 to 1.93); they were less likely to be the main food planner or preparer or shopper for their households. Conclusions: Some indicators of diet quality and diet-related factors differed between female adults with and without disabilities. Additional investigation of dietary intakes and behaviors, as well as access to and availability of healthy foods, among female adults with disabilities is necessary.Food Insecurity and Health Behaviors Among a Sample of Undergraduate Students at an Urban University
AbstractHussain, B. M., Ryan, R., Deierlein, A. L., Lal, S., Bihuniak, J. D., & Parekh, N. (n.d.).Publication year
2023Journal title
Journal of Hunger and Environmental NutritionVolume
18Issue
1Page(s)
65-80AbstractStudents at universities are experiencing food insecurity, which may be associated with health behaviors. In a pilot study to build a survey that assesses food insecurity and health behaviors among undergraduates, we distributed the survey before (Wave 1; fall 2019) and during (Wave 2; summer 2020) COVID-19. During Wave 1, 41% of students reported food insecurity and 61% met criteria for poor sleep. In Wave 2, 26% reported food insecurity and 49% met criteria for poor sleep. Students experiencing food insecurity were more likely to report poor sleep. This survey will inform recruitment and design of a scaled-up multi-campus study. (100/100 words).Prenatal Dietary Patterns and Associations With Weight-Related Pregnancy Outcomes in Hispanic Women With Low Incomes
AbstractBerube, L. T., Deierlein, A. L., Woolf, K., Messito, M. J., & Gross, R. S. (n.d.).Publication year
2023Journal title
Childhood ObesityAbstractBackground: Dietary patterns during pregnancy may contribute to gestational weight gain (GWG) and birthweight, but there is limited research studying these associations in racial and ethnic minority groups. The objective of this study was to evaluate associations between prenatal dietary patterns and measures of GWG and birthweight in a cohort of culturally diverse Hispanic women with low incomes. Methods: Data were analyzed from 500 mother-infant dyads enrolled in the Starting Early Program, a childhood obesity prevention trial. Diet over the previous year was assessed in the third trimester of pregnancy using an interviewer-administered food frequency questionnaire. Dietary patterns were constructed using the Healthy Eating Index-2015 (HEI-2015) and principal components analysis (PCA) and analyzed as tertiles. GWG and birthweight outcomes were abstracted from medical records. Associations between dietary pattern tertiles and outcomes were assessed by multivariable linear and multinomial logistic regression analyses. Results: Dietary patterns were not associated with measures of GWG or adequacy for gestational age. Greater adherence to the HEI-2015 and a PCA-derived dietary pattern characterized by nutrient-dense foods were associated with higher birthweight z-scores [β: 0.2; 95% confidence interval (CI): 0.04 to 0.4 and β: 0.3; 95% CI: 0.1 to 0.5, respectively], but in sex-specific analyses, these associations were only evident in male infants (β: 0.4; 95% CI: 0.03 to 0.7 and β: 0.3; 95% CI: 0.03 to 0.6, respectively). Conclusions: Among a cohort of culturally diverse Hispanic women, adherence to healthy dietary patterns during pregnancy was modestly positively associated with increased birthweight, with sex-specific associations evident only in male infants.Socioeconomic Characteristics, Lifestyle Behaviors, and Health Conditions Among Males of Reproductive Age With and Without Disabilities, NHANES 2013–2018
AbstractDeierlein, A. L., Sun, Y., Prado, G., & Stein, C. R. (n.d.).Publication year
2023Journal title
American Journal of Men's HealthVolume
17Issue
4AbstractHealth status during the reproductive years influences fecundity, fertility, and the future health of males and their offspring. There remains a dearth of literature examining men’s preconception health, especially among high-risk populations, such as those with disabilities. The objective of this study was to examine indicators of preconception health, including chronic medical conditions, lifestyle behaviors, and health care utilization, among males of reproductive age with and without disabilities in the United States. Data were from 3,702 males of reproductive age (18–44 years) who participated in the National Health and Nutrition Examination Surveys, 2013–2018. Approximately 14% of males reported having at least one disability related to vision, hearing, cognition, mobility, self-care, or independent living. Among all men, suboptimal preconception health indicators were prevalent including poor or fair self-rated health; low education and household income status; lack of health insurance and no recent utilization of health care and dental care; cigarette smoking; frequent alcohol consumption and binge drinking; marijuana and illegal drug use; obesity; low fruit and vegetable intake and no multi-vitamin use; low physical activity; short sleep durations; depressive symptoms; and hypertension and asthma. Compared to males with no disabilities, males with any disabilities were more likely to have suboptimal preconception health indicators. Strategies to promote and improve sexual health, preconception care, and family planning services among all men are needed. For males with disabilities, specifically, further investigation of their specific health needs related to sex, reproduction, family planning, and fatherhood, as well as interactions with health care providers, is required.Food Insecurity, Associated Health Behaviors, and Academic Performance Among Urban University Undergraduate Students
AbstractRyan, R. A., Murphy, B., Deierlein, A. L., Lal, S., Parekh, N., & Bihuniak, J. D. (n.d.).Publication year
2022Journal title
Journal of Nutrition Education and BehaviorVolume
54Issue
3Page(s)
269-275AbstractObjective: To explore associations between food insecurity, health behaviors, and academic performance among undergraduates at a private, urban US university. Methods: A cross-sectional web-based survey was conducted among a convenience sample of New York University undergraduates. Multivariable logistic regression estimated associations of food security (using the 6-item US Household Food Security Survey Module) and health behaviors (fruit/vegetable, beverage and alcohol intakes, and sleep), self-rated health, and academic performance. Results: Of the 257 students who completed the survey, 41% reported food insecurity. Food insecurity was associated with approximately 2-fold higher odds of sugar-sweetened beverage consumption (adjusted odds ratio, 1.97; 95% confidence interval, 1.14–3.41) and fair/poor health (adjusted odds ratio, 2.29; 95% confidence interval, 1.23–4.25). Conclusions and Implications: Increased awareness of food insecurity and associated health behaviors among students has implications for higher education's provision of on-campus food support programs.Personal Care and Household Cleaning Product Use among Pregnant Women and New Mothers during the COVID-19 Pandemic
AbstractDeierlein, A. L., Grayon, A. R., Zhu, X., Sun, Y., Liu, X., Kohlasch, K., & Stein, C. R. (n.d.).Publication year
2022Journal title
International journal of environmental research and public healthVolume
19Issue
9AbstractThis study examined product use among pregnant women and new mothers in New York City during the COVID-19 pandemic (July 2020–June 2021). Women reported use of personal care and household cleaning products within the previous month, changes in antibacterial product use, receipt of healthcare provider advice, and opinions on environmental chemicals (n = 320). On average, women used 15 personal care products and 7 household cleaning products. Non-Hispanic Black women used nearly two more personal care products; non-Hispanic Black women, those with a college degree, and essential workers used 1–3 more household cleaning products. Compared to non-Hispanic White women, those who were Hispanic or reported their race and ethnicity as Other were two times more likely to use antibacterial personal care products. Non-Hispanic Black, Hispanic, and women who reported their race and ethnicity as Other were 1.5 times more likely to increase antibacterial product use during the pandemic. Nearly all women agreed that environmental chemicals pose health risks and are impossible to avoid, while less than one quarter received advice regarding product use. Product use is a modifiable source of chemical exposures. Results from this study suggest that women may have increased their product use during the pandemic. Healthcare providers may use the current focus on health hygiene to promote discussion and assessment of environmental chemical exposures with patients.Preconception Health and Disability Status Among Women of Reproductive Age Participating in the National Health and Nutrition Examination Surveys, 2013-2018
AbstractDeierlein, A. L., Litvak, J., & Stein, C. R. (n.d.).Publication year
2022Journal title
Journal of Women's HealthVolume
31Issue
9Page(s)
1320-1333AbstractBackground: Preconception health is a critical determinant of health outcomes for women and their offspring. Given higher rates of prenatal and postpartum complications among women with disabilities, it is important to investigate a range of preconception health indicators in this population. Materials and Methods: Data were from women of reproductive age (18-44 years) who participated in the National Health and Nutrition Examination Surveys, 2013-2018. Disability was self-reported as serious difficulty hearing, seeing, concentrating, walking, dressing, and/or running errands due to physical, mental, or emotional conditions. Preconception health indicators were adapted from those developed by the Core State Preconception Health Indicators Working Group. Multivariable Poisson regression estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals of preconception health indicators among women with disabilities compared with those without disabilities. Results: Of 4055 women, 601 (15%, weighted) reported having any disabilities, and of these women, 220 (6%) reported having 2 or more types of disabilities. Women with any disabilities were more likely to have suboptimal preconception health indicators compared with women without disabilities, including low education and household income, no recent dental visit, difficulty getting pregnant, current smoking, binge drinking, drug use, obesity, no multivitamin use, physical inactivity, long sleep durations, asthma, hypertension, and sexually transmitted infections (aPRs from 1.1 to 2.0). The greatest disparities between women with and without disabilities were for indicators of self-rated poor or fair general health, depression, and diabetes, with aPRs ranging from 2.4 to 3.8. Conclusions: Disparities in preconception health indicators are modifiable and may be addressed through adequate access to health care, interventions targeting lifestyle and health behaviors, and education and training for all health practitioners.Prenatal maternal phthalate exposures and trajectories of childhood adiposity from four to twelve years
AbstractKupsco, A., Wu, H., Calafat, A. M., Kioumourtzoglou, M. A., Cantoral, A., Tamayo-Ortiz, M., Pantic, I., Pizano-Zárate, M. L., Oken, E., Braun, J. M., Deierlein, A. L., Wright, R. O., Téllez-Rojo, M. M., Baccarelli, A. A., & Just, A. C. (n.d.).Publication year
2022Journal title
Environmental ResearchVolume
204AbstractBackground/Aim: Adiposity trajectories reflect dynamic process of growth and may predict later life health better than individual measures. Prenatal phthalate exposures may program later childhood adiposity, but findings from studies examining these associations are conflicting. We investigated associations between phthalate biomarker concentrations during pregnancy with child adiposity trajectories. Methods: We followed 514 mother-child pairs from the Mexico City PROGRESS cohort from pregnancy through twelve years. We measured concentrations of nine phthalate biomarkers in 2nd and 3rd trimester maternal urine samples to create a pregnancy average using the geometric mean. We measured child BMI z-score, fat mass index (FMI), and waist-to-height ratio (WHtR) at three study visits between four and 12 years of age. We identified adiposity trajectories using multivariate latent class growth modeling, considering BMI z-score, FMI, and WHtR as joint indicators of latent adiposity. We estimated associations of phthalates biomarkers with class membership using multinomial logistic regression. We used quantile g-computation to estimate the potential effect of the total phthalate mixture and assessed effect modification by sex. Results: We identified three trajectories of child adiposity, a “low-stable”, a “low-high”, and a “high-high” group. A doubling of the sum of di (2-ethylhexyl) phthalate metabolites (ΣDEHP), was associated with 1.53 (1.08, 2.19) greater odds of being in the “high-high” trajectory in comparison to the “low-stable” group, whereas a doubling in di-isononyl phthalate metabolites (ΣDiNP) was associated with 1.43 (1.02, 2.02) greater odds of being in the “low-high” trajectory and mono (carboxy-isononyl) phthalate (MCNP) was associated with 0.66 (0.45, 97) lower odds of being in the “low-high” trajectory. No sex-specific associations or mixture associations were observed. Conclusions: Prenatal concentrations of urinary DEHP metabolites, DiNP metabolites, and MCNP, a di-isodecyl phthalate metabolite, were associated with trajectories of child adiposity. The total phthalate mixture was not associated with early life child adiposity.Prenatal phthalates, gestational weight gain, and long-term weight changes among Mexican women
AbstractDeierlein, A. L., Wu, H., Just, A. C., Kupsco, A. J., Braun, J. M., Oken, E., Soria-Contreras, D. C., Cantoral, A., Pizano, M. L., McRae, N., Téllez-Rojo, M. M., Wright, R. O., & Baccarelli, A. A. (n.d.).Publication year
2022Journal title
Environmental ResearchVolume
209AbstractBackground: Phthalates are endocrine disrupting chemicals that may influence weight status; however, few studies have considered weight gain during pregnancy and subsequent long-term weight changes in women. Objective: To determine associations of prenatal phthalate exposure with maternal weight during pregnancy and through up to seven years post-delivery. Methods: We analyzed 15 urinary phthalate biomarker concentrations during the 2nd and 3rd trimesters among 874 pregnant women enrolled in the Programming Research in Obesity, Growth Environment and Social Stress Study in Mexico City. We examined three time-specific maternal weight outcomes: gestational weight gain (between 2nd and 3rd trimesters), short-term weight (between 3rd trimester and 12 months post-delivery), and long-term weight (between 18 months and 6–7 years post-delivery). We used Bayesian Kernel Machine Regression (BKMR) to estimate associations for the total phthalate mixture, as well as multivariable linear mixed models for individual phthalate biomarkers. Results: As a mixture, 2nd trimester urinary phthalate biomarker concentrations were associated with somewhat lower gestational weight gain between the 2nd and 3rd trimesters (interquartile range, IQR, difference: −0.07 standard deviations, SD; 95% credible interval, CrI: −0.20, 0.06); multivariable regression and BKMR models indicated that this inverse association was primarily driven by mono-2-ethyl-5-carboxypentyl terephthalate (MECPTP). Prenatal (2nd and 3rd trimesters) urinary phthalate mixture concentrations were positively associated with maternal weight change through 12 months postpartum (IQR difference: 0.11 SD; 95% CrI: 0.00, 0.23); these associations persisted from 18 months to 6–7 years follow-up (IQR difference: 0.07 SD; 95% CrI: 0.04, 0.10). Postpartum weight changes were associated with mono-3-carboxypropyl phthalate (MCPP) and MECPTP. Conclusions: Prenatal phthalate exposure was inversely associated with gestational weight gain and positively associated with long-term changes in maternal weight. Further investigation is required to understand how phthalates may influence body composition and whether they contribute to the development of obesity and other cardiometabolic diseases in women.Ultra-processed Foods and Cardiometabolic Health Outcomes: from Evidence to Practice
AbstractJuul, F., Deierlein, A. L., Vaidean, G., Quatromoni, P. A., & Parekh, N. (n.d.).Publication year
2022Journal title
Current atherosclerosis reportsVolume
24Issue
11Page(s)
849-860AbstractPurpose of Review: Poor diet quality is the leading risk factor related to the overall cardiometabolic disease burden in the USA and globally. We review the current evidence linking ultra-processed foods and cardiometabolic health risk and provide recommendations for action at the clinical and public health levels. Recent Findings: A growing body of evidence conducted in a variety of study populations supports an association between ultra-processed food intake and increased risk of metabolic syndrome, hypertension, type 2 diabetes, overweight and obesity trajectories, and cardiovascular disease. The strongest evidence is observed in relation to weight gain and obesity among adults, as this association is supported by high-quality epidemiological and experimental evidence. Summary: Accumulating epidemiologic evidence and putative biological mechanisms link ultra-processed foods to cardiometabolic health outcomes. The high intake of ultra-processed foods in all population groups and its associated risks make ultra-processed foods an ideal target for intensive health promotion messaging and interventions.Weight gain trajectories patterns from pregnancy to early postpartum: identifying women at risk and timing to prevent weight regain
AbstractMuñoz-Manrique, C., Trejo-Valdivia, B., Hernández-Cordero, S., Cantoral, A., Deierlein, A. L., Colicino, E., Niedzwiecki, M. M., Wright, R. O., Baccarelli, A. A., & Téllez-Rojo, M. M. (n.d.).Publication year
2022Journal title
BMC Pregnancy and ChildbirthVolume
22Issue
1AbstractBackground: Woman's weight changes during pregnancy and postpartum contribute to obesity and health outcomes later in life. This study aimed to identify and characterize weight change trajectories from pregnancy to one year postpartum among adult women. Methods: We used data from an ongoing cohort of healthy adult women (n = 819) with singleton pregnancies from 2007 – 2011. Sociodemographic data, pre-pregnancy body weight, and sedentary and breastfeeding practices were collected using questionaries applied by trained professionals. We applied a group-based trajectory modeling to distinguish weight change measured in the second and third trimesters of pregnancy and at one month, six, and 12 months postpartum. Multinomial regression models were run to characterize each trajectory. Results: We identified six weight change trajectories with the main difference in the patterns followed after one month of delivery. One in three women (36.7%) was classified in some of the three postpartum weight gain trajectories and regained weight from the second trimester of the first year postpartum. Women who followed some of these trajectories were more likely to have higher age, obesity before pregnancy, < 10 years of schooling, and partner, compared with women (10.7%, n = 87) in a postpartum sustained-fast-lost-weight trajectory (p < 0.05). Conclusions: Women with obesity before pregnancy have higher odds of regaining gestational weight after delivery without reaching their pre-pregnancy weight. The first six months postpartum are crucial to establishing obesity prevention strategies. Further research is needed to evaluate the effect of the interventions that prevent substantial weight gain through reproductive years in high-risk women.Dietary Quality and Sociodemographic and Health Behavior Characteristics Among Pregnant Women Participating in the New York University Children's Health and Environment Study
AbstractDeierlein, A. L., Ghassabian, A., Kahn, L. G., Afanasyeva, Y., Mehta-Lee, S. S., Brubaker, S. G., & Trasande, L. (n.d.).Publication year
2021Journal title
Frontiers in NutritionVolume
8AbstractMaternal diet, prior to and during pregnancy, plays an important role in the immediate and long-term health of the mother and her offspring. Our objectives were to assess diet quality among a large, diverse, urban cohort of pregnant women, and examine associations with sociodemographic and health behavior characteristics. Data were from 1,325 pregnant women enrolled in New York University Children's Health and Environment Study (NYU CHES). Diet quality was assessed using the Healthy Eating Index (HEI)-2015. Mean total HEI-2015 score was 74.9 (SD = 8.5); 376 (28%), 612 (46%), 263 (20%), and 74 (6%) of women had scores that fell into the grade range of A/B, C, D, and F, respectively. Mean HEI-2015 component scores were high for fruit and whole grains and low for protein-related, sodium, and fat-related components. In multivariable linear regression models, Hispanic women scored 1.65 points higher on the total HEI-2015 (95% CI: 0.21, 3.10) compared to non-Hispanic White women, while younger age (<30 years), parity, single status, pre-pregnancy obesity, smoking, pre-existing hypertension, moderate/severe depressive symptoms, not meeting physical activity recommendations, and not taking a vitamin before pregnancy were associated with ~1.5–5-point lower mean total HEI-2015 scores. Diet is a modifiable behavior; our results suggest a continued need for pre-conceptional and prenatal nutritional counseling.Maternal Phthalates Exposure and Blood Pressure during and after Pregnancy in the PROGRESS Study
AbstractWu, H., Kupsco, A., Just, A., Calafat, A. M., Oken, E., Braun, J. M., Sanders, A. P., Mercado-Garcia, A., Cantoral, A., Pantic, I., Téllez-Rojo, M. M., Wright, R. O., Baccarelli, A. A., & Deierlein, A. L. (n.d.).Publication year
2021Journal title
Environmental health perspectivesVolume
129Issue
12AbstractBACKGROUND: Phthalate exposure is ubiquitous and may affect biological pathways related to regulators of blood pressure. Given the profound changes in vasculature during pregnancy, pregnant women may be particularly susceptible to the potential effects of phthalates on blood pressure. OBJECTIVES: We examined associations of phthalate exposure during pregnancy with maternal blood pressure trajectories from mid-pregnancy through 72 months postpartum. METHODS: Women with singleton pregnancies delivering a live birth in Mexico City were enrolled during the second trimester (n = 892). Spot urine samples from the second and third trimesters were analyzed for 15 phthalate metabolites. Blood pressure and covariate data were collected over nine visits through 72 months postpartum. We used linear, logistic, and linear mixed models; latent class growth models (LCGMs); and Bayesian kernel machine regression to estimate the relationship of urinary phthalate biomarkers with maternal blood pressure. RESULTS: As a joint mixture, phthalate biomarker concentrations during pregnancy were associated with higher blood pressure rise during mid-to-late gestation. With respect to individual biomarkers, second trimester concentrations of monobenzyl phthalate (MBzP) and di(2-ethylhexyl) phthalate bio-markers (∑DEHP) were associated with higher third trimester blood pressure. Two trajectory classes were identified by LCGM, characterized by increasing blood pressure through 72 months postpartum (“increase–increase”) or decreased blood pressure through 18 months postpartum with a gradual increase thereafter (“decrease–increase”). Increasing exposure to phthalate mixtures during pregnancy was associated with higher odds of being in the increase–increase class. Similar associations were observed for mono-2-ethyl-5-carboxypentyl terephthalate (MECPTP) and dibutyl phthalate (∑DBP) biomarkers. When specific time periods were examined, we observed specific temporal relationships were observed for ∑DEHP, MECPTP, MBzP, and ∑DBP. DISCUSSION: In our cohort of pregnant women from Mexico City, exposure to phthalates and phthalate biomarkers was associated with higher blood pressure during late pregnancy, as well as with long-term changes in blood pressure trajectories.Pregnancy-related outcomes among women with physical disabilities: A systematic review
AbstractDeierlein, A. L., Antoniak, K., Chan, M., Sassano, C., & Stein, C. R. (n.d.).Publication year
2021Journal title
Paediatric and Perinatal EpidemiologyVolume
35Issue
6Page(s)
758-778AbstractBackground: Disability among women of reproductive age is common; many of these women desire children and do not have impaired fertility. Objectives: To examine the epidemiological literature on perinatal health outcomes among women with physical disabilities. Data sources: We searched Medline and CINAHL for articles published January 2009–April 2020 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study selection and data extraction: Eligible studies were observational, quantitative, and reported on physical disabilities in association with prenatal, perinatal, postpartum, and/or infant health outcomes. We included studies that grouped physical and non-physical disabilities, such as surveys that queried only about general daily life limitations. We excluded case reports, descriptive studies without comparison groups, and studies conducted in low- or middle-income countries. Data extraction was done using predefined data fields. Synthesis: All authors were involved in screening activities, data extraction, and/or quality assessment (rating and areas for bias). Results: A total of 2650 articles were evaluated, of which sixteen met inclusion criteria (8 cross-sectional studies and 8 retrospective cohort studies). Assessments of disability status and perinatal outcomes widely varied across studies. Studies were rated as poor (n = 8) or fair quality (n = 8). Findings suggested that women with physical disabilities were at risk of several adverse outcomes, including caesarean delivery, infections, preterm complications, and maternal post-delivery hospitalisations, while their infants may be at risk of low birthweight and small-for-gestational age. Women classified as having complex/severe disabilities were often observed to be at higher risk of adverse outcomes compared to women with less severe disabilities. Conclusions: Research assessing how physical, functional, and medical restrictions influence health outcomes among women with physical disabilities, from preconception through postpartum, is limited. Longitudinal studies with comprehensive data collection that accurately identify women with physical disabilities are critical to understanding their reproductive health risks and outcomes.Prenatal maternal phthalate exposures and child lipid and adipokine levels at age six: A study from the PROGRESS cohort of Mexico City
AbstractKupsco, A., Wu, H., Calafat, A. M., Kioumourtzoglou, M. A., Tamayo-Ortiz, M., Pantic, I., Cantoral, A., Tolentino, M., Oken, E., Braun, J. M., Deierlein, A. L., Wright, R. O., Téllez-Rojo, M. M., Baccarelli, A. A., & Just, A. C. (n.d.).Publication year
2021Journal title
Environmental ResearchVolume
192AbstractBackground: Prenatal phthalate exposures may affect processes that underlie offspring cardiometabolic health, but findings from studies examining these associations are conflicting. We examined associations between biomarkers of phthalate exposures during pregnancy with child lipid and adipokine levels. Methods: Data were from 463 mother-child pairs in the PROGRESS cohort of Mexico City. We quantified 15 phthalate metabolites in 2nd and 3rd trimester maternal urine samples and created an average pregnancy measure using the geometric mean. We evaluated the 15 metabolites as nine biomarkers, including four metabolite molar sums. We measured fasting serum triglycerides, non-HDL cholesterol, leptin, and adiponectin in children at the six-year follow-up visit (mean = 6.8 years). We estimated associations using linear regression, Bayesian kernel machine regression (BKMR), and weighted quantile sum (WQS) and assessed effect modification by sex. Results: In BKMR and WQS models, higher concentrations of the total mixture of phthalate biomarkers were associated with lower triglycerides (β = −3.7% [-6.5, −0.78] per 1 unit increase in WQS biomarker index) and non-HDL cholesterol (β = −2.0 [-3.7, −0.25] ng/ml per increase in WQS biomarker index). Associations between individual biomarkers and child outcomes were largely null. We observed some evidence of effect modification by child sex for mono-3-carboxypropyl phthalate (β = 19.4% [1.26, 40.7] per doubling of phthalate) and monobenzyl phthalate (β = −7.6% [-14.4, -0.23]) in girls for adiponectin. Conclusions: Individual prenatal phthalate biomarkers were not associated with child lipid or adipokine levels. Contrary to our hypothesis, the total phthalate mixture was associated with lower child triglycerides and non-HDL cholesterol.Prenatal urinary concentrations of phthalate metabolites and behavioral problems in Mexican children: The Programming Research in Obesity, Growth Environment and Social Stress (PROGRESS) study
AbstractColicino, E., De Water, E., Just, A. C., Navarro, E., Pedretti, N. F., McRae, N., Braun, J. M., Schnaas, L., Rodríguez-Carmona, Y., Hernández, C., Tamayo-Ortiz, M., Téllez-Rojo, M. M., Deierlein, A. L., Calafat, A. M., Baccarelli, A., Wright, R. O., & Horton, M. K. (n.d.).Publication year
2021Journal title
Environmental ResearchVolume
201AbstractBackground: Phthalate exposure has been associated with increased childhood behavioral problems. Existing studies failed to include phthalate replacements and did not account for high correlations among phthalates. Phthalates’ exposure is higher in Mexico than in U.S. locations, making it an ideal target population for this study. Aim: To examine associations between 15 maternal prenatal phthalate metabolite concentrations and children's behavioral problems. Methods: We quantified phthalate metabolites in maternal urine samples from maternal-child dyads (n = 514) enrolled in the Programming Research in Obesity, Growth Environment and Social Stress (PROGRESS) birth cohort in Mexico City. We performed least absolute shrinkage and selection operator (LASSO) regressions to identify associations between specific-gravity adjusted log2-transformed phthalate metabolites and parent-reported 4–6 year old behavior on the Behavior Assessment System for Children (BASC-2), accounting for metabolite correlations. We adjusted for socio-demographic and birth-related factors, and examined associations stratified by sex. Results: Higher prenatal mono-2-ethyl-5-carboxypentyl terephthalate (MECPTP) urinary concentrations were associated with increased hyperactivity scores in the overall sample (β = 0.57, 95% CI = 0.17, 1.13) and in girls (β = 0.54, 95% CI = 0.16, 1.08), overall behavioral problems in boys (β = 0.58, 95% CI = 0.20, 1.15), and depression scores in boys (β = 0.44, 95% CI = 0.06, 0.88). Higher prenatal monobenzyl phthalate (MBzP) concentrations were associated with reduced hyperactivity scores in girls (ß = −0.54, 95% CI = −1.08, −0.21). Discussion: Our findings suggested that prenatal concentrations of phthalates and their replacements altered child neurodevelopment and those associations may be influenced sex.The associations of phthalate biomarkers during pregnancy with later glycemia and lipid profiles
AbstractWu, H., Just, A. C., Colicino, E., Calafat, A. M., Oken, E., Braun, J. M., McRae, N., Cantoral, A., Pantic, I., Pizano-Zárate, M. L., Tolentino, M. C., Wright, R. O., Téllez-Rojo, M. M., Baccarelli, A. A., & Deierlein, A. L. (n.d.).Publication year
2021Journal title
Environment internationalVolume
155AbstractBackground: Pregnancy induces numerous cardiovascular and metabolic changes. Alterations in these sensitive processes may precipitate long-term post-delivery health consequences. Studies have reported associations between phthalates and metabolic complications of pregnancy, but no study has investigated metabolic outcomes beyond pregnancy. Objectives: To examine associations of exposure to phthalates during pregnancy with post-delivery metabolic health. Design: We quantified 15 urinary phthalate biomarker concentrations during the second and third trimesters among 618 pregnant women from Mexico City. Maternal metabolic health biomarkers included fasting blood measures of glycemia [glucose, insulin, Homeostatic Model Assessment of Insulin Resistance [HOMA-IR], % hemoglobin A1c (HbA1c%)] and lipids (total, high-density lipoprotein (HDL), low-density lipoprotein (LDL) cholesterol, triglycerides), at 4–5 and 6–8 years post-delivery. To estimate the influence of the phthalates mixture, we used Bayesian weighted quantile sum regression and Bayesian kernel machine regression; for individual biomarkers, we used linear mixed models. Results: As a mixture, higher urinary phthalate biomarker concentrations during pregnancy were associated with post-delivery concentrations of plasma glucose (interquartile range [IQR] difference: 0.13 SD, 95%CrI: 0.05, 0.20), plasma insulin (IQR difference: 0.06 SD, 95%CrI: −0.02, 0.14), HOMA-IR (IQR difference: 0.08 SD, 95% CrI: 0.01, 0.16), and HbA1c% (IQR difference: 0.15 SD, 95%CrI: 0.05, 0.24). Associations were primarily driven by mono-2-ethyl-5-carboxypentyl terephthalate (MECPTP) and the sum of dibutyl phthalate biomarkers (∑DBP). The phthalates mixture was associated with lower HDL (IQR difference: −0.08 SD, 95%CrI: −0.16, −0.01), driven by ∑DBP and monoethyl phthalate (MEP), and higher triglyceride levels (IQR difference: 0.15 SD, 95%CrI: 0.08, 0.22), driven by MECPTP and MEP. The overall mixture was not associated with total cholesterol and LDL. However, ∑DBP and MEP were associated with lower and higher total cholesterol, respectively, and MECPTP and ∑DBP were associated with lower LDL. Conclusions: Phthalate exposure during pregnancy is associated with adverse long-term changes in maternal metabolic health. A better understanding of timing of the exact biological changes and their implications on metabolic disease risk is needed.Trends in food consumption by degree of processing and diet quality over 17 years: Results from the Framingham Offspring Study
AbstractJuul, F., Lin, Y., Deierlein, A. L., Vaidean, G., & Parekh, N. (n.d.).Publication year
2021Journal title
British Journal of NutritionVolume
126Issue
12Page(s)
1861-1871AbstractUltraprocessed foods provide the majority of energy content in the American diet, yet little is known regarding consumption trends over time. We determined trends in diet processing level and diet quality from 1991 to 2008 within the prospective Framingham Offspring Cohort. Dietary intakes were collected by FFQ quadrennially 1991-2008 (total of four examinations). The analytical sample included 2893 adults with valid dietary data for ≥3 examinations (baseline mean age = 54 years). Based on the NOVA framework, we classified foods as: unprocessed/minimally processed foods; processed culinary ingredients (salt/sugar/fats/oils); and processed foods and ultraprocessed foods. We evaluated diet quality using the Dietary Guidelines for Americans Adherence Index (DGAI) 2010. Trends in consumption of foods within each processing level (servings/d) and diet quality over the four examinations were evaluated using mixed effects models with subject-specific random intercepts. Analyses were stratified by sex, BMI (<25 kg/m2, 25-29·9 kg/m2, ≥30 kg/m2) and smoking status. Over 17 years of follow-up, ultraprocessed food consumption decreased from 7·5 to 6·0 servings/d and minimally processed food consumption decreased from 11·9 to 11·3 servings/d (Ptrend < 0·001). Changes in intakes of processed foods, culinary ingredients and culinary preparations were minimal. Trends were similar by sex, BMI and smoking status. DGAI-2010 score increased from 60·1 to 61·5, P < 0·001. The current study uniquely describes trends in diet processing level in an ageing US population, highlighting the longstanding presence of ultraprocessed foods in the American diet. Given the poor nutritional quality of ultraprocessed foods, public health efforts should be designed to limit their consumption.Ultra-Processed Foods and Incident Cardiovascular Disease in the Framingham Offspring Study
AbstractJuul, F., Vaidean, G., Lin, Y., Deierlein, A. L., & Parekh, N. (n.d.).Publication year
2021Journal title
Journal of the American College of CardiologyVolume
77Issue
12Page(s)
1520-1531AbstractBackground: Ultra-processed foods provide 58% of total energy in the U.S. diet, yet their association with cardiovascular disease (CVD) remains understudied. Objectives: The authors investigated the associations between ultra-processed foods and CVD incidence and mortality in the prospective Framingham Offspring Cohort. Methods: The analytical sample included 3,003 adults free from CVD with valid dietary data at baseline. Data on diet, measured by food frequency questionnaire, anthropometric measures, and sociodemographic and lifestyle factors were collected quadrennially from 1991 to 2008. Data regarding CVD incidence and mortality were available until 2014 and 2017, respectively. Ultra-processed foods were defined according to the NOVA framework. The authors used Cox proportional hazards models to determine the multivariable association between ultra-processed food intake (energy-adjusted servings per day) and incident hard CVD, hard coronary heart disease (CHD), overall CVD, and CVD mortality. Multivariable models were adjusted for age, sex, education, alcohol consumption, smoking, and physical activity. Results: During follow-up (1991 to 2014/2017), the authors identified 251, 163, and 648 cases of incident hard CVD, hard CHD, and overall CVD, respectively. On average, participants consumed 7.5 servings per day of ultra-processed foods at baseline. Each additional daily serving of ultra-processed foods was associated with a 7% (95% confidence interval [CI]: 1.03 to 1.12), 9% (95% CI: 1.04 to 1.15), 5% (95% CI: 1.02 to 1.08), and 9% (95% CI: 1.02 to 1.16) increase in the risk of hard CVD, hard CHD, overall CVD, and CVD mortality, respectively. Conclusions: The current findings support that higher consumption of ultra-processed foods is associated with increased risk of CVD incidence and mortality. Although additional research in ethnically diverse populations is warranted, these findings suggest cardiovascular benefits of limiting ultra-processed foods.Early-life dietary cadmium exposure and kidney function in 9-year-old children from the progress cohort
AbstractRodríguez-López, E., Tamayo-Ortiz, M., Ariza, A. C., Ortiz-Panozo, E., Deierlein, A. L., Pantic, I., Tolentino, M. C., Estrada-Gutiérrez, G., Parra-Hernández, S., Espejel-Núñez, A., Téllez-Rojo, M. M., Wright, R. O., & Sanders, A. P. (n.d.).Publication year
2020Journal title
ToxicsVolume
8Issue
4Page(s)
1-11AbstractCadmium (Cd) is a toxic metal associated with adverse health effects, including kidney injury or disease. The aims of this study were to estimate dietary Cd exposure during childhood, and to evaluate the association of early-life dietary Cd with biomarkers of glomerular kidney function in 9-year-old Mexican children. Our study included 601 children from the Programming Research in Obesity, Growth, Environment and Social Stressors (PROGRESS) cohort with up to five follow-up food frequency questionnaires from 1 to 9 years of age; and 480 children with measures of serum creatinine, cystatin C, and blood nitrogen urea (BUN), as well as 9-year-old estimated glomerular filtration rate. Dietary Cd was estimated through food composition tables. Multiple linear regression models were used to analyze the association between 1 and 9 years, cumulative dietary Cd, and each kidney parameter. Dietary Cd exposure increased with age and exceeded the tolerable weekly intake (TWI = 2.5 µg/kg body weight) by 16-64% at all ages. Early-life dietary Cd exposure was above the TWI and we observed inverse associations between dietary Cd exposure and kidney function parameters. Additional studies are needed to assess kidney function trajectories through adolescence. Identifying preventable risk factors including environmental exposures in early life can contribute to decreasing the incidence of adult kidney disease.Exposures to phthalates and bisphenols in pregnancy and postpartum weight gain in a population-based longitudinal birth cohort
AbstractPhilips, E. M., Jaddoe, V. W., Deierlein, A., Asimakopoulos, A. G., Kannan, K., Steegers, E. A., & Trasande, L. (n.d.).Publication year
2020Journal title
Environment internationalVolume
144AbstractBackground: Experimental evidence suggests that exposures to phthalates and bisphenols may interfere with processes related to glucose and lipid metabolism, insulin sensitivity, and body weight. Few studies have considered the possible influence of chemical exposures during pregnancy on maternal weight gain or metabolic health outcomes postpartum. Objective: To examine the associations of early and mid-pregnancy bisphenol and phthalate urine concentrations with maternal weight gain 6 years postpartum. Methods: We analyzed urine samples for bisphenol, phthalate and creatinine concentrations from early and mid-pregnancy in 1192 women in a large, population-based birth cohort in Rotterdam, the Netherlands, and examined postpartum weight gain using maternal anthropometrics before pregnancy and 6 years postpartum. We have used covariate-adjusted linear regressions to evaluate associations of early and mid-pregnancy bisphenols and phthalate metabolites with weight change. Mediator and interaction models have been used to assess the role of gestational weight gain and breastfeeding, respectively. Sensitivity analysis is performed among women without subsequent pregnancies. Results: Among all 1192 mothers included in the analysis, each log unit increase in the average bisphenol A and all assessed phthalate groupings were associated with increased maternal weight gain. As a proxy for phthalate exposure, each log unit increase in averaged phthalic acid was associated with 734 g weight gain (95% CI 273–1196 g) between pre-pregnancy and 6 years postpartum. Mediation by gestational weight gain was not present. Breastfeeding and ethnicity did not modify the effects. Stratification revealed these associations to be strongest among overweight and obese women. Among women without subsequent pregnancies (n = 373) associations of bisphenols, HMW phthalate metabolites and di-2-ethylhexylphthalate metabolites attenuated. For phthalic acid, LMW phthalate metabolites and di-n-octylphthalate metabolites associations increased. Similarly to the whole group, stratification yielded significant results among overweight and obese women. Discussion: In a large population-based birth cohort, early and mid-pregnancy phthalate exposures are associated with weight gain 6 years postpartum, particularly among overweight and obese women. These data support ongoing action to replace phthalates with safer alternatives.Food assistance programs and income are associated with the diet quality of grocery purchases for households consisting of women of reproductive age or young children
AbstractLitvak, J., Parekh, N., Juul, F., & Deierlein, A. (n.d.).Publication year
2020Journal title
Preventive MedicineVolume
138AbstractWomen's diet quality during reproductive years and children's diet quality during early life influence long term health. Few studies have evaluated the impact of food assistance programs and income on the diet quality of grocery purchases made by households consisting of women of reproductive age and young children. We used data from the Food Acquisition and Purchase Survey 2012–2013 (FoodAPS) to evaluate how household income, Special Supplemental Nutrition Assistance Program for Women, Infants and Children (WIC) participation, and Supplemental Nutrition Assistance Program (SNAP) participation are related to the diet quality of grocery purchases made by households that include women of reproductive age or young children (n = 2436). The diet quality of household grocery purchases was assessed with the Healthy Eating Index (HEI) 2015. HEI-2015 total score (0−100) and component scores were evaluated according to household income (eligible for WIC: income-to-poverty ratio ≤ 185%; ineligible for WIC: income-to-poverty ratio > 185%) and WIC, SNAP, and WIC + SNAP participation. Median HEI-2015 total score was lowest among SNAP households and highest among income ineligible for WIC and WIC households (47.2 and 54.1, respectively). Compared to income ineligible for WIC households, WIC + SNAP and SNAP households had lower HEI-2015 whole fruit (β = −0.30, 95% CI: −0.59, −0.01 and β = −0.41, 95% CI: −0.63, −0.20, respectively) and total vegetable scores (β = −0.58, 95% CI: −0.83, −0.32 and β = −0.27, 95% CI: −0.45, −0.08, respectively). The diet quality of grocery purchases in this population varies according to household income and food assistance participation.