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Kleine-Levin syndrome is associated with birth difficulties and genetic variants in the TRANK1 gene loci. Proc Natl Acad Sci U S A 2021; 118:2005753118. [PMID: 33737391 DOI: 10.1073/pnas.2005753118] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Kleine-Levin syndrome (KLS) is a rare disorder characterized by severe episodic hypersomnia, with cognitive impairment accompanied by apathy or disinhibition. Pathophysiology is unknown, although imaging studies indicate decreased activity in hypothalamic/thalamic areas during episodes. Familial occurrence is increased, and risk is associated with reports of a difficult birth. We conducted a worldwide case-control genome-wide association study in 673 KLS cases collected over 14 y, and ethnically matched 15,341 control individuals. We found a strong genome-wide significant association (rs71947865, Odds Ratio [OR] = 1.48, P = 8.6 × 10-9) within the 3'region of TRANK1 gene locus, previously associated with bipolar disorder and schizophrenia. Strikingly, KLS cases with rs71947865 variant had significantly increased reports of a difficult birth. As perinatal outcomes have dramatically improved over the last 40 y, we further stratified our sample by birth years and found that recent cases had a significantly reduced rs71947865 association. While the rs71947865 association did not replicate in the entire follow-up sample of 171 KLS cases, rs71947865 was significantly associated with KLS in the subset follow-up sample of 59 KLS cases who reported birth difficulties (OR = 1.54, P = 0.01). Genetic liability of KLS as explained by polygenic risk scores was increased (pseudo R 2 = 0.15; P < 2.0 × 10-22 at P = 0.5 threshold) in the follow-up sample. Pathway analysis of genetic associations identified enrichment of circadian regulation pathway genes in KLS cases. Our results suggest links between KLS, circadian regulation, and bipolar disorder, and indicate that the TRANK1 polymorphisms in conjunction with reported birth difficulties may predispose to KLS.
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Sigmund E, Sigmundová D. Only children or siblings: Who has higher physical activity and healthier weight? ACTA GYMNICA 2021. [DOI: 10.5507/ag.2021.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Jedrychowski WA, Majewska R, Spengler JD, Camann D, Roen EL, Perera FP. Prenatal exposure to fine particles and polycyclic aromatic hydrocarbons and birth outcomes: a two-pollutant approach. Int Arch Occup Environ Health 2017; 90:255-264. [PMID: 28168423 PMCID: PMC5360842 DOI: 10.1007/s00420-016-1192-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 12/23/2016] [Indexed: 10/31/2022]
Abstract
BACKGROUND Previous epidemiologic studies have considered the effects of individual air pollutants on birth outcomes, whereas a multiple-pollutant approach is more relevant to public health policy. OBJECTIVES The present study compared the observed effect sizes of prenatal fine particulate matter (PM2.5) and polycyclic aromatic hydrocarbons (PAH) (a component of PM2.5) exposures on birth outcome deficits, assessed by the single vs. two-pollutant approaches. METHODS The study sample included 455 term infants born in Krakow to non-smoking mothers, among whom personal exposures to PM2.5 and PAH were monitored in the second trimester of pregnancy. The exposure effect estimates (unstandardized and standardized regression coefficients) on birth outcomes were determined using multivariable linear regression models, accounting for relevant covariates. RESULTS In the single-pollutant approach, each pollutant was inversely associated with all birth outcomes. The effect size of prenatal PAH exposure on birth weight and length was twice that of PM2.5, in terms of standardized coefficients. In the two-pollutant approach, the negative effect of PM2.5 on birth weight and length, adjusted for PAH exposure, lost its significance. The standardized effect of PAH on birth weight was 10-fold stronger (β = -0.20, p = 0.004) than that estimated for PM2.5 (β = -0.02, p = 0.757). CONCLUSION The results provide evidence that PAH had a greater impact on several measures of fetal development, especially birth weight, than PM2.5. Though in the single-pollutant models PM2.5 had a significant impact on birth outcomes, this effect appears to be mediated by PAH.
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Affiliation(s)
- W A Jedrychowski
- Former Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Renata Majewska
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, 7, Kopernika Street, Krakow, Poland.
| | - J D Spengler
- Department of Environmental Health, School of Public Health, Harvard University, Boston, MA, USA
| | - David Camann
- Department of Analytical and Environmental Chemistry, Southwest Research Institute, San Antonio, TX, USA
| | - E L Roen
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - F P Perera
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA
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Noel JK, Namazi S, Haddock RL. Disparities in Infant Mortality Due to Congenital Anomalies on Guam. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2015; 74:397-402. [PMID: 26668770 PMCID: PMC4675364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In the 1970's and 1980's, there were large inter-village disparities in infant mortality due to congenital anomalies on Guam. A village-level analysis was conducted to determine if these disparities can be explained by behavioral (ie, median age of village females, village fertility ratio), structural (ie, population density, persons per household, single mother households per village, married females per village), and environmental (ie, living in a village where Agent Orange (AO) spraying was conducted) factors. Village-level data for live births and infant mortality due to congenital anomalies (1970-1989) was collected from Guam's Office of Vital Statistics. Data on median age of village females, village fertility ratio, population density, persons per household, single mother households, and married females were obtained from the 1980 US Census. Estimates of village-level AO use were provided through personal communications, and villages were dichotomized into AO and non-AO spray areas. Village location was classified by usual residence of the mother. Linear regression was used to determine associations between infant mortality due to congenital anomalies and the behavioral, structural, and environmental factors. The association between AO spray area and infant mortality due to congenital anomalies was statistically significant under univariable (B [95%CI] = 1.88 [0.64,3.11], P = .005) and multivariable conditions (B [95%CI] = 2.02 [0.08,3.96], P = .042). These results suggest that infants born to mothers whose usual residence was in an AO spray area on Guam are at an increased risk of mortality due to congenital anomalies. Further studies using individual-level data are needed to validate these results.
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Affiliation(s)
- Jonathan K Noel
- University of Connecticut School of Medicine, Department of Community Medicine and Health Care, Farmington, CT, (JKN)
| | - Sara Namazi
- University of Connecticut School of Medicine, Department of Community Medicine and Health Care, Farmington, CT, (JKN)
| | - Robert L Haddock
- University of Connecticut School of Medicine, Department of Community Medicine and Health Care, Farmington, CT, (JKN)
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López Orellana P. Increase in Preterm Birth during Demographic Transition in Chile from 1991 to 2012. BIOMED RESEARCH INTERNATIONAL 2015; 2015:845968. [PMID: 26413549 PMCID: PMC4564627 DOI: 10.1155/2015/845968] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 04/14/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Universally mothers at 35 years or more have had higher maternal and perinatal risks. This study analyzed the trend of this group in maternal population and determined their risk of having premature children, during the demographic transition period in Chile. MATERIALS AND METHODS Epidemiological study conducted in the population of simple live births registered in the Chilean National Database Births of 1991-2012. Analyses were performed in three categories of maternal age: 35 or more, under 35, and 20 to 29 years. The risk of prematurity was measured by crude and Adjusted Odds Ratio from logistic regression model. RESULTS Mothers aged 35 and older increased in population from 10.6% in 1991 to 16.7% in 2012 and presented an overall prevalence of preterm delivery of 6.7%, higher prevalence than 20-29 age group (4.7%). In aging mothers, the Odds Ratio for preterm birth adjusted for education, marital status, and parity was 1.68 (95% CI (1.66-1.70)) compared to mothers aged 20-29. All differences were significant (p < 0.001). CONCLUSIONS During Chilean demographic transition, mothers aged 35 or older increased steadily and significantly maintaining higher risks of preterm births. Policies to prevent and monitor the late motherhood could contribute to stopping the current trend.
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Goudar SS, Stolka KB, Koso-Thomas M, Honnungar NV, Mastiholi SC, Ramadurg UY, Dhaded SM, Pasha O, Patel A, Esamai F, Chomba E, Garces A, Althabe F, Carlo WA, Goldenberg RL, Hibberd PL, Liechty EA, Krebs NF, Hambidge MK, Moore JL, Wallace DD, Derman RJ, Bhalachandra KS, Bose CL. Data quality monitoring and performance metrics of a prospective, population-based observational study of maternal and newborn health in low resource settings. Reprod Health 2015; 12 Suppl 2:S2. [PMID: 26062714 PMCID: PMC4464020 DOI: 10.1186/1742-4755-12-s2-s2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background To describe quantitative data quality monitoring and performance metrics adopted by the Global Network’s (GN) Maternal Newborn Health Registry (MNHR), a maternal and perinatal population-based registry (MPPBR) based in low and middle income countries (LMICs). Methods Ongoing prospective, population-based data on all pregnancy outcomes within defined geographical locations participating in the GN have been collected since 2008. Data quality metrics were defined and are implemented at the cluster, site and the central level to ensure data quality. Quantitative performance metrics are described for data collected between 2010 and 2013. Results Delivery outcome rates over 95% illustrate that all sites are successful in following patients from pregnancy through delivery. Examples of specific performance metric reports illustrate how both the metrics and reporting process are used to identify cluster-level and site-level quality issues and illustrate how those metrics track over time. Other summary reports (e.g. the increasing proportion of measured birth weight compared to estimated and missing birth weight) illustrate how a site has improved quality over time. Conclusion High quality MPPBRs such as the MNHR provide key information on pregnancy outcomes to local and international health officials where civil registration systems are lacking. The MNHR has measures in place to monitor data collection procedures and improve the quality of data collected. Sites have increasingly achieved acceptable values of performance metrics over time, indicating improvements in data quality, but the quality control program must continue to evolve to optimize the use of the MNHR to assess the impact of community interventions in research protocols in pregnancy and perinatal health. Trial registration number NCT01073475
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Luo M, Zeng J, Li F, He L, Li T. Safety of pregnancy after surgical treatment for breast cancer: a meta-analysis. Int J Gynecol Cancer 2015; 24:1366-72. [PMID: 25188887 DOI: 10.1097/igc.0000000000000242] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Because of the rising trend of delayed pregnancies, more and more women remain nulliparous at the diagnosis of breast cancer, and approximately 71% of them desire to conceive after breast cancer treatment. Advances in breast cancer screening have made early diagnosis of breast cancer possible, and many patients have the opportunity to be treated by surgery. In this study, we conducted a meta-analysis to evaluate the effect of pregnancy on patient survival and prognosis after surgical treatment for breast cancer. METHODS An electronic search was performed in MEDLINE (PubMed), EMBASE, and Web of Science to identify potentially eligible studies published before August 2013. Both fixed-effect and random-effect models were used to calculate the pooled relative risk (PRR). The Q test and I(2) statistics were used to assess the heterogeneity among the studies. RESULTS A total of 5 studies were included in our meta-analysis. Five hundred fifty-four patients who become pregnant after surgical treatment for breast cancer were compared with a control group of 2354 patients for overall survival (OS). Our analysis demonstrated that pregnancy after surgical treatment for breast cancer had a significant beneficial effect on OS (PRR, 0.78; 95% confidence interval, 0.64-0.95). The disease-free survival outcome also favored patients in the pregnancy group (PRR, 0.87; 95% confidence interval, 0.71-1.08). CONCLUSIONS This meta-analysis indicates that pregnancy after surgical treatment does not increase the risk of breast cancer recurrence and may actually improve OS.
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Affiliation(s)
- Ming Luo
- Department of Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Heffley JD, Comber SDW, Wheeler BW, Redshaw CH. Parameterization of pharmaceutical emissions and removal rates for use in UK predictive exposure models: steroid estrogens as a case study. ENVIRONMENTAL SCIENCE. PROCESSES & IMPACTS 2014; 16:2571-2579. [PMID: 25245643 DOI: 10.1039/c4em00374h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Newly available prescription data has been used along with census data to develop a localised method for predicting pharmaceutical concentrations in sewage influent and effluent for England, and applied to a case study: the steroid estrogens estrone, 17β-estradiol, and 17α-ethinylestradiol in a selected catchment. The prescription data allows calculation of the mass consumed of synthetic estrogens, while use of highly localised census data improves predictions of naturally excreted estrogens by accounting for regional variations in population demographics. This serves two key purposes; to increase the accuracy of predictions in general, and to call attention to the need for more accurate predictions at a localised and/or catchment level, especially in light of newly proposed regulatory measures which may in the future require removal of steroid estrogens by sewage treatment facilities. In addition, the general lack of measured sewage works data necessitated the development of a novel approach which allowed comparison of localised predictions to average national measurements of influent and effluent. Overall in the case study catchment, estrogen predictions obtained using the model described herein were within 95% confidence intervals of measured values drawn from across the UK, with large improvements to predictions of EE2 being made compared with previous predictive methods.
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Affiliation(s)
- J D Heffley
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK.
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López PO, Bréart G. Sociodemographic characteristics of mother's population and risk of preterm birth in Chile. Reprod Health 2013; 10:26. [PMID: 23680406 PMCID: PMC3662587 DOI: 10.1186/1742-4755-10-26] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 05/03/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preterm birth is a global problem in Perinatal and infant Health. Currently is gaining a growing attention. Rates of preterm birth have increased in most countries, producing a dramatic impact on public health. Factors of diverse nature have been associated to these trends. In Chile, preterm birth has increased since 90. Simultaneously, the advanced demographic transition has modified the characteristics of woman population related to maternity. The principal objective of this study is to analyze some sociodemographic characteristics of the maternal population over time, and their possible association to rates of preterm birth. The second aim is to identify groups of mothers at high risk of having a preterm child. METHODS This population-based study examined all liveborn singletons in Chile from 1991 to 2008; divided in three periods. Preterm birth rates were measured as % births <37 weeks of gestation. Logistic regression assessed the risk of preterm birth associated with mother's age, parity, and marital status, expressed as crude and adjusted odds ratios. RESULTS Over time, rates of preterm birth increased in overall population, especially during the third period (2001-2008). In the same time, characteristics of maternal population changed: significant increase of extreme reproductive ages, significant decrease in parity and increase in mothers living without a partner. Risk of preterm birth remained higher in groups of mothers: <18 and >38 years of age; without a partner; primiparas and grandmultiparas. However, global increase in preterm birth was not explained by the modification of socio demographics characteristics of maternal population. CONCLUSIONS Some socio demographic characteristics remained associated with preterm birth over time. These associations allowed identifying five groups of mothers at higher risk to have a preterm child in the population. Increase in overall preterm birth affected all women, even those considered at "low sociodemographic risk" and the contribution of more recent period (2001-2008) to this increase is greater. Then, studied factors couldn't explain the increase in preterm birth. Further research will have to consider other factors affecting maternal population that could explain the observed trend of preterm birth.
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Affiliation(s)
- Paulina O López
- INSERM, UMR S953, Recherche épidémiologique en santé périnatale et santé des femmes et des enfants, Hôpital Tenon, Paris F-75020, France.
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Glinianaia SV, Ghosh R, Rankin J, Pearce MS, Parker L, Pless-Mulloli T. No improvement in socioeconomic inequalities in birthweight and preterm birth over four decades: a population-based cohort study. BMC Public Health 2013; 13:345. [PMID: 23587186 PMCID: PMC3651338 DOI: 10.1186/1471-2458-13-345] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 04/09/2013] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Birthweight and gestational age are associated with socioeconomic deprivation, but the evidence in relation to temporal changes in these associations is sparse. We investigated changes in the associations between socioeconomic status (SES) and birthweight and gestational age in Newcastle upon Tyne, North of England, during 1961-2000. METHODS We used population-based data from hospital neonatal records on all singleton births to mothers resident in Newcastle (births with complete covariate information n = 113,182). We used linear regression to analyse the associations between neighbourhood SES and birthweight over the entire 40-year period and by decade, and logistic regression for associations with low birthweight (LBW) and preterm birth, adjusting for potential confounders. RESULTS There was a significant interaction between SES and decade of birth for birthweight (p = 0.028) and preterm birth (p < 0.001). Socioeconomic gradients were similar in each decade for birthweight outcomes, but for preterm birth, socioeconomic disparities were more evident in the later decades [for 1961-70, odds ratio (OR) was 1.1, 95% CI 0.9, 1.3, for the most deprived versus the least deprived quartile, while for 1991-2000, the corresponding OR was 1.5, 95% CI 1.3, 1.7]. In each decade, there was a significant decrease in birthweight adjusted for gestational age for the most deprived compared to the least deprived SES group [1961-1970: -113.4 g (95% CI-133.0, -93.8); 1991-2000: -97.5 g (95% CI-113.0, -82.0)], while there was a significant increase in birthweight in each SES group over time. CONCLUSIONS Socioeconomic inequalities did not narrow over the four decades for birthweight and widened for preterm birth. Mean birthweight adjusted for gestational age increased in all socioeconomic groups, suggesting an overall increase in fetal growth.
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Affiliation(s)
- Svetlana V Glinianaia
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, England, UK
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Rakesh Ghosh
- Department of Public Health Sciences, University of California, Davis, USA
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, England, UK
| | - Mark S Pearce
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, England, UK
| | - Louise Parker
- Departments of Medicine and Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Tanja Pless-Mulloli
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, England, UK
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Dadvand P, Parker J, Bell ML, Bonzini M, Brauer M, Darrow LA, Gehring U, Glinianaia SV, Gouveia N, Ha EH, Leem JH, van den Hooven EH, Jalaludin B, Jesdale BM, Lepeule J, Morello-Frosch R, Morgan GG, Pesatori AC, Pierik FH, Pless-Mulloli T, Rich DQ, Sathyanarayana S, Seo J, Slama R, Strickland M, Tamburic L, Wartenberg D, Nieuwenhuijsen MJ, Woodruff TJ. Maternal exposure to particulate air pollution and term birth weight: a multi-country evaluation of effect and heterogeneity. ENVIRONMENTAL HEALTH PERSPECTIVES 2013; 121:267-373. [PMID: 23384584 PMCID: PMC3621183 DOI: 10.1289/ehp.1205575] [Citation(s) in RCA: 296] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 12/28/2012] [Indexed: 05/18/2023]
Abstract
BACKGROUND A growing body of evidence has associated maternal exposure to air pollution with adverse effects on fetal growth; however, the existing literature is inconsistent. OBJECTIVES We aimed to quantify the association between maternal exposure to particulate air pollution and term birth weight and low birth weight (LBW) across 14 centers from 9 countries, and to explore the influence of site characteristics and exposure assessment methods on between-center heterogeneity in this association. METHODS Using a common analytical protocol, International Collaboration on Air Pollution and Pregnancy Outcomes (ICAPPO) centers generated effect estimates for term LBW and continuous birth weight associated with PM(10) and PM(2.5) (particulate matter ≤ 10 and 2.5 µm). We used meta-analysis to combine the estimates of effect across centers (~ 3 million births) and used meta-regression to evaluate the influence of center characteristics and exposure assessment methods on between-center heterogeneity in reported effect estimates. RESULTS In random-effects meta-analyses, term LBW was positively associated with a 10-μg/m3 increase in PM10 [odds ratio (OR) = 1.03; 95% CI: 1.01, 1.05] and PM(2.5) (OR = 1.10; 95% CI: 1.03, 1.18) exposure during the entire pregnancy, adjusted for maternal socioeconomic status. A 10-μg/m3 increase in PM(10) exposure was also negatively associated with term birth weight as a continuous outcome in the fully adjusted random-effects meta-analyses (-8.9 g; 95% CI: -13.2, -4.6 g). Meta-regressions revealed that centers with higher median PM(2.5) levels and PM(2.5):PM(10) ratios, and centers that used a temporal exposure assessment (compared with spatiotemporal), tended to report stronger associations. CONCLUSION Maternal exposure to particulate pollution was associated with LBW at term across study populations. We detected three site characteristics and aspects of exposure assessment methodology that appeared to contribute to the variation in associations reported by centers.
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Affiliation(s)
- Payam Dadvand
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
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Auger N, Chery M, Daniel M. Rising disparities in severe adverse birth outcomes among Haitians in Québec, Canada, 1981-2006. J Immigr Minor Health 2012; 14:198-208. [PMID: 21424538 DOI: 10.1007/s10903-011-9460-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Perinatal health data for Haitians are scant. We evaluated adverse birth outcomes for Haitians in Québec, Canada. We analyzed 2,124,909 live births from 1981 to 2006. Haitian ethnicity was assessed using maternal birth country (Haiti, other Caribbean country, other foreign country, Canada) and home language (Creole, French/English but Creole mother tongue, French/English, other). Associations between ethnicity and preterm birth (PTB), low birth weight (LBW), and small-for-gestational-age (SGA) birth were calculated. Adverse birth outcomes were more common among mothers with Haitian ethnicity. Relative to Canadian-born mothers, odds for Haitian-born mothers were 4 times greater for extreme PTB (≤27 weeks), twice greater for very PTB (28-31 weeks), and 25% higher for moderate PTB (32-36 weeks). Patterns were similar for SGA birth and severe cases of LBW. Despite overall decreases LBW and SGA birth, relative and absolute inequalities increased over time. Perinatal health inequalities are increasing for Haitian-born mothers.
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Affiliation(s)
- Nathalie Auger
- Institut National de santé publique du Québec, 190, boulevard Crémazie Est, Montréal, QC, H2P 1E2, Canada.
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Abstract
Most young breast cancer survivors consider reproductive issues to be of great importance, but many questions remain undervalued and unanswered. Overall, available data support the safety and feasibility of pregnancy and breastfeeding after breast cancer. The accuracy of the evidence is however limited by: i) the retrospective and frequently incomplete population-based nature of the data, ii) data not representing the entire population, iii) patient-related effects, iv) underpowered sample size, and v) lack of control for biological factors and risk determinants. We review the available evidence in light of these limitations which outline the need for prospective data collection and focused priority research.
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Affiliation(s)
- Olivia Pagani
- Institute of Oncology of Southern Switzerland, Breast Unit of Southern Switzerland, Ospedale san Giovanni, Bellinzona, Switzerland
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Pearce MS, Glinianaia SV, Ghosh R, Rankin J, Rushton S, Charlton M, Parker L, Pless-Mulloli T. Particulate matter exposure during pregnancy is associated with birth weight, but not gestational age, 1962-1992: a cohort study. Environ Health 2012; 11:13. [PMID: 22404858 PMCID: PMC3324390 DOI: 10.1186/1476-069x-11-13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 03/09/2012] [Indexed: 05/31/2023]
Abstract
BACKGROUND Exposure to air pollutants is suggested to adversely affect fetal growth, but the evidence remains inconsistent in relation to specific outcomes and exposure windows. METHODS Using birth records from the two major maternity hospitals in Newcastle upon Tyne in northern England between 1961 and 1992, we constructed a database of all births to mothers resident within the city. Weekly black smoke exposure levels from routine data recorded at 20 air pollution monitoring stations were obtained and individual exposures were estimated via a two-stage modeling strategy, incorporating temporally and spatially varying covariates. Regression analyses, including 88,679 births, assessed potential associations between exposure to black smoke and birth weight, gestational age and birth weight standardized for gestational age and sex. RESULTS Significant associations were seen between black smoke and both standardized and unstandardized birth weight, but not for gestational age when adjusted for potential confounders. Not all associations were linear. For an increase in whole pregnancy black smoke exposure, from the 1(st) (7.4 μg/m(3)) to the 25(th) (17.2 μg/m(3)), 50(th) (33.8 μg/m(3)), 75(th) (108.3 μg/m(3)), and 90(th) (180.8 μg/m(3)) percentiles, the adjusted estimated decreases in birth weight were 33 g (SE 1.05), 62 g (1.63), 98 g (2.26) and 109 g (2.44) respectively. A significant interaction was observed between socio-economic deprivation and black smoke on both standardized and unstandardized birth weight with increasing effects of black smoke in reducing birth weight seen with increasing socio-economic disadvantage. CONCLUSIONS The findings of this study progress the hypothesis that the association between black smoke and birth weight may be mediated through intrauterine growth restriction. The associations between black smoke and birth weight were of the same order of magnitude as those reported for passive smoking. These findings add to the growing evidence of the harmful effects of air pollution on birth outcomes.
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Affiliation(s)
- Mark S Pearce
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England, UK
| | - Svetlana V Glinianaia
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England, UK
| | - Rakesh Ghosh
- Department of Public Health Sciences, University of California, Davis, California, USA
| | - Judith Rankin
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England, UK
| | - Steven Rushton
- Newcastle Institute for Research on Sustainability, Newcastle University, Newcastle upon Tyne, England, UK
| | - Martin Charlton
- National Centre for Geocomputation, National University of Ireland, Maynooth, Ireland
| | - Louise Parker
- Departments of Medicine and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tanja Pless-Mulloli
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England, UK
- Newcastle Institute for Research on Sustainability, Newcastle University, Newcastle upon Tyne, England, UK
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Parker JD, Rich DQ, Glinianaia SV, Leem JH, Wartenberg D, Bell ML, Bonzini M, Brauer M, Darrow L, Gehring U, Gouveia N, Grillo P, Ha E, van den Hooven EH, Jalaludin B, Jesdale BM, Lepeule J, Morello-Frosch R, Morgan GG, Slama R, Pierik FH, Pesatori AC, Sathyanarayana S, Seo J, Strickland M, Tamburic L, Woodruff TJ. The International Collaboration on Air Pollution and Pregnancy Outcomes: initial results. ENVIRONMENTAL HEALTH PERSPECTIVES 2011; 119:1023-8. [PMID: 21306972 PMCID: PMC3222970 DOI: 10.1289/ehp.1002725] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 02/09/2011] [Indexed: 05/05/2023]
Abstract
BACKGROUND The findings of prior studies of air pollution effects on adverse birth outcomes are difficult to synthesize because of differences in study design. OBJECTIVES The International Collaboration on Air Pollution and Pregnancy Outcomes was formed to understand how differences in research methods contribute to variations in findings. We initiated a feasibility study to a) assess the ability of geographically diverse research groups to analyze their data sets using a common protocol and b) perform location-specific analyses of air pollution effects on birth weight using a standardized statistical approach. METHODS Fourteen research groups from nine countries participated. We developed a protocol to estimate odds ratios (ORs) for the association between particulate matter ≤ 10 μm in aerodynamic diameter (PM₁₀) and low birth weight (LBW) among term births, adjusted first for socioeconomic status (SES) and second for additional location-specific variables. RESULTS Among locations with data for the PM₁₀ analysis, ORs estimating the relative risk of term LBW associated with a 10-μg/m³ increase in average PM₁₀ concentration during pregnancy, adjusted for SES, ranged from 0.63 [95% confidence interval (CI), 0.30-1.35] for the Netherlands to 1.15 (95% CI, 0.61-2.18) for Vancouver, with six research groups reporting statistically significant adverse associations. We found evidence of statistically significant heterogeneity in estimated effects among locations. CONCLUSIONS Variability in PM₁₀-LBW relationships among study locations remained despite use of a common statistical approach. A more detailed meta-analysis and use of more complex protocols for future analysis may uncover reasons for heterogeneity across locations. However, our findings confirm the potential for a diverse group of researchers to analyze their data in a standardized way to improve understanding of air pollution effects on birth outcomes.
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Affiliation(s)
- Jennifer D Parker
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA.
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Liu N, Wen SW, Katherine W, Bottomley J, Yang Q, Walker MC. Neighbourhood family income and adverse birth outcomes among singleton deliveries. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011; 32:1042-1048. [PMID: 21176315 DOI: 10.1016/s1701-2163(16)34711-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE to assess the association between neighbourhood family income and adverse birth outcomes. METHODS we conducted a retrospective cohort study of 334 231 singleton births during 2004 and 2006 based on the Niday Perinatal Database from Ontario. Median neighbourhood family incomes from the 2001 Canadian census were linked with the Niday Perinatal Database by dissemination areas. Generalized estimating equations were applied to estimate the odds ratios of adverse birth outcomes associated with lower neighbourhood income, with adjustment for maternal confounding variables at the individual level. RESULTS compared with the highest neighbourhood income quintile, mothers from the lowest quintile were at increased risk of having small for gestational age neonates (OR 1.51; 95% CI 1.46 to 1.57), low birth weight (OR 1.43; 95% CI 1.36 to 1.50), preterm birth (OR 1.17; 95% CI 1.12 to 1.23), low Apgar score (< 7) at five minutes (OR 1.32; 95% CI 1.21 to 1.44), and stillbirth (OR 1.39; 95% CI 1.19 to 1.62). The risks of women from the lowest income quintiles delivering a macrosomic baby (OR 0.81; 95% CI 0.79 to 0.84) or a large for gestational age baby (OR 0.82; 95% CI 0.80 to 0.85) were significantly decreased. No difference in risk of congenital anomaly was found among different income quintiles. CONCLUSION a lower level of neighbourhood income is associated with increased risks of small for gestational age babies, low birth weight, preterm birth, low Apgar score at five minutes, and stillbirth.
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Affiliation(s)
- Ning Liu
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON
| | - Shi Wu Wen
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON; Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON
| | - Wendy Katherine
- Ontario Ministry of Health and Long-Term Care, Toronto, ON; Better Outcomes Registry & Network Ontario (BORN Ontario), Ottawa, ON
| | - Jim Bottomley
- Better Outcomes Registry & Network Ontario (BORN Ontario), Ottawa, ON
| | - Qiuying Yang
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON
| | - Mark C Walker
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON; Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON; Better Outcomes Registry & Network Ontario (BORN Ontario), Ottawa, ON
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Glinianaia SV, Pearce MS, Rankin J, Pless-Mulloli T, Parker L, McNally RJQ. Birth weight by gestational age and risk of childhood acute leukemia: a population-based study 1961-2002. Leuk Lymphoma 2011; 52:709-12. [PMID: 21438834 DOI: 10.3109/10428194.2010.546915] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Glinianaia SV, Rankin J, Pearce MS, Parker L, Pless-Mulloli T. Stillbirth and infant mortality in singletons by cause of death, birthweight, gestational age and birthweight-for-gestation, Newcastle upon Tyne 1961-2000. Paediatr Perinat Epidemiol 2010; 24:331-42. [PMID: 20618722 DOI: 10.1111/j.1365-3016.2010.01119.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The dramatic reduction observed in stillbirth and infant mortality over the last few decades has not been assessed by both birthweight and gestation. We have explored temporal changes in stillbirth and infant mortality in Newcastle upon Tyne, UK, by cause of death, birthweight, gestational age, birthweight standardised for gestation and infant sex during 1961-2000. We included 131 044 singleton births to mothers resident in Newcastle, including 1342 stillbirths and 1620 infant deaths. Cause-, birthweight-, gestational age- and birthweight-for-gestation-specific stillbirth (per 1000 total births) and infant mortality (per 1000 livebirths) rates were compared between 1961-80 and 1981-2000 and between individual consecutive decades. Between 1961 and 2000, total stillbirth and infant mortality rates declined dramatically from 23.4 to 4.7 per 1000 total births and from 25.7 to 5.9 per 1000 livebirths, respectively. Rates fell continuously during the first two study decades; however, from 1981-90 to 1991-2000 the decline was not statistically significant. Between 1961-80 and 1981-2000, both stillbirth and infant mortality significantly declined in all birthweight and gestational age categories and for most leading causes of death. Although the population mean birthweight during 1981-2000 [3304 g (SD +/- 569)] was significantly higher than during 1961-80 [3255 g (SD +/- 572)] (P < 0.0001), the lowest stillbirth and infant mortality rates in 1981-2000 were consistently at about 1 SD above the mean birthweight, with mortality rates increasing for babies with lower or higher weight-for-gestation. Declines in stillbirth and infant mortality in Newcastle were associated with reductions in birthweight- and gestational age-specific mortality rates and occurred in most cause-specific groups of death.
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Affiliation(s)
- Svetlana V Glinianaia
- Institute of Health and Society, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
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Pearce MS, Glinianaia SV, Rankin J, Rushton S, Charlton M, Parker L, Pless-Mulloli T. No association between ambient particulate matter exposure during pregnancy and stillbirth risk in the north of England, 1962-1992. ENVIRONMENTAL RESEARCH 2010; 110:118-22. [PMID: 19863953 PMCID: PMC2832733 DOI: 10.1016/j.envres.2009.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 10/01/2009] [Accepted: 10/02/2009] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Research evidence suggests that exposure to ambient air pollutants can adversely affect the growth and development of the foetus and infant survival. Much less is known regarding the potential for an association between black smoke air pollution and stillbirth risk. This potential association was examined using data from the historical cohort UK Particulate Matter and Perinatal Events Research (PAMPER) study. METHODS Using data from paper-based neonatal records from the two major maternity hospitals in Newcastle upon Tyne (UK), a birth record database of all singletons born during 1961-1992 to mothers resident in the city was constructed. Weekly black smoke levels were obtained from routine data recorded at 20 air pollution monitoring stations over the study period. A two-stage statistical modelling strategy was used, incorporating temporally and spatially varying covariates to estimate black smoke exposure during each trimester and for the whole pregnancy period for each individual pregnancy. Conditional logistic regression models, with stratification on year of birth, were used to assess potential associations between black smoke exposures in pregnancy and stillbirth risk. RESULTS The PAMPER database consists of 90,537 births, between 1962 and 1992, with complete gestational age and residential address information, of which 812 were stillborn. There was no association between black smoke exposures in any trimester or across whole pregnancy and risk of stillbirth. Adjustment for potential confounders did not alter these results. CONCLUSIONS While black smoke in pregnancy is likely to be related to other pregnancy outcomes, our findings do not suggest that black smoke air pollution exposure during pregnancy increases the risk of stillbirth.
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Affiliation(s)
- M S Pearce
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK.
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Impact of change in maternal age composition on the incidence of Caesarean section and low birth weight: analysis of delivery records at a tertiary hospital in Tanzania, 1999-2005. BMC Pregnancy Childbirth 2009; 9:30. [PMID: 19622146 PMCID: PMC2718860 DOI: 10.1186/1471-2393-9-30] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 07/21/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies on change in maternal age composition in Tanzania do not indicate its impact on adverse pregnancy outcomes. We sought to establish temporal changes in maternal age composition and their impact on annual Caesarean section (CS) and low birth weight deliveries (LBWT) at Muhimbili National Hospital in Tanzania. METHODS We conducted data analysis of 91,699 singleton deliveries that took place in the hospital between 1999 and 2005. The data were extracted from the obstetric data base. Annual proportions of individual age groups were calculated and their trends over the years studied. Multiple logistic analyses were conducted to ascertain trends in the risks of CS and LBWT. The impact of age composition changes on CS and LBWT was estimated by calculating annual numbers of these outcomes with and without the major changes in age composition, all others remaining equal. In all statistics, a p value < 0.05 was considered significant. RESULTS The proportion of teenage mothers (12-19 years) progressively decreased over time while that of 30-34 years age group increased. From 1999, the risk of Caesarean delivery increased steadily to a maximum in 2005 [adjusted OR = 1.7; 95%CI (1.6-1.8)] whereas that of LBWT declined to a minimum in 2005 (adjusted OR = 0.76; 95% CI (0.71-0.82). The current major changes in age trend were responsible for shifts in the number of CS of up to206 cases per year. Likewise, the shift in LBWT was up to 158 cases per year, but the 30-34 years age group had no impact on this. CONCLUSION The population of mothers giving birth at MNH is progressively becoming older with substantial impact on the incidence of CS and LBWT. Further research is needed to estimate the health cost implications of this change.
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Peper JS, Brouwer RM, van Baal GCM, Schnack HG, van Leeuwen M, Boomsma DI, Kahn RS, Hulshoff Pol HE. Does having a twin brother make for a bigger brain? Eur J Endocrinol 2009; 160:739-46. [PMID: 19218283 DOI: 10.1530/eje-08-0915] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Brain volume of boys is larger than that of girls by approximately 10%. Prenatal exposure to testosterone has been suggested in the masculinization of the brain. For example, in litter-bearing mammals intrauterine position increases prenatal testosterone exposure through adjacent male fetuses, resulting in masculinization of brain morphology. DESIGN The influence of intrauterine presence of a male co-twin on masculinization of human brain volume was studied in 9-year old twins. METHODS Magnetic resonance imaging brain scans, current testosterone, and estradiol levels were acquired from four groups of dizygotic (DZ) twins: boys from same-sex twin-pairs (SSM), boys from opposite-sex twin-pairs (OSM), girls from opposite-sex twin-pairs (OSF), and girls from same-sex twin-pairs (SSF; n=119 individuals). Data on total brain, cerebellum, gray and white matter volumes were examined. RESULTS Irrespective of their own sex, children with a male co-twin as compared to children with a female co-twin had larger total brain (+2.5%) and cerebellum (+5.5%) volumes. SSM, purportedly exposed to the highest prenatal testosterone levels, were found to have the largest volumes, followed by OSM, OSF and SSF children. Birth weight partly explained the effect on brain volumes. Current testosterone and estradiol levels did not account for the volumetric brain differences. However, the effects observed in children did not replicate in adult twins. CONCLUSIONS Our study indicates that sharing the uterus with a DZ twin brother increases total brain volume in 9-year olds. The effect may be transient and limited to a critical period in childhood.
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Affiliation(s)
- Jiska S Peper
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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