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Objective: This study aimed to explore the combination effects of prenatal exposure to environment tobacco smoke (ETS) and nutrients supplement during pregnancy on childhood obesity in preschoolers., Methods: A cross-sectional study was conducted with 58,814 child-mother dyads from 235 kindergartens in Longhua District of Shenzhen, China in 2021. A self-administered structured questionnaire was completed by mothers to collect socio-demographic characteristics, prenatal ETS exposure, and nutrients supplement in pregnancy, and preschoolers' heights and weights were measured at the same time. After controlling for potential confounding variables, logistic regression models and cross-analyses were used to examine the independent and combination effects of maternal prenatal ETS exposure and nutrients supplementation during pregnancy on obesity in preschool children., Results: The results of our study showed that prenatal ETS exposure increased the risk of childhood obesity (AOR = 1.22, 95% CI = 1.11-1.34) in preschoolers. In addition, risk of childhood obesity was significantly higher when mothers didn't take supplements of multivitamins (AOR = 1.12, 95% CI = 1.05-1.20), folic acid (AOR = 1.23, 95% CI = 1.10-1.37) and iron (AOR = 1.11, 95% CI = 1.04-1.19) during pregnancy. The cross-over analysis showed that the combination of prenatal ETS exposure with mothers taking no multivitamins (AOR = 1.40, 95% CI = 1.21-1.62), no folic acid (AOR = 1.55, 95% CI = 1.12-2.14) and no iron (AOR = 1.38, 95% CI = 1.19-1.59) during pregnancy also increased the risk of obesity among Chinese preschoolers. We also discovered additive interactive effects between prenatal ETS exposure and no maternal multivitamin, folic acid and iron supplementation in pregnancy on the risk of obesity in preschoolers., Conclusion: The combination of prenatal exposure to ETS with no supplementation of these nutrients might jointly increase the risk of childhood obesity. Public health interventions are needed to reduce prenatal exposure to ETS and to encourage mothers to take appropriate multivitamin, folic acid and iron supplements during pregnancy., Competing Interests: 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., (© 2024 Zhang, Strodl, Yang, Yin, Wen, Sun, Xian, Zhao and Chen.)

Background: Previous studies have demonstrated the impacts of genetic, family, and community factors on child conduct problems (CPs). However, little is understood regarding the association between family childcare types and child conduct problem behaviors, as well as whether and to what extent caregiver-child interaction mediates the above association. Methods: 9,289 children first entering kindergartens in the Longhua New District of Shenzhen, China were enrolled in this cross-sectional study. Primary caregivers were invited to fulfill a self-administered structured questionnaire containing data regarding socio-demographics, family childcare types, caregiver-child interaction, and child conduct problem behaviors (measured by the Conners' Conduct Problem Subscale). A series of multiple logistic and linear regression models were employed to assess the associations among family childcare, caregiver-child interaction, and child conduct problem behaviors. Results: Family childcare types other than by parents together (i.e., mother alone, mother with others, grandparents, or changing caregivers) were all significantly associated with higher risks of conduct problem behaviors in young children (adjusted ORs ranged from 2.18 to 2.55, and adjusted βs ranged from 0.043 to 0.073; all p < 0.05), after adjusting for confounders including child age, gender, parental education level, parental age at pregnancy, marital status, and family income. The following family childcare types (mother alone, or grandparents, or changing caregivers) vs. the childcare by parents together showed significant relative indirect effects on conduct problem behaviors through caregiver-child interaction, indicating the significant mediation effect of caregiver-child interaction on the above associations. Mediation of caregiver-child interaction on the effect of being cared by mother with others relative to care by parents together on child conduct problem behaviors was yet non-significant. Conclusions: Family childcare types other than by parents together are associated with increased risks for conduct problem behaviors in young children. Caregiver-child interaction may function as a potential mediator for the above association.