1
|
Ulziikhuu B, Gombojav E, Banzrai C, Batsukh S, Enkhtuya E, Boldbaatar B, Bellinger DC, Lanphear BP, McCandless LC, Nepomnaschy P, Salvante K, Weinberg J, Allen RW. Who benefits most from a prenatal HEPA filter air cleaner intervention on childhood cognitive development? The UGAAR randomized controlled trial. Environ Res 2023; 231:115991. [PMID: 37121346 DOI: 10.1016/j.envres.2023.115991] [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] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/05/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Air pollution exposure during pregnancy affects children's brain function. Maternal stress and nutrition, socioeconomic status, and the child's sex may modify this relationship. OBJECTIVE To identify characteristics of children with the largest increases in full-scale IQ (FSIQ) after their mothers used HEPA filter air cleaners during pregnancy. METHODS In this randomized controlled trial we randomly assigned women to receive 1-2 air cleaners or no air cleaners during pregnancy. We analyzed maternal hair samples for cortisol and dehydroepiandrosterone (DHEA). When the children were 48 months old, we measured FSIQ with the Wechsler Preschool and Primary Scale of Intelligence. We evaluated ten potential modifiers of the intervention-FSIQ relationship using interaction terms in separate regression models. To account for correlations between modifiers, we also used a single regression model containing main effects and intervention x modifier terms for all potential modifiers. RESULTS Among 242 mother-child dyads with complete data, the intervention was associated with a 2.3-point increase (95% CI: -1.5, 6.0 points) in mean FSIQ. The intervention improved mean FSIQ among children of mothers in the bottom (5.4 points; 95% CI: -0.8, 11.5) and top (6.1 points; 95% CI: 0.5, 11.8) cortisol tertiles, but not among those whose mothers were in the middle tertile. The largest between-group difference in the intervention's effect was a 7.5-point (95% CI: -0.7, 15.7) larger increase in mean FSIQ among children whose mothers did not take vitamins than among children whose mothers did take vitamins (interaction p-value = 0.07). We also observed larger benefits among children whose mothers did not complete university, and those with lower hair DHEA concentrations, hair cortisol concentrations outside the middle tertile, or more perceived stress. CONCLUSION The benefits of reducing air pollution during pregnancy on brain development may be greatest for children whose mothers who do not take vitamins, experience more stress, or have less education.
Collapse
Affiliation(s)
| | | | | | - Sarangerel Batsukh
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Enkhtuul Enkhtuya
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | | | | | | | | | - Joanne Weinberg
- University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada
| | | |
Collapse
|
2
|
Abstract
We provide the first analysis and synthesis of the evolutionary and mechanistic bases for risk of endometriosis in humans, structured around Niko Tinbergen's four questions about phenotypes: phylogenetic history, development, mechanism and adaptive significance. Endometriosis, which is characterized by the proliferation of endometrial tissue outside of the uterus, has its phylogenetic roots in the evolution of three causally linked traits: (1) highly invasive placentation, (2) spontaneous rather than implantation-driven endometrial decidualization and (3) frequent extensive estrogen-driven endometrial proliferation and inflammation, followed by heavy menstrual bleeding. Endometriosis is potentiated by these traits and appears to be driven, proximately, by relatively low levels of prenatal and postnatal testosterone. Testosterone affects the developing hypothalamic-pituitary-ovarian (HPO) axis, and at low levels, it can result in an altered trajectory of reproductive and physiological phenotypes that in extreme cases can mediate the symptoms of endometriosis. Polycystic ovary syndrome, by contrast, is known from previous work to be caused primarily by high prenatal and postnatal testosterone, and it demonstrates a set of phenotypes opposite to those found in endometriosis. The hypothesis that endometriosis risk is driven by low prenatal testosterone, and involves extreme expression of some reproductive phenotypes, is supported by a suite of evidence from genetics, development, endocrinology, morphology and life history. The hypothesis also provides insights into why these two diametric, fitness-reducing disorders are maintained at such high frequencies in human populations. Finally, the hypotheses described and evaluated here lead to numerous testable predictions and have direct implications for the treatment and study of endometriosis. Lay summary: Endometriosis is caused by endometrial tissue outside of the uterus. We explain why and how humans are vulnerable to this disease, and new perspectives on understanding and treating it. Endometriosis shows evidence of being caused in part by relatively low testosterone during fetal development, that 'programs' female reproductive development. By contrast, polycystic ovary syndrome is associated with relatively high testosterone in prenatal development. These two disorders can thus be seen as 'opposite' to one another in their major causes and correlates. Important new insights regarding diagnosis, study and treatment of endometriosis follow from these considerations.
Collapse
Affiliation(s)
- Natalie Dinsdale
- Department of Biological Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Pablo Nepomnaschy
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Bernard Crespi
- Department of Biological Sciences, Simon Fraser University, Burnaby, BC, Canada
| |
Collapse
|
3
|
Kumaran K, Krishnaveni GV, Suryanarayana KG, Prasad MP, Belavendra A, Atkinson S, Balasubramaniam R, Bandsma RHJ, Bhutta ZA, Chandak GR, Comelli EM, Davidge ST, Dennis CL, Hammond GL, Jha P, Joseph KS, Joshi SR, Krishna M, Lee K, Lye S, McGowan P, Nepomnaschy P, Padvetnaya V, Pyne S, Sachdev HS, Sahariah SA, Singhal N, Trasler J, Yajnik CS, Baird J, Barker M, Martin MC, Husain N, Sellen D, Fall CHD, Shah PS, Matthews SG. Protocol for a cluster randomised trial evaluating a multifaceted intervention starting preconceptionally-Early Interventions to Support Trajectories for Healthy Life in India (EINSTEIN): a Healthy Life Trajectories Initiative (HeLTI) Study. BMJ Open 2021; 11:e045862. [PMID: 33593789 PMCID: PMC7888364 DOI: 10.1136/bmjopen-2020-045862] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The Healthy Life Trajectories Initiative is an international consortium comprising four harmonised but independently powered trials to evaluate whether an integrated intervention starting preconceptionally will reduce non-communicable disease risk in their children. This paper describes the protocol of the India study. METHODS AND ANALYSIS The study set in rural Mysore will recruit ~6000 married women over the age of 18 years. The village-based cluster randomised design has three arms (preconception, pregnancy and control; 35 villages per arm). The longitudinal multifaceted intervention package will be delivered by community health workers and comprise: (1) measures to optimise nutrition; (2) a group parenting programme integrated with cognitive-behavioral therapy; (3) a lifestyle behaviour change intervention to support women to achieve a diverse diet, exclusive breast feeding for the first 6 months, timely introduction of diverse and nutritious infant weaning foods, and adopt appropriate hygiene measures; and (4) the reduction of environmental pollution focusing on indoor air pollution and toxin avoidance.The primary outcome is adiposity in children at age 5 years, measured by fat mass index. We will report on a host of intermediate and process outcomes. We will collect a range of biospecimens including blood, urine, stool and saliva from the mothers, as well as umbilical cord blood, placenta and specimens from the offspring.An intention-to-treat analysis will be adopted to assess the effect of interventions on outcomes. We will also undertake process and economic evaluations to determine scalability and public health translation. ETHICS AND DISSEMINATION The study has been approved by the institutional ethics committee of the lead institute. Findings will be published in peer-reviewed journals. We will interact with policy makers at local, national and international agencies to enable translation. We will also share the findings with the participants and local community through community meetings, newsletters and local radio. TRIAL REGISTRATION NUMBER ISRCTN20161479, CTRI/2020/12/030134; Pre-results.
Collapse
Affiliation(s)
- Kalyanaraman Kumaran
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, Karnataka, India
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | - Kumar Gavali Suryanarayana
- Department of Academics and Research, Vivekananda Memorial Hospital, Saragur, Karnataka, India
- Development Support, Swami Vivekananda Youth Movement, Mysore, India
| | - Manohar Prabhu Prasad
- Department of Academics and Research, Vivekananda Memorial Hospital, Saragur, Karnataka, India
| | | | - Stephanie Atkinson
- Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Robert H J Bandsma
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics and Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences and Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Giriraj Ratan Chandak
- Genomic Research on Complex Diseases, CSIR - Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
| | - Elena M Comelli
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, Toronto, Ontario, Canada
| | - Sandra T Davidge
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Geoffrey L Hammond
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Prabhat Jha
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - K S Joseph
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sadhana R Joshi
- Nutritional Medicine Division, Interactive Research School for Health Affairs, Bharati Vidyapeeth, Pune, India
| | - Murali Krishna
- Foundation for Research and Advocacy in Mental Health (FRAMe), Mysore, India
| | - Kang Lee
- Department of Applied Psychology and Human Development, OISE/University of Toronto, Toronto, Ontario, Canada
| | - Stephen Lye
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Departments of Obstetrics & Gynecology, Physiology, and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Patrick McGowan
- Department of Biological Sciences, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Pablo Nepomnaschy
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Vivek Padvetnaya
- Jindal School of Government and Public Policy, O.P. Jindal Global University, Sonipat, Haryana, India
| | - Saumyadipta Pyne
- Public Health Dynamics Lab and Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Health Analytics Network, Pennsylvania, Harrisburg, USA
| | - Harshpal Singh Sachdev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Sirazul Ameen Sahariah
- Reproductive Maternal Newborn Child and Adolescent Health and Nutrition, MAMTA Health Institute for Mother and Child, New Delhi, Delhi, India
| | - Nalini Singhal
- Department of Paediatrics, University of Calgary, Calgary, Mull, Canada
| | - Jacquetta Trasler
- Departments of Pediatrics, Human Genetics, and Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Janis Baird
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, Southampton, UK
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, Southampton, UK
| | - Marie-Claude Martin
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Daniel Sellen
- Joannah and Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Anthropology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Prakesh S Shah
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Paediatrics and Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Stephen G Matthews
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Departments of Obstetrics & Gynecology, Physiology, and Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Hoi AG, Daiy K, Altman RM, Venners S, Valeggia C, Nepomnaschy P. Postpartum amenorrhea duration by sex of the newborn in two natural fertility populations. Am J Phys Anthropol 2020; 174:661-669. [PMID: 33314035 DOI: 10.1002/ajpa.24193] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/30/2020] [Accepted: 11/21/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Postpartum amenorrhea (PA) affects the length of interbirth intervals and thus is intimately related to human life history strategies. PA duration appears to be influenced by maternal energetic status. In humans, as in other mammals, sons are costlier than daughters. Thus, we hypothesize that, in energetically constrained environments, a newborn's sex should be associated with PA duration. METHODS We analyzed data from two natural fertility populations in which mothers have differing energy budgets: Qom women (n = 121) from a periurban village in Argentina, who have a comparatively calorically dense diet and are sedentary (prepregnancy mean BMI = 24.8 ± 4.5 kg/m2 in 1997), and agropastoral Kaqchikel Maya women (n = 88), who have a comparatively calorically restricted diet and high physical activity levels (mean BMI = 21.8 ± 3.7 kg/m2 ). We predict that (a) mothers of sons exhibit longer PA duration than mothers of daughters and (b) this association between offspring sex and PA duration is stronger in the Maya, who have smaller energy budgets. RESULTS Maya mothers with sons exhibited estimated mean and median PA durations that were 1.34 times the estimated mean and median PA duration of mothers with daughters (p = 0.02). Among the Qom, mean, and median PA duration did not differ significantly in relation to offspring sex (p = 0.94). CONCLUSIONS Maya mothers with sons exhibited longer PA duration than those with daughters. This phenomenon was not observed in the well-nourished Qom, possibly due to "buffering" effects from larger energy budgets. Offspring sex may influence birth spacing and maternal life history strategies in energetically constrained environments.
Collapse
Affiliation(s)
- Amber Gigi Hoi
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Katherine Daiy
- Department of Anthropology, Yale University, New Haven, Connecticut, USA
| | - Rachel MacKay Altman
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Scott Venners
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Claudia Valeggia
- Department of Anthropology, Yale University, New Haven, Connecticut, USA
| | - Pablo Nepomnaschy
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| |
Collapse
|
5
|
McKerracher L, Collard M, Altman R, Richards M, Nepomnaschy P. The ex-pat effect: presence of recent Western immigrants is associated with changes in age at first birth and birth rate in a Maya population from rural Guatemala. Ann Hum Biol 2017. [PMID: 28625087 DOI: 10.1080/03014460.2017.1343385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Economic transitions expose indigenous populations to a variety of ecological and cultural challenges, especially regarding diet and stress. These kinds of challenges are predicted by evolutionary ecological theory to have fitness consequences (differential reproduction) and, indeed, are often associated with changes in fertility dynamics. It is currently unclear whether international immigration might impact the nature of such an economic transition or its consequences for fertility. AIM To examine measures of fertility, diet and stress in two economically transitioning Maya villages in Guatemala that have been differentially exposed to immigration by Westerners. SUBJECTS AND METHODS This study compared Maya women's ages at first birth and birth rates between villages and investigated whether these fertility indicators changed through time. It also explored whether the villages differed in relation to diet and/or a proxy of stress. RESULTS It was found that, in the village directly impacted by immigration, first births occurred earlier, but birth rate was slower. In both villages, over the sampled time window, age at first birth increased, while birth rate decreased. The villages do not differ significantly in dietary indicators, but the immigration-affected village scored higher on the stress proxy. CONCLUSION Immigration can affect fertility in host communities. This relationship between immigration and fertility dynamics may be partly attributable to stress, but this possibility should be evaluated prospectively in future research.
Collapse
Affiliation(s)
| | - Mark Collard
- a Department of Archaeology , Simon Fraser University , Burnaby , BC , Canada.,b Department of Archaeology , University of Aberdeen, King's College , Aberdeen , Scotland
| | - Rachel Altman
- c Department of Statistics and Actuarial Science , Simon Fraser University , Burnaby , BC , Canada
| | - Michael Richards
- a Department of Archaeology , Simon Fraser University , Burnaby , BC , Canada
| | - Pablo Nepomnaschy
- d Faculty of Health Sciences , Simon Fraser University , Burnaby , BC , Canada
| |
Collapse
|