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Zhang Y, Dai K, Chen X, Cui L, Chen ZJ. Association between being large for gestational age and cardiovascular metabolic health in children conceived from assisted reproductive technology: a prospective cohort study. BMC Med 2024; 22:203. [PMID: 38764021 PMCID: PMC11104001 DOI: 10.1186/s12916-024-03419-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 05/03/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND To the best of our knowledge, no study has investigated the potential joint effect of large for gestational age (LGA) and assisted reproductive technology (ART) on the long-term health of children. METHODS This was a prospective cohort study that recruited children whose parents had received ART treatment in the Center for Reproductive Medicine, Shandong Provincial Hospital, affiliated to Shandong University, between January 2006 and December 2017. Linear mixed model was used to compare the main outcomes. The mediation model was used to evaluate the intermediary effect of body mass index (BMI). RESULTS 4138 (29.5%) children born LGA and 9910 (70.5%) children born appropriate for gestational age (AGA) were included in the present study. The offspring ranged from 0.4 to 9.9 years. LGAs conceived through ART were shown to have higher BMI, blood pressure, fasting blood glucose, fasting insulin, and homeostatic model assessment of insulin resistance values, even after controlling for all covariates. The odds of overweight and insulin resistance are also higher in LGA subjects. After adjusting for all covariates, LGAs conceived through ART had BMI and BMI z-scores that were 0.48 kg/m2 and 0.34 units greater than those of AGAs, respectively. The effect of LGA on BMI was identified as early as infancy and remained consistently significant throughout pre-puberty. CONCLUSIONS Compared to AGA, LGA children conceived from ART were associated with increased cardiovascular-metabolic events, which appeared as early as infancy and with no recovery by pre-puberty.
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Affiliation(s)
- Yiyuan Zhang
- Institute of Women, Children and Reproductive Health, Cheeloo College of Medicine, Shandong University, Shandong, 250012, China
- Institute of Women, Children and Reproductive Health, the Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, 250012, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, Shandong, 250012, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China
- Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, Shandong, 250012, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, 250012, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, 250012, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250012, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No.2021RU001), Jinan, Shandong, 250012, China
| | - Kexin Dai
- Institute of Women, Children and Reproductive Health, Cheeloo College of Medicine, Shandong University, Shandong, 250012, China
- Institute of Women, Children and Reproductive Health, the Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, 250012, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, Shandong, 250012, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China
- Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, Shandong, 250012, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, 250012, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, 250012, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250012, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No.2021RU001), Jinan, Shandong, 250012, China
| | - Xiaojing Chen
- Institute of Women, Children and Reproductive Health, Cheeloo College of Medicine, Shandong University, Shandong, 250012, China
- Institute of Women, Children and Reproductive Health, the Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, 250012, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, Shandong, 250012, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China
- Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, Shandong, 250012, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, 250012, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, 250012, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250012, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No.2021RU001), Jinan, Shandong, 250012, China
| | - Linlin Cui
- Institute of Women, Children and Reproductive Health, the Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, 250012, China.
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, Shandong, 250012, China.
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China.
- Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, Shandong, 250012, China.
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, 250012, China.
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, 250012, China.
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250012, China.
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No.2021RU001), Jinan, Shandong, 250012, China.
- , Jinan, China.
| | - Zi-Jiang Chen
- Institute of Women, Children and Reproductive Health, Cheeloo College of Medicine, Shandong University, Shandong, 250012, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, Shandong, 250012, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China
- Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, Shandong, 250012, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, 250012, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, 250012, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250012, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No.2021RU001), Jinan, Shandong, 250012, China
- Department of Reproductive Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
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Callanan S, Killeen SL, Delahunt A, Cooney N, Cushion R, McKenna MJ, Crowley RK, Twomey PJ, Kilbane MT, McDonnell CM, Phillips CM, Cody D, McAuliffe FM. The impact of macrosomia on cardiometabolic health in preteens: findings from the ROLO longitudinal birth cohort study. Nutr Metab (Lond) 2023; 20:37. [PMID: 37667333 PMCID: PMC10476328 DOI: 10.1186/s12986-023-00759-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Macrosomia (birthweight ≥ 4 kg or ≥ 4.5 kg) is strongly associated with a predisposition to childhood obesity, which in turn is linked with adverse cardiometabolic health. Despite this, there is a lack of longitudinal investigation on the impact of high birthweight on cardiometabolic outcomes in youth. The preteen period represents an important window of opportunity to further explore this link, to potentially prevent cardiometabolic profiles worsening during puberty. METHODS This is a secondary analysis of 9-11-year-olds (n = 405) born to mothers in the ROLO longitudinal birth cohort study, who previously delivered an infant with macrosomia. Preteens were dichotomised into those born with and without macrosomia, using two common cut-off criteria (birthweight ≥ 4 kg (n = 208) and < 4 kg; ≥ 4.5 kg (n = 65) and < 4.5 kg). Cardiometabolic health was assessed using anthropometry, dual-energy x-ray absorptiometry, blood pressure, heart rate, cardiorespiratory endurance (20-m shuttle run test), and non-fasting serum biomarkers for a subgroup (n = 213). Statistical comparisons between the two groups were explored using independent t-tests, Mann-Whitney U tests, and Chi-square tests. Crude and adjusted linear regression models investigated associations between macrosomia and preteen cardiometabolic outcomes. RESULTS In total, 29.3% (n = 119) of preteens had overweight/obesity based on their BMI z-score. Preteens born ≥ 4 kg had lower median (IQR) C3 concentrations (1.38 (1.22, 1.52) g/L vs. 1.4 (1.26, 1.6) g/L, p = 0.043) and lower median (IQR) ICAM-1 concentrations (345.39 (290.34, 394.91) ng/mL vs. 387.44 (312.91, 441.83) ng/mL, p = 0.040), than those born < 4 kg. Those born ≥ 4.5 kg had higher mean (SD) BMI z-scores (0.71 (0.99) vs. 0.36 (1.09), p = 0.016), and higher median (IQR) lean mass (24.76 (23.28, 28.51) kg vs. 23.87 (21.9, 26.79) kg, p = 0.021), than those born < 4.5 kg. Adjusted linear regression analyses revealed birthweight ≥ 4 kg was negatively associated with C3 concentration (g/L) (B = - 0.095, 95% CI = - 0.162, - 0.029, p = 0.005) and birthweight ≥ 4.5 kg was positively associated with weight z-score (B = 0.325, 95% CI = 0.018, 0.633, p = 0.038), height z-score (B = 0.391, 95% CI = 0.079, 0.703, p = 0.014), lean mass (kg) (B = 1.353, 95% CI = 0.264, 2.442, p = 0.015) and cardiorespiratory endurance (B = 0.407, 95% CI = 0.006, 0.808, p = 0.047). CONCLUSION This study found no strong evidence to suggest that macrosomia is associated with adverse preteen cardiometabolic health. Macrosomia alone may not be a long-term cardiometabolic risk factor. Trial registration ISRCTN54392969 registered at www.isrctn.com .
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Affiliation(s)
- Sophie Callanan
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, The National Maternity Hospital, Dublin, Ireland
| | - Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, The National Maternity Hospital, Dublin, Ireland
| | - Anna Delahunt
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, The National Maternity Hospital, Dublin, Ireland
| | - Nessa Cooney
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, The National Maternity Hospital, Dublin, Ireland
| | - Rosemary Cushion
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, The National Maternity Hospital, Dublin, Ireland
| | - Malachi J McKenna
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, The National Maternity Hospital, Dublin, Ireland
- Department of Endocrinology, St Vincent's University Hospital, Dublin, Ireland
| | - Rachel K Crowley
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, The National Maternity Hospital, Dublin, Ireland
- Department of Endocrinology, St Vincent's University Hospital, Dublin, Ireland
| | - Patrick J Twomey
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, The National Maternity Hospital, Dublin, Ireland
- Department of Clinical Chemistry, St Vincent's University Hospital, Dublin, Ireland
| | - Mark T Kilbane
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, The National Maternity Hospital, Dublin, Ireland
- Department of Clinical Chemistry, St Vincent's University Hospital, Dublin, Ireland
| | - Ciara M McDonnell
- Department of Paediatric Endocrinology and Diabetes, Children's Health Ireland, Temple Street and Tallaght, Dublin, Ireland
| | - Catherine M Phillips
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Declan Cody
- Department of Diabetes and Endocrinology, Children's Health Ireland, Crumlin, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, The National Maternity Hospital, Dublin, Ireland.
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Kavurt S, Uzlu SE, Bas AY, Tosun M, Çelen Ş, Üstün YE, Demirel N. Can the triglyceride-glucose index predict insulin resistance in LGA newborns? J Perinatol 2023; 43:1119-1124. [PMID: 36564472 DOI: 10.1038/s41372-022-01586-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The aim of this study is to investigate the TyG index and TG/HDL-C ratio and their relationships with insulin resistance in LGA infants. METHODS A prospective controlled study was conducted including 65 LGA and gestational age, gender-matched appropriate for gestational age (AGA) neonates. Serum TG, total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), insulin and glucose levels were measured within two hours after birth, TyG index and HOMA-IR values were calculated. RESULTS TyG index and TG/HDL- C ratio were higher in LGA neonates compared to AGA ones (p = 0.03; p = 0.00, respectively). Compared with AGA newborns, LGA newborns had higher levels of insulin and HOMA-IR (p = 0.00; p = 0.00, respectively). TyG index and TG/HDL-C ratio showed moderate correlation with HOMA-IR (r = 0.59 R2 = 0.35 p < 0.001; r = 0.5 R2 = 0.25 p < 0.001, respectively). CONCLUSıON: The results of this study show that LGA newborns have increased levels of TyG index and TG/HDL-C associated with insulin resistance.
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Affiliation(s)
- Sumru Kavurt
- Department of Neonatology, Etlik Zubeyde Hanım Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
| | - Safiye Elif Uzlu
- Department of Neonatology, Etlik Zubeyde Hanım Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ahmet Yagmur Bas
- Department of Neonatology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Mehtap Tosun
- Department of Neonatology, Etlik Zubeyde Hanım Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Şevki Çelen
- Department of Perinatology, Etlik Zubeyde Hanım Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Yaprak Engin Üstün
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanım Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Nihal Demirel
- Department of Neonatology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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Kelly A, Chan J, Powell TL, Cox LA, Jansson T, Rosario FJ. Maternal obesity alters the placental transcriptome in a fetal sex-dependent manner. Front Cell Dev Biol 2023; 11:1178533. [PMID: 37397247 PMCID: PMC10309565 DOI: 10.3389/fcell.2023.1178533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Infants born to obese mothers have an increased risk of developing obesity and metabolic diseases in childhood and adulthood. Although the molecular mechanisms linking maternal obesity during pregnancy to the development of metabolic diseases in offspring are poorly understood, evidence suggests that changes in the placental function may play a role. Using a mouse model of diet-induced obesity with fetal overgrowth, we performed RNA-seq analysis at embryonic day 18.5 to identify genes differentially expressed in the placentas of obese and normal-weight dams (controls). In male placentas, 511 genes were upregulated and 791 genes were downregulated in response to maternal obesity. In female placentas, 722 genes were downregulated and 474 genes were upregulated in response to maternal obesity. The top canonical pathway downregulated in maternal obesity in male placentas was oxidative phosphorylation. In contrast, sirtuin signaling, NF-kB signaling, phosphatidylinositol, and fatty acid degradation were upregulated. In female placentas, the top canonical pathways downregulated in maternal obesity were triacylglycerol biosynthesis, glycerophospholipid metabolism, and endocytosis. In contrast, bone morphogenetic protein, TNF, and MAPK signaling were upregulated in the female placentas of the obese group. In agreement with RNA-seq data, the expression of proteins associated with oxidative phosphorylation was downregulated in male but not female placentas of obese mice. Similarly, sex-specific changes in the protein expression of mitochondrial complexes were found in placentas collected from obese women delivering large-for-gestational-age (LGA) babies. In conclusion, maternal obesity with fetal overgrowth differentially regulates the placental transcriptome in male and female placentas, including genes involved in oxidative phosphorylation.
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Affiliation(s)
- Amy Kelly
- Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, United States
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jeannie Chan
- Center for Precision Medicine, Department of Internal Medicine, Section of Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Theresa L. Powell
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Section of Neonatology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Laura A. Cox
- Center for Precision Medicine, Department of Internal Medicine, Section of Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Thomas Jansson
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Fredrick J. Rosario
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Zhang Y, Liu P, Zhou W, Hu J, Cui L, Chen ZJ. Association of large for gestational age with cardiovascular metabolic risks: a systematic review and meta-analysis. Obesity (Silver Spring) 2023; 31:1255-1269. [PMID: 37140379 DOI: 10.1002/oby.23701] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVE The aim of this study was to clarify the relationships among large for gestational age (LGA) and cardiometabolic risk factors. METHODS PubMed, Web of Science, and the Cochrane Library databases were searched to identify studies on LGA and outcomes of interest, including BMI, blood pressure, glucose metabolism, and lipid profiles. Data were independently extracted by two reviewers. A meta-analysis was performed using a random-effects model. The Newcastle-Ottawa Scale and funnel graph were used to assess the quality and publication bias, respectively. RESULTS Overall, 42 studies involving 841,325 individuals were included. Compared with individuals born appropriate for gestational age, individuals born LGA had higher odds of overweight and obesity (odds ratios [OR] = 1.44, 95% CI: 1.31-1.59), type 1 diabetes (OR = 1.28, 95% CI: 1.15-1.43), hypertension (OR = 1.23, 95% CI: 1.01-1.51), and metabolic syndrome (OR = 1.43, 95%; CI: 1.05-1.96). No significant difference was found in hypertriglyceridemia and hypercholesterolemia. Stratified analyses showed that, compared with individuals born appropriate for gestational age, individuals born LGA had higher odds for overweight and obesity from toddler age to puberty age (toddler age: OR = 2.12, 95% CI: 1.22-3.70; preschool: OR = 1.81, 95% CI: 1.55-2.12; school age: OR = 1.53, 95% CI: 1.09-2.14; puberty: OR = 1.40, 95% CI: 1.11-1.77). CONCLUSIONS LGA is associated with increased odds of obesity and metabolic syndrome later in life. Future studies should focus on elucidating the potential mechanisms and identifying risk factors.
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Affiliation(s)
- Yiyuan Zhang
- Center for Reproductive Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Peihao Liu
- Center for Reproductive Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Wei Zhou
- Center for Reproductive Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Jingmei Hu
- Center for Reproductive Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Linlin Cui
- Center for Reproductive Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
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Damhuis SE, Ganzevoort W, Gordijn SJ. Abnormal Fetal Growth: Small for Gestational Age, Fetal Growth Restriction, Large for Gestational Age: Definitions and Epidemiology. Obstet Gynecol Clin North Am 2021; 48:267-279. [PMID: 33972065 DOI: 10.1016/j.ogc.2021.02.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abnormal fetal growth (growth restriction and overgrowth) is associated with perinatal morbidity, mortality, and lifelong risks to health. To describe abnormal growth, "small for gestational age" and "large for gestational age" are commonly used terms. However, both are statistical definitions of fetal size below or above a certain threshold related to a reference population, rather than referring to an abnormal condition. Fetuses can be constitutionally small or large and thus healthy, whereas fetuses with seemingly normal size can be growth restricted or overgrown. Although golden standards to detect abnormal growth are lacking, understanding of both pathologic conditions has improved significantly.
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Affiliation(s)
- Stefanie E Damhuis
- Department of Obstetrics and Gynaecology, University Medical Center of Groningen, CB20, Hanzeplein 1, 9700RB Groningen, the Netherlands; Department of Obstetrics and Gynaecology, University Medical Centers Amsterdam, University of Amsterdam, H4, PO Box 22660, Amsterdam 1105 AZ, the Netherlands.
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynaecology, University Medical Centers Amsterdam, University of Amsterdam, H4, PO Box 22660, Amsterdam 1105 AZ, the Netherlands
| | - Sanne J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Center of Groningen, CB20, Hanzeplein 1, 9700RB Groningen, the Netherlands
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Hong YH, Lee JE. Large for Gestational Age and Obesity-Related Comorbidities. J Obes Metab Syndr 2021; 30:124-131. [PMID: 34053939 PMCID: PMC8277589 DOI: 10.7570/jomes20130] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 01/11/2023] Open
Abstract
Both small for gestational age and large for gestational age (LGA) size at birth are associated with metabolic complications throughout life. The long-term consequences of LGA have been investigated in only a few studies. LGA is thought to be associated with early obesity and metabolic risk. Understanding how LGA can influence later obesity risk is important for pediatric obesity interventions. Pregnant women who are overweight or obese are at high risk of having LGA babies. Infants born LGA are at increased risk of becoming overweight or obese children, adolescents, and young adults and can have an increased risk of metabolic syndrome later in life and giving birth to LGA offspring. Education and intervention for weight control before and during pregnancy should be conducted to prevent LGA births. Particular attention is needed for women of childbearing age who are diabetic and obese, which could be the starting point for lifelong management of obesity.
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Affiliation(s)
- Yong Hee Hong
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ji-Eun Lee
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
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Abstract
PURPOSE The aim of the study was to evaluate the association of antidepressant continuation in pregnancy with infant birth weight among women using antidepressants before pregnancy. METHODS This retrospective cohort study used electronic health data linked with state birth records. We identified singleton live births (2001-2014) to enrolled women with 1 or more antidepressant prescriptions filled 6 months or less before pregnancy, including "continuers" (≥1 antidepressant fills during pregnancy, n = 1775) and "discontinuers" (no fill during pregnancy, n = 1249). We compared birth weight, small or large for gestational age (SGA or LGA), low birth weight (LBW; <2500 g), and macrosomia (>4500 g) between the 2 groups, using inverse probability of treatment weighting to account for pre-pregnancy characteristics, including mental health conditions. RESULTS After weighting, infants born to antidepressant continuers weighed 71.9 g less than discontinuers' infants (95% confidence interval [CI], -115.5 to -28.3 g), with a larger difference for female infants (-106.4 g; 95% CI, -164.6 to -48.1) than male infants (-48.5 g; 95% CI, -107.2 to 10.3). For female infants, SGA risk was greater in continuers than discontinuers (relative risk [RR],1.54; 95% CI, 1.02 to 2.32). Low birth weight risk was greater in continuers with 50% or more of days covered (RR, 1.69; 95% CI, 1.11 to 2.58) and exposure in the second trimester (RR, 1.53; 95% CI, 1.02 to 2.29), as compared with discontinuers. CONCLUSIONS Depending on infant sex, as well as duration and timing of use, continuation of antidepressant use during pregnancy may be associated with lower infant birth weight, with corresponding increases in LBW and SGA.
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Placental function in maternal obesity. Clin Sci (Lond) 2020; 134:961-984. [PMID: 32313958 DOI: 10.1042/cs20190266] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023]
Abstract
Maternal obesity is associated with pregnancy complications and increases the risk for the infant to develop obesity, diabetes and cardiovascular disease later in life. However, the mechanisms linking the maternal obesogenic environment to adverse short- and long-term outcomes remain poorly understood. As compared with pregnant women with normal BMI, women entering pregnancy obese have more pronounced insulin resistance, higher circulating plasma insulin, leptin, IGF-1, lipids and possibly proinflammatory cytokines and lower plasma adiponectin. Importantly, the changes in maternal levels of nutrients, growth factors and hormones in maternal obesity modulate placental function. For example, high insulin, leptin, IGF-1 and low adiponectin in obese pregnant women activate mTOR signaling in the placenta, promoting protein synthesis, mitochondrial function and nutrient transport. These changes are believed to increase fetal nutrient supply and contribute to fetal overgrowth and/or adiposity in offspring, which increases the risk to develop disease later in life. However, the majority of obese women give birth to normal weight infants and these pregnancies are also associated with activation of inflammatory signaling pathways, oxidative stress, decreased oxidative phosphorylation and lipid accumulation in the placenta. Recent bioinformatics approaches have expanded our understanding of how maternal obesity affects the placenta; however, the link between changes in placental function and adverse outcomes in obese women giving birth to normal sized infants is unclear. Interventions that specifically target placental function, such as activation of placental adiponectin receptors, may prevent the transmission of metabolic disease from obese women to the next generation.
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The Role of circRNA-SETD2/miR-519a/PTEN Axis in Fetal Birth Weight through Regulating Trophoblast Proliferation. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9809632. [PMID: 32626774 PMCID: PMC7306081 DOI: 10.1155/2020/9809632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/12/2020] [Accepted: 05/25/2020] [Indexed: 01/20/2023]
Abstract
Abnormal birth weight is the one of the major causes of adulthood diseases such as obesity, metabolic syndrome, cardiovascular disease, type 2 diabetes, and hypertension. Accumulating evidence has suggested that the placental trophoblast is one of the most important reasons that influence birth weight. Our previous study showed that miR-519a are correlated with low fetal birth weight through regulating trophoblast proliferation. To further clarify the detailed mechanisms on how it is regulated, we screened the placental-specific circular RNAs (circRNAs) via microarray assay. The result identified that circ-SETD2 was highly expressed in the placenta of the patients with fetal macrosomia compared with healthy donors. Furthermore, bioinformatic analyses and the luciferase reporter assay revealed that miR-519a possessing the binding sites for both circ-SETD2 and phosphate and tensin homolog was deleted on chromosome 10 (PTEN). Interestingly, upregulation of circ-SETD2 enhanced the proliferation and invasion of the human trophoblast-like cell line HTR8/SVneo cell. A parallel study performed by Western blotting showed that overexpression of circ-SETD2 reduced miR-519a levels and increased PTEN levels in HTR8/SVneo cells. Importantly, the enhancement of HTR8/SVneo cell activity by circ-SETD2 overexpression was nullified when the cells were cotransfected by circ-SETD2 and miR-519a, suggesting the involvement of the circ-SETD2/miR-519a/PTEN axis in trophoblast activity. Taken together, we illustrate the role of circ-SETD2, as an upstream signaling of miR-519a/PTEN, in placenta development via regulating trophoblast proliferation and invasion. These findings improve our understanding of the mechanisms of progression of fetal macrosomia and will guide future development of therapeutic strategies against the disease by targeting the circ-SETD2/miR-519a/PTEN axis.
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11
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Zhou YB, Li HT, Si KY, Zhang YL, Wang LL, Liu JM. Association of elective cesarean delivery with metabolic measures in childhood: A prospective cohort study in China. Nutr Metab Cardiovasc Dis 2019; 29:775-782. [PMID: 31151881 DOI: 10.1016/j.numecd.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/03/2019] [Accepted: 04/03/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS Cesarean delivery may increase the risk of childhood obesity, a precursor of metabolic syndrome (MetS). We aimed to investigate the association of elective cesarean delivery (ElCD) with MetS and its components in a Chinese birth cohort. METHODS AND RESULTS This cohort included 1467 children (737 delivered by ElCD and 730 by spontaneous vaginal delivery [SVD]) who were followed up at the age of 4-7 years in 2013. MetS was defined as the presence of ≥3 components: central obesity, hypertriglyceridemia, low high-density lipoprotein (HDL), high fasting glucose, and hypertension. Of the 1467 children, 93 (6.3%) were categorized as having MetS: 50 (6.8%) delivered by ElCD and 43 (5.9%) by SVD. After multivariable adjustment, ElCD was not associated with MetS (adjusted odds ratio [AOR] 1.15, 95% confidence interval [CI] 0.74, 1.78) or certain components including hypertriglyceridemia, low HDL, and high fasting glucose but was associated with central obesity (AOR 1.33, 95% CI 1.02, 1.72) and hypertension (AOR 1.50, 95% CI 1.15, 1.96), as well as higher levels of total cholesterol (3.43 vs. 3.04 mmol/L; P < 0.001), low-density lipoprotein-cholesterol (1.77 vs. 1.67 mmol/L, P = 0.002), fasting glucose (5.08 vs. 5.02 mmol/L, P = 0.022), systolic (97.57 vs. 94.69 mmHg, P < 0.001)/diastolic blood pressure (63.72 vs. 62.24 mmHg, P < 0.001), and BMI (15.46 vs. 14.83 kg/m2, P < 0.001) than SVD. CONCLUSIONS ElCD is not associated with MetS in early to middle childhood but is associated with its components including central obesity and hypertension, as well as various continuous indices.
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Affiliation(s)
- Y-B Zhou
- Institute of Reproductive and Child Health, Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - H-T Li
- Institute of Reproductive and Child Health, Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - K-Y Si
- Institute of Reproductive and Child Health, Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Y-L Zhang
- Institute of Reproductive and Child Health, Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - L-L Wang
- Institute of Reproductive and Child Health, Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - J-M Liu
- Institute of Reproductive and Child Health, Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.
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Abstract
BACKGROUND Women who had delivered a macrosomic newborn will have a higher risk to deliver another macrosomia. We aimed to examine the recurrence risk of macrosomia in the subsequent pregnancy and the implications in long-term child health. METHODS Data from the Collaborative Perinatal Project, a longitudinal birth cohort with 54,371 singleton births, were used. 401 recurrent macrosomic infants (macro-macro) and 1327 normal weight babies with a macrosomia in the last pregnancy (macro-normal) were selected to explore risk factors for recurrent macrosomia. Furthermore, 768 newly onset macrosomia with normal birthweight infant in previous pregnancies (normal-macro) were identified to examine long-term health effects of recurrent macrosomia. RESULTS The recurrent rate of macrosomia was 23.2% [95% confidence interval (CI) 21.2%, 25.2%]. White race, higher pre-pregnant body mass index (BMI), more gestational weight gain, male infant and more prior macrosomic infants were significant risk factors for recurrent macrosomia. At 4 years of age, recurrent macrosomic infants had a higher BMI (16.7 vs. 16.1 kg/m2, adjusted β: 0.36, 95% CI: 0.12, 0.60) and a higher risk of overweight and obesity (adjusted OR: 1.56, 95% CI: 1.10, 2.23) than infants with normal birthweight after a previous macrosomic sibling. There was no significant difference between recurrent macrosomia and newly onset macrosomia in child outcomes after adjustment for covariates. CONCLUSIONS Fetal macrosomia has a high recurrence rate in the following pregnancy. Higher maternal pre-pregnant BMI and gestational weight gain are still important risk factors for recurrence of macrosomia, which in turn increases the risk for childhood obesity.
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Paulsen ME, Rosario FJ, Wesolowski SR, Powell TL, Jansson T. Normalizing adiponectin levels in obese pregnant mice prevents adverse metabolic outcomes in offspring. FASEB J 2019; 33:2899-2909. [PMID: 30346829 PMCID: PMC6338628 DOI: 10.1096/fj.201801015r] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/24/2018] [Indexed: 12/13/2022]
Abstract
Infants of obese mothers have an increased risk of developing obesity, insulin resistance, and type 2 diabetes. The underlying mechanisms remain elusive, and no effective interventions to limit the transmission of metabolic disease from the obese mother to her infant are currently available. Obese pregnant women have decreased circulating levels of adiponectin, which is associated with increased placental nutrient transport and fetal overgrowth. We have reported that normalization of adiponectin levels during late gestation reversed placental dysfunction and fetal overgrowth in a mouse model of maternal obesity in pregnancy. In the current study, we hypothesized that adiponectin supplementation during pregnancy in obese mice attenuates the adverse metabolic outcomes in adult offspring. Adult male offspring of obese mice developed obesity, fatty liver, and insulin resistance, with adult female offspring of obese mice having a less pronounced metabolic phenotype. These metabolic abnormalities in offspring born to obese mice were largely prevented by normalization of maternal adiponectin levels in late pregnancy. We provide evidence that low circulating maternal adiponectin is a critical mechanistic link between maternal obesity and the development of metabolic disease in offspring. Strategies aimed at improving maternal adiponectin levels may prevent long-term metabolic dysfunction in offspring of obese mothers.-Paulsen, M. E., Rosario, F. J., Wesolowski, S. R., Powell, T. L., Jansson, T. Normalizing adiponectin levels in obese pregnant mice prevents adverse metabolic outcomes in offspring.
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Affiliation(s)
- Megan E. Paulsen
- Section of Neonatology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Fredrick J. Rosario
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Stephanie R. Wesolowski
- Section of Neonatology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Theresa L. Powell
- Section of Neonatology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Thomas Jansson
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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McDonald SM, Yeo S, Liu J, Wilcox S, Sui X, Pate RR. Associations between maternal physical activity and fitness during pregnancy and infant birthweight. Prev Med Rep 2018; 11:1-6. [PMID: 30065908 PMCID: PMC6066610 DOI: 10.1016/j.pmedr.2018.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/09/2018] [Accepted: 04/25/2018] [Indexed: 12/16/2022] Open
Abstract
Prenatal physical activity (PA) reduces the risk of delivering infants with a birthweight ≥4000 g among normal-weight pregnant women, but evidence on the impact of maternal cardiorespiratory fitness (CRF) on birthweight remains equivocal among overweight or obese (OW/OB) pregnant women. The purpose of this study was to evaluate the relationship between maternal prenatal PA and CRF and birthweight in OW/OB pregnant women. Data from a randomized controlled exercise intervention trial in sedentary, OW/OB pregnant women were used. Women with complete data (n = 89) on birthweight, peak oxygen consumption (at 17 weeks), and daily PA were selected for analyses. Multiple linear regression models were performed to determine the independent and joint associations of maternal PA and CRF with birthweight while adjusting for gestational age, weight gain, and group allocation. On average, participants were 32 years old, OW/OB (BMI 29.97 ± 7.14 kg/m2), unfit (VO2peak: 19.85 ± 3.35 ml O2 kg-1 min-1), and led low active lifestyles (6579.91 ± 2379.17 steps/day). Analyses showed that maternal PA (steps·day-1·month-1) (β = 0.03 g, 95% CI: -0.03, 0.08 g) and CRF (ml O2·kg-1·min-1) (β = -8.8 g, 95%CI: -42.2, 24.5 g) were neither independently nor jointly (β = 0.006 g, 95%CI: -0.005, 0.02 g) associated with birthweight. Maternal PA and CRF during pregnancy were not related to birthweight in OW/OB pregnant women. The limited variability in maternal PA and CRF and low dose of PA may explain the null findings of this study. Given the paucity of studies examining these relationships in OW/OB pregnant women, more research is warranted.
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Affiliation(s)
- Samantha M. McDonald
- Department of Physical Education, Sport and Human Performance, Winthrop University, Rock Hill, SC, United States
| | - SeonAe Yeo
- School of Nursing, University of North Carolina, Chapel Hill, NC, United States
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, United States
| | - Sara Wilcox
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Xuemei Sui
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Russell R. Pate
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
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Fioravanti S, Cesaroni G, Badaloni C, Michelozzi P, Forastiere F, Porta D. Traffic-related air pollution and childhood obesity in an Italian birth cohort. ENVIRONMENTAL RESEARCH 2018; 160:479-486. [PMID: 29078141 DOI: 10.1016/j.envres.2017.10.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Air pollution is associated with several adverse health outcomes in children, such as respiratory illnesses and cognitive development impairment. There are suggestions of an effect of traffic-related air pollution on the occurrence of childhood obesity, but the results are not consistent. OBJECTIVES The aim of the study is to analyse whether air pollution and vehicular traffic exposure, during the first four years of life, influence obesity- related measures among 4 and 8-year-old children from a prospective birth cohort in Rome. METHODS A cohort of newborns, enrolled in 2003-2004 within the GASPII project, was followed at 4 and 8 years of age with parental interviews and clinical examinations. Air pollution was assessed at residential address using Land Use Regression models (for NO2, NOx, PM10, PM2.5, PMcoarse, PM2.5 absorbance and one traffic variable (Total traffic load of all roads in a 100m buffer)). The outcomes under study were body mass index (BMI Z-scores according to WHO recommendations, considered both categorical and continuous) measured at 4 and 8 years, and, waist circumference, waist-to-hip ratio, total and HDL cholesterol measured at 8 years. The associations were evaluated through both cross-sectional and longitudinal approaches, using logistic regression models, Generalized Estimating Equation models (GEE) and linear regression models, as appropriate. Moreover, Inverse Probability Weighting (IPW) methodology was used to account for selection bias at enrolment and at follow-up. RESULTS A total of 719 infants were enrolled and 581 (80.8%) and 499 (69.4%) were followed at 4 and 8 years, respectively. The prevalence of overweight/obesity was 9.3% and 36.9% at 4 and 8 years. No evidence of an association was found between vehicular traffic and being overweight/obese. Similarly, there was no evidence of an association between exposure to air pollutants and all other ponderal excess parameters. CONCLUSIONS The study shows no association between exposure to vehicular traffic and exposure to pollutants on obesity related parameters such as BMI, blood lipids and abdominal adiposity during childhood. Overall evidence of air pollution being obesogenic remains limited.
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Affiliation(s)
- Sara Fioravanti
- Department of Statistical Science University of Rome "La Sapienza", Piazzale Aldo Moro, 5, 00185 Rome, Italy; Department of Epidemiology of the Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147 Rome, Italy.
| | - Giulia Cesaroni
- Department of Epidemiology of the Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147 Rome, Italy.
| | - Chiara Badaloni
- Department of Epidemiology of the Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147 Rome, Italy.
| | - Paola Michelozzi
- Department of Epidemiology of the Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147 Rome, Italy.
| | - Francesco Forastiere
- Department of Epidemiology of the Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147 Rome, Italy.
| | - Daniela Porta
- Department of Epidemiology of the Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147 Rome, Italy.
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Wu K, Cheng Y, Li T, Ma Z, Liu J, Zhang Q, Cheng H. The utility of HbA1c combined with haematocrit for early screening of gestational diabetes mellitus. Diabetol Metab Syndr 2018. [PMID: 29541163 PMCID: PMC5844109 DOI: 10.1186/s13098-018-0314-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIMS To evaluate the utility of glycated haemoglobin A1c (HbA1c) alone and in combination with haematocrit (HCT) for screening gestational diabetes mellitus (GDM) between 12-16 gestational weeks. METHODS This prospective study was carried out in the Obstetrics and Gynaecology Hospital of Fudan University from November 2014 to February 2015. In total, 690 pregnant women between 20 and 35 years old were included in this study. All subjects received a routine blood examination for HbA1c and HCT at 12-16 gestational weeks (gw) and a 75-g oral glucose tolerance test at 24-28 gw. Threshold values for the diagnosis of GDM were a plasma glucose concentration of 5.1 mmol/L after fasting, 10.0 mmol/L at 60 min, and 8.5 mmol/L at 120 min. Receiver operating characteristic curves were used to evaluate the diagnostic performance of HbA1c with or without HCT. RESULTS One hundred seven women were diagnosis with GDM at 24-28 gw. An HbA1c cutoff value < 4.55% at 12-16 gw showed adequate sensitivity to exclude GDM (85.0%) but low specificity (17.3%), while an HbA1c cutoff value ≥ 5.25% presented adequate specificity (96.6%) but low sensitivity (13.3%) in diagnosing GDM. The area under the receiver operating characteristic curve for HbA1c (12-16 gw) detection of GDM was 0.563 (95% confidence interval [CI], 0.50-0.625). When combined HbA1c with HCT ( > 38.8%) for the screening of GDM, the area under the receiver operating characteristic curve was 0.604 (95% [CI] 0.509, 0.701). CONCLUSIONS Whether the adoption of HbA1c as a screening test for GDM would benefit pregnant women remains to be determined. However, combining HbA1c with HCT for the screening of GDM may be a useful tool to predict GDM.
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Affiliation(s)
- Kui Wu
- Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090 People’s Republic of China
| | - Yan Cheng
- Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090 People’s Republic of China
| | - Tingting Li
- Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090 People’s Republic of China
| | - Ziwen Ma
- Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090 People’s Republic of China
| | - Junxiu Liu
- Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090 People’s Republic of China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011 China
| | - Qingying Zhang
- Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090 People’s Republic of China
| | - Haidong Cheng
- Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090 People’s Republic of China
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Badeli H, Dalili H, Rad AH, Medghalchi A, Dalili S, Koohmanaee S. Birth Weight as a Cardio Metabolic Risk Factor in Iranian Adolescents. Int J Prev Med 2017; 8:72. [PMID: 28983401 PMCID: PMC5625358 DOI: 10.4103/ijpvm.ijpvm_48_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 07/12/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND A large number of epidemiological studies from different geographical regions showed a considerable relationship between low birth weight (LBW) and adverse health effects later in life. This study aims to assess the birth weight (BW) as a cardio metabolic risk factor in Iranian adolescents. METHODS This cross-sectional study was conducted on 12-year-old students from different areas of Rasht, North Iran. Data were collected by a questionnaire including variables as birth height, BW, gestational age, blood pressure, and laboratory tests including triglycerides (TGs), total cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), and insulin level. Data were analyzed using t-test, Chi-square, and Pearson correlation coefficient. RESULTS Overall, 858 adolescents participated in this study. Results showed significant correlation between BW and abdominal circumference, hip circumference, total cholesterol, TG, HDL-C and LDL-C (P = 0.064, 0.194, 0.224, 0.017, and 0.017, respectively). CONCLUSIONS The study findings on the correlation between BW and cardio metabolic factors might serve as confirmatory evidence on the association of LBW with future cardio metabolic disorders.
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Affiliation(s)
- Hamidreza Badeli
- Pediatric Growth Disorders Research Center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Guilan, Iran
| | - Hossein Dalili
- Department of Pediatrics, Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Afagh Hassanzadeh Rad
- Department of Pediatrics, Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Medghalchi
- Department of Ophthalmology, Eye Research Center, Guilan University of Medical Sciences, Guilan, Iran
| | - Setila Dalili
- Pediatric Growth Disorders Research Center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Guilan, Iran
| | - Shahin Koohmanaee
- Pediatric Growth Disorders Research Center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Guilan, Iran
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Quantitative assessment of the effect of pre-gestational diabetes and risk of adverse maternal, perinatal and neonatal outcomes. Oncotarget 2017; 8:61048-61056. [PMID: 28977845 PMCID: PMC5617405 DOI: 10.18632/oncotarget.17824] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 04/05/2017] [Indexed: 01/11/2023] Open
Abstract
Pregnancies complicated by pre-gestational diabetes (PGD) are associated with a higher rate of adverse outcomes, including an increased rage of preterm delivery, pregnancy-induced hypertension, pre-eclampsia, caesarean section, perinatal mortality, stillbirth, shoulder dystocia, macrosomia, small for gestational age, large for gestational age, low birth weight, neonatal hypoglycemia, neonatal death, low Apgar score, NICU admission, jaundice and respiratory distress. In the past two decades, numerous reports have been published regarding associations between PGD and risk of adverse outcomes. However, study results are inconsistent. To provide a synopsis of the current understanding of PGD for risk of adverse pregnancy outcomes, a random-effects meta-analysis over 40 million subjects from 100 studies was performed to calculate the pooled ORs. Potential sources of heterogeneity were systematically explored by multiple strata analyses and meta-regression. Overall, PGD were significantly associated with increased risk of preterm delivery (OR=3.48), LGA (OR=3.90), perinatal mortality (OR=3.39), stillbirth (OR=3.52), pre-eclampsia (OR=3.48), caesarean section (OR=3.52), NICU admission (OR=3.92), and neonatal hypoglycemia (OR=26.62). Significant results were also observed for 7 adverse outcomes with OR range from 1.54 to 2.82, while no association was found for SGA and respiratory distress after Bonferroni correction. We found that women with T1DM had higher risks for most of adverse pregnancy outcomes compared with women with T2DM. When stratified by study design, sample size, type of diabetes, geographic region, and study quality, significant associations remains. Our findings demonstrated that PGD is a strong risk-conferring factor for adverse maternal, perinatal and neonatal outcomes.
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Kuhle S, Maguire B, Ata N, MacInnis N, Dodds L. Birth Weight for Gestational Age, Anthropometric Measures, and Cardiovascular Disease Markers in Children. J Pediatr 2017; 182:99-106. [PMID: 28012695 DOI: 10.1016/j.jpeds.2016.11.067] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/10/2016] [Accepted: 11/23/2016] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To examine the association of birth weight for gestational age with anthropometric measures and cardiometabolic markers in a population-based sample of Canadian children. STUDY DESIGN The study used data from 2016 children aged 6-12 years from the first 2 cycles of the Canadian Health Measures Survey, a population-based survey of Canadian residents. The main exposure was birth weight for gestational age (small [SGA], large [LGA], and appropriate for gestational age [AGA]). The outcomes were anthropometric measures, blood pressure, and laboratory cardiovascular disease markers. The association between the exposure and the outcomes was examined using multiple regression. Analyses were weighted to account for the complex sampling design and for nonresponse. RESULTS SGA infants had lower and LGA infants had higher z scores for anthropometric measures compared with the AGA group but most differences were not statistically significant. There were no differences between the SGA or LGA infants and the AGA group in blood pressure or individual cardiometabolic markers but SGA infants were significantly less likely to have elevated levels of 3 or more components of the metabolic syndrome compared with their AGA peers. CONCLUSIONS Former SGA and LGA infants have lower (SGA) and higher (LGA) body mass index and waist circumference, respectively, than their AGA peers. The known long-term increased cardiovascular disease risk among SGA or LGA infants was not reflected in the blood pressure and laboratory measurements at age 6-12 years.
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Affiliation(s)
- Stefan Kuhle
- Perinatal Epidemiology Research Unit, Departments of Obstetrics and Gynaecology and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Bryan Maguire
- Perinatal Epidemiology Research Unit, Departments of Obstetrics and Gynaecology and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Mathematics and Statistics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nicole Ata
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Natasha MacInnis
- Perinatal Epidemiology Research Unit, Departments of Obstetrics and Gynaecology and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Linda Dodds
- Perinatal Epidemiology Research Unit, Departments of Obstetrics and Gynaecology and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
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Brankica K, Valentina VN, Slagjana SK, Sasha JM. Maternal 75-g OGTT glucose levels as predictive factors for large-for-gestational age newborns in women with gestational diabetes mellitus. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2016; 60:36-41. [PMID: 26909480 PMCID: PMC10118908 DOI: 10.1590/2359-3997000000126] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 09/29/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our goal was to investigate which glucose measurement from the 75-g oral glucose tolerance test (OGTT) has more capability of predicting large for-gestational-age (LGA) newborns of mothers with gestational diabetes mellitus (GDM). SUBJECTS AND METHODS The study group consisted of 118 consecutively pregnant women with singleton pregnancy, patients of Outpatients Department of the Endocrinology, Diabetes, and Metabolic Disorders Clinic. All were prospectively screened for GDM between 24th and 28th week of pregnancy and followed to delivery. Outcome measures included: patients' ages, pre-pregnancy BMI, BMI before delivery, FPG, 1 and 2 hour OGTT glucose values, haemoglobin A1c at third trimester, gestational week of delivery, mode of delivery and baby birth weight. RESULTS From 118 pregnancies, 78 (66.1%) women were with GDM, and 40 (33.9%) without GDM. There were statistically significant differences (30.7 versus 5.0%, p < 0.01) between LGA newborns from GDM and control group, respectively. Gestation week of delivery and fasting glucose levels were independent predictors for LGA (Beta = 0.58 and Beta = 0.37 respectively, p < 0.01). Areas under the receiver operator characteristic curve (AUC) were compared for the prediction of LGA (0.782 (0.685-0.861) for fasting, 0.719 (0.607-0.815) for 1-hour and 0.51 (0.392-0.626) for 2-hour OGTT plasma glucose levels). CONCLUSION Fasting and 1-hour plasma glucose levels from OGTT may predict LGA babies in GDM pregnancies.
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Affiliation(s)
- Krstevska Brankica
- Endocrinology Diabetes and Metabolic Disorders Clinic, Medical Faculty, Skopje, R. Macedonia
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Giapros V, Vavva E, Siomou E, Kolios G, Tsabouri S, Cholevas V, Bairaktari E, Tzoufi M, Challa A. Low-birth-weight, but not catch-up growth, correlates with insulin resistance and resistin level in SGA infants at 12 months. J Matern Fetal Neonatal Med 2016; 30:1771-1776. [PMID: 27609490 DOI: 10.1080/14767058.2016.1224838] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate the insulin resistance status in SGA infants at 12 months and its relationship with auxological and metabolic parameters. METHODS One group of 45 SGA and one of 50 appropriate for gestational age infants were followed from birth to the end of the first year of life. At 12 months, skinfold thickness, waist circumference, and blood levels of glucose, insulin, adiponectin, leptin, resistin, visfatin, retinol-binding protein 4, IGFs, lipids profile were determined, and the HOMA-IR index was calculated. RESULTS The SGAs had increased insulin (5.2 ± 2.7 versus 2.9 ± 2.4 μIU/ml, p = 0.012) and HOMA-IR (1.09 ± 0.9 versus 0.59 ± 0.55, p = 0.016). In multiple regression, insulin resistance indices were independently correlated with low-birth-weight (β = -2.92, p = 0.015 for insulin, β = -2.98, p = 0.011 for HOMA-IR) but not with catch-up growth in either height or weight or any other metabolic parameter. Resistin was higher in the SGAs (5.1 ± 2.1 versus 3.9 ± 2.1 ng/ml, p = 0.03) and independently correlated with low-birth-weight but not insulin resistance. Resistin was negatively correlated with total cholesterol (R = -0.33, p = 0.007) and positively with lipoprotein(a) (R = 0.49, p = 0.001). CONCLUSION Low-birth-weight, but not catch-up growth or adiposity tissue hormones, was correlated with insulin resistance at 12 months in non-obese SGA infants. The higher resistin in SGA infants and its correlation with total cholesterol and lipoprotein(a) need further clarification.
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Affiliation(s)
| | | | | | | | | | - Vasileios Cholevas
- c Pediatric Research Laboratory , University of Ioannina , Ioannina , Greece
| | | | - Meropi Tzoufi
- a Neonatal Intensive Care Unit, Child Health Department
| | - Anna Challa
- c Pediatric Research Laboratory , University of Ioannina , Ioannina , Greece
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22
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Briana DD, Baka S, Boutsikou M, Boutsikou T, Xagorari M, Gourgiotis D, Malamitsi-Puchner A. Cord blood copeptin concentrations in fetal macrosomia. Metabolism 2016; 65:89-94. [PMID: 26477270 DOI: 10.1016/j.metabol.2015.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 09/12/2015] [Accepted: 09/19/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND/AIM Excessive fetal growth is associated with increased adiposity and reduced insulin sensitivity at birth. Copeptin, a surrogate marker of arginine vasopressin (AVP) secretion, is upregulated in states of hyperinsulinemia and is considered one of the mediators of insulin resistance. We aimed to investigate cord blood concentrations of copeptin (C-terminal fragment of AVP pro-hormone) in healthy large-for-gestational-age (LGA) infants at term. METHODS This prospective study was conducted on 30 LGA (n=30) and 20 appropriate-for-gestational-age (AGA, n=20) singleton full-term healthy infants. Cord blood copeptin and insulin concentrations were determined by ELISA and IRMA, respectively. Infants were classified as LGA or AGA, based on customized birth-weight standards adjusted for significant determinants of fetal growth. RESULTS Cord blood copeptin concentrations were similar in LGA cases, compared to AGA controls, after adjusting for delivery mode. However, in the LGA group, cord blood copeptin concentrations positively correlated with birth-weight (r=0.422, p=0.020). In the AGA group, cord blood copeptin concentrations were elevated in cases of vaginal delivery vs elective cesarean section (p=0.003). Cord blood insulin concentrations were higher in LGA cases, compared to AGA controls (p=0.036). No association was recorded between cord blood copeptin concentrations and maternal age, parity, gestational age or fetal gender in both groups. CONCLUSIONS Cord blood copeptin concentrations may not be up-regulated in non-distressed LGA infants. However, the positive correlation between cord blood copeptin concentrations and birth-weight in the LGA group may point to the documented association between AVP release and increased fat deposition. Vaginal delivery vs elective cesarean section is accompanied by a marked stress-related increase of cord blood copeptin concentrations.
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Affiliation(s)
- Despina D Briana
- Department of Neonatology, Athens University Medical School, Athens, Greece
| | - Stavroula Baka
- Department of Neonatology, Athens University Medical School, Athens, Greece
| | - Maria Boutsikou
- Department of Neonatology, Athens University Medical School, Athens, Greece
| | - Theodora Boutsikou
- Department of Neonatology, Athens University Medical School, Athens, Greece
| | - Marieta Xagorari
- Laboratory of Clinical Biochemistry-Molecular Diagnostics, 2nd Department of Pediatrics, Athens University Medical School, Athens, Greece
| | - Dimitrios Gourgiotis
- Laboratory of Clinical Biochemistry-Molecular Diagnostics, 2nd Department of Pediatrics, Athens University Medical School, Athens, Greece
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Chiavaroli V, Cutfield WS, Derraik JGB, Pan Z, Ngo S, Sheppard A, Craigie S, Stone P, Sadler L, Ahlsson F. Infants born large-for-gestational-age display slower growth in early infancy, but no epigenetic changes at birth. Sci Rep 2015; 5:14540. [PMID: 26419812 PMCID: PMC4588582 DOI: 10.1038/srep14540] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 08/26/2015] [Indexed: 12/20/2022] Open
Abstract
We evaluated the growth patterns of infants born large-for-gestational-age (LGA) from birth to age 1 year compared to those born appropriate-for-gestational-age (AGA). In addition, we investigated possible epigenetic changes associated with being born LGA. Seventy-one newborns were classified by birth weight as AGA (10(th)-90(th) percentile; n = 42) or LGA (>90(th) percentile; n = 29). Post-natal follow-up until age 1 year was performed with clinical assessments at 3, 6, and 12 months. Genome-wide DNA methylation was analysed on umbilical tissue in 19 AGA and 27 LGA infants. At birth, LGA infants had greater weight (p < 0.0001), length (p < 0.0001), ponderal index (p = 0.020), as well as greater head (p < 0.0001), chest (p = 0.044), and abdominal (p = 0.007) circumferences than AGA newborns. LGA infants were still larger at the age of 3 months, but by age 6 months there were no more differences between groups, due to higher length and weight increments in AGA infants between 0 and 6 months (p < 0.0001 and p = 0.002, respectively). Genome-wide analysis showed no epigenetic differences between LGA and AGA infants. Overall, LGA infants had slower growth in early infancy, being anthropometrically similar to AGA infants by 6 months of age. In addition, differences between AGA and LGA newborns were not associated with epigenetic changes.
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Affiliation(s)
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Zengxiang Pan
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Sherry Ngo
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Allan Sheppard
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Susan Craigie
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Peter Stone
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lynn Sadler
- National Women's Health, Auckland District Health Board, Auckland, New Zealand
| | - Fredrik Ahlsson
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Owens LA, Sedar J, Carmody L, Dunne F. Comparing type 1 and type 2 diabetes in pregnancy- similar conditions or is a separate approach required? BMC Pregnancy Childbirth 2015; 15:69. [PMID: 25885892 PMCID: PMC4390076 DOI: 10.1186/s12884-015-0499-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 03/11/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Pregnancy in women with type 1 (T1DM) or type 2 diabetes (T2DM) is associated with increased risk. These conditions are managed similarly during pregnancy, and compared directly in analyses, however they affect women of different age, body mass index and ethnicity. METHODS We assess if differences exist in pregnancy outcomes between T1DM and T2DM by comparing them directly and with matched controls. We also analyze the effect of glycemic control on pregnancy outcomes and analyze predictive variables for poor outcome. RESULTS We include 323 women with diabetes and 660 glucose-tolerant controls. T2DM women had higher BMI, age and parity with a shorter duration of diabetes and better glycemic control. Preeclampsia occurred more in women with T1DM only. Rates of elective cesarean section were similar between groups but greater than in controls, emergency cesarean section was increased in women with type 1 diabetes. Maternal morbidity in T1DM was double that of matched controls but T2DM was similar to controls. Babies of mothers with diabetes were more likely to be delivered prematurely. Neonatal hypoglycemia occurred more in T1DM than T2DM and contributed to a higher rate of admission to neonatal intensive care for both groups. Adverse neonatal outcomes including stillbirths and congenital abnormalities were seen in both groups but were more common in T1DM pregnancies. HbA1C values at which these poor outcomes occurred differed between T1 and T2DM. CONCLUSIONS Pregnancy outcomes in T1DM and T2DM are different and occur at different levels of glycemia. This should be considered when planning and managing pregnancy and when counseling women.
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Affiliation(s)
- Lisa A Owens
- Atlantic Diabetes in Pregnancy Programme, Galway, Ireland. .,Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland.
| | - Jon Sedar
- Atlantic Diabetes in Pregnancy Programme, Galway, Ireland.
| | - Louise Carmody
- Atlantic Diabetes in Pregnancy Programme, Galway, Ireland. .,Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland.
| | - Fidelma Dunne
- Atlantic Diabetes in Pregnancy Programme, Galway, Ireland. .,Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland.
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Progression of cardio-metabolic risk factors in subjects born small and large for gestational age. PLoS One 2014; 9:e104278. [PMID: 25117750 PMCID: PMC4130586 DOI: 10.1371/journal.pone.0104278] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 07/10/2014] [Indexed: 01/31/2023] Open
Abstract
Background Subjects born small (SGA) and large (LGA) for gestational age have an increased risk of cardio-metabolic alterations already during prepuberty. Nevertheless, the progression of their cardio-metabolic profile from childhood to adolescence has not been fully explored. Our aim was to assess potential changes in the cardio-metabolic profile from childhood to adolescence in subjects born SGA and LGA compared to those born appropriate (AGA) for gestational age. Methods This longitudinal study included 35 AGA, 24 SGA and 31 LGA subjects evaluated during childhood (mean age (±SD) 8.4±1.4 yr) and then re-assessed during adolescence (mean age 13.3±1.8 yr). BMI, blood pressure, insulin resistance (fasting insulin, HOMA-IR) and lipids were assessed. A cardio-metabolic risk z-score was applied and this consisted in calculating the sum of sex-specific z-scores for BMI, blood pressure, HOMA-IR, triglycerides and triglycerides:high-density lipoprotein cholesterol ratio. Results Fasting insulin and HOMA-IR were higher in SGA and LGA than AGA subjects both during childhood (all P<0.01) and adolescence (all P<0.01). Similarly, the clustered cardio-metabolic risk score was higher in SGA and LGA than AGA children (both P<0.05), and these differences among groups increased during adolescence (both P<0.05). Of note, a progression of the clustered cardio-metabolic risk score was observed from childhood to adolescence within SGA and within LGA subjects (both P<0.05). Conclusions SGA and LGA subjects showed an adverse cardio-metabolic profile during childhood when compared to AGA peers, with a worsening of this profile during adolescence. These findings indicate an overtime progression of insulin resistance and overall estimated cardiovascular risk from childhood to adolescence in SGA and LGA populations.
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Lager S, Samulesson AM, Taylor PD, Poston L, Powell TL, Jansson T. Diet-induced obesity in mice reduces placental efficiency and inhibits placental mTOR signaling. Physiol Rep 2014; 2:e00242. [PMID: 24744907 PMCID: PMC3966251 DOI: 10.1002/phy2.242] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/26/2014] [Accepted: 01/29/2014] [Indexed: 11/17/2022] Open
Abstract
As in humans, obesity during pregnancy in mice results in elevated maternal insulin levels and metabolic programming of offspring. mTOR signaling regulates amino acid transport and may function as a placental nutrient sensor. Because obesity is a condition with increased nutrient availability, we hypothesized that diet‐induced obesity activates placental mTOR signaling. To test this hypothesis, female C57BL/6J mice were fed an obesogenic diet or standard chow prior to and throughout pregnancy. Fetuses and placentas were collected at gestational day 18. Using Western blot analysis, placental mTOR activity was determined along with energy, inflammatory, and insulin signaling pathways (upstream modulators of mTOR). At gestational day 18, fetal and placental weights did not differ, however, in obese dams, the fetal/placental weight ratio was lower (P <0.01). In placentas from obese dams, mTOR signaling was inhibited, as determined by decreased Rheb and S6K1 expression, and lower rpS6 phosphorylation (P <0.05). In contrast, energy, inflammatory, and insulin signaling pathways were unaffected. Contrary to our hypothesis, diet‐induced obesity in pregnant mice was associated with inhibition of placental mTOR signaling. However, this finding is consistent with the lower fetal/placental weight ratio, indicating reduced placental efficiency. In this report, we explore placental signaling in an obese mouse model known to result in adverse metabolic programming of the offspring without altering fetal growth. This model parallels with human pregnancies, where maternal obesity also is associated with adverse metabolic programming. In this report, we show that maternal obesity in the mouse leads to reduced placental efficiency potentially caused by lowered signaling activity of the mTOR pathway (a known positive regulator of placental nutrient transport) and that the placentas of obese, hyperinsulinemic dams are insulin resistant.
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Affiliation(s)
- Susanne Lager
- Department of Obstetrics and Gynecology, Center for Pregnancy and Newborn Research, University of Texas Health Science Center, San Antonio, Texas
| | - Anne-Maj Samulesson
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
| | - Paul D Taylor
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
| | - Lucilla Poston
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
| | - Theresa L Powell
- Department of Obstetrics and Gynecology, Center for Pregnancy and Newborn Research, University of Texas Health Science Center, San Antonio, Texas
| | - Thomas Jansson
- Department of Obstetrics and Gynecology, Center for Pregnancy and Newborn Research, University of Texas Health Science Center, San Antonio, Texas
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Mossayebi E, Arab Z, Rahmaniyan M, Almassinokiani F, Kabir A. Prediction of neonates' macrosomia with maternal lipid profile of healthy mothers. Pediatr Neonatol 2014; 55:28-34. [PMID: 23911877 DOI: 10.1016/j.pedneo.2013.05.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 05/27/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The aim of this study is to identify the association between the lipid profile of healthy nondiabetic, nonobese pregnant women in the first weeks of the third trimester of pregnancy and macrosomia or large-for-gestational-age (LGA) neonates with normal pregnancies. MATERIALS AND METHODS In this cohort study, 200 pregnant healthy women without gestational diabetes mellitus (GDM), obesity, or hypertension and carrying a single fetus in a prenatal clinic of a referral hospital were included based on a convenience sampling. Then, we took a blood sample to assess fasting blood sugar (FBS), triglyceride (TG), total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). GDM was assessed after administering 50 g of oral glucose. All cases were followed until the end of pregnancy. The main outcome measurement was neonatal birth weight. RESULTS Only 154 mothers met eligibility criteria. There were eight cases (5.2%) with macrosomia (birth weight ≥ 4000 g) and 35 cases (22.7%) with LGA. Linear regression showed that mothers' TG and neonates' gender were independent predictors of the birth weight of the children (R-square = 0.52, p < 0.001). Logistic regression analysis showed that maternal FBS and TG are the most independent variables which can predict the presence of macrosomia (Nagelkerke R-square = 0.53, p < 0.001) and maternal TG and child gender are the most independent variables that can predict the presence of LGA in neonates of a healthy mother (Nagelkerke R-square = 0.49, p < 0.001). CONCLUSION Maternal triglyceride levels may be a significant predictor of fetal size in late pregnancy but not in early pregnancy. Our study reinforces that this is true not only in the case of macrosomia (birth weight > 4500 g), but also for LGA.
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Affiliation(s)
- Elaheh Mossayebi
- Assistant Professor of Obstetrics and Gynecology, Shahid Akbar Abadi Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Zohreh Arab
- Assistant of Obstetrics and Gynecology, Shahid Akbar Abadi Hospital, Iran University of Medical Sciences, Iran.
| | - Mojgan Rahmaniyan
- Assistant Professor of Obstetrics and Gynecology, Semnan University of Medical Sciences, Semnan, Iran.
| | - Fariba Almassinokiani
- Associate Professor of Obstetrics and Gynecology, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Iran.
| | - Ali Kabir
- Candidate of Epidemiology, Department of Epidemiology, Faculty of Public Health, Shahid Beheshti University of Medical Sciences, and Center for Educational Research in Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
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Abstract
PURPOSE OF REVIEW The prevalence of obesity is on the increase, and consequently metabolic syndrome is also becoming a serious health problem in children and adolescents all over the world. This review attempts to summarize the recent literature on metabolic syndrome in children and adolescents. RECENT FINDINGS To date, a standard definition of metabolic syndrome for the pediatric population is not available. Recently, the International Diabetes Federation has proposed a new set of criteria to define metabolic syndrome in children and adolescents aged 6-16 years. The relationships between obesity, insulin resistance and metabolic syndrome may be explained by the pattern of lipid partitioning. Fatty liver plays a central role in the insulin-resistant state in obese adolescents. Although insulin resistance has been proposed as the central factor leading to the abnormalities observed in metabolic syndrome, most definitions of metabolic syndrome use impaired fasting glucose as a marker. Nutrition impairment during both prenatal and early postnatal life can cause metabolic disturbances leading to insulin-resistance, type 2 diabetes, hypertension and cardiovascular disease. SUMMARY Metabolic syndrome prevalence in children and adolescents is on the increase. Therefore, the emphasis in all studies and programs related to metabolic syndrome should be focused on prevention, early detection of metabolic risk factors and interventions that will have a significant impact on future adult health.
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Affiliation(s)
- Sukran Poyrazoglu
- Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
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Çetin C, Uçar A, Bas F, Poyrazoğlu Ş, Bundak R, Saka N, Özden T, Darendeliler F. Are metabolic syndrome antecedents in prepubertal children associated with being born idiopathic large for gestational age? Pediatr Diabetes 2013; 14:585-92. [PMID: 23627262 DOI: 10.1111/pedi.12041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 03/07/2013] [Accepted: 03/26/2013] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Being born large for gestational age (LGA) is a risk factor for development of metabolic syndrome (MS) in adolescents and adults. OBJECTIVE To evaluate prepubertal children born idiopathic LGA to non-obese mothers without gestational diabetes or glucosuria with respect to the presence of MS antecedents. PATIENTS AND METHODS We conducted a cross-sectional study to compare 40 (19 F) LGA-born prepubertal children of a mean age of 6.1 ± 2.5 yr and 49 (25 F) appropriate for gestational age (AGA)-born body mass index (BMI)-matched peers of a mean age of 5.4 ± 1.8 yr with respect to their anthropometric data, blood pressure measurements, fasting serum glucose and insulin levels, homeostasis model assessment-insulin resistance (HOMA-IR), and lipids and atherogenic index (AI) [triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C)]. HOMA-IR > 2.5 was used to define IR. HDL-C ≤ 40 mg/dL and TG ≥ 110 mg/dL were used to define dyslipidemia. Both groups were further divided into subgroups as obese and non-obese according to their BMI percentiles and the analyses were repeated. RESULTS Non-obese LGA children had higher waist circumference (WC) standard deviation scores (SDSs) than BMI-matched AGA-born peers (p = 0.024). There were no significant differences between pooled, obese and non-obese subgroups of LGA-born children and their AGA counterparts with respect to dyslipidemia and IR. AI was higher in non-obese LGA children than in AGA counterparts (p = 0.028). CONCLUSIONS Non-obese idiopathic LGA-born children have higher AIs than AGA-born counterparts in the absence of IR. WC seems to be a good clinical screening tool in identifying at risk of non-obese LGA children. Further studies are needed to evaluate MS antecedents in idiopathic LGA-born children.
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Affiliation(s)
- Ceren Çetin
- Paediatric Endocrinology and Diabetes Unit, Istanbul Faculty of Medicine, Istanbul University, İstanbul, Turkey
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Zhang Y, Li H, Liu SJ, Fu GJ, Zhao Y, Xie YJ, Zhang Y, Wang YX. The associations of high birth weight with blood pressure and hypertension in later life: a systematic review and meta-analysis. Hypertens Res 2013; 36:725-35. [PMID: 23595042 DOI: 10.1038/hr.2013.33] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 01/06/2013] [Accepted: 01/09/2013] [Indexed: 12/23/2022]
Abstract
The 'fetal origin hypothesis' suggests that metabolic diseases are directly related to poor nutritional status in early life. Thus, a high birth weight (HBW) may pose a lower risk than normal birth weight. Overweight and overnutrition are among the most widely recognized risk factors of metabolic diseases. To explore the possible effects of HBW on blood pressure and hypertension, a systematic review was performed. The PubMed and Embase databases were searched for relevant studies. The outcomes included systolic blood pressure (SBP), diastolic blood pressure (DBP) and hypertension. We included all of the studies that assessed the differences in outcomes for children aged >1 year between those born with normal birth weight (birth weight between 2500 and 4000 g or between the 10th and 90th percentiles for their gestational age) and those born with HBW (birth weight4000 g or 90th percentile for their gestational age). The outcomes were analyzed descriptively and by conducting a meta-analysis. Thirty-one studies satisfied the inclusion criteria. The mean difference in blood pressure and the relative risk of hypertension between individuals with HBW and individuals with normal birth weight was inversely associated with age. SBP and DBP, as well as the prevalence of hypertension, were higher in younger children with HBW but lower in older adults with HBW compared with individuals with normal birth weight. The findings suggested that an individual with HBW is prone to hypertension and higher blood pressure during childhood. However, a 'catch-down' effect in the elevation of blood pressure is observed in subjects with HBW as they grow older. Thus, older individuals with HBW are less susceptible to hypertension than those with normal birth weight.
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Affiliation(s)
- Yong Zhang
- School of Public Health and Health Management, Chongqing Medical University, Chongqing, China
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Adipokines vaspin and omentin-1 are up-regulated in large for gestational age infants at term. Cytokine 2013; 62:70-4. [PMID: 23490415 DOI: 10.1016/j.cyto.2013.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 12/21/2012] [Accepted: 02/11/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Large- (LGA) and appropriate-for-gestational age (AGA) infants differ in body fat mass and metabolic/endocrine mechanisms. We aimed to investigate in LGA and AGA infants possible alterations in cord blood levels of insulin and the adipokines vaspin and omentin-1 which are secreted by the adipose tissue and are implicated in insulin resistance/metabolic syndrome. METHODS Cord blood vaspin, omentin-1 and insulin levels were prospectively measured in 61 LGA and 36 AGA singleton full-term infants. Of the LGA group 13 infants were born from diabetic and 48 from non-diabetic mothers. RESULTS Cord blood vaspin and omentin-1 levels were significantly higher in LGA compared with AGA neonates (p = 0.021 and b = 0.115, SE 0.037, p = 0.002, respectively). Umbilical cord omentin-1 levels were significantly decreased in neonates delivered vaginally (b = -0.075, SE 0.031, p = 0.016), after controlling for group. Insulin levels increased in proportion to the customized centiles of the infants (b = 0.004, SE = 0.001, p = 0.009). Finally, in the LGA group vaspin levels correlated with omentin-1 serum levels (r = 0.318, p = 0.013). CONCLUSIONS The increased levels of vaspin observed in LGA infants compared with AGA ones, possibly represent a defensive mechanism against insulin/glucose dysregulation, commonly seen in the former. In addition, the increased omentin-1 levels in the LGA group could possibly reflect the amount of developing adipose tissue in the early stages of life in this group. Alternatively, these levels could reflect the growth-promoting effect of omentin-1 in the fetus. The inflammation associated with vaginal deliveries may account for the lower cord blood omentin-1 levels in neonates delivered by this mode.
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Boutsikou T, Briana DD, Boutsikou M, Kafalidis G, Piatopoulou D, Baka S, Hassiakos D, Gourgiotis D, Malamitsi-Puchner A. Cord blood nesfatin-1 in large for gestational age pregnancies. Cytokine 2012. [PMID: 23178145 DOI: 10.1016/j.cyto.2012.10.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To investigate possible alterations in cord blood levels of adipokine nesfatin-1 (secreted by adipose tissue and pancreatic β-cells and implicated in glucose metabolism and insulin resistance), as well as insulin, in large (LGA) and appropriate for gestational age (AGA) pregnancies, granted that these groups differ in body fat mass and metabolic/endocrine mechanisms. MATERIALS AND METHODS Cord blood nesfatin-1 and insulin concentrations were prospectively measured in 40 LGA (9 born from diabetic and 31 from non-diabetic mothers) and 20 AGA singleton full-term infants as well as their mothers. RESULTS Cord blood nesfatin-1 concentrations were significantly lower in LGA compared to AGA neonates (b=-0.206, SE 0.07, p=0.005). However, cord blood nesfatin-1 concentrations were elevated in infants born from mothers with gestational diabetes mellitus (GDM), compared to those born from non-diabetic mothers, after controlling for group (b=0.190, SE 0.10, p=0.05). Finally, cord blood nesfatin-1 concentrations were lower in cases of vaginal delivery (b=0.11, SE 0.05, p=0.042). Insulin levels were significantly elevated, as customized centiles increased (b=0.004, SE=0.002, p=0.016). No significant correlation was found between insulin and nesfatin-1 in maternal and umbilical cord levels. CONCLUSIONS In this study nesfatin-1 levels are decreased in LGA compared to AGA fetuses. Fetal nesfatin-1 concentrations are higher in cases of GDM and cord blood nesfatin-1 concentrations are lower in cases of vaginal delivery.
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Affiliation(s)
- Theodora Boutsikou
- Neonatal Division, 2nd Department of Obstetrics and Gynecology, Athens University, Medical School, Athens, Greece
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Wells JCK, DeSilva JM, Stock JT. The obstetric dilemma: an ancient game of Russian roulette, or a variable dilemma sensitive to ecology? AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2012; 149 Suppl 55:40-71. [PMID: 23138755 DOI: 10.1002/ajpa.22160] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The difficult birth process of humans, often described as the "obstetric dilemma," is commonly assumed to reflect antagonistic selective pressures favoring neonatal encephalization and maternal bipedal locomotion. However, cephalo-pelvic disproportion is not exclusive to humans, and is present in some primate species of smaller body size. The fossil record indicates mosaic evolution of the obstetric dilemma, involving a number of different evolutionary processes, and it appears to have shifted in magnitude between Australopithecus, Pleistocene Homo, and recent human populations. Most attention to date has focused on its generic nature, rather than on its variability between populations. We re-evaluate the nature of the human obstetric dilemma using updated hominin and primate literature, and then consider the contribution of phenotypic plasticity to variability in its magnitude. Both maternal pelvic dimensions and fetal growth patterns are sensitive to ecological factors such as diet and the thermal environment. Neonatal head girth has low plasticity, whereas neonatal mass and maternal stature have higher plasticity. Secular trends in body size may therefore exacerbate or decrease the obstetric dilemma. The emergence of agriculture may have exacerbated the dilemma, by decreasing maternal stature and increasing neonatal growth and adiposity due to dietary shifts. Paleodemographic comparisons between foragers and agriculturalists suggest that foragers have considerably lower rates of perinatal mortality. In contemporary populations, maternal stature remains strongly associated with perinatal mortality in many populations. Long-term improvements in nutrition across future generations may relieve the dilemma, but in the meantime, variability in its magnitude is likely to persist.
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Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London WC1N 1EH, UK.
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Boutsikou T, Briana DD, Boutsikou M, Kafalidis G, Stamati L, Baka S, Hassiakos D, Gourgiotis D, Malamitsi-Puchner A. Cord blood chemerin and obestatin levels in large for gestational age infants. J Matern Fetal Neonatal Med 2012; 26:123-6. [PMID: 22963327 DOI: 10.3109/14767058.2012.728648] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate possible alterations in cord blood levels of adipokines, chemerin and obestatin (secreted by adipose tissue and associated with later development of insulin resistance/metabolic syndrome), as well as insulin, in large for gestational age (LGA) and appropriate for gestational age (AGA) pregnancies, granted that these groups differ in body fat mass and metabolic/endocrine mechanisms. METHODS Cord blood chemerin, obestatin, and insulin concentrations were prospectively measured in 40 LGA (9 born from diabetic and 31 from nondiabetic mothers) and 40 AGA singleton full-term infants. RESULTS Cord blood chemerin concentrations were significantly higher in LGA compared with AGA neonates (b = 38.91, SE 9.29, p < 0.001). In contrast, no significant differences in obestatin concentrations were observed between groups. Insulin levels were significantly elevated as customized centiles increased (b = 0.003, SE = 0.001, p = 0.032). CONCLUSIONS Higher chemerin concentrations in LGA neonates possibly reflect the increased adipose tissue in this group. Lack of difference between the two groups in circulating levels of obestatin-possibly a sensitive marker of insulin resistance-might be due to development of metabolic disorders later in life.
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Affiliation(s)
- Theodora Boutsikou
- Neonatal Division, 2nd Department of Obstetrics and Gynecology, Athens University, Medical School, Athens, Greece
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Chiavaroli V, D'Adamo E, Giannini C, de Giorgis T, De Marco S, Chiarelli F, Mohn A. Serum levels of receptors for advanced glycation end products in normal-weight and obese children born small and large for gestational age. Diabetes Care 2012; 35:1361-3. [PMID: 22511256 PMCID: PMC3357256 DOI: 10.2337/dc11-2302] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess potential alterations in soluble and endogenous secretory receptors for advanced glycation end products (sRAGE and esRAGE) in normal-weight (NW) and obese (Ob) children born small (SGA) and large (LGA) compared with appropriate for gestational age (AGA) subjects and to explore if birth weight (BW), insulin resistance (IR), and obesity represent independent risk factors. RESEARCH DESIGN AND METHODS We categorized 130 prepubertal children into six groups according to BW and obesity and evaluated sRAGE, esRAGE, and homeostasis model assessment of IR. RESULTS sRAGE and esRAGE were lower in Ob SGA and LGA children than Ob AGA subjects (all P < 0.05), and in NW SGA and LGA children than NW AGA subjects (all P < 0.05). Interestingly, BW and IR were significantly and independently related to RAGE. CONCLUSIONS sRAGE and esRAGE are decreased in SGA and LGA children, and BW and IR seem to play an important role in the reduction of RAGE.
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Savvidou MD, Akolekar R, Samaha RBB, Masconi AP, Nicolaides KH. Maternal serum 25-hydroxyvitamin D levels at 11(+0) -13(+6) weeks in pregnant women with diabetes mellitus and in those with macrosomic neonates. BJOG 2011; 118:951-5. [PMID: 21658195 DOI: 10.1111/j.1471-0528.2011.02982.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate whether maternal serum levels of 25-hydroxyvitamin D [25(OH)D] in the first trimester are altered in pregnant women with pre-existing type 2 diabetes, women who subsequently develop gestational diabetes mellitus (GDM) and women who deliver large for gestational age (LGA) neonates compared with normoglycaemic pregnant women who deliver an appropriate for gestational age (AGA) neonate. DESIGN Case-control study. SETTING Antenatal clinic. POPULATION Singleton pregnancies at 11(+0) -13(+6) weeks, including 50 women with type 2 diabetes, 100 women who subsequently developed GDM, 50 nondiabetic women who subsequently delivered LGA neonates and 1000 nondiabetic controls who delivered AGA neonates. METHODS Maternal serum total 25(OH)D levels were measured in the four groups of pregnancies. Multiple regression analysis in the controls was used to identify factors among maternal characteristics with a significant contribution to the levels of serum 25(OH)D, so that the values in all cases were expressed as a multiple of the median (MoM) in the controls. MAIN OUTCOME MEASURES Comparison of MoM 25(OH)D in the four groups. RESULTS In controls, significant independent contributions to the serum level of 25(OH)D were provided by maternal age, body mass index, smoking status, racial origin and season of sampling. The median and interquartile range (IQR) of serum 25(OH)D in the type 2 diabetes group (1.01; IQR, 0.68-1.47 MoM), GDM group (0.93; IQR, 0.67-1.23 MoM) and LGA group (0.97; IQR, 0.67-1.25 MoM) were not significantly different from those in the controls (0.99; IQR, 0.71-1.33 MoM) (overall P = 0.643). CONCLUSIONS The first-trimester maternal serum level of 25(OH)D is not altered in women with type 2 diabetes, those who develop GDM or those who deliver LGA neonates.
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Affiliation(s)
- M D Savvidou
- Department of Maternal Fetal Medicine, Imperial College School of Medicine, Chelsea and Westminster Hospital, London UK.
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Cekmez F, Canpolat FE, Pirgon O, Çetinkaya M, Aydinoz S, Suleymanoglu S, Ipcioglu OM, Sarici SU. Apelin, vaspin, visfatin and adiponectin in large for gestational age infants with insulin resistance. Cytokine 2011; 56:387-91. [DOI: 10.1016/j.cyto.2011.06.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 06/01/2011] [Accepted: 06/05/2011] [Indexed: 11/28/2022]
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Renom Espineira A, Fernandes-Rosa FL, Bueno AC, de Souza RM, Moreira AC, de Castro M, Barbieri MA, Bettiol H, Antonini SR. Postnatal growth and cardiometabolic profile in young adults born large for gestational age. Clin Endocrinol (Oxf) 2011; 75:335-41. [PMID: 21521322 DOI: 10.1111/j.1365-2265.2011.04054.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT The association between large for gestational age (LGA) phenotype, postnatal growth and cardiometabolic risk (CMR) in adult life remains unclear. The role of IGF1 genotype on LGA-related outcomes in adult life is unknown. AIM To assess the postnatal growth, IGF-I levels, CMR and the influence of the 737.738 IGF1 in adults born LGA. SUBJECTS Case-control study (n = 515) nested in a population-based prospective cohort (n = 2063); 117 LGA and 398 gender-matched controls appropriate for gestational age (AGA) subjects. METHODS Anthropometry was evaluated at birth, at 9-10 and at 23-25 years old. At the age of 23-25 years, blood pressure (BP), glycaemia, insulinaemia, homeostasis model assessment - insulin resistance, lipids, fibrinogen, and plasma IGF-I and 737.738 IGF1 polymorphism were assessed. RESULTS Large for gestational age subjects remained heavier and taller than AGA at 9-10 and 23-25 years (P < 0·05); at 23-25 years, LGA had greater waist circumference (WC; P < 0·05) and higher BP (P < 0·05) than controls. Body proportionality at birth did not predict metabolic outcome. LGA subjects presenting catch-down of weight in childhood had lower body mass index (BMI; P = 0·001), lower WC (P < 0·05) and lower BP (P < 0·05) at 23-25 years. 737.738 IGF-I genotype differed between groups (P < 0·001). Homozygosis for polymorphic alleles was associated with increased odds of LGA (OR: 3·2; 95% CI: 1·5-6·9), higher IGF-I (56·9 ± 16·4 vs 37·7 ± 16·0 nm; P < 0·01) and lower BP (114/68 vs 121/73 mmHg; P < 0·05). CONCLUSIONS Young adults born LGA presented higher BMI, WC and BP and appear to be at higher CMR risk than AGA subjects. The 737.738 IGF1 polymorphism appears to play a role on birth size and LGA-related metabolic outcomes.
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Affiliation(s)
- Aniette Renom Espineira
- Department of Pediatrics, School of Medicine of Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil
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Evagelidou EN, Giapros VI, Challa AS, Cholevas VK, Vartholomatos GA, Siomou EC, Kolaitis NI, Bairaktari ET, Andronikou SK. Prothrombotic state, cardiovascular, and metabolic syndrome risk factors in prepubertal children born large for gestational age. Diabetes Care 2010; 33:2468-70. [PMID: 20724652 PMCID: PMC2963515 DOI: 10.2337/dc10-1190] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate metabolic syndrome and cardiovascular disease risk factors in prepubertal children born large for gestational age (LGA) to nondiabetic, nonobese mothers. RESEARCH DESIGN AND METHODS At 6-7 years of age, the comparison of various factors was made between 31 LGA and 34 appropriate-for-gestational-age (AGA) children: fibrinogen, antithrombin III, protein C and S, fasting insulin, glucose, homeostasis assessment model of insulin resistance (HOMA-IR) index, adiponectin, leptin, visfatin, IGF-1, IGF-binding protein (IGFBP)-1, IGFBP-3, lipids, and the genetic factors V Leiden G1691A mutation, prothrombin 20210A/G polymorphism, and mutation in the enzyme 5,10-methylenetetrahydrofolate-reductase gene (MTHFR-C677T). RESULTS LGA children had higher levels of leptin (P<0.01), fasting insulin (P<0.01), and HOMA-IR (P<0.01), but lower IGFBP-3 (P=0.0001), fibrinogen (P=0.0001), and lipoprotein(a) (P<0.001) than AGA children. Significantly more LGA children were homozygous for the MTHFR-C677T mutation (P=0.0016). CONCLUSIONS Being born LGA to nondiabetic, nonobese mothers is associated with diverse effects on cardiometabolic risk factors at prepuberty.
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Affiliation(s)
- Eleni N Evagelidou
- Neonatal Intensive Care Unit, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
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Meral C, Cekmez F, Pirgon O, Asya Tanju I, Metin Ipcioglu O, Karademir F, Gocmen I. The relationship between serum visfatin, adiponectin, and insulin sensitivity markers in neonates after birth. J Matern Fetal Neonatal Med 2010; 24:166-70. [DOI: 10.3109/14767058.2010.482604] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bueno AC, Espiñeira AR, Fernandes-Rosa FL, de Souza RM, de Castro M, Moreira AC, Bettiol H, Barbieri MA, Antonini SR. Adiponectin: serum levels, promoter polymorphism, and associations with birth size and cardiometabolic outcome in young adults born large for gestational age. Eur J Endocrinol 2010; 162:53-60. [PMID: 19841046 DOI: 10.1530/eje-09-0697] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To assess whether the -11391G>A polymorphism in the regulatory region of the adiponectin gene (ADIPOQ) is associated with birth size, postnatal growth, adiponectinemia, and cardiometabolic risk in adult life. DESIGN Case-control study nested within a prospective cohort of 2063 community subjects born in 1978/1979 and followed since birth to date. METHODS ADIPOQ -11391G>A genotype-phenotype associations were evaluated in 116 subjects born large for gestational age (LGA) and 392 gender-matched controls at birth (birth size), at 8-10 years (catch-down growth), and at 23-25 years of age (cardiometabolic profile). RESULTS The -11391A variant allele frequency was higher in LGA subjects (P=0.04). AA genotype was associated with augmented probability of being born LGA (odds ratio=4.14; 95% confidence interval: 1.16-16.7; P=0.03). This polymorphism was associated neither with body composition nor with postnatal growth pattern. At the age of 23-25 years, the -11391A variant allele was associated with higher serum adiponectin levels (GG: 10.7+/-6.2 versus GA: 12.2+/-6.5 versus AA: 14.2+/-6.8 microg/ml; P<0.01). Subjects born LGA presented higher body mass index (BMI; P=0.01), abdominal circumference (P=0.04), blood pressure (P=0.04), and homeostasis assessment model for insulin resistance (P=0.01) than adequate for gestational age. Symmetry at birth did not influence these variables. The occurrence of catch-down of weight was associated with lower BMI and abdominal circumference (P<0.001) at 23-25 years. CONCLUSIONS The -11391A ADIPOQ gene variant was associated with increased chance of being born LGA and with higher adiponectin levels in early adult life.
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Affiliation(s)
- Ana Carolina Bueno
- Department of Pediatrics, School of Medicine of Ribeirao Preto, University of Sao Paulo, Monte Alegre, Ribeirao Preto, Sao Paulo, Brazil
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Chiavaroli V, Giannini C, D'Adamo E, de Giorgis T, Chiarelli F, Mohn A. Insulin resistance and oxidative stress in children born small and large for gestational age. Pediatrics 2009; 124:695-702. [PMID: 19651586 DOI: 10.1542/peds.2008-3056] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our aim was to evaluate the effect of BW and obesity on oxidative stress and IR in prepubertal SGA and LGA children compared with appropriate-for-gestational-age (AGA) children. METHODS We performed a cross-sectional study comparing oxidative stress and IR in 103 children categorized into 6 groups according to BW (26 SGA, 15 AGA, and 16 LGA normal-weight children) and obesity (15 SGA, 15 AGA, and 16 LGA obese children). Indexes of IR (HOMA-IR, G/I) and the marker of oxidative stress (urinary isoprostanes) were evaluated. RESULTS Homeostasis Model Assessment was higher in both normal-weight SGA and LGA children than in normal-weight AGA children (all P <or= .02). Furthermore, a difference was detected between obese SGA and obese LGA subjects compared with normal-weight SGA (all P <or= .0007) and LGA (all P <or= .01) children, respectively. The G/I ratio was lower in the 3 obese groups than normal-weight AGA (all P <or= .009) and normal-weight SGA children (all P <or= .02). Furthermore, a difference was detected between obese SGA and obese LGA children compared with normal-weight LGA children (all P <or= .0002). Isoprostane levels were higher in both normal-weight SGA and LGA children than in normal-weight AGA children (all P <or= .002). Moreover, both obese SGA and LGA children showed higher levels than obese AGA children (all P <or= .01) and in comparison to the 3 normal-weight groups (all P <or= .04). CONCLUSION Increased IR and oxidative stress are already present in prepubertal normal-weight SGA and LGA children with a continuous alteration in relation to obesity, suggesting that BW and adiposity represent 2 independent risk factors for degenerative diseases.
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Injury patterns among obese children involved in motor vehicle collisions. J Pediatr Surg 2009; 44:1218-22; discussion 1222. [PMID: 19524744 DOI: 10.1016/j.jpedsurg.2009.02.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Accepted: 02/17/2009] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to compare injury patterns among obese children to their nonobese counterparts involved in motor vehicle collisions. METHODS A nationwide data collection program containing occupant, collision, and injury details from police-reported tow-away crashes between 1997 and 2006 were used. Risk ratios (RRs) and associated 95% confidence intervals (CIs) were adjusted for age, sex, restraint, seat track position, vehicle curb weight, and total velocity change. RESULTS An estimated 9 million children aged 2 to 17 years (20.2% obese) were involved in motor vehicle collisions during the study period. Among 2-to-5-year-olds, obesity increased the risk of severe head (RR, 3.67; 95% CI, 1.03-13.08) and thoracic (2.27; 1.01-5.08) injuries. Among 6-to-9-year-olds, obesity increased risk of thoracic (2.31; 1.08-4.95) and lower extremity (LE) injuries (1.89; 1.03-3.47). Among 10-to-13-year-olds, obesity increased the risk of severe thoracic (1.98; 1.08-3.65) and LE (6.06; 2.23-16.44) injuries. Among 14-to-17-year-olds, obesity increased risk of severe LE injuries (1.44; 1.04-2.00) but decreased risk of abdominal (0.20; 0.07-0.60) and head (0.33; 0.18-0.60) injuries, very similar to the pattern reported in obese adults. CONCLUSION The pattern of obesity-associated injuries changes from a higher risk of head and thoracic injuries among young children to a pattern in late teenagers that is similar to obese adults.
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Darendeliler F, Poyrazoglu S, Sancakli O, Bas F, Gokcay G, Aki S, Eskiyurt N. Adiponectin is an indicator of insulin resistance in non-obese prepubertal children born large for gestational age (LGA) and is affected by birth weight. Clin Endocrinol (Oxf) 2009; 70:710-6. [PMID: 18759869 DOI: 10.1111/j.1365-2265.2008.03394.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Being born as large for gestational age (LGA) has an increased risk of developing insulin resistance. Hypoadiponectinaemia is associated with insulin resistance. The aim of this study was to evaluate adiponectin levels and insulin resistance in association with body composition in LGA born non-obese children at prepubertal ages. PATIENTS AND METHODS Thirty-five (17 female and 18 male) LGA born non-obese children (mean age 4.8 +/- 0.3 years) were evaluated with respect to glucose, insulin, IGFBP-1, leptin, adiponectin levels and body composition by DEXA. Their data were compared to that of non-obese 49 (20 female, 29 male) appropriate for gestational age (AGA) children (mean age 3.8 +/- 0.1 year). RESULTS LGA children, who had similar body mass index standard deviation scores (BMI SDS) as AGA children, had significantly higher insulin (P = 0.043) and statistically borderline significant homeostasis model assessment-insulin resistance (HOMA-IR) levels (P = 0.054) than those of AGA children. Adiponectin levels were significantly lower in LGA than AGA children (P = 0.004) even after controlling for age, sex and BMI (P = 0.016). IGFBP-1, leptin levels and body composition did not show a difference. When the LGA group was divided into subgroups according to birth weight, the analysis revealed that after controlling for BMI, being an LGA and having a higher birth weight in the upper half were associated with lower adiponectin levels (estimated marginal means of logarithmic adiponectin levels 2.6 +/- 0.2 vs. 2.1 +/- 0.2 microg/ml, P = 0.042). CONCLUSION LGA children have higher insulin and lower adiponectin levels than AGA children in spite of similar BMI. Adiponectin is a better indicator of insulin resistance in LGA children at prepubertal ages and is affected by birth weight.
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Affiliation(s)
- Feyza Darendeliler
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Challa AS, Evagelidou EN, Cholevas VI, Kiortsis DN, Giapros VI, Drougia AA, Andronikou SK. Growth factors and adipocytokines in prepubertal children born small for gestational age: relation to insulin resistance. Diabetes Care 2009; 32:714-9. [PMID: 19131467 PMCID: PMC2660477 DOI: 10.2337/dc08-1570] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to test whether being born small for gestational age (SGA) has an impact on adiponectin and leptin levels and the IGF system in relation to insulin sensitivity, taking into consideration the severity of growth restriction. RESEARCH DESIGN AND METHODS Serum levels of adiponectin, leptin, fasting glucose, fasting insulin (I(F)), the homeostasis model assessment insulin resistance index (HOMA-IR), IGF-1, free IGF-1, IGF-binding protein (IGFBP)-1 and -3, total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides were evaluated in 57 children at age 4-10 years. Of these, 32 had been born appropriate size for gestational age (AGA) and 25 SGA (14 in the <3rd percentile and 11 in the 3rd-10th percentile). RESULTS; The SGA 3rd-10th percentile children were already insulin resistant at prepubertal age (I(F) 39.6 +/- 16.8 vs. 27 +/- 12 pmol/l, P < 0.01, and HOMA-IR 1.4 +/- 0.6 vs. 0.95 +/- 0.42 in SGA vs. AGA children, P < 0.05). Their IGF-1 and IGFBP-3 concentrations were significantly lower than those in AGA children (160.4 +/- 66.2 vs. 207 +/- 66.8 microg/l, P < 0.05 and 2.3 +/- 0.4 vs. 3.51 +/- 1.21 mg/l in SGA vs. AGA children, P < 0.01). The SGA <3rd percentile children had higher adiponectin (15.6 +/- 5.7 mg/l, P < 0.05) and IGFBP-1 levels (113.5 +/- 33.9 microg/l, P < 0.05) than AGA children (11.3 +/- 6.6 mg/l and 90.8 +/- 24.2 microg/l, respectively) and lower IGF-1 and IGFBP-3 concentrations (162.6 +/- 68.4 microg/l, P < 0.05 and 2.4 +/- 0.7 mg/l, P < 0.01). They also had significantly lower waist circumference (P < 0.05). Leptin levels did not differ among groups, but an inverse correlation with IGFBP-1 (r = -0.55, P < 0.01) was found in the pooled SGA group. CONCLUSIONS Intrauterine growth restriction appears to affect the IGF axis at prepubertal age, and its severity plays a role in insulin sensitivity.
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Affiliation(s)
- Anna S Challa
- Pediatric Research Laboratory, Child Health Department, University of Ioannina, Ioannina, Greece
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Chiesa C, Osborn JF, Haass C, Natale F, Spinelli M, Scapillati E, Spinelli A, Pacifico L. Ghrelin, leptin, IGF-1, IGFBP-3, and insulin concentrations at birth: is there a relationship with fetal growth and neonatal anthropometry? Clin Chem 2008; 54:550-8. [PMID: 18202160 DOI: 10.1373/clinchem.2007.095299] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Insulin, growth hormone (GH), and growth factors (insulin-like growth factors [IGFs] and their binding proteins [IGFBPs]) are known to influence fetal growth and also the synthesis/secretion of the recently discovered hormones leptin and ghrelin. METHODS In 153 delivering mothers and their offspring at birth, we prospectively investigated the association between mothers' and babies' serum concentrations of ghrelin, leptin, insulin, IGF-1, and IGFBP-3 and neonatal anthropometric characteristics and the growth of the fetus. We also tried to put babies' serum glucose and GH measurements in this context. RESULTS Birth weight (BW), birth length, head circumference, and ponderal index (PI) were positively associated with cord IGF-1, IGFBP-3, and leptin and negatively associated with GH. BW was independently associated with maternal stature and prepartum weight, birth length with maternal stature, PI with maternal insulin and prepartum weight, and head circumference with maternal ghrelin. Compared with preterm infants whose development was appropriate for gestational age (AGA), preterm growth-restricted babies displayed alteration in GH-IGF axis (increased GH and low IGF-1 and IGFBP-3 concentrations), low leptin and glucose concentrations, and increased ghrelin concentrations. In large-for-gestational-age (LGA) babies, leptin, IGFBP-3, insulin, and glucose concentrations were significantly higher in asymmetric LGA newborns than in symmetric LGA and AGA newborns. CONCLUSIONS We found relationships between metabolic factors, fetal growth, and anthropometry. Intrauterine growth restriction involved alteration in the fetal GH-IGF axis, with relatively low leptin and glucose concentrations and increased ghrelin concentrations. Leptin, insulin, and IGFBP-3 delineated subtypes of fetal overgrowth.
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Affiliation(s)
- Claudio Chiesa
- Department of Pediatrics, La Sapienza University of Rome, Viale Regina Elena, 32400161 Rome, Italy.
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Haynes A, Bower C, Bulsara MK, Finn J, Jones TW, Davis EA. Perinatal risk factors for childhood Type 1 diabetes in Western Australia--a population-based study (1980-2002). Diabet Med 2007; 24:564-70. [PMID: 17470192 DOI: 10.1111/j.1464-5491.2007.02149.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To investigate perinatal risk factors for childhood Type 1 diabetes in Western Australia, using a complete population-based cohort. METHODS Children born between 1980 and 2002 and diagnosed with Type 1 diabetes aged < 15 years (n = 940) up to 31 December 2003 were identified using a prospective population-based diabetes register with a case ascertainment rate of 99.8%. Perinatal data were obtained for all live births in Western Australia from 1980 to 2002 (n = 558 633) and record linkage performed to identify the records of cases. RESULTS The incidence of Type 1 diabetes increased by 13% for each 5-year increase in maternal age [adjusted incidence rate ratio (IRR) 1.13, 95% confidence interval (CI) 1.05, 1.21], by 13% for every 500-g increase in birth weight (adjusted IRR 1.13, 95% CI 1.04, 1.23). The incidence decreased with increasing birth order (adjusted IRR 0.89, 95% CI 0.82, 0.96) and increasing gestational age (adjusted IRR 0.84, 95% CI 0.77, 0.93). A higher incidence of Type 1 diabetes was associated with an urban vs. non-urban maternal address at the time of birth (adjusted IRR 1.38, 95% CI 1.18, 1.63), but no association was found with socio-economic status of the area. CONCLUSIONS A higher incidence of Type 1 diabetes was associated with increasing maternal age, higher birth weight, lower gestational age, lower birth order and urban place of residence at the time of birth.
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Affiliation(s)
- A Haynes
- Department of Endocrinology & Diabetes, Princess Margaret Hospital, and Telethon Institute of Child Health Research, Centre for Child Health Research, Perth, Western Australia, Australia
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Giapros V, Evagelidou E, Challa A, Kiortsis D, Drougia A, Andronikou S. Serum adiponectin and leptin levels and insulin resistance in children born large for gestational age are affected by the degree of overweight. Clin Endocrinol (Oxf) 2007; 66:353-9. [PMID: 17302868 DOI: 10.1111/j.1365-2265.2006.02736.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Children born large for gestational age (LGA) are prone to develop insulin resistance later in life. One factor that affects insulin sensitivity is the hormone adiponectin. The aim of this study was to determine whether being LGA has an impact on serum adiponectin and leptin levels and insulin resistance parameters during childhood, taking into account the severity of overweight. STUDY DESIGN Serum levels of adiponectin, leptin, fasting glucose and insulin, homeostasis model assessment insulin resistance index (HOMA-IR), and anthropometric indices were evaluated in groups of non-obese children aged 6.5-8 years, born appropriate for gestational age (AGA, n = 40) or LGA (n = 41), matched for age, gender, height, weight and body mass index. The LGA group was divided in two subgroups according to the degree of overweight: (a) LGA with birthweight 90th-97th percentile (n = 25); and (b) LGA with birthweight > 97th percentile (n = 16). RESULTS LGA children had a higher mean serum adiponectin level than AGA children: 17.0 +/- 9 vs. 11.1 +/- 5 (microg/ml) (P < 0.01). LGA children had also higher insulin 6.2 +/- 2.8 vs. 4.8 +/- 2.4 (microU/ml) (P < 0.05) and HOMA-IR 1.32 +/- 0.66 vs. 1.02 +/- 0.55 (P < 0.01) than AGA children. Children born LGA > 97th percentile had a significantly higher mean serum leptin level than both AGA and LGA 90th-97th percentile children (17 +/- 13, 9.6 +/- 9.5, 7.8 +/- 7.9 ng/ml, respectively, P < 0.05), and more severely affected insulin resistance indices than LGA 90th-97th percentile children. In the regression analysis, birthweight was found to be an independent predictor of adiponectin serum levels. CONCLUSION Prepubertal LGA-born children had a higher mean serum adiponectin levels than matched AGA controls despite the fact that they were more insulin resistant. The degree of excess in utero weight gain appears to influence the metabolic profile in LGA-born prepubertal children. Further studies are needed to delineate the role of adiponectin in the risk of development of insulin resistance in children born LGA.
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Affiliation(s)
- Vasileios Giapros
- Neonatal Intensive Care Unit, University of Ioannina, Ioannina, Greece.
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