Introduction
Growth and physical development |
Fetal growth patterns and organ development |
Pregnancy complications |
Postnatal growth patterns |
Body composition and obesity |
Risk factors for development of cardiovascular disease |
Risk factors for type 2 diabetes |
Behavioural and cognitive development |
Fetal and postnatal brain development |
Behavioural and emotional problems |
Child psychopathology |
Neuromotor development |
Verbal and nonverbal cognitive development |
Neuropsychology—executive function |
Chronic pain |
Attachment |
Stress reactivity |
Compliance and moral development |
Diseases in childhood |
Infectious diseases in childhood |
Bacterial carriage |
Abdominal symptoms and celiac disease |
Development of the immune system |
Asthma, eczema and related symptoms |
Paroxysmal neurological disorders |
Febrile seizures |
Tooth development |
Health and healthcare |
Social en ethnic health inequalities |
Quality of life |
Health care utilization |
Effectiveness of screening programmes |
Biological determinants |
Parental anthropometrics and blood pressure |
Fetal and postnatal growth characteristics |
Endocrine and immunological factors |
Genetic variants/genome wide association scan |
Environmental determinants |
Maternal prenatal diet and childhood diet, and their biomarkers |
Parental life style habits (including smoking, alcohol consumption) |
Air pollution |
Housing conditions |
Home environment |
Social determinants |
Parental education, employment status and household income |
Parental marital status |
Parental psychopathology |
Ethnicity |
Study area
Study design
Overview
Early pregnancy | Mid-pregnancy | Late pregnancy | Birth | |
---|---|---|---|---|
Mother | ||||
Physical examination | + | + | + | |
Questionnaire | + | + | + | |
Interview | S | |||
Fetal ultrasound examination | + | + | + | |
Detailed fetal ultrasound | S | |||
Blood sample | + | + | ||
Urine sample | + | + | + | |
Father | ||||
Physical examination | + | |||
Questionnaire | + | |||
Interview | ||||
Blood sample | + | |||
Child | ||||
Physical examination | + | |||
Cord blood | + |
Age (months) | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
2 | 3 | 4 | 6 | 11 | 12 | 14 | 18 | 24 | 30 | 36 | 45 | 48 | |
Child | |||||||||||||
Questionnaire (parent) | + | + | + | + | + | + | + | + | |||||
Physical examination | + | + | + | + | + | + | + | + | + | ||||
Ultrasound | S | S | S | ||||||||||
Airway inflammation | S | S | |||||||||||
Behavioural observation | S | S | S | ||||||||||
Bacterial carriage | S | S | S | S | |||||||||
Blood sample | S | S | |||||||||||
Mother specific | |||||||||||||
Questionnaire | + | + | + | S | |||||||||
Interaction with child | S | S | |||||||||||
Father specific | |||||||||||||
Questionnaire | + | ||||||||||||
Interaction with child | S |
Eligibility and enrolment
Study cohort
Parents
Mothers | Partners | |
---|---|---|
(n = 9,778) | (n = 6,347) | |
Gestational age at enrolment (%) | ||
Early pregnancy | 69 | – |
Mid-pregnancy | 19 | – |
Late pregnancy | 3 | – |
Birth | 9 | – |
Pregnancy number in study (%) | ||
1st pregnancy | 94 | – |
2nd pregnancy | 6 | – |
3rd pregnancy | 0.1 | – |
Age at enrolment (years)a
| 29.9 (5.4) | 32.7 (5.7) |
Parity (%) | ||
0 | 55 | – |
1 | 30 | – |
≥2 | 15 | – |
Ethnicity (%) | ||
Dutch, other-European | 59 | 68 |
Surinamese | 9 | 7 |
Moroccan | 6 | 4 |
Turkish | 9 | 7 |
Dutch Antilles | 3 | 3 |
Cape verdian | 4 | 2 |
Others | 10 | 9 |
Highest completed education (%) | ||
Primary school | 11 | 8 |
Intermediate | 46 | 41 |
Higher | 43 | 51 |
Children at birth and overall response
Participation in postnatal follow up studies
Data collection in the prenatal phase
Physical examinations
Questionnaires
-
Mother 1: medical and family history, previous pregnancies, quality of life, life style habits, housing conditions, ethnicity, educational level;
-
Mother 2: diet, including macronutrients and micronutrients;
-
Mother 3: current pregnancy, quality of life, life style habits, psychopathology;
-
Mother 4: current pregnancy, quality of life, life style habits, working conditions, household income, self-esteem;
-
Father: medical history, family history, life style habits, educational level, psychopathology.
Fetal ultrasound examinations
Pregnancy complications and outcomes
Biological samples
DNA and genome wide association studies
Data collection in the first 4 postnatal years
Physical examinations
Questionnaires
Main themes | 2 months | 6 months | 12 months | 18 months | 24 months | 30 months | 36 monthse
| 48 months |
---|---|---|---|---|---|---|---|---|
Mother | ||||||||
General health | ||||||||
+ | + | |||||||
Pregnancy complications | + | |||||||
Life events | + | |||||||
Social and demographic factors | ||||||||
Housing conditionsa
| + | + | + | + | ||||
Working conditions | + | |||||||
Educational level and household income | + | + | ||||||
Social support | ||||||||
Mental health and stress | + | |||||||
+ | + | |||||||
Depressive symptoms [191] | + | |||||||
Psychopathology [192] | + | + | + | |||||
Child | ||||||||
Diet and physical activity | ||||||||
Dietb [193] | + | + | + | +/S | ||||
Eating behaviour [194] | + | + | ||||||
Television watching, physical activity | + | + | + | |||||
Day-care | + | + | + | |||||
Childhood health and diseases | ||||||||
Quality of life [195] | + | + | ||||||
+ | + | + | + | + | + | |||
+ | + | + | + | + | ||||
Accidents | + | + | + | |||||
Seizuresc [205] | + | + | + | + | + | + | ||
Abdominal pain, stool pattern [206] | + | + | + | |||||
Doctors visit | + | + | + | + | + | |||
Behaviour and cognition | ||||||||
+ | + | + | + | + | ||||
Temperament [209] | + | |||||||
Motor development [210] | + | + | + | + | + | |||
+ | + | + | ||||||
+ | + | |||||||
Language development [221] | + | + | ||||||
Non verbal cognition [222] | + | + | ||||||
Executive function [223] | + |
Hands on assessments and observations in subgroup
Measurements from the age of 5 years
Ethical issues
Follow up and retention strategies
-
Addresses: new addresses of participants, which are known by the municipal health service are forwarded to the study staff;
-
Newsletters: participants receive four newsletters per year, in which several results of the study are presented and explained, questions of participants are answered and new research initiatives are presented;
-
Presents and discounts: all children who visit our research center receive small presents. Also, discount offers are regularly part of the newsletter;
-
Transport costs: all costs for transport and parking related to visits to the research center are paid by Generation R;
-
Reminders for questionnaires: when the questionnaire has not been returned within 3 weeks, a kind reminder letter is send to the parents. After 6 weeks, when the questionnaire has still not been returned, the parents receive a phone call. If necessary, help for completing the questionnaire is offered and the importance of filling in the questionnaire is explained once more during this phone call;
-
Individual feedback: if clinically relevant, all results of hands-on measurements are discussed with the parents at the visit. If necessary, follow up appointments with the general practitioner or pediatrician are planned;
-
Support for ethnic minorities: all study materials such as questionnaires, newsletters, website, and information folders are available in three languages (Dutch, English, and Turkish). Furthermore, staff from different ethnic minorities is available and able to verbally translate these materials into Arabic, French and Portuguese. With this, the study staff is able to communicate to all participants.
-
Care-cases: children and parents who showed low response rates for different measurements, showed difficulties in completing questionnaires or require additional explanation or support are considered as care-cases. Care—cases have a more individual based approach and are pro-actively contacted by one dedicated member of the study staff.
Data management and privacy protection
Statistical power
Proportion exposed (%) | Whole cohort (n = 7,000) | Focus cohort (n = 700) |
---|---|---|
50 | 0.067 | 0.212 |
25 | 0.077 | 0.276 |
10 | 0.112 | 0.353 |
5 | 0.154 | 0.486 |
1 | 0.337 | 1.064 |
Proportion exposed (%) | Incidence (1 year) of outcome of interest | |||||
---|---|---|---|---|---|---|
Whole cohort (n = 7,000) | Focus cohort (n = 700) | |||||
10% | 5% | 1% | 10% | 5% | 1% | |
50 | 1.23 | 1.33 | 1.83 | 1.83 | 2.28 | 4.94 |
25 | 1.26 | 1.38 | 1.94 | 1.96 | 2.46 | 5.41 |
10 | 1.39 | 1.56 | 2.42 | 2.48 | 3.26 | 7.92 |
5 | 1.55 | 1.80 | 3.09 | 3.20 | 4.39 | 11.74 |
1 | 2.36 | 3.04 | 6.83 | 7.75 | 11.61 | 37.55 |