De Smidt, Juléy Janice Abigail2026-06-092026-06-092019https://hdl.handle.net/10566/23178Background: In utero exposure to teratogens, increasing urbanization, rapid nutritional transition from poverty to affluence, adoption of a Western-style diet and physical inactivity have contributed to the growing obesity epidemic in the low income countries. Aim: To investigate the associations between in utero exposure to alcohol and nicotine on the growth and development of children aged five years from a low income setting. These effects will be observed in children aged five years as a reduced pancreas and kidney size, higher aorta and carotid intima thickness as well as higher visceral abdominal adiposity measurements. Methods: A prospective cohort study of children aged five years from a low-income setting. This is a further follow-up study of children born in the Safe Passage Study. Data was collected from 500 mother-child pairs at antenatal clinic visits, at birth and at the age five years. Maternal data were collected at antenatal clinics in the residential area of Bishop Lavis, Western Cape, when women enrolled for their first antenatal visit. All other assessments were done at follow-up study visits at Tygerberg Academic Hospital in Bellville, South Africa. Dependent variables included: anthropometric measurements at birth, weight (BW), length (BL), mid-upper-arm circumference (MUAC). And, body mass index (BMI), skinfold thickness (SFT) and waist circumference (WC) at age five years. Also, clinical assessments at five years, blood pressure (BP), mean arterial pressure (MAP) and heart rate (HR). And, ultrasound assessments consisted of the aorta and carotid intima media thickness (aIMT and cIMT) and visceral adipose tissue (VAT), kidney and pancreas size. With independent variables: maternal in utero exposure to nicotine and alcohol, maternal BMI and MUAC. Results: We observed higher cIMT and lower visceral adipose tissue values as a result of dual in utero exposure to alcohol and nicotine in males; maternal adiposity influenced the adiposity measures of their children. Females had higher SBP, DBP and HR values compared to males. Also, females born to overweight mothers had higher SFT values compared to those born to normal weight mothers (OR 1.62, 95 % confidence interval 1.24 – 2.13). Pancreas body and kidney length were associated with in utero nicotine exposure [F (3, 485) = 2.86 at p = 0.04] and [F (3, 493) = 2.99 at p = 0.03]. Conclusions: In utero exposure to alcohol and nicotine had both individual as well as compounding negative effects on the growth and development. Ultimately, higher cIMT and visceral adipose tissue values translate to cardiometabolic risk factors which are present in these five-year-old children from a low-income setting in South Africa.enAlcoholNicotenePancreas sizeKidney sizeINTERDISCIPLINARY RESEARCH AREAS::ChildrenThesis