1
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Fejzo M, Rocha N, Cimino I, Lockhart SM, Petry CJ, Kay RG, Burling K, Barker P, George AL, Yasara N, Premawardhena A, Gong S, Cook E, Rimmington D, Rainbow K, Withers DJ, Cortessis V, Mullin PM, MacGibbon KW, Jin E, Kam A, Campbell A, Polasek O, Tzoneva G, Gribble FM, Yeo GSH, Lam BYH, Saudek V, Hughes IA, Ong KK, Perry JRB, Sutton Cole A, Baumgarten M, Welsh P, Sattar N, Smith GCS, Charnock-Jones DS, Coll AP, Meek CL, Mettananda S, Hayward C, Mancuso N, O'Rahilly S. GDF15 linked to maternal risk of nausea and vomiting during pregnancy. Nature 2024; 625:760-767. [PMID: 38092039 PMCID: PMC10808057 DOI: 10.1038/s41586-023-06921-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 11/30/2023] [Indexed: 01/19/2024]
Abstract
GDF15, a hormone acting on the brainstem, has been implicated in the nausea and vomiting of pregnancy, including its most severe form, hyperemesis gravidarum (HG), but a full mechanistic understanding is lacking1-4. Here we report that fetal production of GDF15 and maternal sensitivity to it both contribute substantially to the risk of HG. We confirmed that higher GDF15 levels in maternal blood are associated with vomiting in pregnancy and HG. Using mass spectrometry to detect a naturally labelled GDF15 variant, we demonstrate that the vast majority of GDF15 in the maternal plasma is derived from the feto-placental unit. By studying carriers of rare and common genetic variants, we found that low levels of GDF15 in the non-pregnant state increase the risk of developing HG. Conversely, women with β-thalassaemia, a condition in which GDF15 levels are chronically high5, report very low levels of nausea and vomiting of pregnancy. In mice, the acute food intake response to a bolus of GDF15 is influenced bi-directionally by prior levels of circulating GDF15 in a manner suggesting that this system is susceptible to desensitization. Our findings support a putative causal role for fetally derived GDF15 in the nausea and vomiting of human pregnancy, with maternal sensitivity, at least partly determined by prepregnancy exposure to the hormone, being a major influence on its severity. They also suggest mechanism-based approaches to the treatment and prevention of HG.
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Affiliation(s)
- M Fejzo
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - N Rocha
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - I Cimino
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - S M Lockhart
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - C J Petry
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - R G Kay
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Peptidomics and Proteomics Core Facility, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - K Burling
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Core Biochemical Assay Laboratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - P Barker
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Core Biochemical Assay Laboratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A L George
- Peptidomics and Proteomics Core Facility, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - N Yasara
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, Sri Lanka
| | - A Premawardhena
- Adolescent and Adult Thalassaemia Care Center (University Medical Unit), North Colombo Teaching Hospital, Kadawatha, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - S Gong
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - E Cook
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - D Rimmington
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - K Rainbow
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - D J Withers
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - V Cortessis
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - P M Mullin
- Department of Obstetrics and Gynaecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - K W MacGibbon
- Hyperemesis Education and Research Foundation, Clackamas, OR, USA
| | - E Jin
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - A Kam
- Department of Obstetrics and Gynaecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - A Campbell
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - O Polasek
- Faculty of Medicine, University of Split, Split, Croatia
| | - G Tzoneva
- Regeneron Genetics Center, Tarrytown, NY, USA
| | - F M Gribble
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - G S H Yeo
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - B Y H Lam
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - V Saudek
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - I A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - K K Ong
- Department of Paediatrics, University of Cambridge, Cambridge, UK
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - J R B Perry
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - A Sutton Cole
- Department of Obstetrics and Gynaecology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M Baumgarten
- Department of Obstetrics and Gynaecology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - P Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - N Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - G C S Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - D S Charnock-Jones
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - A P Coll
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - C L Meek
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - S Mettananda
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, Sri Lanka
- University Paediatrics Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - C Hayward
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - N Mancuso
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Quantitative and Computational Biology, University of Southern California, California, CA, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, California, CA, USA
| | - S O'Rahilly
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
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Eleftheriou A, Ong KK, Hughes IA, Petry CJ. Leptin and IGF-1 in Infancy Are Associated With Variants in DHCR7 and CYP2R1 That Relate With Type 1 Diabetes and 25OHD. J Clin Endocrinol Metab 2023; 108:e1394-e1402. [PMID: 37170809 PMCID: PMC10584008 DOI: 10.1210/clinem/dgad263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/13/2023]
Abstract
CONTEXT Vitamin D has been variably implicated in risk of developing type 1 diabetes based on cohorts of at-risk individuals. Emergent type 1 diabetes in childhood is putatively preceded by altered growth. OBJECTIVE We explored whether polymorphisms in vitamin D metabolism genes modify risk of type 1 diabetes via effects on growth in a prospective, population-based cohort of infants. METHODS The Cambridge Baby Growth Study enrolled newborns from Cambridgeshire, UK, for follow-up in infancy. In 612 infants, we genotyped single nucleotide polymorphisms in vitamin D metabolism genes that relate with type 1 diabetes: rs10741657 and rs12794714 in CYP2R1, rs12785878 in DHCR7, and rs10877012 in CYP27B1. Multivariate linear regression analyses tested associations between genotypes and anthropometric indices (weight, length, and skinfold thickness) or growth-related hormones (C-peptide, IGF-1, and leptin) in infancy. RESULTS Birth weight showed borderline associations with the diabetes risk-increasing alleles in CYP2R1, rs10741657 (β = -.11, P = .02) and rs12794714 (β = -.09, P = .04). The risk-increasing allele rs12794714 was also associated with higher IGF-1 levels at age 24 months (β = .30, P = .01). At age 3 months, the risk-increasing allele rs12785878 in DHCR7, known to negatively associate with 25-hydroxyvitamin D levels, showed a positive association with leptin levels (β = .23, P = .009), which was pronounced in girls (P = .004) vs boys (P = .7). CONCLUSION The vitamin D metabolism genes DHCR7 and CYP2R1 might influence infancy leptin and IGF-1 levels respectively. These findings open the possibility for a developmental role of vitamin D that is mediated by growth-related hormones with implications for the onset of type 1 diabetes autoimmunity.
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Affiliation(s)
| | - Ken K Ong
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0QQ, UK
- Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Clive J Petry
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK
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3
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Olwi DI, Day FR, Cheng TS, Olga L, Petry CJ, Hughes IA, Smith AD, Ong KK. Associations of appetitive traits with growth velocities from infancy to childhood. Sci Rep 2023; 13:16056. [PMID: 37749117 PMCID: PMC10520028 DOI: 10.1038/s41598-023-42899-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023] Open
Abstract
Several studies have reported associations between appetitive traits and weight gain during infancy or childhood, but none have directly compared these associations across both age periods. Here, we tested the associations between appetitive traits and growth velocities from birth to childhood. Appetitive trait data were collected using the Children's Eating Behaviour Questionnaire (CEBQ) in 149 children from the Cambridge Baby Growth Study at age 9-17 years. These participants also provided anthropometric measurements during infancy (birth, 3, 12, 18, and 24 months) and childhood (5 to 11 years). Standardized growth velocities (in weight, length/height, BMI, and body fat percentage) for 0-3 months, 3-24 months, and 24 months to childhood were estimated using individual linear-spline models. Associations between each of the eight CEBQ traits and each growth velocity were tested in separate multilevel linear regression models, adjusted for sex, age at CEBQ completion, and the corresponding birth measurement (weight, length, BMI, or body fat percentage). The three food-approach traits (food responsiveness, enjoyment of food and emotional overeating) were positively associated with infancy and childhood growth velocities in weight, BMI, and body fat percentage. By contrast, only one of the food-avoidant traits, satiety responsiveness, was negatively associated with all growth velocities. Significant associations were mostly of similar magnitude across all age periods. These findings reveal a broadly consistent relationship between appetitive traits with gains in weight and adiposity throughout infancy and childhood. Future interventions and strategies to prevent obesity may benefit from measuring appetitive traits in infants and children and targeting these as part of their programs.
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Affiliation(s)
- Duaa Ibrahim Olwi
- MRC Epidemiology Unit, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, School of Clinical Medicine, Box 285, Cambridge, CB2 0QQ, UK.
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
- King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
| | - Felix R Day
- MRC Epidemiology Unit, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, School of Clinical Medicine, Box 285, Cambridge, CB2 0QQ, UK
| | - Tuck Seng Cheng
- MRC Epidemiology Unit, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, School of Clinical Medicine, Box 285, Cambridge, CB2 0QQ, UK
| | - Laurentya Olga
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Clive J Petry
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Andrea D Smith
- MRC Epidemiology Unit, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, School of Clinical Medicine, Box 285, Cambridge, CB2 0QQ, UK
| | - Ken K Ong
- MRC Epidemiology Unit, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, School of Clinical Medicine, Box 285, Cambridge, CB2 0QQ, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
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4
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Olga L, Vervoort J, van Diepen JA, Gross G, Petry CJ, Prentice PM, Chichlowski M, van Tol EAF, Hughes IA, Dunger DB, Ong KK. Associations between breast milk intake volume, macronutrient intake and infant growth in a longitudinal birth cohort: the Cambridge Baby Growth and Breastfeeding Study (CBGS-BF). Br J Nutr 2023; 130:56-64. [PMID: 36259139 PMCID: PMC10244014 DOI: 10.1017/s0007114522003178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/14/2022] [Accepted: 09/27/2022] [Indexed: 02/16/2023]
Abstract
Growth patterns of breastfed infants show substantial inter-individual differences, partly influenced by breast milk (BM) nutritional composition. However, BM nutritional composition does not accurately indicate BM nutrient intakes. This study aimed to examine the associations between both BM intake volumes and macronutrient intakes with infant growth. Mother-infant dyads (n 94) were recruited into the Cambridge Baby Growth and Breastfeeding Study (CBGS-BF) from a single maternity hospital at birth; all infants received exclusive breast-feeding (EBF) for at least 6 weeks. Infant weight, length and skinfolds thicknesses (adiposity) were repeatedly measured from birth to 12 months. Post-feed BM samples were collected at 6 weeks to measure TAG (fat), lactose (carbohydrate) (both by 1H-NMR) and protein concentrations (Dumas method). BM intake volume was estimated from seventy infants between 4 and 6 weeks using dose-to-the-mother deuterium oxide (2H2O) turnover. In the full cohort and among sixty infants who received EBF for 3+ months, higher BM intake at 6 weeks was associated with initial faster growth between 0 and 6 weeks (β + se 3·58 + 0·47 for weight and 4·53 + 0·6 for adiposity gains, both P < 0·0001) but subsequent slower growth between 3 and 12 months (β + se - 2·27 + 0·7 for weight and -2·65 + 0·69 for adiposity gains, both P < 0·005). BM carbohydrate and protein intakes at 4-6 weeks were positively associated with early (0-6 weeks) but tended to be negatively related with later (3-12 months) adiposity gains, while BM fat intake showed no association, suggesting that carbohydrate and protein intakes may have more functional relevance to later infant growth and adiposity.
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Affiliation(s)
- Laurentya Olga
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Jacques Vervoort
- Department of Agrotechnology and Food Sciences, Wageningen University, Wageningen, the Netherlands
| | - Janna A. van Diepen
- Medical and Scientific Affairs, Reckitt/Mead Johnson Nutrition Institute, Nijmegen, the Netherlands; Evansville, IN, USA
| | - Gabriele Gross
- Medical and Scientific Affairs, Reckitt/Mead Johnson Nutrition Institute, Nijmegen, the Netherlands; Evansville, IN, USA
| | - Clive J. Petry
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | | | - Maciej Chichlowski
- Medical and Scientific Affairs, Reckitt/Mead Johnson Nutrition Institute, Nijmegen, the Netherlands; Evansville, IN, USA
| | - Eric A. F. van Tol
- Medical and Scientific Affairs, Reckitt/Mead Johnson Nutrition Institute, Nijmegen, the Netherlands; Evansville, IN, USA
| | - Ieuan A. Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - David B. Dunger
- Department of Paediatrics, University of Cambridge, Cambridge, UK
- Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Ken K. Ong
- Department of Paediatrics, University of Cambridge, Cambridge, UK
- Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- MRC Epidemiology Unit, Wellcome Trust-MRC Institute of Metabolic Science, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge, CB2 0QQ, UK
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5
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Fejzo M, Rocha N, Cimino I, Lockhart SM, Petry C, Kay RG, Burling K, Barker P, George AL, Yasara N, Premawardhena A, Gong S, Cook E, Rainbow K, Withers DJ, Cortessis V, Mullin PM, MacGibbon KW, Jin E, Kam A, Campbell A, Polasek O, Tzoneva G, Gribble FM, Yeo G, Lam B, Saudek V, Hughes IA, Ong KK, Perry J, Sutton Cole A, Baumgarten M, Welsh P, Sattar N, Smith G, Charnock Jones DS, Coll AP, Meek CL, Mettananda S, Hayward C, Mancuso N, O'Rahilly S. Fetally-encoded GDF15 and maternal GDF15 sensitivity are major determinants of nausea and vomiting in human pregnancy. bioRxiv 2023:2023.06.02.542661. [PMID: 37398065 PMCID: PMC10312505 DOI: 10.1101/2023.06.02.542661] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Human pregnancy is frequently accompanied by nausea and vomiting that may become severe and life-threatening, as in hyperemesis gravidarum (HG), the cause of which is unknown. Growth Differentiation Factor-15 (GDF15), a hormone known to act on the hindbrain to cause emesis, is highly expressed in the placenta and its levels in maternal blood rise rapidly in pregnancy. Variants in the maternal GDF15 gene are associated with HG. Here we report that fetal production of GDF15, and maternal sensitivity to it, both contribute substantially to the risk of HG. We found that the great majority of GDF15 in maternal circulation is derived from the feto-placental unit and that higher GDF15 levels in maternal blood are associated with vomiting and are further elevated in patients with HG. Conversely, we found that lower levels of GDF15 in the non-pregnant state predispose women to HG. A rare C211G variant in GDF15 which strongly predisposes mothers to HG, particularly when the fetus is wild-type, was found to markedly impair cellular secretion of GDF15 and associate with low circulating levels of GDF15 in the non-pregnant state. Consistent with this, two common GDF15 haplotypes which predispose to HG were associated with lower circulating levels outside pregnancy. The administration of a long-acting form of GDF15 to wild-type mice markedly reduced subsequent responses to an acute dose, establishing that desensitisation is a feature of this system. GDF15 levels are known to be highly and chronically elevated in patients with beta thalassemia. In women with this disorder, reports of symptoms of nausea or vomiting in pregnancy were strikingly diminished. Our findings support a causal role for fetal derived GDF15 in the nausea and vomiting of human pregnancy, with maternal sensitivity, at least partly determined by pre-pregnancy exposure to GDF15, being a major influence on its severity. They also suggest mechanism-based approaches to the treatment and prevention of HG.
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Affiliation(s)
- M Fejzo
- Department of Obstetrics and Gynaecology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - N Rocha
- Medical Research Council (MRC) Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - I Cimino
- Medical Research Council (MRC) Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - S M Lockhart
- Medical Research Council (MRC) Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - C Petry
- Medical Research Council (MRC) Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - R G Kay
- Medical Research Council (MRC) Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Peptidomics and Proteomics Core Facility, Level 4, Wellcome-MRC Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - K Burling
- Medical Research Council (MRC) Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Core Biochemical Assay Laboratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - P Barker
- Medical Research Council (MRC) Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Core Biochemical Assay Laboratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - A L George
- Peptidomics and Proteomics Core Facility, Level 4, Wellcome-MRC Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - N Yasara
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010, Sri Lanka
| | - A Premawardhena
- Adolescent and Adult Thalassaemia Care Center (University Medical Unit), North Colombo Teaching Hospital, Kadawatha, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - S Gong
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - E Cook
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - K Rainbow
- Medical Research Council (MRC) Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - D J Withers
- Medical Research Council (MRC) Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - V Cortessis
- Department of Obstetrics and Gynaecology, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - P M Mullin
- Department of Obstetrics and Gynaecology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - K W MacGibbon
- Hyperemesis Education and Research Foundation, Clackamas, OR
| | - E Jin
- Department of Obstetrics and Gynaecology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - A Kam
- Department of Obstetrics and Gynaecology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - A Campbell
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - O Polasek
- Faculty of Medicine, University of Split, Split, Croatia
| | - G Tzoneva
- Regeneron Genetics Center, Tarrytown, NY, USA
| | - F M Gribble
- Medical Research Council (MRC) Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Gsh Yeo
- Medical Research Council (MRC) Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Byh Lam
- Medical Research Council (MRC) Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - V Saudek
- Medical Research Council (MRC) Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - I A Hughes
- Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Cambridge, UK
| | - K K Ong
- Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Cambridge, UK
- MRC Epidemiology Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Jrb Perry
- Medical Research Council (MRC) Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- MRC Epidemiology Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - A Sutton Cole
- Department of Obstetrics and Gynaecology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M Baumgarten
- Department of Obstetrics and Gynaecology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - P Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - N Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Gcs Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - D S Charnock Jones
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - A P Coll
- Medical Research Council (MRC) Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - C L Meek
- Medical Research Council (MRC) Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - S Mettananda
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010, Sri Lanka
- University Paediatrics Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - C Hayward
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU,16, UK
| | - N Mancuso
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
- Department of Quantitative and Computational Biology, University of Southern California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California
| | - S O'Rahilly
- Medical Research Council (MRC) Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
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Guaragna-Filho G, Guerra-Junior G, Tadokoro-Cuccaro R, Hughes IA, Barros BA, Hiort O, Balsamo A, Guran T, Holterhus PM, Hannema S, Poyrazoglu S, Darendeliler F, Bryce J, Ahmed SF, Quigley CA. Pubertal and Gonadal Outcomes in 46,XY Individuals with Partial Androgen Insensitivity Syndrome Raised as Girls. Sex Dev 2023; 17:16-25. [PMID: 36917969 DOI: 10.1159/000526997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 09/06/2022] [Indexed: 03/15/2023] Open
Abstract
INTRODUCTION Although it was common in the 1970s-1990s to assign female gender of rearing to 46,XY infants with limited virilization of varying etiologies, including those with partial androgen insensitivity syndrome (PAIS), long-term data on outcomes for these individuals are sparse. Therefore, our goal was to use the power of an international registry to evaluate clinical features, surgical management, and pubertal data in patients with a molecularly confirmed diagnosis of PAIS who were born before 2008 and were raised as girls. METHODS The current study interrogated the International Disorders of Sex Development Registry for available data on management and pubertal outcomes in individuals with genetically confirmed PAIS who were raised as girls. RESULTS Among the 11 individuals who fulfilled the key criteria for inclusion, the external masculinization score (EMS) at presentation ranged from 2 to 6 (median 5); 7 girls underwent gonadectomy before the age of 9 years, whereas 4 underwent gonadectomy in the teenage years (≥ age 13). Clitoral enlargement at puberty was reported for 3 girls (27%) who presented initially at the time of puberty with intact gonads. In the 9 individuals (82%) for whom gonadal pathology data were provided, there was no evidence of germ cell tumor at median age of 8.1 years. All girls received estrogen replacement, and 8/11 had attained Tanner stage 4-5 breast development at the last assessment. CONCLUSION In general, although it appears that female assignment in PAIS is becoming uncommon, our data provide no evidence to support the practice of prophylactic prepubertal gonadectomy with respect to the risk of a germ cell tumor.
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Affiliation(s)
| | - Gil Guerra-Junior
- Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), State University of Campinas, Campinas, Brazil
| | | | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Beatriz A Barros
- Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), State University of Campinas, Campinas, Brazil
| | - Olaf Hiort
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University of Lübeck, Lübeck, Germany
| | - Antonio Balsamo
- Department of Medical and Surgical Sciences, Pediatric Unit, Center for Rare Endocrine Conditions (Endo-ERN), S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Tulay Guran
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Turkey
| | - Paul M Holterhus
- Department of Pediatrics, Pediatric Endocrinology and Diabetes, University Hospital of Schleswig-Holstein, UKSH, Campus Kiel, Kiel, Germany
| | - Sabine Hannema
- Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands
- Expertise Center DSD and Department of Paediatric Endocrinology, Sophia Children's Hospital, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sukran Poyrazoglu
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Feyza Darendeliler
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Jillian Bryce
- Office for Rare Conditions, University of Glasgow, Glasgow, UK
| | - S Faisal Ahmed
- Office for Rare Conditions, University of Glasgow, Glasgow, UK
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Charmian A Quigley
- Department of Endocrinology, Sydney Children's Hospital, Randwick, New South Wales, Australia
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Neufeld SAS, Collaer ML, Spencer D, Pasterski V, Hindmarsh PC, Hughes IA, Acerini C, Hines M. Androgens and child behavior: Color and toy preferences in children with congenital adrenal hyperplasia (CAH). Horm Behav 2023; 149:105310. [PMID: 36738514 PMCID: PMC9976950 DOI: 10.1016/j.yhbeh.2023.105310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 02/05/2023]
Abstract
Human males and females show average gender/sex differences for certain psychological phenomena. Multiple factors may contribute to these differences, including sex chromosomes, exposure to gonadal hormones, and socialization or learning. This study investigated potential hormonal and socialization/learning influences on gender/sex differences in childhood preferences for color, specifically pink and red vs. blues, and for toys. Children (aged 4 to 11 years) with congenital adrenal hyperplasia (CAH, n = 43 girls and 37 boys), marked by elevated prenatal adrenal androgen exposure, and without CAH (n = 41 girls and 31 boys) were studied. Prior research indicates girls with CAH are masculinized for certain behaviors, such as toy choices, while boys with CAH generally do not differ from boys without CAH. In the current study, children indicated preferences for stereotyped hues of pink vs. blue as well as two control color pairs. They also indicated their preference between gender/sex-typed toys (doll vs. car) presented in black and white, in gender/sex-congruent colors (pink doll vs. blue car) and in gender/sex-incongruent colors (pink car vs. blue doll). Color findings: Control girls preferred stereotyped pink over blue more than boys or girls with CAH did; the latter two groups did not differ in their color preferences. No preference differences occurred for other color pairs. Toy findings: In black/white or gender/sex-congruent colors, boys preferred the car more than control girls or girls with CAH did, while girls with CAH preferred the car more than control girls did. In gender/sex-incongruent colors (pink car vs. blue doll), boys still preferred the car, while girls with CAH showed reduced and control girls showed increased preferences for the pink car compared to the car preferences in black/white. Results support learning theories of color preferences, perhaps also influenced by pre-existing toy preferences which may occur for other reasons, including early androgen exposure. Specifically, girls with CAH may have learned they do not enjoy stereotypical toys for girls, often colored pink, and pink coloring may subsequently diminish their preference for a car. Our results highlight the importance of gonadal hormones and learning in the development of childhood toy and color preferences.
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Affiliation(s)
- Sharon A S Neufeld
- Department of Psychology, University of Cambridge, Downing Place, Cambridge CB2 3EB, UK.
| | - Marcia L Collaer
- Department of Psychology and Neuroscience Program, Middlebury College, Middlebury, VT 05753, USA.
| | - Debra Spencer
- Department of Psychology, University of Cambridge, Downing Place, Cambridge CB2 3EB, UK.
| | - Vickie Pasterski
- Department of Psychology, University of Cambridge, Downing Place, Cambridge CB2 3EB, UK; Department of Paediatrics, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
| | - Peter C Hindmarsh
- Developmental Endocrinology Research Group, Institute of Child Health, University College London, London, UK.
| | - Ieuan A Hughes
- Department of Paediatrics, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
| | - Carlo Acerini
- Department of Paediatrics, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Melissa Hines
- Department of Psychology, University of Cambridge, Downing Place, Cambridge CB2 3EB, UK.
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8
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Man E, Mushtaq I, Barnicoat A, Carmichael P, Hughes CR, Davies K, Aitkenhead H, Amin R, Buchanan CR, Cherian A, Costa NJ, Creighton SM, Duffy PG, Hewson E, Hindmarsh PC, Monzani LC, Peters CJ, Ransley PG, Smeulders N, Spoudeas HA, Wood D, Hughes IA, Katugampola H, Brain CE, Dattani MT, Achermann JC. A Single-Center, Observational Study of 607 Children and Young People Presenting With Differences of Sex Development (DSD). J Endocr Soc 2022; 7:bvac165. [DOI: 10.1210/jendso/bvac165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Indexed: 11/22/2022] Open
Abstract
Abstract
Context
Differences of sex development (DSD) represent a wide range of conditions presenting at different ages to various health professionals. Establishing a diagnosis, supporting the family, and developing a management plan are important.
Objective
We aimed to better understand the presentation and prevalence of pediatric DSD.
Methods
A retrospective, observational cohort study was undertaken in a single tertiary pediatric center of all children and young people (CYP) referred to a DSD multidisciplinary team over 25 years (1995-2019). In total, 607 CYP (520 regional referrals) were included. Data were analyzed for diagnosis, sex-assignment, age and mode of presentation, additional phenotypic features, mortality, and approximate point prevalence.
Results
Among the 3 major DSD categories, sex chromosome DSD was diagnosed in 11.2% (68/607) (most commonly 45,X/46,XY mosaicism), 46,XY DSD in 61.1% (371/607) (multiple diagnoses often with associated features), while 46,XX DSD occurred in 27.7% (168/607) (often 21-hydroxylase deficiency). Most children (80.1%) presented as neonates, usually with atypical genitalia, adrenal insufficiency, undescended testes or hernias. Those presenting later had diverse features. Rarely, the diagnosis was made antenatally (3.8%, n = 23) or following incidental karyotyping/family history (n = 14). Mortality was surprisingly high in 46,XY children, usually due to complex associated features (46,XY girls, 8.3%; 46,XY boys, 2.7%). The approximate point prevalence of neonatal referrals for investigation of DSD was 1 in 6347 births, and 1 in 5101 overall throughout childhood.
Conclusion
DSD represent a diverse range of conditions that can present at different ages. Pathways for expert diagnosis and management are important to optimize care.
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Affiliation(s)
- Elim Man
- Genetics & Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London , London WC1N 1EH , UK
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital , Hong Kong SAR , People’s Republic of China
| | - Imran Mushtaq
- Department of Urology, Great Ormond Street Hospital for Children , London WC1N 3JH , UK
| | - Angela Barnicoat
- Department of Clinical Genetics, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - Polly Carmichael
- Department of Clinical Psychology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust , London NW3 5BA , UK
| | - Claire R Hughes
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London , London EC1M 6BQ , UK
| | - Kate Davies
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
- Institute of Health and Social Care, London South Bank University , London SE1 0AA , UK
| | - Helen Aitkenhead
- Department of Chemical Pathology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - Rakesh Amin
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - Charles R Buchanan
- Department of Child Health, King's College Hospital NHS Foundation Trust , London SE5 9RS , UK
| | - Abraham Cherian
- Department of Urology, Great Ormond Street Hospital for Children , London WC1N 3JH , UK
| | - Nikola J Costa
- Department of Chemical Pathology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - Sarah M Creighton
- Institute for Women's Health, University College London Hospitals NHS Foundation Trust , London NW1 2BU , UK
| | - Patrick G Duffy
- Department of Urology, Great Ormond Street Hospital for Children , London WC1N 3JH , UK
| | - Emma Hewson
- Department of Clinical Psychology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - Peter C Hindmarsh
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
- Department of Paediatrics, University College London Hospitals NHS Foundation Trust , London NW1 2BU , UK
| | - Louisa C Monzani
- Department of Clinical Psychology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - Catherine J Peters
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - Philip G Ransley
- Department of Urology, Great Ormond Street Hospital for Children , London WC1N 3JH , UK
| | - Naima Smeulders
- Department of Urology, Great Ormond Street Hospital for Children , London WC1N 3JH , UK
| | - Helen A Spoudeas
- Genetics & Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London , London WC1N 1EH , UK
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - Dan Wood
- Department of Urology, Great Ormond Street Hospital for Children , London WC1N 3JH , UK
- Department of Urology, University College London Hospitals NHS Foundation Trust , London NW1 2BU , UK
- Department of Urology, Children's Hospital Colorado and University of Colorado , Aurora, Colorado 80045 , USA
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge , Cambridge CB2 0QQ , UK
| | - Harshini Katugampola
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - Caroline E Brain
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - Mehul T Dattani
- Genetics & Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London , London WC1N 1EH , UK
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
| | - John C Achermann
- Genetics & Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London , London WC1N 1EH , UK
- Department of Endocrinology, Great Ormond Street Hospital NHS Foundation Trust , London WC1N 3JH , UK
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Petry CJ, Olga L, Hughes IA, Ong KK. Associations between maternal iron supplementation in pregnancy and offspring growth and cardiometabolic risk outcomes in infancy and childhood. PLoS One 2022; 17:e0263148. [PMID: 35622831 PMCID: PMC9140278 DOI: 10.1371/journal.pone.0263148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/12/2022] [Indexed: 11/18/2022] Open
Abstract
It was previously observed that maternal iron supplementation in pregnancy was associated with increased offspring size and adiposity at birth, possibly mediated through increased risk of gestational diabetes. In this study we investigated potential long-term associations of maternal iron supplementation in pregnancy with offspring growth in infancy, and growth and cardiometabolic risk factors in mid-childhood to seek evidence of nutritional programming. Using a nested case-control format, markers of growth and adiposity were measured at 3, 12 and 24 months of age in 341 infants from the Cambridge Baby Growth Study whose mothers supplemented with iron in pregnancy and 222 infants whose mothers did not. Measures of growth, glucose tolerance (using a 30 minute 1.75 g glucose/kg body weight oral glucose tolerance test), insulin sensitivity (HOMA IR) and blood pressure were collected in 122 and 79 of these children, respectively, at around 9.5 years of age. In infancy adiposity-promoting associations with maternal iron supplementation in pregnancy were evident at 3 months of age (e.g. mean difference in skinfold thickness: β = +0.15 mm, p = 0.02, in n = 341 whose mothers supplemented versus 222 that did not; waist circumference: β = +0.7 cm, p = 0.04, in n = 159 and 78, respectively) but differences lessened after this time (e.g. 3–12 month change in mean difference in skinfold thickness: β = -0.2 mm, p = 0.03, in n = 272 and 178, respectively). At ~9.5 years of age children whose mothers supplemented with iron in pregnancy had lower mean arterial blood pressures (β = -1.0 mmHg, p = 0.03, in n = 119 and 78, respectively). There were no apparent differences in markers of growth or other cardiometabolic factors. These results suggest that most of the associations of maternal iron supplementation in pregnancy on growth and adiposity evident at birth disappear during infancy, but there may be some evidence of long-term nutritional programming of blood pressure in mid-childhood.
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Affiliation(s)
- Clive J. Petry
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | - Laurentya Olga
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Ieuan A. Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Ken K. Ong
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
- Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
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10
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Petry CJ, Hughes IA, Ong KK. Increased basal insulin sensitivity in late pregnancy in women carrying a male fetus: a cohort study. Biol Sex Differ 2022; 13:20. [PMID: 35509032 PMCID: PMC9069709 DOI: 10.1186/s13293-022-00429-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has been suggested that fetal sex may be able to modify maternal metabolism and physiology during pregnancy. Recently pregnant women carrying a male fetus were reported to be more insulin sensitive than those carrying females, although related evidence is inconsistent. METHODS In this study we administered a 75 g oral glucose tolerance test at around week 28 of pregnancy in 813 pregnant women from a contemporary birth cohort (the Cambridge Baby Growth Study), derived surrogate indices of insulin secretion and sensitivity, and related them to the fetal sex. RESULTS Carrying a male fetus was associated with lower fasting glucose (difference in mean concentrations ≈ 0.1 mmol/L; β' = 0.063; p = 0.02) and insulin (≈ 1.1 pmol/L; β' = 0.075; p = 0.01) concentrations but not with post-load glucose or insulin concentrations. Male fetal sex was also associated with lower HOMA IR (≈ 1.08 units; β' = 0.071; p = 0.02) and higher QUICKI (≈ 1.06 units; β' = 0.080; p = 0.007) values suggesting increased basal insulin sensitivity. There were no differences in indices of insulin secretion, except for the insulin disposition index which was higher in women carrying a male fetus (≈ 1.15 units; β' = 0.090; p = 0.007). Birth weights were higher in male offspring. CONCLUSIONS Women carrying a male fetus were relatively more insulin sensitive in the fasting state and secreted more insulin relative to this degree of insulin sensitivity. These results are consistent with the idea that the fetal sex may be able to modify the maternal glucose-insulin axis.
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Affiliation(s)
- Clive J Petry
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Box 116, Cambridge, CB2 0QQ, UK.
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Box 116, Cambridge, CB2 0QQ, UK
| | - Ken K Ong
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Box 116, Cambridge, CB2 0QQ, UK.,MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,Institute of Metabolic Science, University of Cambridge, Cambridge, UK
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11
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Tadokoro-Cuccaro R, Fisher BG, Thankamony A, Ong KK, Hughes IA. Maternal Paracetamol Intake During Pregnancy-Impacts on Offspring Reproductive Development. Front Toxicol 2022; 4:884704. [PMID: 35499038 PMCID: PMC9047911 DOI: 10.3389/ftox.2022.884704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/22/2022] [Indexed: 02/02/2023] Open
Abstract
Paracetamol (acetaminophen) is the preferred antipyretic/analgesic for pregnant women as it is believed there are no adverse fetal effects at the recommended dose. However, emerging evidence suggests that intrauterine paracetamol exposure may be associated with certain urogenital/reproductive disorders in the offspring. In this mini-review, we describe human fetal sex development and possible pharmacological mechanisms by which paracetamol may disrupt this process, including reduced testicular production of testosterone and/or insulin-like peptide 3. We then review the available epidemiological literature on associations between maternal paracetamol exposure and offspring sexual development. Three epidemiological studies have reported associations between maternal paracetamol intake and increased risk of cryptorchidism, although five others have not. None have found associations with hypospadias or penile length. Two out of three studies have reported a shorter anogenital distance (a marker of androgen action during the masculinisation programming window, ∼8-14 weeks of gestation) in male infants antenatally exposed to paracetamol. One study has described a dose-dependent relationship between maternal paracetamol consumption and earlier female (but not male) attainment of puberty. Such epidemiological analyses are complicated by various factors, including method of paracetamol exposure assessment (usually retrospective self-report), variation in diagnostic accuracy, selection bias, confounding by clinical indication, and demographic/genetic differences between geographically separated populations. There is an urgent need for stronger evidence in this area, from both relevant experimental studies and large, carefully-designed prospective studies. In the meantime, a precautionary attitude to gestational paracetamol usage should be considered as the evidence for clinically significant reproductive effects in humans is limited.
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Affiliation(s)
| | - Benjamin G. Fisher
- Wellcome/Cancer Research UK Gurdon Institute, University of Cambridge, Cambridge, United Kingdom,*Correspondence: Benjamin G. Fisher,
| | - Ajay Thankamony
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ken K. Ong
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom,Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom,MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Ieuan A. Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
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Ahmed SF, Achermann J, Alderson J, Crouch NS, Elford S, Hughes IA, Krone N, McGowan R, Mushtaq T, O'Toole S, Perry L, Rodie ME, Skae M, Turner HE. Society for Endocrinology UK Guidance on the initial evaluation of a suspected difference or disorder of sex development (Revised 2021). Clin Endocrinol (Oxf) 2021; 95:818-840. [PMID: 34031907 DOI: 10.1111/cen.14528] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/30/2021] [Accepted: 05/13/2021] [Indexed: 11/26/2022]
Abstract
It is paramount that any child or adolescent with a suspected difference or disorder of sex development (DSD) is assessed by an experienced clinician with adequate knowledge about the range of conditions associated with DSD and is discussed with the regional DSD service. In most cases, the paediatric endocrinologist within this service acts as the first point of contact but involvement of the regional multidisciplinary service will also ensure prompt access to specialist psychology and nursing care. The underlying pathophysiology of DSD and the process of delineating this should be discussed with the parents and affected young person with all diagnostic tests undertaken in a timely fashion. Finally, for rare conditions such as these, it is imperative that clinical experience is shared through national and international clinical and research collaborations.
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Affiliation(s)
- S Faisal Ahmed
- Developmental Endocrinology Research Group, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, UK
- Office for Rare Conditions, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - John Achermann
- Genetics & Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Julie Alderson
- Psychological Health Services, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | - Naomi S Crouch
- Department of Women's Health, St Michael's Hospital, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | | | - Ieuan A Hughes
- DSDFamilies, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Nils Krone
- Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Ruth McGowan
- Developmental Endocrinology Research Group, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- West of Scotland Centre for Genomic Medicine, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Talat Mushtaq
- Department of Paediatric Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Stuart O'Toole
- Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, UK
- Department of Paediatric Urology, Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Leslie Perry
- Department of Clinical Biochemistry, Croydon University Hospital, London, UK
| | - Martina E Rodie
- Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, UK
- Office for Rare Conditions, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- Department of Neonatology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Mars Skae
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Helen E Turner
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Olga L, van Beijsterveldt IALP, Hughes IA, Dunger DB, Ong KK, Hokken-Koelega ACS, De Lucia Rolfe E. Anthropometry-based prediction of body composition in early infancy compared to air-displacement plethysmography. Pediatr Obes 2021; 16:e12818. [PMID: 34114363 PMCID: PMC7614814 DOI: 10.1111/ijpo.12818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/14/2021] [Accepted: 04/26/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Anthropometry-based equations are commonly used to estimate infant body composition. However, existing equations were designed for newborns or adolescents. We aimed to (a) derive new prediction equations in infancy against air-displacement plethysmography (ADP-PEA Pod) as the criterion, (b) validate the newly developed equations in an independent infant cohort and (c) compare them with published equations (Slaughter-1988, Aris-2013, Catalano-1995). METHODS Cambridge Baby Growth Study (CBGS), UK, had anthropometry data at 6 weeks (N = 55) and 3 months (N = 64), including skinfold thicknesses (SFT) at four sites (triceps, subscapular, quadriceps and flank) and ADP-derived total body fat mass (FM) and fat-free mass (FFM). Prediction equations for FM and FFM were developed in CBGS using linear regression models and were validated in Sophia Pluto cohort, the Netherlands, (N = 571 and N = 447 aged 3 and 6 months, respectively) using Bland-Altman analyses to assess bias and 95% limits of agreement (LOA). RESULTS CBGS equations consisted of sex, age, weight, length and SFT from three sites and explained 65% of the variance in FM and 79% in FFM. In Sophia Pluto, these equations showed smaller mean bias than the three published equations in estimating FM: mean bias (LOA) 0.008 (-0.489, 0.505) kg at 3 months and 0.084 (-0.545, 0.713) kg at 6 months. Mean bias in estimating FFM was 0.099 (-0.394, 0.592) kg at 3 months and -0.021 (-0.663, 0.621) kg at 6 months. CONCLUSIONS CBGS prediction equations for infant FM and FFM showed better validity in an independent cohort at ages 3 and 6 months than existing equations.
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Affiliation(s)
- Laurentya Olga
- Department of Paediatrics, Cambridge Biomedical Campus Box 118, University of Cambridge, Cambridge, UK
| | - Inge ALP van Beijsterveldt
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ieuan A Hughes
- Department of Paediatrics, Cambridge Biomedical Campus Box 118, University of Cambridge, Cambridge, UK
| | - David B Dunger
- Department of Paediatrics, Cambridge Biomedical Campus Box 118, University of Cambridge, Cambridge, UK
- Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Ken K Ong
- Department of Paediatrics, Cambridge Biomedical Campus Box 118, University of Cambridge, Cambridge, UK
- Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
- MRC Epidemiology Unit, Cambridge Biomedical Campus Box 285, University of Cambridge, Cambridge, UK
| | - Anita CS Hokken-Koelega
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Emanuella De Lucia Rolfe
- MRC Epidemiology Unit, Cambridge Biomedical Campus Box 285, University of Cambridge, Cambridge, UK
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14
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Eleftheriou A, Petry CJ, Hughes IA, Ong KK, Dunger DB. The High-Risk Type 1 Diabetes HLA-DR and HLA-DQ Polymorphisms Are Differentially Associated With Growth and IGF-I Levels in Infancy: The Cambridge Baby Growth Study. Diabetes Care 2021; 44:1852-1859. [PMID: 34172490 DOI: 10.2337/dc20-2820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/05/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study explored the link between HLA polymorphisms that predispose to type 1 diabetes and birth size, infancy growth, and/or circulating IGF-I in a general population-based birth cohort. RESEARCH DESIGN AND METHODS The Cambridge Baby Growth Study is a prospective observational birth cohort study that recruited 2,229 newborns for follow-up in infancy. Of these, 612 children had DNA available for genotyping single nucleotide polymorphisms in the HLA region that capture the highest risk of type 1 diabetes: rs17426593 for DR4, rs2187668 for DR3, and rs7454108 for DQ8. Multivariate linear regression models at critical ages (cross-sectional) and mixed-effects models (longitudinal) were performed under additive genetic effects to test for associations between HLA polymorphisms and infancy weight, length, skinfold thickness (indicator of adiposity), and concentrations of IGF-I and IGF-binding protein-3 (IGFBP-3). RESULTS In longitudinal models, the minor allele of rs2187668 tagging DR3 was associated with faster linear growth (P = 0.007), which was more pronounced in boys (P = 3 × 10-7) than girls (P = 0.07), and was also associated with increasing IGF-I (P = 0.002) and IGFBP-3 (P = 0.003) concentrations in infancy. Cross-sectionally, the minor alleles of rs7454108 tagging DQ8 and rs17426593 tagging DR4 were associated with lower IGF-I concentrations at age 12 months (P = 0.003) and greater skinfold thickness at age 24 months (P = 0.003), respectively. CONCLUSIONS The variable associations of DR4, DR3, and DQ8 alleles with growth measures and IGF-I levels in infants from the general population could explain the heterogeneous growth trajectories observed in genetically at-risk cohorts. These findings could suggest distinct mechanisms involving endocrine pathways related to the HLA-conferred type 1 diabetes risk.
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Affiliation(s)
| | - Clive J Petry
- Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | - Ken K Ong
- Department of Paediatrics, University of Cambridge, Cambridge, U.K.,MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, U.K.,Institute of Metabolic Science, University of Cambridge, Cambridge, U.K
| | - David B Dunger
- Department of Paediatrics, University of Cambridge, Cambridge, U.K. .,Institute of Metabolic Science, University of Cambridge, Cambridge, U.K
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15
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Kung KTF, Thankamony A, Ong KKL, Acerini CL, Dunger DB, Hughes IA, Hines M. No relationship between prenatal or early postnatal androgen exposure and autistic traits: evidence using anogenital distance and penile length measurements at birth and 3 months of age. J Child Psychol Psychiatry 2021; 62:876-883. [PMID: 33049073 DOI: 10.1111/jcpp.13335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Autism is more prevalent in males than in females. Hypotheses related to the extreme male brain theory of autism suggest that heightened androgen exposure during early development contributes to autistic traits. Whilst prior research focused mostly on the prenatal period, the current study tests the influences of androgen exposure during both the prenatal and the early postnatal periods on autistic traits during childhood. METHODS Anthropometric measures that are putative biomarkers of early androgen exposure were employed. Anogenital distance (AGD) was measured at birth and 3 months of age in boys and girls. Penile length at birth and 3 months of age was also measured in boys. When the children were 9-13 years old, a parent-reported questionnaire (the 10-item children's version of the Autism Spectrum Quotient; AQ-10 Child) was used to assess autistic traits in 97 boys and 110 girls. RESULTS There were no significant associations between any of the AGD or penile length measures and scores on the AQ-10 Child in boys, girls or the entire sample. CONCLUSIONS The current study provides the first test of whether early measurements of AGD and/or penile length predict subsequent autistic traits. The current findings do not support a relationship between prenatal or early postnatal androgen exposure and autistic traits. The current study augments prior research showing no consistent relationship between early androgen exposure and autistic traits.
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Affiliation(s)
- Karson T F Kung
- Department of Psychology, University of Hong Kong, Pokfulam, Hong Kong.,School of Psychology, University of Kent, Canterbury, UK.,Department of Psychology, University of Cambridge, Cambridge, UK
| | - Ajay Thankamony
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Ken K L Ong
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - David B Dunger
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Melissa Hines
- Department of Psychology, University of Cambridge, Cambridge, UK
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16
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Petry CJ, Burling KA, Barker P, Hughes IA, Ong KK, Dunger DB. Pregnancy Serum DLK1 Concentrations Are Associated With Indices of Insulin Resistance and Secretion. J Clin Endocrinol Metab 2021; 106:e2413-e2422. [PMID: 33640968 PMCID: PMC8424055 DOI: 10.1210/clinem/dgab123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Delta like noncanonical notch ligand 1 (DLK1) is a paternally expressed imprinted gene that encodes an epidermal growth factor repeat-containing transmembrane protein. A bioactive, truncated DLK1 protein is present in the circulation and has roles in development and metabolism. OBJECTIVE We sought to investigate links between maternal pregnancy circulating DLK1 concentrations and: (1) maternal and fetal DLK1 genotypes, (2) maternal insulin resistance and secretion, and (3) offspring size at birth. PATIENTS, DESIGN, AND SETTING We measured third-trimester maternal serum DLK1 concentrations and examined their associations with parentally transmitted fetal and maternal DLK1 genotypes, indices of maternal insulin resistance and secretion derived from 75-g oral glucose tolerance tests performed around week 28 of pregnancy, and offspring size at birth in 613 pregnancies from the Cambridge Baby Growth Study. RESULTS Maternal DLK1 concentrations were associated with the paternally transmitted fetal DLK1 rs12147008 allele (P = 7.8 × 10-3) but not with maternal rs12147008 genotype (P = 0.4). Maternal DLK1 concentrations were positively associated with maternal prepregnancy body mass index (P = 3.5 × 10-6), and (after adjustment for maternal body mass index) with both maternal fasting insulin resistance (Homeostatic Model Assessment of Insulin Resistance: P = 0.01) and measures of maternal insulin secretion in response to oral glucose (insulinogenic index: P = 1.2 × 10-3; insulin disposition index: P = 0.049). Further positive associations were found with offspring weight (P = 0.02) and head circumference at birth (P = 0.04). CONCLUSION These results are consistent with a partial paternal or placental origin for the maternal circulating DLK1 which may lead to increased maternal circulating DLK1 concentrations, stimulation of maternal insulin resistance and compensatory hyperinsulinemia during pregnancy, and the promotion of fetal growth.
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Affiliation(s)
- Clive J Petry
- Department of Paediatrics, Cambridge Biomedical Campus, Cambridge, UK
- Correspondence: Clive Petry, Department of Paediatrics, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK.
| | - Keith A Burling
- NIHR Biomedical Research Centre Core Biochemistry Assay Lab, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Peter Barker
- NIHR Biomedical Research Centre Core Biochemistry Assay Lab, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Ieuan A Hughes
- Department of Paediatrics, Cambridge Biomedical Campus, Cambridge, UK
| | - Ken K Ong
- Department of Paediatrics, Cambridge Biomedical Campus, Cambridge, UK
- MRC Epidemiology Unit, Cambridge Biomedical Campus, Cambridge, UK
- Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - David B Dunger
- Department of Paediatrics, Cambridge Biomedical Campus, Cambridge, UK
- Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
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17
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Lucas-Herald AK, Bryce J, Kyriakou A, Ljubicic ML, Arlt W, Audi L, Balsamo A, Baronio F, Bertelloni S, Bettendorf M, Brooke A, Claahsen van der Grinten HL, Davies JH, Hermann G, de Vries L, Hughes IA, Tadokoro-Cuccaro R, Darendeliler F, Poyrazoglu S, Ellaithi M, Evliyaoglu O, Fica S, Nedelea L, Gawlik A, Globa E, Zelinska N, Guran T, Güven A, Hannema SE, Hiort O, Holterhus PM, Iotova V, Mladenov V, Jain V, Sharma R, Jennane F, Johnston C, Guerra Junior G, Konrad D, Gaisl O, Krone N, Krone R, Lachlan K, Li D, Lichiardopol C, Lisa L, Markosyan R, Mazen I, Mohnike K, Niedziela M, Nordenstrom A, Rey R, Skaeil M, Tack LJW, Tomlinson J, Weintrob N, Cools M, Ahmed SF. Gonadectomy in conditions affecting sex development: a registry-based cohort study. Eur J Endocrinol 2021; 184:791-801. [PMID: 33780351 DOI: 10.1530/eje-20-1058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/29/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To determine trends in clinical practice for individuals with DSD requiring gonadectomy. DESIGN Retrospective cohort study. METHODS Information regarding age at gonadectomy according to diagnosis; reported sex; time of presentation to specialist centre; and location of centre from cases reported to the International DSD Registry and who were over 16 years old in January 2019. RESULTS Data regarding gonadectomy were available in 668 (88%) individuals from 44 centres. Of these, 248 (37%) (median age (range) 24 (17, 75) years) were male and 420 (63%) (median age (range) 26 (16, 86) years) were female. Gonadectomy was reported from 36 centres in 351/668 cases (53%). Females were more likely to undergo gonadectomy (n = 311, P < 0.0001). The indication for gonadectomy was reported in 268 (76%). The most common indication was mitigation of tumour risk in 172 (64%). Variations in the practice of gonadectomy were observed; of the 351 cases from 36 centres, 17 (5%) at 9 centres had undergone gonadectomy before their first presentation to the specialist centre. Median age at gonadectomy of cases from high-income countries and low-/middle-income countries (LMIC) was 13.0 years (0.1, 68) years and 16.5 years (1, 28), respectively (P < 0.0001) with the likelihood of long-term retention of gonads being higher in LMIC countries. CONCLUSIONS The likelihood of gonadectomy depends on the underlying diagnosis, sex of rearing and the geographical setting. Clinical benchmarks, which can be studied across all forms of DSD will allow a better understanding of the variation in the practice of gonadectomy.
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Affiliation(s)
| | - Jillian Bryce
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Andreas Kyriakou
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Marie Lindhardt Ljubicic
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Laura Audi
- Department of Pediatrics and Pediatric Endocrinology Unit, Vall d'Hebron Research Institute (VHIR), Hospital Vall d'Hebron, Barcelona, Spain
| | - Antonio Balsamo
- Department of Pediatrics, University of Bologna Hospital of Bologna Sant Orsola-Malpighi, Bologna, Italy
| | - Federico Baronio
- Department of Pediatrics, University of Bologna Hospital of Bologna Sant Orsola-Malpighi, Bologna, Italy
| | | | - Markus Bettendorf
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Antonia Brooke
- Macleod Diabetes and Endocrine Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | | | - Justin H Davies
- Department of Paediatric Endocrinology, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Gloria Hermann
- Department of Pediatrics and Adolescent Medicine, University Medical Centre, Ulm, Germany
| | - Liat de Vries
- Paediatrics, Tel Aviv Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Centre of Israel, Petah Tikvah, Israel
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | | | - Feyza Darendeliler
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Medical School, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Medical School, Istanbul, Turkey
| | - Mona Ellaithi
- Faculty of Medical Laboratory Sciences, Al-Neelain University, Khartoum, Sudan
| | - Olcay Evliyaoglu
- Department of Pediatric Endocrinology, Istanbul University - Cerrahpasa, Cerrahpaşa Medical School, Istanbul, Turkey
| | - Simone Fica
- Endocrinologie, Universitatea de Medicina si Farmacie Carol Davila Facultatea de Medicine, Bucharest, Romania
| | - Lavinia Nedelea
- Endocrinologie, Universitatea de Medicina si Farmacie Carol Davila Facultatea de Medicine, Bucharest, Romania
| | - Aneta Gawlik
- Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Evgenia Globa
- Ukrainian Research Center of Endocrine Surgery, Endocrine Organs and Tissue Transplantation, MOH of Ukraine, Kyiv, Ukraine
| | - Nataliya Zelinska
- Ukrainian Research Center of Endocrine Surgery, Endocrine Organs and Tissue Transplantation, MOH of Ukraine, Kyiv, Ukraine
| | - Tulay Guran
- Department of Pediatric Endocrinology, Marmara University, Istanbul, Turkey
| | - Ayla Güven
- Pediatric Endocrinology Clinic, Zeynep Kamil Women and Children Hospital, Istanbul, Turkey
| | - Sabine E Hannema
- Pediatric Endocrinology, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Olaf Hiort
- Division of Paediatrics, University of Lübeck, Lübeck, Germany
| | - Paul-Martin Holterhus
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University Hospital of Schleswig-Holstein Campus Kiel/Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Violeta Iotova
- UMHAT 'Sveta Marina', Medical University of Varna, Varna, Bulgaria
| | - Vilhelm Mladenov
- UMHAT 'Sveta Marina', Medical University of Varna, Varna, Bulgaria
| | - Vandana Jain
- Division of Pediatric Endocrinology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rajni Sharma
- Division of Pediatric Endocrinology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Farida Jennane
- Unité d'Endocrinologie/Diabétologie et Gynécologie de l'Enfant et de l'Adolescent, Hôpital d'Enfants, Casablanca, Morocco
| | - Colin Johnston
- Department of Endocrinology, St Albans City Hospital, West Hertfordshire Hospitals Trust, St Albans, UK
| | - Gil Guerra Junior
- Disciplina de Endocrinologia e Metabologia, Faculdade deo Ciencias Medicas da Universidade de Campinas, Departamento de Pediatria e Departamento de Clinica Medica, Sao Paolo, Brazil
| | - Daniel Konrad
- Division of Pediatric Endocrinology and Diabetology and Children's Research Center, University Children's Hospital, Zürich, Switzerland
| | - Odile Gaisl
- Division of Pediatric Endocrinology and Diabetology and Children's Research Center, University Children's Hospital, Zürich, Switzerland
| | - Nils Krone
- Department of Oncology and Metabolism, Academic Unit of Child Health, University of Sheffield, Sheffield, UK
| | - Ruth Krone
- Endocrinology, Birmingham Children's Hospital, Birmingham, UK
| | - Katherine Lachlan
- Department of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Dejun Li
- Centre for Prenatal Diagnosis, Jilin University First Hospital, Jilin, China
| | - Corina Lichiardopol
- Endocrinology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Lidka Lisa
- Endocrinology, Institute of Prague, Czech Republic
| | - Renata Markosyan
- Endocrinology, Yerevan State Medical University Endocrinology Clinic, Yerevan, Armenia
| | - Inas Mazen
- Department of Clinical Genetics, National Research Centre, Cairo, Egypt
| | - Klaus Mohnike
- Department of Pediatrics, Otto-von-Guericke University, Magdeburg, Germany
| | - Marek Niedziela
- Department of Pediatric Endocrinology, Poznan University of Medical Sciences, Poznan, Wielkopolskie, Poland
| | - Anna Nordenstrom
- Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Rodolfo Rey
- CONICET - FEI - División de Endocrinología, Centro de Investigaciones Endocrinológicas 'Dr. César Bergadá' (CEDIE), Buenos Aires, Argentina
| | - Mars Skaeil
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
| | - Lloyd J W Tack
- Pediatric Endocrinology Service, University Hospital Ghent, Ghent, Belgium
| | - Jeremy Tomlinson
- Oxford Centre for Diabetes, Endocrinology & Metabolism, NIHR Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, UK
| | - Naomi Weintrob
- Paediatrics, Tel Aviv Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology, Dana Dwek Children's Hospital, Tel Aviv Medical Centre, Tel Aviv, Israel
| | - Martine Cools
- Pediatric Endocrinology Service, University Hospital Ghent, Ghent, Belgium
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
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18
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Petry CJ, Ong KK, Hughes IA, Dunger DB. Folic acid supplementation during pregnancy and associations with offspring size at birth and adiposity: a cohort study. BMC Res Notes 2021; 14:160. [PMID: 33931129 PMCID: PMC8086326 DOI: 10.1186/s13104-021-05575-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/20/2021] [Indexed: 02/08/2023] Open
Abstract
Objective Previously we observed that maternal multiple micronutrient supplementation in pregnancy was associated with increased offspring size at birth and adiposity, as well as with maternal gestational diabetes risk, in the Cambridge Baby Growth Study. In this study we therefore investigated whether folic acid supplementation specifically is associated with similar changes, to test the hypothesis that folic acid supplementation mediates such changes. Results The majority of mothers who reported supplementing with folic acid in pregnancy (n = 776 in total, 526 of which took multiple micronutrient preparations) did so either from pre- (n = 139) or post-conception (n = 637) largely for all or just the first half of pregnancy. A minority of mothers (n = 198) reported not supplementing with folic acid. Folic acid supplementation in pregnancy was not associated with birth weight [β’ = − 0.003, p = 0.9], height [β’ = − 0.013, p = 0.6], head circumference [β’ = 0.003, p = 0.09] or adiposity (ponderal index [β’ = 0.020, p = 0.5], skinfolds thicknesses [β’ = − 0.029 to + 0.008, p = 0.4–0.9]). Neither was it associated with the development of maternal gestational diabetes (risk ratio 1.2 [0.6‒2.2], p = 0.6). These results suggest that folic acid supplementation in pregnancy did not mediate the previously observed increases in offspring size at birth and adiposity, or the raised gestational diabetes risk, in response to supplementation with multiple micronutrients.
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Affiliation(s)
- Clive J Petry
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Ken K Ong
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.,MRC Department of Epidemiology, University of Cambridge, Cambridge, UK.,Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - David B Dunger
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.,Institute of Metabolic Science, University of Cambridge, Cambridge, UK
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19
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Fisher BG, Thankamony A, Mendiola J, Petry CJ, Frederiksen H, Andersson AM, Juul A, Ong KK, Dunger DB, Hughes IA, Acerini CL. Maternal serum concentrations of bisphenol A and propyl paraben in early pregnancy are associated with male infant genital development. Hum Reprod 2021; 35:913-928. [PMID: 32325494 DOI: 10.1093/humrep/deaa045] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 02/10/2020] [Indexed: 12/12/2022] Open
Abstract
STUDY QUESTION Are maternal serum phthalate metabolite, phenol and paraben concentrations measured at 10-17 weeks of gestation associated with male infant genital developmental outcomes, specifically cryptorchidism, anogenital distance (AGD), penile length and testicular descent distance, at birth and postnatally? SUMMARY ANSWER Maternal serum bisphenol A (BPA) concentration at 10-17 weeks of gestation was positively associated with congenital or postnatally acquired cryptorchidism, and n-propyl paraben (n-PrP) concentration was associated with shorter AGD from birth to 24 months of age. WHAT IS KNOWN ALREADY Male reproductive disorders are increasing in prevalence, which may reflect environmental influences on foetal testicular development. Animal studies have implicated phthalates, BPA and parabens, to which humans are ubiquitously exposed. However, epidemiological studies have generated conflicting results and have often been limited by small sample size and/or measurement of chemical exposures outside the most relevant developmental window. STUDY DESIGN, SIZE, DURATION Case-control study of cryptorchidism nested within a prospective cohort study (Cambridge Baby Growth Study), with recruitment of pregnant women at 10-17 postmenstrual weeks of gestation from a single UK maternity unit between 2001 and 2009 and 24 months of infant follow-up. Of 2229 recruited women, 1640 continued with the infancy study after delivery, of whom 330 mothers of 334 male infants (30 with congenital cryptorchidism, 25 with postnatally acquired cryptorchidism and 279 unmatched controls) were included in the present analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS Maternal blood was collected at enrolment, and serum levels of 16 phthalate metabolites, 9 phenols (including BPA) and 6 parabens were measured using liquid chromatography/tandem mass spectrometry. Logistic regression was used to model the association of cryptorchidism with serum chemical concentrations, adjusting for putative confounders. Additionally, offspring AGD, penile length and testicular descent distance were assessed at 0, 3, 12, 18 and 24 months of age, and age-specific Z scores were calculated. Associations between serum chemical levels and these outcomes were tested using linear mixed models. MAIN RESULTS AND THE ROLE OF CHANCE Maternal serum BPA concentration was associated with offspring all-type cryptorchidism both when considered as a continuous exposure (adjusted odds ratio per log10 μg/l: 2.90, 95% CI 1.31-6.43, P = 0.009) and as quartiles (phet = 0.002). Detection of n-PrP in maternal serum was associated with shorter AGD (by 0.242 standard deviations, 95% CI 0.051-0.433, P = 0.01) from birth to 24 months of age; this reduction was independent of body size and other putative confounders. We did not find any consistent associations with offspring outcomes for the other phenols, parabens, and phthalate metabolites measured. LIMITATIONS, REASONS FOR CAUTION We cannot discount confounding by other demographic factors or endocrine-disrupting chemicals. There may have been misclassification of chemical exposure due to use of single serum measurements. The cohort was not fully representative of pregnant women in the UK, particularly in terms of smoking prevalence and maternal ethnicity. WIDER IMPLICATIONS OF THE FINDINGS Our observational findings support experimental evidence that intrauterine exposure to BPA and n-PrP during early gestation may adversely affect male reproductive development. More evidence is required before specific public health recommendations can be made. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by a European Union Framework V programme, the World Cancer Research Fund International, the Medical Research Council (UK), Newlife the Charity for Disabled Children, the Mothercare Group Foundation, Mead Johnson Nutrition and the National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre. Visiting Fellowship (J.M.): Regional Programme 'Jiménez de la Espada' for Research Mobility, Cooperation and Internationalization, Seneca Foundation-Science and Technology Agency for the Region of Murcia (No. 20136/EE/17). K.O. is supported by the Medical Research Council (UK) (Unit Programme number: MC_UU_12015/2). The authors declare no conflict of interest.
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Affiliation(s)
- B G Fisher
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - A Thankamony
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - J Mendiola
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, IMIB-Arrixaca, Avda. Teniente Flomesta, 5, 30003 Murcia, Spain
| | - C J Petry
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - H Frederiksen
- Department of Growth and Reproduction & International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - A M Andersson
- Department of Growth and Reproduction & International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - A Juul
- Department of Growth and Reproduction & International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - K K Ong
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.,MRC Epidemiology Unit, University of Cambridge, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - D B Dunger
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.,Metabolic Research Laboratories, University of Cambridge, Box 289, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - I A Hughes
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - C L Acerini
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
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20
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Ali SR, Bryce J, Haghpanahan H, Lewsey JD, Tan LE, Atapattu N, Birkebaek NH, Blankenstein O, Neumann U, Balsamo A, Ortolano R, Bonfig W, Claahsen-van der Grinten HL, Cools M, Costa EC, Darendeliler F, Poyrazoglu S, Elsedfy H, Finken MJJ, Fluck CE, Gevers E, Korbonits M, Guaragna-Filho G, Guran T, Guven A, Hannema SE, Higham C, Hughes IA, Tadokoro-Cuccaro R, Thankamony A, Iotova V, Krone NP, Krone R, Lichiardopol C, Luczay A, Mendonca BB, Bachega TASS, Miranda MC, Milenkovic T, Mohnike K, Nordenstrom A, Einaudi S, van der Kamp H, Vieites A, de Vries L, Ross RJM, Ahmed SF. Real-World Estimates of Adrenal Insufficiency-Related Adverse Events in Children With Congenital Adrenal Hyperplasia. J Clin Endocrinol Metab 2021; 106:e192-e203. [PMID: 32995889 PMCID: PMC7990061 DOI: 10.1210/clinem/dgaa694] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/24/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Although congenital adrenal hyperplasia (CAH) is known to be associated with adrenal crises (AC), its association with patient- or clinician-reported sick day episodes (SDE) is less clear. METHODS Data on children with classic 21-hydroxylase deficiency CAH from 34 centers in 18 countries, of which 7 were Low or Middle Income Countries (LMIC) and 11 were High Income (HIC), were collected from the International CAH Registry and analyzed to examine the clinical factors associated with SDE and AC. RESULTS A total of 518 children-with a median of 11 children (range 1, 53) per center-had 5388 visits evaluated over a total of 2300 patient-years. The median number of AC and SDE per patient-year per center was 0 (0, 3) and 0.4 (0.0, 13.3), respectively. Of the 1544 SDE, an AC was reported in 62 (4%), with no fatalities. Infectious illness was the most frequent precipitating event, reported in 1105 (72%) and 29 (47%) of SDE and AC, respectively. On comparing cases from LMIC and HIC, the median SDE per patient-year was 0.75 (0, 13.3) vs 0.11 (0, 12.0) (P < 0.001), respectively, and the median AC per patient-year was 0 (0, 2.2) vs 0 (0, 3.0) (P = 0.43), respectively. CONCLUSIONS The real-world data that are collected within the I-CAH Registry show wide variability in the reported occurrence of adrenal insufficiency-related adverse events. As these data become increasingly used as a clinical benchmark in CAH care, there is a need for further research to improve and standardize the definition of SDE.
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Affiliation(s)
- Salma R Ali
- Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
- Office for Rare Conditions, Royal Hospital for Children & Queen Elizabeth University Hospital, Glasgow, UK
| | - Jillian Bryce
- Office for Rare Conditions, Royal Hospital for Children & Queen Elizabeth University Hospital, Glasgow, UK
| | - Houra Haghpanahan
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - James D Lewsey
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Li En Tan
- Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | | | - Niels H Birkebaek
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Oliver Blankenstein
- Centre for Chronic Sick Children, Institute for Experimental Paediatric Endocrinology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Uta Neumann
- Centre for Chronic Sick Children, Institute for Experimental Paediatric Endocrinology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Antonio Balsamo
- Department of Medical and Surgical Sciences, Pediatric Unit, Center for Rare Endocrine Conditions (Endo-ERN), S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Rita Ortolano
- Department of Medical and Surgical Sciences, Pediatric Unit, Center for Rare Endocrine Conditions (Endo-ERN), S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Walter Bonfig
- Department of Paediatrics, Technical University München, Munich, Germany
- Department of Paediatrics, Klinikum Wels-Grieskirchen, Wels, Austria
| | | | - Martine Cools
- University Hospital Ghent, Ghent University, Ghent, Belgium
| | - Eduardo Correa Costa
- Pediatric Surgery Service, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, Brazil
| | - Feyza Darendeliler
- Istanbul Faculty of Medicine, Department of Paediatrics, Paediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Istanbul Faculty of Medicine, Department of Paediatrics, Paediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
| | - Heba Elsedfy
- Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Martijn J J Finken
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Endocrinology, Amsterdam, The Netherlands
| | - Christa E Fluck
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics and Department of BioMedical Research, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Evelien Gevers
- Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Márta Korbonits
- Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Guilherme Guaragna-Filho
- Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Tulay Guran
- Marmara University, Department of Pediatric Endocrinology and Diabetes, Pendik, Istanbul, Turkey
| | - Ayla Guven
- Health Science University, Medical Faculty, Zeynep Kamil Women and Children Hospital, Pediatric Endocrinology Clinic, Istanbul, Turkey
| | - Sabine E Hannema
- Department of Paediatric Endocrinology, Sophia Children’s Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Claire Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, University Of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | | | - Ajay Thankamony
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Violeta Iotova
- Department of Paediatrics, Medical University-Varna, UMHAT “Sv. Marina,” Varna, Bulgaria
| | - Nils P Krone
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Ruth Krone
- Birmingham Women’s & Children’s Hospital, Department for Endocrinology & Diabetes, Birmingham, UK
| | - Corina Lichiardopol
- Department of Endocrinology, University of Medicine and Pharmacy Craiova, University Emergency Hospital, Craiova, Romania
| | - Andrea Luczay
- Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Berenice B Mendonca
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Disciplina de Endocrinologia, Hospital Das Clinicas, Faculdade De Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Tania A S S Bachega
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Disciplina de Endocrinologia, Hospital Das Clinicas, Faculdade De Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Mirela C Miranda
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Disciplina de Endocrinologia, Hospital Das Clinicas, Faculdade De Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Tatjana Milenkovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia “Dr Vukan Čupić,” Belgrade, Serbia
| | | | | | - Silvia Einaudi
- Pediatric Endocrinology Regina Margherita Children’s Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Hetty van der Kamp
- Wilhelmina Kinderziekenhuis, Division of Pediatric Endocrinology, Utrecht, Netherlands
| | - Ana Vieites
- Centro de Investigaciones Endocrinológicas, División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Liat de Vries
- The Jesse and Sara Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikvah, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Richard J M Ross
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
- Office for Rare Conditions, Royal Hospital for Children & Queen Elizabeth University Hospital, Glasgow, UK
- Correspondence and Reprint Requests: Professor S. Faisal Ahmed, MD FRCPCH, Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Royal Hospital for Children, Office Block, 1345 Govan Road, Glasgow G51 4TF, UK. E-mail:
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21
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Spencer D, Pasterski V, Neufeld SAS, Glover V, O'Connor TG, Hindmarsh PC, Hughes IA, Acerini CL, Hines M. Prenatal androgen exposure and children's gender-typed behavior and toy and playmate preferences. Horm Behav 2021; 127:104889. [PMID: 33181133 PMCID: PMC7856278 DOI: 10.1016/j.yhbeh.2020.104889] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 10/23/2022]
Abstract
We report findings from two studies investigating possible relations of prenatal androgen exposure to a broad measure of children's gender-typed behavior, as well as specifically to children's toy and playmate preferences. Study 1 investigated these outcomes for 43 girls and 38 boys, aged 4 to 11 years, with congenital adrenal hyperplasia (CAH, a genetic condition causing increased adrenal androgen production beginning prenatally) compared to similarly-aged, unaffected relatives (41 girls, 31 boys). The predicted sex differences were found for all of the outcome measures. Furthermore, girls with CAH showed increased male-typical and decreased female-typical behavior and toy and playmate preferences compared to unaffected girls. Study 2 investigated the relationship of amniotic fluid testosterone to gender-typed behavior and toy and playmate preferences in typically developing children (48 girls, 44 boys) aged 3 to 5 years. Although the predicted sex differences were found for all of the outcome measures, amniotic fluid testosterone was not a significant correlate, in the predicted direction, of any outcome measure for either sex. The results of study 1 provide additional support for an influence of prenatal androgen exposure on children's gender-typed behavior, including toy and playmate preferences. The results of study 2 do not, but amniotic fluid testosterone may be an insufficiently sensitive measure of early androgen exposure. A more sensitive and reliable measure of prenatal androgen exposure may be needed to consistently detect relations to later gender typed behavior in non-clinical populations.
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Affiliation(s)
- Debra Spencer
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, United Kingdom.
| | - Vickie Pasterski
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, United Kingdom; Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom.
| | - Sharon A S Neufeld
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, United Kingdom.
| | - Vivette Glover
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, United Kingdom.
| | - Thomas G O'Connor
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA.
| | - Peter C Hindmarsh
- Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom.
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom.
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom
| | - Melissa Hines
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, United Kingdom.
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22
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Stancampiano MR, Lucas-Herald AK, Bryce J, Russo G, Barera G, Balsamo A, Baronio F, Bertelloni S, Valiani M, Cools M, Tack LJW, Darendeliler F, Poyrazoglu S, Globa E, Grinspon R, Hannema SE, Hughes IA, Tadokoro-Cuccaro R, Thankamony A, Iotova V, Mladenov V, Konrad D, Mazen I, Niedziela M, Kolesinska Z, Nordenström A, Ahmed SF. Testosterone Therapy and Its Monitoring in Adolescent Boys with Hypogonadism: Results of an International Survey from the I-DSD Registry. Sex Dev 2021; 15:236-243. [PMID: 34350903 DOI: 10.1159/000516784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/15/2021] [Indexed: 11/19/2022] Open
Abstract
It is unclear whether testosterone replacement therapy (TRT) in adolescent boys, affected by a range of endocrine diseases that may be associated with hypogonadism, is particularly common. The aim of this study was to assess the contemporary practice of TRT in boys included in the I-DSD Registry. All participating centres in the I-DSD Registry that had boys between 10 and 18 years of age and with a condition that could be associated with hypogonadism were invited to provide further information in 2019. Information on 162 boys was collected from 15 centres that had a median (range) number of 6 boys per centre (1.35). Of these, 30 (19%) from 9 centres were receiving TRT and the median (range) age at the start was 12.6 years (10.8-16.2), with 6 boys (20%) starting at <12 years. Median (range) age of boys not on TRT was 11.7 years (10.7-17.7), and 69 out of 132 (52%) were <12 years. TRT had been initiated in 20 of 71 (28%) boys with a disorder of gonadal development, 3 of 14 (21%) with a disorder of androgen synthesis, and all 7 (100%) boys with hypogonadotropic hypogonadism. The remainder who did not have TRT included 15 boys with partial androgen insensitivity, 52 with non-specific XY DSD, and 3 with persistent Müllerian duct syndrome. Before starting TRT, liver function and blood count were checked in 19 (68%) and 18 boys (64%), respectively, a bone age assessment was performed in 23 (82%) and bone mineral density assessment in 12 boys (43%). This snapshot of contemporary practice reveals that TRT in boys included in the I-DSD Registry is not very common, whilst the variation in starting and monitoring therapy is quite marked. Standardisation of practice may lead to more effective assessment of treatment outcomes.
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Affiliation(s)
- Marianna R Stancampiano
- Department of Paediatrics, Endocrine Unit, Scientific Institute San Raffaele, Milan, Italy,
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, United Kingdom,
| | - Angela K Lucas-Herald
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, United Kingdom
| | - Jillian Bryce
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, United Kingdom
| | - Gianni Russo
- Department of Paediatrics, Endocrine Unit, Scientific Institute San Raffaele, Milan, Italy
| | - Graziano Barera
- Department of Paediatrics, Endocrine Unit, Scientific Institute San Raffaele, Milan, Italy
| | - Antonio Balsamo
- Department of Medical and Surgical Sciences, Paediatric Unit, Endo-ERN Center IT11, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Federico Baronio
- Department of Medical and Surgical Sciences, Paediatric Unit, Endo-ERN Center IT11, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Silvano Bertelloni
- Paediatric and Adolescent Endocrinology, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero, Universitaria Pisana, Pisa, Italy
| | - Margherita Valiani
- Paediatric and Adolescent Endocrinology, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero, Universitaria Pisana, Pisa, Italy
| | - Martine Cools
- Department of Internal Medicine and Paediatrics, Ghent University and Department of Paediatric Endocrinology, University Hospital Ghent, Ghent, Belgium
| | - Lloyd J W Tack
- Department of Internal Medicine and Paediatrics, Ghent University and Department of Paediatric Endocrinology, University Hospital Ghent, Ghent, Belgium
| | - Feyza Darendeliler
- Paediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Paediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Evgenia Globa
- Department of Pediatric Endocrinology, Ukrainian Scientific Center of Endocrine Surgery, Endocrine Organs and Tissue Transplantation, MoH of Ukraine, Kyiv, Ukraine
| | - Romina Grinspon
- Centro de Investigaciones Endocrinológicas 'Dr. César Bergadá' (CEDIE), CONICET - FEI, División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Sabine E Hannema
- Department of Paediatric Endocrinology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Paediatrics, Leiden University Medical Centre, Amsterdam, The Netherlands
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | | | - Ajay Thankamony
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Violeta Iotova
- Department of Paediatrics - UMHAT 'Sv.Marina', Medical University of Varna, Varna, Bulgaria
| | - Vilhelm Mladenov
- Department of Paediatrics - UMHAT 'Sv.Marina', Medical University of Varna, Varna, Bulgaria
| | - Daniel Konrad
- Division of Paediatric Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland
| | - Inas Mazen
- Department of Clinical Genetics, National Research Center, Cairo, Egypt
| | - Marek Niedziela
- Department of Paediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Zofia Kolesinska
- Department of Paediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Nordenström
- Department of Women's and Children's Health, Karolinska Institutet, Paediatric Endocrinology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, United Kingdom
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Petry CJ, Ong KK, Hughes IA, Dunger DB. Multiple Micronutrient Supplementation during Pregnancy and Increased Birth Weight and Skinfold Thicknesses in the Offspring: The Cambridge Baby Growth Study. Nutrients 2020; 12:nu12113466. [PMID: 33198145 PMCID: PMC7697774 DOI: 10.3390/nu12113466] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 01/08/2023] Open
Abstract
Multiple micronutrient supplementation (MMS) in pregnancy has previously been associated with positive effects on fetal growth, but its value in high-income countries remains controversial. In this study, we investigated effects of pregnancy MMS on offspring size at birth and adiposity, along with risks of various maternal outcomes of pregnancy, using the prospective Cambridge Baby Growth Study. Maternal MMS was reported in 528 out of 970 women who completed pregnancy questionnaires. Gestational diabetes (GDM) was assessed using results from 75 g oral glucose tolerance tests at week 28 of pregnancy. Offspring size at birth was assessed using standard anthropometric measurements and adiposity using skinfold calipers. MMS was associated with increased risk of developing GDM (risk ratio = 1.86 (1.13–3.08), p = 0.02), as well as increased offspring size at birth in terms of weight (p = 0.03), head circumference (p = 0.04), and flank, and subscapular and triceps skinfold thicknesses (p = 0.04, 0.03, and 0.003, respectively). There was no association with quadriceps skinfold thickness (p = 0.2), suggesting that the increased adiposity was partially regionalized. In women who underwent oral glucose tolerance testing, nearly all of these associations were attenuated by adjusting for GDM. These results suggest that the increased offspring size at birth, including (regionalized) adiposity associated with pregnancy, and MMS may be partially related to the development of GDM.
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Affiliation(s)
- Clive J. Petry
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
- Correspondence: ; Tel.: +44-(0)1223-762945
| | - Ken K. Ong
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
- MRC Department of Epidemiology, University of Cambridge, Cambridge CB2 0SL, UK
- Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Ieuan A. Hughes
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
| | - David B. Dunger
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
- Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
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24
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Petry CJ, Ong KK, Hughes IA, Acerini CL, Dunger DB. Temporal Trends in Maternal Food Intake Frequencies and Associations with Gestational Diabetes: The Cambridge Baby Growth Study. Nutrients 2019; 11:E2822. [PMID: 31752255 PMCID: PMC6893826 DOI: 10.3390/nu11112822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 12/11/2022] Open
Abstract
Previous studies have suggested that in the first decade of this century the incidence of gestational diabetes (GDM) in pregnancy rose worldwide. In the Cambridge Baby Growth Study cohort we observed that this temporal trend was associated with an index of multiple deprivation and reductions in indices of insulin secretion. Deprivation level was not directly associated with GDM, suggesting that the temporal trend may relate more to other factors linked to it, such as dietary composition. In this study we investigated temporal trends in perceived food intake frequencies, derived from a qualitative, short questionnaire, in 865 pregnant Cambridge Baby Growth Study (CBGS) recruits. A number of food frequency ranks showed both temporal trends and associations with GDM, but of note is the frequency of egg consumption (negative temporal trend p = 0.03, slope = -6.2 ranks/year; negative association with GDM p = 3.0 × 10-8, slope = -0.002 increased risk/rank) as it was also positively associated with the insulin disposition index (p = 1.17 × 10-3, slope = 0.42 ranks. L/mmoL). These results are consistent with a potential protective effect of factors related to the frequency of egg consumption in pregnancy. Such factors may have contributed to the observed temporal trend in GDM risk but the overall detectable effect appears to have been small.
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Affiliation(s)
- Clive J. Petry
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
| | - Ken K. Ong
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
- MRC Epidemiology Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
- Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Ieuan A. Hughes
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
| | - Carlo L. Acerini
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
| | - David B. Dunger
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; (K.K.O.); (I.A.H.); (D.B.D.)
- Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
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25
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Prentice PM, Olga L, Petry CJ, Simmons D, Murphy HR, Hughes IA, Acerini CL, Ong KK, Dunger DB. Reduced size at birth and persisting reductions in adiposity in recent, compared with earlier, cohorts of infants born to mothers with gestational diabetes mellitus. Diabetologia 2019; 62:1977-1987. [PMID: 31396660 PMCID: PMC6805804 DOI: 10.1007/s00125-019-4970-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/27/2019] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS This study aimed to explore the infancy growth trajectories of 'recent' and 'earlier' offspring of mothers with gestational diabetes mellitus (OGDM), each compared with the same control infants, and investigate whether 'recent' OGDM still exhibit a classical phenotype, with macrosomia and increased adiposity. METHODS Within a prospective observational birth cohort, 98 'earlier' OGDM born between 2001 and 2009 were identified using 75 g oral glucose tolerance testing at 28 weeks gestation, 122 recent OGDM born between 2011 and 2013 were recruited postnatally through antenatal diabetes clinics, and 876 normal birthweight infants of mothers with no history of diabetes were recruited across the full study period as the control group. All infants followed the same study protocol (measurements at birth, 3, 12 and 24 months, including weight, length and skinfold thickness indicating adiposity, and detailed demographic data). In all cases, GDM was defined using the International Association of Diabetes and Pregnancy Study Group criteria. RESULTS Earlier OGDM had higher birthweight SD scores (SDS) than control infants. Conversely, recent OGDM had similar birthweight- and length SDS to control infants (mean ± SD, 0.1 ± 1.0 and- 0.1 ± 0.9, respectively), but lower mean skinfold thickness SDS (-0.4 ± 0.6 vs 0.0 ± 0.9; p < 0.001). After birth, earlier OGDM showed reduced gains in weight and length between 3 and 12 months. In contrast, recent OGDM had increased weight and skinfold thickness gains until 3 months, followed by reduced gains in those variables from 3 to 12 months, compared with control infants. At 24 months, recent OGDM had lower adiposity than control infants (mean skinfold thickness SDS -0.3 ± 0.7 vs 0.0 ± 0.8; p < 0.001). At all time points recent OGDM had lower growth measurements than earlier OGDM. CONCLUSIONS/INTERPRETATION Recent OGDM showed different growth trajectories to the earlier group, namely normalisation of birthweight and reduced adiposity at birth, followed by initial rapid weight gain but subsequent reduced adiposity postnatally. While avoidance of macrosomia at birth may be advantageous, the longer-term health implications of these changing growth trajectories are uncertain.
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Affiliation(s)
- Philippa M Prentice
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
- Department of Paediatrics, North Middlesex University Hospital NHS Trust, London, UK
| | - Laurentya Olga
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Clive J Petry
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - David Simmons
- Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Macarthur Clinical School, Western Sydney University, Sydney, NSW, Australia
| | - Helen R Murphy
- Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital, Norwich, UK
- Women's Health Academic Centre, Division of Women's and Children's Health, King's College London, London, UK
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Ken K Ong
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK
- Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - David B Dunger
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
- Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
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Furse S, Snowden SG, Olga L, Prentice P, Ong KK, Hughes IA, Acerini CL, Dunger DB, Koulman A. Evidence from 3-month-old infants shows that a combination of postnatal feeding and exposures in utero shape lipid metabolism. Sci Rep 2019; 9:14321. [PMID: 31586083 PMCID: PMC6778076 DOI: 10.1038/s41598-019-50693-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/17/2019] [Indexed: 12/13/2022] Open
Abstract
We tested the hypothesis that both postnatal feeding and conditions in utero affect lipid metabolism in infants. Infants who experienced restrictive growth conditions in utero and others exposed to maternal hyperglycaemia were compared to a control group with respect to feeding mode. Dried blood spots were collected from a pilot subset of infant participants of the Cambridge Baby Growth Study at 3mo. Groups: (a) a normal gestation (control, n = 40), (b) small for gestational age (SGA, n = 34) and (c) whose mothers developed hyperglycaemia (n = 59). These groups were further stratified by feeding mode; breastfed, formula-fed or received a mixed intake. Their phospholipid, glyceride and sterol fractions were profiled using direct infusion mass spectrometry. Statistical tests were used to identify molecular species that indicated differences in lipid metabolism. The abundance of several phospholipids identified by multivariate analysis, PC(34:1), PC(34:2) and PC-O(34:1), was 30-100% higher across all experimental groups. SM(39:1) was around half as abundant in in utero groups among breastfed infants only. The evidence from this pilot study shows that phospholipid metabolism is modulated by both conditions in utero and postnatal feeding in a cohort of 133 Caucasian infants, three months post partum.
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Affiliation(s)
- Samuel Furse
- Core Metabolomics and Lipidomics Laboratory, Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Level 4 Pathology, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Stuart G Snowden
- Core Metabolomics and Lipidomics Laboratory, Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Level 4 Pathology, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Laurentya Olga
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Philippa Prentice
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Ken K Ong
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
- MRC Epidemiology Unit, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - David B Dunger
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Albert Koulman
- Core Metabolomics and Lipidomics Laboratory, Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Level 4 Pathology, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
- MRC Epidemiology Unit, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
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Petry CJ, Fisher BG, Ong KK, Hughes IA, Acerini CL, Dunger DB. Temporal trends without seasonal effects on gestational diabetes incidence relate to reductions in indices of insulin secretion: the Cambridge Baby Growth Study. Acta Diabetol 2019; 56:1133-1140. [PMID: 31087162 PMCID: PMC6746879 DOI: 10.1007/s00592-019-01354-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/26/2019] [Indexed: 12/16/2022]
Abstract
AIMS The incidence of gestational diabetes has been reported to have risen over the first decade of this century. Some studies have also found it to vary with seasons of the year. We investigated temporal and seasonal trends on gestational diabetes incidence in a single-centre cohort study from Cambridge, UK, and attempted to explain trends using associated risk factors. METHODS Using a cosinor model, we tested both temporal and seasonal trends in gestational diabetes incidence in 1074 women recruited to the Cambridge Baby Growth Study in 2001-2009 who underwent oral glucose tolerance tests around week 28 of pregnancy. RESULTS There was a temporal increase in gestational diabetes incidence over the course of recruitment to this study [0.014 (0.005, 0.022) proportional increase per year, p = 2.1 × 10-3], but no seasonal effect (p = 0.7). HOMA B [- 0.015 (- 0.025, - 0.005) per year, p = 3.0 × 10-3] and the insulin disposition index [- 0.036 (- 0.060, - 0.013) per year, p = 3.0 × 10-3], unlike HOMA S, showed negative temporal trends. Risk factor analyses showed a concomitant temporal slight increase in the index of multiple deprivation [0.191 (0.138, 0.257) units per year, p = 4.6 × 10-10]. This index was positively associated with HOMA B (p = 6.1 × 10-5) but not directly with gestational diabetes (p = 0.6), HOMA S (p = 0.2) or the insulin disposition index (p = 0.4). CONCLUSIONS In this cohort, there were temporal, but not seasonal, increases in gestational diabetes incidence between the years 2001 and 2009, which appeared to be related more to reductions in insulin secretion than sensitivity. Possible mediators of this link include confounding factors related to deprivation.
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Affiliation(s)
- Clive J Petry
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Benjamin G Fisher
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Ken K Ong
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, CB2 0QQ, UK
- The Institute of Metabolic Science, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - David B Dunger
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
- The Institute of Metabolic Science, University of Cambridge, Cambridge, CB2 0QQ, UK
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Ameyaw E, Asafo-Agyei SB, Hughes IA, Zacharin M, Chanoine JP. Incidence of disorders of sexual development in neonates in Ghana: prospective study. Arch Dis Child 2019; 104:636-638. [PMID: 31097528 DOI: 10.1136/archdischild-2019-316986] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/29/2019] [Accepted: 03/31/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The incidence of disorders of sexual development (DSD) is unknown in sub-Saharan Africa. We describe the characteristics and incidence of DSD in a cohort of infants born in Ghana. DESIGN Trained research assistants performed systematic genital examination at birth. All infants with suspected abnormal genitalia were further examined by a paediatric endocrinologist. SETTING Komfo Anokye Teaching Hospital, Kumasi, Ghana. PATIENTS Consecutive infants born in a single centre over a 1-year period (May 2014 to April 2015). MAIN OUTCOME MEASURES Incidence of DSD. Micropenis was defined as a stretched length <2.1 cm and clitoromegaly as a clitoral length >8.6 mm. RESULTS We examined 9255 infants (93% of all live births) within 72 hours of birth. Twenty-six neonates had a DSD. Nineteen infants had DSD without genital ambiguity: isolated micropenis (n=2), hypospadias (n=7), cryptorchidism (n=4) and clitoromegaly (n=6). Seven infants had DSD with ambiguity: clitoromegaly with a uterus on ultrasound and elevated 17-hydoxyprogesterone, suggesting XX DSD due to congenital adrenal hyperplasia (CAH)(n=4) and micropenis, hypospadias and gonads in a bifid scrotum or in the inguinal region, consistent with XY DSD (n=3). CONCLUSION The incidence of atypical genitalia was 28/10,000 (95% CI 17/10 000 to 39/10 000) live births. The incidence of CAH was 4.3/10 000 (95% CI 1.2/10 000 to 11.1/10 000) and was strongly associated with consanguinity.
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Affiliation(s)
| | | | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Margaret Zacharin
- Pediatrics, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Jean-Pierre Chanoine
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Prentice PM, Schoemaker MH, Vervoort J, Hettinga K, Lambers TT, van Tol EAF, Acerini CL, Olga L, Petry CJ, Hughes IA, Koulman A, Ong KK, Dunger DB. Human Milk Short-Chain Fatty Acid Composition is Associated with Adiposity Outcomes in Infants. J Nutr 2019; 149:716-722. [PMID: 31050748 DOI: 10.1093/jn/nxy320] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/25/2018] [Accepted: 12/18/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Presumed benefits of human milk (HM) in avoiding rapid infancy weight gain and later obesity could relate to its nutrient composition. However, data on breast milk composition and its relation with growth are sparse. OBJECTIVE We investigated whether short-chain fatty acids (SCFAs), known to be present in HM and linked to energy metabolism, are associated with infancy anthropometrics. METHODS In a prospective birth cohort, HM hindmilk samples were collected from 619 lactating mothers at 4-8 wk postnatally [median (IQR) age: 33.9 (31.3-36.5) y, body mass index (BMI) (kg/m2): 22.8 (20.9-25.2)]. Their offspring, born at 40.1 (39.1-41.0) wk gestation with weight 3.56 (3.22-3.87) kg and 51% male, were assessed with measurement of weight, length, and skinfold thickness at ages 3, 12, and 24 mo, and transformed to age- and sex-adjusted z scores. HM SCFAs were measured by 1H-nuclear magnetic resonance spectroscopy (NMR) and GC-MS. Multivariable linear regression models were conducted to analyze the relations between NMR HM SCFAs and infancy growth parameters with adjustment for potential confounders. RESULTS NMR peaks for HM butyrate, acetate, and formic acid, but not propionate, were detected. Butyrate peaks were 17.8% higher in HM from exclusively breastfeeding mothers than mixed-feeding mothers (P = 0.003). HM butyrate peak values were negatively associated with changes in infant weight (standardized B = -0.10, P = 0.019) and BMI (B = -0.10, P = 0.018) between 3 and 12 mo, and negatively associated with BMI (B = -0.10, P = 0.018) and mean skinfold thickness (B = -0.10, P = 0.049) at age 12 mo. HM formic acid peak values showed a consistent negative association with infant BMI at all time points (B < = -0.10, P < = 0.014), whereas HM acetate was negatively associated with skinfold thickness at 3 mo (B = -0.10, P = 0.028) and 24 mo (B = -0.10, P = 0.036). CONCLUSIONS These results suggest that HM SCFAs play a beneficial role in weight gain and adiposity during infancy. Further knowledge of HM SCFA function may inform future strategies to support healthy growth.
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Affiliation(s)
- Philippa M Prentice
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | | | - Jacques Vervoort
- Department of Agrotechnology and Food Sciences, Wageningen University, the Netherlands
| | - Kasper Hettinga
- Department of Agrotechnology and Food Sciences, Wageningen University, the Netherlands
| | - Tim T Lambers
- Mead Johnson Pediatric Nutrition Institute, Nijmegen, the Netherlands
| | - Eric A F van Tol
- Mead Johnson Pediatric Nutrition Institute, Nijmegen, the Netherlands
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Laurentya Olga
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Clive J Petry
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Albert Koulman
- MRC Epidemiology Unit, Wellcome Trust-MRC Institute of Metabolic Science, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge, United Kingdom
| | - Ken K Ong
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom.,Wellcome Trust-MRC Institute of Metabolic Science, NIHR Cambridge Comprehensive Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom.,MRC Epidemiology Unit, Wellcome Trust-MRC Institute of Metabolic Science, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge, United Kingdom
| | - David B Dunger
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom.,Wellcome Trust-MRC Institute of Metabolic Science, NIHR Cambridge Comprehensive Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
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Abstract
Objectives To investigate whether age at menarche is related to maternal blood pressure in pregnancy and, if so, whether obesity and insulin resistance can modify the associations. Study Design Analysis of data collected from 438 pregnant women from the longitudinal and prospective Cambridge Baby Growth Study. Main Outcome Testing associations between questionnaire-derived age at menarche and blood pressure measurements in pregnancy collected from hospital notes, and investigating whether any associations were altered by maternal pre-pregnancy body mass index (BMI) and insulin resistance. Measures Mean arterial blood pressure at four time points across pregnancy, age at menarche, (Homeostasis Model Assessment) insulin resistance around week 28 of pregnancy. Results For each increased year in age at menarche there was a drop in mean arterial blood pressure (mmHg) of 0.6 at 11.9 weeks, 0.9 at 31.4 and 37.0 weeks, and 0.4 at 38.8 weeks (a maximal difference of over 7 mmHg across extremes of AAM). Each association was attenuated by both maternal pre-pregnancy BMI and insulin resistance. Conclusions Age at menarche is negatively associated with future blood pressure in pregnancy, so those with the earliest age at menarche have the highest blood pressures. Either these associations may be mediated by links between age at menarche and obesity/insulin resistance, or there may be a confounder (e.g. systemic inflammation) that links age at menarche to each of them.
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Affiliation(s)
- Clive J Petry
- Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | - Ken K Ong
- Department of Paediatrics, University of Cambridge, Cambridge, U.K.,Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, U.K.,The Institute of Metabolic Science, University of Cambridge, Cambridge, U.K
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | - David B Dunger
- Department of Paediatrics, University of Cambridge, Cambridge, U.K.,The Institute of Metabolic Science, University of Cambridge, Cambridge, U.K
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31
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Petry CJ, Ong KK, Hughes IA, Acerini CL, Dunger DB. The influence of maternal pregnancy glucose concentrations on associations between a fetal imprinted gene allele score and offspring size at birth. BMC Res Notes 2018; 11:821. [PMID: 30454065 PMCID: PMC6245772 DOI: 10.1186/s13104-018-3933-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/14/2018] [Indexed: 02/06/2023] Open
Abstract
Objective Previously we found that certain fetal imprinted genes represented as an allele score are associated with maternal pregnancy glucose concentrations. Recently it was reported that fetal polymorphisms with strong associations with birth weight tend to mediate these independently of increases in maternal pregnancy glucose concentrations. We therefore investigated whether potential associations between the fetal allele score and birth weight were related to maternal glucose concentrations in the Cambridge Baby Growth Study. Results The fetal imprinted gene allele score was positively associated with birth weight (β = 63 (17–109) g/risk allele, β′ = 0.113, p = 7.6 × 10−3, n = 405). This association was partially attenuated by adjusting for maternal glucose concentrations (β = 50 (4–95) g/risk allele, β′ = 0.089, p = 0.03, n = 405). The allele score was also positively associated with risk of being large for gestational age at birth (odds ratio 1.60 (1.19–2.15) per risk allele, p = 2.1 × 10−3, n = 660) and negatively associated with risk of being small for gestational age at birth (odds ratio 0.65 (0.44–0.96) per risk allele, p = 0.03, n = 660). The large for gestational age at birth association was also partially attenuated by maternal glucose concentrations. These results suggest that associations between the fetal imprinted gene allele score and size at birth are mediated through both glucose-dependent and glucose-independent mechanisms.
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Affiliation(s)
- Clive J Petry
- Department of Paediatrics, Addenbrooke's Hospital, University of Cambridge, Hills Road, Box 116, Cambridge, CB2 0QQ, UK.
| | - Ken K Ong
- Department of Paediatrics, Addenbrooke's Hospital, University of Cambridge, Hills Road, Box 116, Cambridge, CB2 0QQ, UK.,Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, CB2 0QQ, UK.,The Institute of Metabolic Science, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Ieuan A Hughes
- Department of Paediatrics, Addenbrooke's Hospital, University of Cambridge, Hills Road, Box 116, Cambridge, CB2 0QQ, UK
| | - Carlo L Acerini
- Department of Paediatrics, Addenbrooke's Hospital, University of Cambridge, Hills Road, Box 116, Cambridge, CB2 0QQ, UK
| | - David B Dunger
- Department of Paediatrics, Addenbrooke's Hospital, University of Cambridge, Hills Road, Box 116, Cambridge, CB2 0QQ, UK.,The Institute of Metabolic Science, University of Cambridge, Cambridge, CB2 0QQ, UK
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32
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Kung KTF, Spencer D, Pasterski V, Neufeld SAS, Hindmarsh PC, Hughes IA, Acerini CL, Hines M. Emotional and behavioral adjustment in 4 to 11-year-old boys and girls with classic congenital adrenal hyperplasia and unaffected siblings. Psychoneuroendocrinology 2018; 97:104-110. [PMID: 30015005 DOI: 10.1016/j.psyneuen.2018.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/20/2018] [Accepted: 07/02/2018] [Indexed: 01/27/2023]
Abstract
It has been suggested that atypical hormone environments during early development may contribute to subsequent development of psychopathology. Also, it has been suggested that individuals with the autosomal recessive genetic variant, classic congenital adrenal hyperplasia (CAH), might be at increased risk of psychopathology. The present study examined emotional and behavioral adjustment in young children with CAH and their unaffected siblings in the United Kingdom. The parent-reported version of the Strengths and Difficulties Questionnaire (SDQ) was employed to assess adjustment in children aged 4 to 11 years. There were 38 boys with CAH, 43 girls with CAH, 23 unaffected brothers, and 31 unaffected sisters. No differences in emotional or behavioral problems were found between boys or girls with CAH and unaffected same-sex siblings. In addition, affected and unaffected boys in the current sample generally did not differ from boys in the general population. However, compared with girls in the general population, girls with CAH had more difficulties related to conduct problems, hyperactivity/ inattention, and prosocial behavior, and unaffected sisters had more difficulties related to peer problems, conduct problems, and prosocial behavior. These findings suggest that both girls with CAH and unaffected sisters of girls or boys with CAH may be at increased risk of developing behavioral problems. Potential influences related to the early hormone environment, familial process, and social stigma are considered.
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Affiliation(s)
- Karson T F Kung
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK.
| | - Debra Spencer
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK
| | - Vickie Pasterski
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK; Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Sharon A S Neufeld
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK
| | - Peter C Hindmarsh
- Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Melissa Hines
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK
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Petry CJ, Ong KK, Burling KA, Barker P, Goodburn SF, Perry JRB, Acerini CL, Hughes IA, Painter RC, Afink GB, Dunger DB, O'Rahilly S. Associations of vomiting and antiemetic use in pregnancy with levels of circulating GDF15 early in the second trimester: A nested case-control study. Wellcome Open Res 2018; 3:123. [PMID: 30345390 PMCID: PMC6171563 DOI: 10.12688/wellcomeopenres.14818.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2018] [Indexed: 12/23/2022] Open
Abstract
Background: Although nausea and vomiting are very common in pregnancy, their pathogenesis is poorly understood. We tested the hypothesis that circulating growth and differentiation factor 15 (GDF15) concentrations in early pregnancy, whose gene is implicated in hyperemesis gravidarum, are associated with nausea and vomiting. Methods: Blood samples for the measurement of GDF15 and human chorionic gonadotrophin (hCG) concentrations were obtained early in the second trimester (median 15.1 (interquartile range 14.4-15.7) weeks) of pregnancy from 791 women from the Cambridge Baby Growth Study, a prospective pregnancy and birth cohort. During each trimester participants completed a questionnaire which included questions about nausea, vomiting and antiemetic use. Associations with pre-pregnancy body mass indexes (BMI) were validated in 231 pregnant NIPTeR Study participants. Results: Circulating GDF15 concentrations were higher in women reporting vomiting in the second trimester than in women reporting no pregnancy nausea or vomiting: 11,581 (10,977-12,219) (n=175) vs. 10,593 (10,066-11,147) (n=193) pg/mL, p=0.02). In women who took antiemetic drugs during pregnancy (n=11) the GDF15 levels were also raised 13,157 (10,558-16,394) pg/mL (p =0.04). Serum GFD15 concentrations were strongly positively correlated with hCG levels but were inversely correlated with maternal BMIs, a finding replicated in the NIPTeR Study. Conclusions: Week 15 serum GDF15 concentrations are positively associated with second trimester vomiting and maternal antiemetic use in pregnancy. Given GDF15's site of action in the chemoreceptor trigger zone of the brainstem and its genetic associations with hyperemesis gravidarum, these data support the concept that GDF15 may be playing a pathogenic role in pregnancy-associated vomiting.
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Affiliation(s)
- Clive J Petry
- Department of Paediatrics, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK
| | - Ken K Ong
- Department of Paediatrics, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK.,Medical Research Council Epidemiology Unit, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK
| | - Keith A Burling
- NIHR Biomedical Research Centre Core Biochemistry Assay Lab, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK
| | - Peter Barker
- NIHR Biomedical Research Centre Core Biochemistry Assay Lab, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK
| | - Sandra F Goodburn
- Department of Clinical Biochemistry, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - John R B Perry
- Medical Research Council Epidemiology Unit, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK
| | - Rebecca C Painter
- Department of Gynaecology and Obstetrics, Academic Medical Center of the University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
| | - Gijs B Afink
- Reproductive Biology Laboratory, Academic Medical Center of the University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
| | - David B Dunger
- Department of Paediatrics, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK.,Metabolic Research Laboratories and MRC Metabolic Diseases Unit, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK
| | - Stephen O'Rahilly
- Metabolic Research Laboratories and MRC Metabolic Diseases Unit, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK
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34
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Petry CJ, Koulman A, Lu L, Jenkins B, Furse S, Prentice P, Matthews L, Hughes IA, Acerini CL, Ong KK, Dunger DB. Associations between the maternal circulating lipid profile in pregnancy and fetal imprinted gene alleles: a cohort study. Reprod Biol Endocrinol 2018; 16:82. [PMID: 30157874 PMCID: PMC6116391 DOI: 10.1186/s12958-018-0399-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/13/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Imprinted genes, which are expressed in a parent of origin-specific manner, are thought to mediate the genetic priorities of each parent in pregnancy. Recently we reported that some fetal imprinted gene variants are associated with maternal glucose concentrations and blood pressures in pregnancy. We suggest that the conflict between the effects of paternal and maternal transmitted genes starts at conception and may already be evident in measures of maternal metabolism in early pregnancy, before gestational diabetes is manifest. METHODS Lipid fractions in maternal non-fasting serum collected around week 15 of pregnancy were profiled using direct infusion mass spectrometry in a subset Discovery Cohort (n = 200) of women from the Cambridge Baby Growth Study using direct infusion mass spectrometry. Associations between 151 haplotype-tag fetal polymorphisms in 16 imprinted genes and lipids were determined using partial least squares discriminant analysis. Variable importance in projection scores were used to identify those lipid species that contribute most to the underlying variation in the lipid profile and the concentrations of these species tested for associations with fetal imprinted gene alleles using linear regression. In an internal Validation Cohort (n = 567 women from the same cohort) the lipid fraction was profiled using liquid chromatography-mass spectrometry and tested for associations with the same fetal imprinted gene variants as above, followed by meta-analysis of associations from the Discovery and Validation Cohorts. RESULTS The most significant associations were between a monounsaturated triglyceride (44:1) and both paternally-transmitted fetal H19 rs7950932 (R = 0.14, p = 2.9 × 10- 3, n = 386) and maternally-transmitted fetal FAM99A rs7131362 (R = 0.18, p = 6.2 × 10- 3, n = 351; association with maternal-untransmitted allele R = 0.08, p = 0.07, n = 328). This same triglyceride isoform was also associated with subsequent week 28 fasting glucose concentrations (R = 0.09, p = 9.9 × 10- 3, n = 673) and homeostasis model assessment of insulin resistance (R = 0.09, p = 0.01, n = 664). CONCLUSIONS Fetal imprinted genes may influence maternal circulating clinically relevant triglyceride concentrations early in pregnancy.
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Affiliation(s)
- Clive J Petry
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Albert Koulman
- Medical Research Council Human Nutrition Research, Cambridge, UK
- The Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Liangjian Lu
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Benjamin Jenkins
- Medical Research Council Human Nutrition Research, Cambridge, UK
| | - Samuel Furse
- The Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Philippa Prentice
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Lee Matthews
- Medical Research Council Human Nutrition Research, Cambridge, UK
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Ken K Ong
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
- The Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - David B Dunger
- Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
- The Institute of Metabolic Science, University of Cambridge, Cambridge, UK
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Petry CJ, Ong KK, Hughes IA, Acerini CL, Dunger DB. The association between age at menarche and later risk of gestational diabetes is mediated by insulin resistance. Acta Diabetol 2018; 55:853-859. [PMID: 29789944 PMCID: PMC6060956 DOI: 10.1007/s00592-018-1162-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/15/2018] [Indexed: 02/07/2023]
Abstract
AIMS Associations have been reported between age at menarche and the later risk of gestational diabetes. However, it is not known whether these associations reflect differences in insulin sensitivity and/or pancreatic β-cell function in pregnancy. METHODS We examined this question in women enrolled in the prospective Cambridge Baby Growth Study who recalled their age at menarche in questionnaires during pregnancy. Polynomial logistic and linear regression models were used to relate menarche timing to the risk of gestational diabetes, both unadjusted and adjusted for the Homeostasis Model Assessments of insulin resistance (HOMA IR) and pancreatic β-cell function (HOMA B) at week 28 of pregnancy. RESULTS Age at menarche showed a U-shaped association with gestational diabetes risk (linear term: p = 9.5 × 10-4; quadratic term: p = 1.0 × 10-3; n = 889; overall model p = 8.1 × 10-3). Age at menarche showed a negative linear association with insulin resistance (HOMA IR: β = -0.13, p = 5.2 × 10-4, n = 771), which explained the relationship between age at menarche and gestational diabetes risk (adjusted linear term going from p = 0.03-0.08; adjusted quadratic term going from p = 0.04-0.08; n = 771). Age at menarche also showed a negative linear association with β-cell function (HOMA B: β = -0.11, p = 2.8 × 10-3, n = 771) but this did not attenuate the relationship between age at menarche and gestational diabetes (adjusted linear term p = 0.02; adjusted quadratic term p = 0.03, n = 771). CONCLUSIONS These results suggest that the associations between age at menarche and risk of gestational diabetes and raised pregnancy glucose concentrations may be mediated by insulin resistance.
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Affiliation(s)
- Clive J Petry
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Box 116, Cambridge, CB2 0QQ, UK.
| | - Ken K Ong
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Box 116, Cambridge, CB2 0QQ, UK
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, CB2 0QQ, UK
- The Institute of Metabolic Science, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Box 116, Cambridge, CB2 0QQ, UK
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Box 116, Cambridge, CB2 0QQ, UK
| | - David B Dunger
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Box 116, Cambridge, CB2 0QQ, UK
- The Institute of Metabolic Science, University of Cambridge, Cambridge, CB2 0QQ, UK
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Petry CJ, Ong KK, Beardsall K, Hughes IA, Acerini CL, Dunger DB. Vomiting in pregnancy is associated with a higher risk of low birth weight: a cohort study. BMC Pregnancy Childbirth 2018; 18:133. [PMID: 29728080 PMCID: PMC5935997 DOI: 10.1186/s12884-018-1786-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 04/26/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Low birth weight has important short- and long-term health implications. Previously it has been shown that pregnancies affected by hyperemesis gravidarum in the mother are at higher risk of having low birth weight offspring. In this study we tested whether such risks are also evident with less severe nausea and vomiting in pregnancy. METHODS One thousand two hundred thirty-eight women in the prospective Cambridge Baby Growth Study filled in pregnancy questionnaires which included questions relating to adverse effects of pregnancy and drugs taken during that time. Ordinal logistic regression models, adjusted for parity, ethnicity, marital and smoking status were used to relate the risk of giving birth to low birth weight (< 2.5 kg) babies to nausea and/or vomiting in pregnancy that were not treated with anti-emetics and did not report suffering from hyperemesis gravidarum. RESULTS Only three women in the cohort reported having had hyperemesis gravidarum although a further 17 women reported taking anti-emetics during pregnancy. Of those 1218 women who did not take anti-emetics 286 (23.5%) did not experience nausea or vomiting, 467 (38.3%) experienced nausea but not vomiting and 465 experienced vomiting (38.2%). Vomiting during pregnancy was associated with higher risk of having a low birth weight baby (odds ratio 3.5 (1.2, 10.8), p = 0.03). The risk associated with vomiting was found in the first (p = 0.01) and second (p = 0.01) trimesters but not the third (p = 1.0). The higher risk was not evident in those women who only experienced nausea (odds ratio 1.0 (0.3, 4.0), p = 1.0). CONCLUSIONS Vomiting in early pregnancy, even when not perceived to be sufficiently severe to merit treatment, is associated with a higher risk of delivering a low birth weight baby. Early pregnancy vomiting might therefore be usable as a marker of higher risk of low birth weight in pregnancy. This may be of benefit in situations where routine ultrasound is not available to distinguish prematurity from fetal growth restriction, so low birth weight is used as an alternative.
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Affiliation(s)
- Clive J. Petry
- 0000000121885934grid.5335.0Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - Ken K. Ong
- 0000000121885934grid.5335.0Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK ,0000000121885934grid.5335.0Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, CB2 0QQ UK ,0000000121885934grid.5335.0The Institute of Metabolic Science, University of Cambridge, Cambridge, CB2 0QQ UK
| | - Kathryn Beardsall
- 0000000121885934grid.5335.0Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - Ieuan A. Hughes
- 0000000121885934grid.5335.0Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - Carlo L. Acerini
- 0000000121885934grid.5335.0Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - David B. Dunger
- 0000000121885934grid.5335.0Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK ,0000000121885934grid.5335.0The Institute of Metabolic Science, University of Cambridge, Cambridge, CB2 0QQ UK
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Fisher BG, Frederiksen H, Andersson AM, Juul A, Thankamony A, Ong KK, Dunger DB, Hughes IA, Acerini CL. Serum Phthalate and Triclosan Levels Have Opposing Associations With Risk Factors for Gestational Diabetes Mellitus. Front Endocrinol (Lausanne) 2018; 9:99. [PMID: 29593656 PMCID: PMC5859030 DOI: 10.3389/fendo.2018.00099] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/28/2018] [Indexed: 02/02/2023] Open
Abstract
Certain phthalates and bisphenol A (BPA) have been associated with insulin resistance and type 2 diabetes in non-pregnant adults, but studies of gestational diabetes mellitus (GDM) have reported conflicting results for phthalates and no associations with BPA. Our aim was to investigate the relationship between maternal serum levels of phthalate metabolites and phenols at 10-17 weeks of gestation and glucose homeostasis at 28 weeks of gestation. 232 women aged ≥16 years without type 1 or 2 diabetes with singleton male pregnancies were recruited from a single UK maternity centre between 2001 and 2009 as part of a prospective observational study (Cambridge Baby Growth Study). Serum levels of 16 phthalate metabolites and 9 phenols (including BPA) were measured using liquid chromatography/tandem mass spectrometry. Oral glucose tolerance tests were performed at 28 weeks. 47/232 (20.3%) women had GDM. First-trimester triclosan (TCS) was inversely associated with incident GDM (adjusted odds ratio per log increase in concentration 0.54, 95% confidence interval 0.34-0.86, p = 0.010). Amongst women without GDM, first-trimester mono-(2-ethylhexyl) phthalate and mono(carboxyisooctyl) phthalate levels were positively associated with 120-min plasma glucose (adjusted β 0.268 and 0.183, p = 0.0002 and 0.010, respectively) in mid-pregnancy. No other monotonic associations were detected between phthalate or phenol levels and fasting or stimulated plasma glucose, β-cell function, insulin resistance, or 60-min disposition index. Our results support a glycaemia-raising effect of phthalates during pregnancy, consistent with findings in non-pregnant populations and suggest a possible protective effect of exposure to TCS against GDM.
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Affiliation(s)
- Benjamin G. Fisher
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Hanne Frederiksen
- EDMaRC, Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna-Maria Andersson
- EDMaRC, Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anders Juul
- EDMaRC, Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ajay Thankamony
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Ken K. Ong
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - David B. Dunger
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Ieuan A. Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Carlo L. Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
- *Correspondence: Carlo L. Acerini,
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Spencer D, Pasterski V, Neufeld S, Glover V, O'Connor TG, Hindmarsh PC, Hughes IA, Acerini CL, Hines M. Prenatal androgen exposure and children's aggressive behavior and activity level. Horm Behav 2017; 96:156-165. [PMID: 28939371 PMCID: PMC5722694 DOI: 10.1016/j.yhbeh.2017.09.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 09/15/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022]
Abstract
Some human behaviors, including aggression and activity level, differ on average for males and females. Here we report findings from two studies investigating possible relations between prenatal androgen and children's aggression and activity level. For study 1, aggression and activity level scores for 43 girls and 38 boys, aged 4 to 11years, with congenital adrenal hyperplasia (CAH, a genetic condition causing increased adrenal androgen production beginning prenatally) were compared to those of similarly-aged, unaffected relatives (41 girls, 31 boys). Girls with CAH scored higher on aggression than unaffected girls, d=0.69, and unaffected boys scored higher on activity level than unaffected girls, d=0.50. No other group differences were significant. For study 2, the relationship of amniotic fluid testosterone to aggression and activity level was investigated in typically-developing children (48 girls, 44 boys), aged 3 to 5years. Boys scored higher than girls on aggression, d=0.41, and activity level, d=0.50. However, amniotic fluid testosterone was not a significant predictor of aggression or activity level for either sex. The results of the two studies provide some support for an influence of prenatal androgen exposure on children's aggressive behavior, but not activity level. The within-sex variation in amniotic fluid testosterone may not be sufficient to allow reliable assessment of relations to aggression or activity level.
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Affiliation(s)
- Debra Spencer
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, United Kingdom.
| | - Vickie Pasterski
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, United Kingdom; Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom.
| | - Sharon Neufeld
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, United Kingdom.
| | - Vivette Glover
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, United Kingdom.
| | - Thomas G O'Connor
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA.
| | - Peter C Hindmarsh
- Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, United Kingdom.
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom.
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom.
| | - Melissa Hines
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, United Kingdom.
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Chaudhry S, Tadokoro-Cuccaro R, Hannema SE, Acerini CL, Hughes IA. Frequency of gonadal tumours in complete androgen insensitivity syndrome (CAIS): A retrospective case-series analysis. J Pediatr Urol 2017; 13:498.e1-498.e6. [PMID: 28351649 DOI: 10.1016/j.jpurol.2017.02.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/13/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Complete androgen insensitivity syndrome (CAIS) is an X-linked recessive disorder of sex development (DSD) where affected individuals are phenotypically female, but have an XY karyotype and testes. The risk of gonadal tumour development in CAIS may increase with age; incidence rates have been reported to be 0.8-22% in patients who have retained their gonads into adulthood. Consequently, gonadectomy has been recommended either during childhood or after puberty is complete, although there is no consensus on the optimal timing for this procedure. OBJECTIVE AND HYPOTHESES To establish the frequency of histological abnormalities in CAIS in relation to the age at gonadectomy. METHOD Data were collected from the Cambridge DSD database on patients with CAIS (n = 225; age range 3-88 years) who had undergone gonadectomy, and their age of gonadectomy, gonadal histology and immunohistochemistry. RESULTS Evaluable data were obtained from 133 patients. Median age at gonadectomy was 14.0 years (range: 18 days-68 years). Pubertal status was: prepuberty, n = 62; postpuberty, n = 68. Thirteen cases were aged >20 years at gonadectomy. The pattern of histology is summarised in the Summary table. DISCUSSION In this large case series of CAIS patients who had undergone gonadectomy, while the combined malignant and premalignant gonadal histology prevalence was 6.0%, the findings confirm the low occurrence of gonadal malignancy in CAIS, with a frequency of 1.5%. The two cases of malignancy were postpubertal. Germ cell neoplasia in situ (GCNIS) was observed in six cases, of which one occurred prepuberty and five postpuberty. The study highlighted difficulties in diagnosis of GCNIS and the need for histological analysis in expert centres. CONCLUSION The results support the current recommendation that gonads in CAIS can be retained until early adulthood. The small number of individuals with gonadectomy after age 20 years do not allow firm conclusion regarding later adulthood. Therefore, it is recommended that the option of gonadectomy be discussed in adulthood. Some form of regular surveillance of the gonads is then recommended, although none of the available options are ideal.
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Affiliation(s)
- S Chaudhry
- Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - R Tadokoro-Cuccaro
- Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
| | - S E Hannema
- Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands; Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - C L Acerini
- Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - I A Hughes
- Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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Petry CJ, Ong KK, Hughes IA, Acerini CL, Dunger DB. Associations between bacterial infections and blood pressure in pregnancy. Pregnancy Hypertens 2017; 10:202-206. [PMID: 29153680 PMCID: PMC5710763 DOI: 10.1016/j.preghy.2017.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/29/2017] [Accepted: 09/10/2017] [Indexed: 01/06/2023]
Abstract
Antibiotic use in pregnancy was associated with a 2–3 mmHg rise in blood pressure. It was related more to changes in diastolic than systolic blood pressure. The most likely cause is exposure to bacterial infections.
Objectives To test the hypothesis that bacterial infections in pregnancy are related to maternal blood pressure. Study design Bacterial infection was assessed using antibiotic usage as a surrogate and its association with blood pressure in pregnancy tested in the Cambridge Baby Growth Study. Main outcome measures Antibiotic usage in pregnancy was self-reported in questionnaires. Blood pressure measurements at four time points in pregnancy were collected from the hospital notes of 622 women. Results Using all the available blood pressure readings (adjusted for weeks gestation) antibiotic usage was associated with a higher mean arterial blood pressure across pregnancy: antibiotics used 85 (84, 87) mmHg vs. no antibiotics used 83 (83, 84) mmHg (β = 2.3 (0.6, 4.0) mmHg, p = 9.6 × 10−3, from 621 individuals). Further analysis revealed that antibiotic usage was associated with diastolic (β = 2.3 (0.6, 4.0) mmHg; p = 7.0 × 10−3) more than systolic blood pressure (β = 1.4 (−0.9, 3.7) mmHg; p = 0.2). The effect size associated with antibiotic usage appeared to rise slightly after the first trimester. Conclusions Bacterial infection in pregnancy, as assessed by self-reported antibiotic usage, is associated with small rises in blood pressure.
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Affiliation(s)
- Clive J Petry
- Department of Paediatrics, University of Cambridge, Cambridge, UK.
| | - Ken K Ong
- Department of Paediatrics, University of Cambridge, Cambridge, UK; Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - David B Dunger
- Department of Paediatrics, University of Cambridge, Cambridge, UK; The Institute of Metabolic Science, University of Cambridge, Cambridge, UK
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Petry CJ, Ong KK, Hughes IA, Acerini CL, Frystyk J, Dunger DB. Early Pregnancy-Associated Plasma Protein A Concentrations Are Associated With Third Trimester Insulin Sensitivity. J Clin Endocrinol Metab 2017; 102:2000-2008. [PMID: 28323969 PMCID: PMC5464396 DOI: 10.1210/jc.2017-00272] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/08/2017] [Indexed: 01/04/2023]
Abstract
CONTEXT First or early second trimester pregnancy-associated plasma protein A (PAPP-A) concentrations have previously been shown to be lower in women who subsequently develop gestational diabetes mellitus (GDM) and gestational hypertension. OBJECTIVE We therefore sought to investigate why circulating PAPP-A concentrations are related to the subsequent risk of GDM and gestational hypertension. PATIENTS, DESIGN, AND SETTING We measured serum PAPP-A concentrations around week 15 of pregnancy and related these to indices derived from week 28 oral glucose tolerance tests and blood pressures across pregnancy in the Cambridge Baby Growth Study cohort. RESULTS Increased PAPP-A concentrations were associated with reduced GDM risk [odds ratio 0.623 (0.453, 0.856), P = 3.5 × 10-3, n = 777] and reduced mean arterial blood pressures (β = -0.202 to -0.177, P = 1.7 to 6.9 × 10-3, n = 347 to 355). They were also negatively associated with week 28 fasting (β = -0.149, P = 6.6 × 10-4, n = 777) and 60-minute (β = -0.188, P = 1.5 × 10-5, n = 777) oral glucose tolerance test glucose concentrations. These associations were underpinned by the strong associations between increased week 15 PAPP-A concentrations and decreased week 28 insulin resistance (homeostasis model assessment of insulin resistance: β = -0.319, P = 1.7 × 10-13, n = 768), as well as increased insulin secretion relative to insulin sensitivity (insulin disposition index: β = 0.202, P = 6.5 × 10-6, n = 731). CONCLUSIONS These results suggest that links between PAPP-A concentrations in early pregnancy and subsequent glucose concentrations and blood pressures may be mediated by changes in insulin sensitivity (and secretion).
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Affiliation(s)
- Clive J. Petry
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Ken K. Ong
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Ieuan A. Hughes
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Carlo L. Acerini
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Jan Frystyk
- Medical Research Laboratory, Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
| | - David B. Dunger
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
- Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
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Petry CJ, Mooslehner K, Prentice P, Hayes MG, Nodzenski M, Scholtens DM, Hughes IA, Acerini CL, Ong KK, Lowe WL, Dunger DB. Associations between a fetal imprinted gene allele score and late pregnancy maternal glucose concentrations. Diabetes Metab 2017; 43:323-331. [PMID: 28392167 PMCID: PMC5507297 DOI: 10.1016/j.diabet.2017.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/21/2017] [Accepted: 03/10/2017] [Indexed: 12/11/2022]
Abstract
Aim We hypothesised that some of the genetic risk for gestational diabetes (GDM) is due to the fetal genome affecting maternal glucose concentrations. Previously, we found associations between fetal IGF2 gene variants and maternal glucose concentrations in late pregnancy. Methods In the present study, we tested associations between SNP alleles from 15 fetal imprinted genes and maternal glucose concentrations in late pregnancy in the Cambridge Baby Growth and Wellbeing cohorts (1160 DNA trios). Results Four fetal SNP alleles with the strongest univariate associations: paternally-transmitted IGF2 rs10770125 (P-value = 2 × 10–4) and INS rs2585 (P-value = 7 × 10–4), and maternally-transmitted KCNQ1(OT1) rs231841 (P-value = 1 × 10–3) and KCNQ1(OT1) rs7929804 (P-value = 4 × 10–3), were used to construct a composite fetal imprinted gene allele score which was associated with maternal glucose concentrations (P-value = 4.3 × 10–6, n = 981, r2 = 2.0%) and GDM prevalence (odds ratio per allele 1.44 (1.15, 1.80), P-value = 1 × 10–3, n = 89 cases and 899 controls). Meta-analysis of the associations including data from 1367 Hyperglycaemia and Adverse Pregnancy Outcome Study participants confirmed the paternally-transmitted fetal IGF2/INS SNP associations (rs10770125, P-value = 3.2 × 10–8, rs2585, P-value = 3.6 × 10–5) and the composite fetal imprinted gene allele score association (P-value = 1.3 × 10–8), but not the maternally-transmitted fetal KCNQ1(OT1) associations (rs231841, P-value = 0.4; rs7929804, P-value = 0.2). Conclusion This study suggests that polymorphic variation in fetal imprinted genes, particularly in the IGF2/INS region, contribute a small but significant part to the risk of raised late pregnancy maternal glucose concentrations.
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Affiliation(s)
- C J Petry
- Department of Paediatrics, Box 116, Addenbrooke's Hospital, University of Cambridge, Hills Road, CB2 0QQ Cambridge, UK.
| | - K Mooslehner
- Department of Paediatrics, Box 116, Addenbrooke's Hospital, University of Cambridge, Hills Road, CB2 0QQ Cambridge, UK
| | - P Prentice
- Department of Paediatrics, Box 116, Addenbrooke's Hospital, University of Cambridge, Hills Road, CB2 0QQ Cambridge, UK
| | - M G Hayes
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - M Nodzenski
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - D M Scholtens
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - I A Hughes
- Department of Paediatrics, Box 116, Addenbrooke's Hospital, University of Cambridge, Hills Road, CB2 0QQ Cambridge, UK
| | - C L Acerini
- Department of Paediatrics, Box 116, Addenbrooke's Hospital, University of Cambridge, Hills Road, CB2 0QQ Cambridge, UK
| | - K K Ong
- Department of Paediatrics, Box 116, Addenbrooke's Hospital, University of Cambridge, Hills Road, CB2 0QQ Cambridge, UK; Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - W L Lowe
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - D B Dunger
- Department of Paediatrics, Box 116, Addenbrooke's Hospital, University of Cambridge, Hills Road, CB2 0QQ Cambridge, UK; Medical Research Laboratories, The Institute of Metabolic Science, University of Cambridge, Cambridge, UK
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Metzler VM, de Brot S, Robinson RS, Jeyapalan JN, Rakha E, Walton T, Gardner DS, Lund EF, Whitchurch J, Haigh D, Lochray JM, Robinson BD, Allegrucci C, Fray RG, Persson JL, Ødum N, Miftakhova RR, Rizvanov AA, Hughes IA, Tadokoro-Cuccaro R, Heery DM, Rutland CS, Mongan NP. Androgen dependent mechanisms of pro-angiogenic networks in placental and tumor development. Placenta 2017; 56:79-85. [PMID: 28238455 DOI: 10.1016/j.placenta.2017.02.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 11/25/2022]
Abstract
The placenta and tumors share important characteristics, including a requirement to establish effective angiogenesis. In the case of the placenta, optimal angiogenesis is required to sustain the blood flow required to maintain a successful pregnancy, whereas in tumors establishing new blood supplies is considered a key step in supporting metastases. Therefore the development of novel angiogenesis inhibitors has been an area of active research in oncology. A subset of the molecular processes regulating angiogenesis are well understood in the context of both early placentation and tumorigenesis. In this review we focus on the well-established role of androgen regulation of angiogenesis in cancer and relate these mechanisms to placental angiogenesis. The physiological actions of androgens are mediated by the androgen receptor (AR), a ligand dependent transcription factor. Androgens and the AR are essential for normal male embryonic development, puberty and lifelong health. Defects in androgen signalling are associated with a diverse range of clinical disorders in men and women including disorders of sex development (DSD), polycystic ovary syndrome in women and many cancers. We summarize the diverse molecular mechanisms of androgen regulation of angiogenesis and infer the potential significance of these pathways to normal and pathogenic placental function. Finally, we offer potential research applications of androgen-targeting molecules developed to treat cancer as investigative tools to help further delineate the role of androgen signalling in placental function and maternal and offspring health in animal models.
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Affiliation(s)
- Veronika M Metzler
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Health Sciences, University of Nottingham, LE12 5RD, UK
| | - Simone de Brot
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Health Sciences, University of Nottingham, LE12 5RD, UK
| | - Robert S Robinson
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Health Sciences, University of Nottingham, LE12 5RD, UK
| | - Jennie N Jeyapalan
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Health Sciences, University of Nottingham, LE12 5RD, UK
| | - Emad Rakha
- School of Medicine and Sciences, University of Nottingham, Nottingham City Hospital, NG5 1PB, UK
| | - Thomas Walton
- Department of Urology, Nottingham University Hospitals NHS Trust, NG5 1PB, UK
| | - David S Gardner
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Health Sciences, University of Nottingham, LE12 5RD, UK
| | - Emma F Lund
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Health Sciences, University of Nottingham, LE12 5RD, UK
| | | | - Daisy Haigh
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Health Sciences, University of Nottingham, LE12 5RD, UK
| | - Jack M Lochray
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Health Sciences, University of Nottingham, LE12 5RD, UK
| | - Brian D Robinson
- Department of Pathology, Weill Cornell Medicine, New York 10065, USA
| | - Cinzia Allegrucci
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Health Sciences, University of Nottingham, LE12 5RD, UK
| | - Rupert G Fray
- School of Biosciences, University of Nottingham, LE12 5RD, UK
| | - Jenny L Persson
- Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Molecular Biology, Umeå University, Sweden
| | - Niels Ødum
- Department of Immunology and Microbiology, University of Copenhagen, Denmark
| | - Regina R Miftakhova
- Department of Molecular Biology, Umeå University, Sweden; Kazan Federal University, Kazan, Republic of Tatarstan 420008, Russian Federation
| | - Albert A Rizvanov
- Kazan Federal University, Kazan, Republic of Tatarstan 420008, Russian Federation
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Hills Rd, Cambridge CB2 0QQ, UK
| | | | - David M Heery
- School of Pharmacy, University of Nottingham, NG7 2TQ, UK
| | - Catrin S Rutland
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Health Sciences, University of Nottingham, LE12 5RD, UK.
| | - Nigel P Mongan
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Health Sciences, University of Nottingham, LE12 5RD, UK; Department of Pharmacology, Weill Cornell Medicine, New York 10065, USA.
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Affiliation(s)
- Ieuan A Hughes
- Emeritus Professor of Paediatrics, University of Cambridge, Cambridge, UK.
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45
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Acharjee A, Prentice P, Acerini C, Smith J, Hughes IA, Ong K, Griffin JL, Dunger D, Koulman A. The translation of lipid profiles to nutritional biomarkers in the study of infant metabolism. Metabolomics 2017; 13:25. [PMID: 28190990 PMCID: PMC5272886 DOI: 10.1007/s11306-017-1166-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/12/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Links between early life exposures and later health outcomes may, in part, be due to nutritional programming in infancy. This hypothesis is supported by observed long-term benefits associated with breastfeeding, such as better cognitive development in childhood, and lower risks of obesity and high blood pressure in later life. However, the possible underlying mechanisms are expected to be complex and may be difficult to disentangle due to the lack of understanding of the metabolic processes that differentiate breastfed infants compared to those receiving just formula feed. OBJECTIVE Our aim was to investigate the relationships between infant feeding and the lipid profiles and to validate specific lipids in separate datasets so that a small set of lipids can be used as nutritional biomarkers. METHOD We utilized a direct infusion high-resolution mass spectrometry method to analyse the lipid profiles of 3.2 mm dried blood spot samples collected at age 3 months from the Cambridge Baby Growth Study (CBGS-1), which formed the discovery cohort. For validation two sample sets were profiled: Cambridge Baby Growth Study (CBGS-2) and Pregnancy Outcome Prediction Study (POPS). Lipidomic profiles were compared between infant groups who were either exclusively breastfed, exclusively formula-fed or mixed-fed at various levels. Data analysis included supervised Random Forest method with combined classification and regression mode. Selection of lipids was based on an iterative backward elimination procedure without compromising the class error in the classification mode. CONCLUSION From this study, we were able to identify and validate three lipids: PC(35:2), SM(36:2) and SM(39:1) that can be used collectively as biomarkers for infant nutrition during early development. These biomarkers can be used to determine whether young infants (3-6 months) are breast-fed or receive formula milk.
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Affiliation(s)
- Animesh Acharjee
- 0000 0004 0606 2472grid.415055.0MRC Elsie Widdowson Laboratory, Cambridge, UK
- 0000000121885934grid.5335.0Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - Philippa Prentice
- 0000000121885934grid.5335.0Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Carlo Acerini
- 0000000121885934grid.5335.0Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - James Smith
- 0000 0004 0606 2472grid.415055.0MRC Elsie Widdowson Laboratory, Cambridge, UK
- 0000 0004 1936 8403grid.9909.9School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Ieuan A. Hughes
- 0000000121885934grid.5335.0Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Ken Ong
- 0000000121885934grid.5335.0Department of Paediatrics, University of Cambridge, Cambridge, UK
- 0000000121885934grid.5335.0MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Julian L. Griffin
- 0000 0004 0606 2472grid.415055.0MRC Elsie Widdowson Laboratory, Cambridge, UK
- 0000000121885934grid.5335.0Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - David Dunger
- 0000000121885934grid.5335.0Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Albert Koulman
- 0000 0004 0606 2472grid.415055.0MRC Elsie Widdowson Laboratory, Cambridge, UK
- 0000000121885934grid.5335.0NIHR BRC Clinical Metabolomics and Lipidomics Laboratory, Level 4, Laboratory Block, Cambridge University Hospitals, University of Cambridge, Hills Road, Cambridge, CB2 0QQ UK
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Kung KTF, Spencer D, Pasterski V, Neufeld S, Glover V, O’Connor TG, Hindmarsh PC, Hughes IA, Acerini CL, Hines M. No relationship between prenatal androgen exposure and autistic traits: convergent evidence from studies of children with congenital adrenal hyperplasia and of amniotic testosterone concentrations in typically developing children. J Child Psychol Psychiatry 2016; 57:1455-1462. [PMID: 27460188 PMCID: PMC6100761 DOI: 10.1111/jcpp.12602] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND There is a marked male preponderance in autism spectrum conditions. The extreme male brain theory and the fetal androgen theory of autism suggest that elevated prenatal testosterone exposure is a key contributor to autistic traits. The current paper reports findings from two separate studies that test this hypothesis. METHODS A parent-report questionnaire, the Childhood Autism Spectrum Test (CAST), was employed to measure autistic traits in both studies. The first study examined autistic traits in young children with congenital adrenal hyperplasia (CAH), a condition causing unusually high concentrations of testosterone prenatally in girls. Eighty one children with CAH (43 girls) and 72 unaffected relatives (41 girls), aged 4-11 years, were assessed. The second study examined autistic traits in relation to amniotic testosterone in 92 typically developing children (48 girls), aged 3-5 years. RESULTS Findings from neither study supported the association between prenatal androgen (testosterone) exposure and autistic traits. Specifically, young girls with and without CAH did not differ significantly in CAST scores and amniotic testosterone concentrations were not significantly associated with CAST scores in boys, girls, or the whole sample. CONCLUSIONS These studies do not support a relationship between prenatal testosterone exposure and autistic traits. These findings augment prior research suggesting no consistent relationship between early androgen exposure and autistic traits.
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Affiliation(s)
| | | | - Vickie Pasterski
- Department of Psychology, University of Cambridge,Department of Paediatrics, University of Cambridge, UK
| | | | - Vivette Glover
- Institute of Reproductive and Developmental Biology, Imperial College London
| | - Thomas G. O’Connor
- School of Medicine and Dentistry, University of Rochester Medical Center, NY, USA
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Lu L, Koulman A, Petry CJ, Jenkins B, Matthews L, Hughes IA, Acerini CL, Ong KK, Dunger DB. An Unbiased Lipidomics Approach Identifies Early Second Trimester Lipids Predictive of Maternal Glycemic Traits and Gestational Diabetes Mellitus. Diabetes Care 2016; 39:2232-2239. [PMID: 27703025 PMCID: PMC5123716 DOI: 10.2337/dc16-0863] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 09/10/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the relationship between early second trimester serum lipidomic variation and maternal glycemic traits at 28 weeks and to identify predictive lipid biomarkers for gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS Prospective study of 817 pregnant women (discovery cohort, n = 200; validation cohort, n = 617) who provided an early second trimester serum sample and underwent an oral glucose tolerance test (OGTT) at 28 weeks. In the discovery cohort, lipids were measured using direct infusion mass spectrometry and correlated with OGTT results. Variable importance in projection (VIP) scores were used to identify candidate lipid biomarkers. Candidate biomarkers were measured in the validation cohort using liquid chromatography-mass spectrometry and tested for associations with OGTT results and GDM status. RESULTS Early second trimester lipidomic variation was associated with 1-h postload glucose levels but not with fasting plasma glucose levels. Of the 13 lipid species identified by VIP scores, 10 had nominally significant associations with postload glucose levels. In the validation cohort, 5 of these 10 lipids had significant associations with postload glucose levels that were independent of maternal age and BMI, i.e., TG(51.1), TG(48:1), PC(32:1), PCae(40:3), and PCae(40:4). All except the last were also associated with maternal GDM status. Together, these four lipid biomarkers had moderate ability to predict GDM (area under curve [AUC] = 0.71 ± 0.04, P = 4.85 × 10-7) and improved the prediction of GDM by age and BMI alone from AUC 0.69 to AUC 0.74. CONCLUSIONS Specific early second trimester lipid biomarkers can predict maternal GDM status independent of maternal age and BMI, potentially enhancing risk factor-based screening.
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Affiliation(s)
- Liangjian Lu
- Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | - Albert Koulman
- Medical Research Council Human Nutrition Research, Cambridge, U.K
| | - Clive J Petry
- Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | - Benjamin Jenkins
- Medical Research Council Human Nutrition Research, Cambridge, U.K
| | - Lee Matthews
- Medical Research Council Human Nutrition Research, Cambridge, U.K
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | - Ken K Ong
- Department of Paediatrics, University of Cambridge, Cambridge, U.K
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, U.K
| | - David B Dunger
- Department of Paediatrics, University of Cambridge, Cambridge, U.K.
- Wellcome Trust-Medical Research Council Institute of Metabolic Science, Cambridge, U.K
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Hornig NC, Ukat M, Schweikert HU, Hiort O, Werner R, Drop SLS, Cools M, Hughes IA, Audi L, Ahmed SF, Demiri J, Rodens P, Worch L, Wehner G, Kulle AE, Dunstheimer D, Müller-Roßberg E, Reinehr T, Hadidi AT, Eckstein AK, van der Horst C, Seif C, Siebert R, Ammerpohl O, Holterhus PM. Identification of an AR Mutation-Negative Class of Androgen Insensitivity by Determining Endogenous AR Activity. J Clin Endocrinol Metab 2016; 101:4468-4477. [PMID: 27583472 PMCID: PMC5095254 DOI: 10.1210/jc.2016-1990] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT Only approximately 85% of patients with a clinical diagnosis complete androgen insensitivity syndrome and less than 30% with partial androgen insensitivity syndrome can be explained by inactivating mutations in the androgen receptor (AR) gene. OBJECTIVE The objective of the study was to clarify this discrepancy by in vitro determination of AR transcriptional activity in individuals with disorders of sex development (DSD) and male controls. DESIGN Quantification of DHT-dependent transcriptional induction of the AR target gene apolipoprotein D (APOD) in cultured genital fibroblasts (GFs) (APOD assay) and next-generation sequencing of the complete coding and noncoding AR locus. SETTING The study was conducted at a university hospital endocrine research laboratory. PATIENTS GFs from 169 individuals were studied encompassing control males (n = 68), molecular defined DSD other than androgen insensitivity syndrome (AIS; n = 18), AR mutation-positive AIS (n = 37), and previously undiagnosed DSD including patients with a clinical suspicion of AIS (n = 46). INTERVENTION(S) There were no interventions. MAIN OUTCOME MEASURE(S) DHT-dependent APOD expression in cultured GF and AR mutation status in 169 individuals was measured. RESULTS The APOD assay clearly separated control individuals (healthy males and molecular defined DSD patients other than AIS) from genetically proven AIS (cutoff < 2.3-fold APOD-induction; 100% sensitivity, 93.3% specificity, P < .0001). Of 46 DSD individuals with no AR mutation, 17 (37%) fell below the cutoff, indicating disrupted androgen signaling. CONCLUSIONS AR mutation-positive AIS can be reliably identified by the APOD assay. Its combination with next-generation sequencing of the AR locus uncovered an AR mutation-negative, new class of androgen resistance, which we propose to name AIS type II. Our data support the existence of cellular components outside the AR affecting androgen signaling during sexual differentiation with high clinical relevance.
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Affiliation(s)
- N C Hornig
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - M Ukat
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - H U Schweikert
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - O Hiort
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - R Werner
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - S L S Drop
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - M Cools
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - I A Hughes
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - L Audi
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - S F Ahmed
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - J Demiri
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - P Rodens
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - L Worch
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - G Wehner
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - A E Kulle
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - D Dunstheimer
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - E Müller-Roßberg
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - T Reinehr
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - A T Hadidi
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - A K Eckstein
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - C van der Horst
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - C Seif
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - R Siebert
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - O Ammerpohl
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - P-M Holterhus
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
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Lucas-Herald A, Bertelloni S, Juul A, Bryce J, Jiang J, Rodie M, Sinnott R, Boroujerdi M, Lindhardt Johansen M, Hiort O, Holterhus PM, Cools M, Guaragna-Filho G, Guerra-Junior G, Weintrob N, Hannema S, Drop S, Guran T, Darendeliler F, Nordenstrom A, Hughes IA, Acerini C, Tadokoro-Cuccaro R, Ahmed SF. The Long-Term Outcome of Boys With Partial Androgen Insensitivity Syndrome and a Mutation in the Androgen Receptor Gene. J Clin Endocrinol Metab 2016; 101:3959-3967. [PMID: 27403927 PMCID: PMC5095251 DOI: 10.1210/jc.2016-1372] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND In boys with suspected partial androgen insensitivity syndrome (PAIS), systematic evidence that supports the long-term prognostic value of identifying a mutation in the androgen receptor gene (AR) is lacking. OBJECTIVE To assess the clinical characteristics and long-term outcomes in young men with suspected PAIS in relation to the results of AR analysis. METHODS Through the International Disorders of Sex Development Registry, clinical information was gathered on young men suspected of having PAIS (n = 52) who presented before the age of 16 years and had genetic analysis of AR. RESULTS The median ages at presentation and at the time of the study were 1 month (range, 1 day to 16 years) and 22 years (range, 16 to 52 years), respectively. Of the cohort, 29 men (56%) had 20 different AR mutations reported. At diagnosis, the median external masculinization scores were 7 and 6 in cases with and without AR mutation, respectively (P = .9), and median current external masculinization scores were 9 and 10, respectively (P = .28). Thirty-five men (67%) required at least one surgical procedure, and those with a mutation were more likely to require multiple surgeries for hypospadias (P = .004). All cases with an AR mutation had gynecomastia, compared to 9% of those without an AR mutation. Of the six men who had a mastectomy, five (83%) had an AR mutation. CONCLUSIONS Boys with genetically confirmed PAIS are likely to have a poorer clinical outcome than those with XY DSD, with normal T synthesis, and without an identifiable AR mutation. Routine genetic analysis of AR to confirm PAIS informs long-term prognosis and management.
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MESH Headings
- Adolescent
- Adult
- Aging
- Androgen-Insensitivity Syndrome/diagnosis
- Androgen-Insensitivity Syndrome/genetics
- Androgen-Insensitivity Syndrome/physiopathology
- Child
- Child, Preschool
- Cohort Studies
- Disease Progression
- Disorder of Sex Development, 46,XY/diagnosis
- Disorder of Sex Development, 46,XY/genetics
- Disorder of Sex Development, 46,XY/physiopathology
- Gynecomastia/etiology
- Gynecomastia/surgery
- Humans
- Hypospadias/etiology
- Hypospadias/surgery
- Infant
- Infant, Newborn
- International Agencies
- Male
- Mastectomy
- Middle Aged
- Mutation
- Prognosis
- Puberty, Delayed
- Receptors, Androgen/genetics
- Receptors, Androgen/metabolism
- Registries
- Retrospective Studies
- Severity of Illness Index
- Young Adult
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Affiliation(s)
- A Lucas-Herald
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - S Bertelloni
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - A Juul
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - J Bryce
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - J Jiang
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - M Rodie
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - R Sinnott
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - M Boroujerdi
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - M Lindhardt Johansen
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - O Hiort
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - P M Holterhus
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - M Cools
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - G Guaragna-Filho
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - G Guerra-Junior
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - N Weintrob
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - S Hannema
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - S Drop
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - T Guran
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - F Darendeliler
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - A Nordenstrom
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - I A Hughes
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - C Acerini
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - R Tadokoro-Cuccaro
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - S F Ahmed
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
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Petry CJ, Sanz Marcos N, Pimentel G, Hayes MG, Nodzenski M, Scholtens DM, Hughes IA, Acerini CL, Ong KK, Lowe WL, Dunger DB. Associations Between Fetal Imprinted Genes and Maternal Blood Pressure in Pregnancy. Hypertension 2016; 68:1459-1466. [PMID: 27777362 DOI: 10.1161/hypertensionaha.116.08261] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 08/19/2016] [Accepted: 09/28/2016] [Indexed: 12/31/2022]
Abstract
In addition to maternal genes and environmental exposures, variation in fetal imprinted genes could also affect maternal blood pressure during pregnancy. Our objective was to test the associations between polymorphic variants in 16 imprinted genes and maternal mean arterial blood pressures in 1160 DNA trios from 2 established birth cohorts (the Cambridge Baby Growth and Wellbeing Studies) and seek replication in 1367 Hyperglycemia and Adverse Pregnancy Outcome Study participants. Significant univariate associations, all independent of fetal sex, were observed in the Cambridge cohorts, including FAM99A rs1489945 transmitted from the mother (P=2×10-4), DLK1 rs10139403 (mother; P=9×10-4), DLK1 rs12147008 (mother; P=1×10-3), H19 rs217222 (father; P=1×10-3), SNRPN rs1453556 (father; P=1×10-3), IGF2 rs6356 (father; P=1×10-3), and NNAT rs6066671 (father; P=1×10-3). In meta-analysis including additional independent Hyperglycemia and Adverse Pregnancy Outcome Study data, the association with maternally transmitted fetal DLK1 rs10139403 reached genome-wide significance (P=6.3×10-10). With the exception of fetal rs1489945 and rs217222, all of other associations were unidirectional and most were statistically significant. To further explore the significance of these relationships, we developed an allele score based on the univariate findings. The score was strongly associated with maternal blood pressure at 31 weeks (P=4.1×10-8; adjusted r2=5.6%) and 37 weeks of pregnancy (P=1.1×10-4; r2=3.6%), and during the last 2 weeks before parturition (P=1.1×10-10; r2=8.7%). It was also associated with gestational hypertension (odds ratio, 1.54 [range, 1.14-2.09] per allele; P=0.005; 45 cases and 549 controls). These data support the concept that fetal imprinted genes are related to the development of gestational hypertension.
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Affiliation(s)
- Clive J Petry
- From the Department of Paediatrics (C.J.P., N.S.M., G.P., I.A.H., C.L.A., K.K.O., D.B.D.), Medical Research Council Epidemiology Unit (K.K.O.), and Institute of Metabolic Science (D.B.D.), University of Cambridge, United Kingdom; Hospital Sant Joan de Déu, Servicio de Pediatría, Barcelona, Spain (N.S.M.); Divisão de Endocrinologia Pediátrica, Departamento de Pediatria, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (G.P.); and Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine (M.G.H., W.L.L.) and Division of Biostatistics, Department of Preventive Medicine (M.N., D.M.S.), Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Nuria Sanz Marcos
- From the Department of Paediatrics (C.J.P., N.S.M., G.P., I.A.H., C.L.A., K.K.O., D.B.D.), Medical Research Council Epidemiology Unit (K.K.O.), and Institute of Metabolic Science (D.B.D.), University of Cambridge, United Kingdom; Hospital Sant Joan de Déu, Servicio de Pediatría, Barcelona, Spain (N.S.M.); Divisão de Endocrinologia Pediátrica, Departamento de Pediatria, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (G.P.); and Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine (M.G.H., W.L.L.) and Division of Biostatistics, Department of Preventive Medicine (M.N., D.M.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Gracielle Pimentel
- From the Department of Paediatrics (C.J.P., N.S.M., G.P., I.A.H., C.L.A., K.K.O., D.B.D.), Medical Research Council Epidemiology Unit (K.K.O.), and Institute of Metabolic Science (D.B.D.), University of Cambridge, United Kingdom; Hospital Sant Joan de Déu, Servicio de Pediatría, Barcelona, Spain (N.S.M.); Divisão de Endocrinologia Pediátrica, Departamento de Pediatria, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (G.P.); and Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine (M.G.H., W.L.L.) and Division of Biostatistics, Department of Preventive Medicine (M.N., D.M.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - M Geoffrey Hayes
- From the Department of Paediatrics (C.J.P., N.S.M., G.P., I.A.H., C.L.A., K.K.O., D.B.D.), Medical Research Council Epidemiology Unit (K.K.O.), and Institute of Metabolic Science (D.B.D.), University of Cambridge, United Kingdom; Hospital Sant Joan de Déu, Servicio de Pediatría, Barcelona, Spain (N.S.M.); Divisão de Endocrinologia Pediátrica, Departamento de Pediatria, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (G.P.); and Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine (M.G.H., W.L.L.) and Division of Biostatistics, Department of Preventive Medicine (M.N., D.M.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael Nodzenski
- From the Department of Paediatrics (C.J.P., N.S.M., G.P., I.A.H., C.L.A., K.K.O., D.B.D.), Medical Research Council Epidemiology Unit (K.K.O.), and Institute of Metabolic Science (D.B.D.), University of Cambridge, United Kingdom; Hospital Sant Joan de Déu, Servicio de Pediatría, Barcelona, Spain (N.S.M.); Divisão de Endocrinologia Pediátrica, Departamento de Pediatria, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (G.P.); and Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine (M.G.H., W.L.L.) and Division of Biostatistics, Department of Preventive Medicine (M.N., D.M.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Denise M Scholtens
- From the Department of Paediatrics (C.J.P., N.S.M., G.P., I.A.H., C.L.A., K.K.O., D.B.D.), Medical Research Council Epidemiology Unit (K.K.O.), and Institute of Metabolic Science (D.B.D.), University of Cambridge, United Kingdom; Hospital Sant Joan de Déu, Servicio de Pediatría, Barcelona, Spain (N.S.M.); Divisão de Endocrinologia Pediátrica, Departamento de Pediatria, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (G.P.); and Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine (M.G.H., W.L.L.) and Division of Biostatistics, Department of Preventive Medicine (M.N., D.M.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ieuan A Hughes
- From the Department of Paediatrics (C.J.P., N.S.M., G.P., I.A.H., C.L.A., K.K.O., D.B.D.), Medical Research Council Epidemiology Unit (K.K.O.), and Institute of Metabolic Science (D.B.D.), University of Cambridge, United Kingdom; Hospital Sant Joan de Déu, Servicio de Pediatría, Barcelona, Spain (N.S.M.); Divisão de Endocrinologia Pediátrica, Departamento de Pediatria, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (G.P.); and Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine (M.G.H., W.L.L.) and Division of Biostatistics, Department of Preventive Medicine (M.N., D.M.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Carlo L Acerini
- From the Department of Paediatrics (C.J.P., N.S.M., G.P., I.A.H., C.L.A., K.K.O., D.B.D.), Medical Research Council Epidemiology Unit (K.K.O.), and Institute of Metabolic Science (D.B.D.), University of Cambridge, United Kingdom; Hospital Sant Joan de Déu, Servicio de Pediatría, Barcelona, Spain (N.S.M.); Divisão de Endocrinologia Pediátrica, Departamento de Pediatria, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (G.P.); and Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine (M.G.H., W.L.L.) and Division of Biostatistics, Department of Preventive Medicine (M.N., D.M.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ken K Ong
- From the Department of Paediatrics (C.J.P., N.S.M., G.P., I.A.H., C.L.A., K.K.O., D.B.D.), Medical Research Council Epidemiology Unit (K.K.O.), and Institute of Metabolic Science (D.B.D.), University of Cambridge, United Kingdom; Hospital Sant Joan de Déu, Servicio de Pediatría, Barcelona, Spain (N.S.M.); Divisão de Endocrinologia Pediátrica, Departamento de Pediatria, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (G.P.); and Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine (M.G.H., W.L.L.) and Division of Biostatistics, Department of Preventive Medicine (M.N., D.M.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - William L Lowe
- From the Department of Paediatrics (C.J.P., N.S.M., G.P., I.A.H., C.L.A., K.K.O., D.B.D.), Medical Research Council Epidemiology Unit (K.K.O.), and Institute of Metabolic Science (D.B.D.), University of Cambridge, United Kingdom; Hospital Sant Joan de Déu, Servicio de Pediatría, Barcelona, Spain (N.S.M.); Divisão de Endocrinologia Pediátrica, Departamento de Pediatria, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (G.P.); and Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine (M.G.H., W.L.L.) and Division of Biostatistics, Department of Preventive Medicine (M.N., D.M.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David B Dunger
- From the Department of Paediatrics (C.J.P., N.S.M., G.P., I.A.H., C.L.A., K.K.O., D.B.D.), Medical Research Council Epidemiology Unit (K.K.O.), and Institute of Metabolic Science (D.B.D.), University of Cambridge, United Kingdom; Hospital Sant Joan de Déu, Servicio de Pediatría, Barcelona, Spain (N.S.M.); Divisão de Endocrinologia Pediátrica, Departamento de Pediatria, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (G.P.); and Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine (M.G.H., W.L.L.) and Division of Biostatistics, Department of Preventive Medicine (M.N., D.M.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
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