P–617 Idiopathic early ovarian aging: Do biomarkers of ageing indicate premenopausal accelerated biological ageing in young women with diminished response to ART?

Study question

Do young women with idiopathic early ovarian ageing have changes in telomere length and epigenetic age indicating accelerated biological aging?

Summary answer

The telomere length and epigenetic age were comparable to those in young women with normal ovarian ageing.

What is known already

Increased risk of several health events usually considered to be age-related such as cardiovascular disease, osteoporosis, over-all morbidity and mortality have been associated with premature and early menopause when compared to the risk in women with normal menopausal age suggesting an accelerated general ageing process associated to early ovarian ageing. It is unclear whether the onset of this process may start before menopause.

Study design, size, duration

A prospective cohort study. Young women (≤ 37 years) having ART at two Danish Public fertility clinics during the period 2016 to 2018 were divided into two groups dependent on their ovarian reserve status: early ovarian ageing (EOA) (N = 55) and normal ovarian ageing (NOA)( N = 52). Number of oocytes harvested in first and subsequent cycles was used as a marker of ovarian reserve. Blood samples was drawn at time of oocyte retrieval to assess biological age.

Participants/materials, setting, methods

EOA was defined as ≥ 2 IVF cycles with ≤ 5 harvested oocytes despite sufficient stimulation with FSH and NOA as ≥ 8 oocytes harvested in minimum 1 cycle. Known causes influencing the ovarian reserve (endometriosis, ovarian surgery, etc.) was reason for exclusion. Relative telomere length (qPCR) and epigenetic age acceleration (DNA methylation levels) were measured in white blood cells as markers of accelerated biological ageing.

Main results and the role of chance

Relative telomere length was comparable with a mean of 0.46 (± sd 0.12) in the EOA group and 0.47 (0.14) in the normal ovarian ageing group (p = 0.64). The difference of predicted mean epigenetic age and mean chronological age (i.e. epigenetic age acceleration) was, insignificantly, 0.5 years older in the EOA group when compared to the NOA group( (–1.02 years (2.62) and –1.57 years (2.56), respectively, p = 0.27)), but this difference disappeared when adjusting for chronological age.

Limitations, reasons for caution

Discrete changes in epigenetic age acceleration may not have been captured as the study only had power to detect an age acceleration of ≥ 2 years.

Wider implications of the findings: By analysis of biomarkers for ageing in whole blood, we did not find any indications of a premenopausal accelerated aging in young women with idiopathic EOA. Further investigations in a similar cohort of premenopausal women is needed to fully elucidate the potential relationship between premenopausal accelerated biological ageing and EOA.

Trial registration number

The study was approved by the Danish Data protection Agency (nr 1–16–02–320–14) and the Regional committee on health research ethics of Central Region Denmark (jr.no 1–10–72–142–14).

Efficacy of metformin in obese and non-obese women with polycystic ovary syndrome: a randomized, double-blinded, placebo-controlled cross-over trial

BACKGROUND

Our aim was to assess the effects of metformin on menstrual frequency, fasting plasma glucose (FPG), insulin resistance assessed as HOMA-index, weight, waist/hip ratio, blood pressure (BP), serum lipids, and testosterone levels in women with polycystic ovary syndrome (PCOS) METHODS: In a randomized, controlled, double-blinded setup, 56 women aged 18-45 with PCOS were treated with either metformin 850 mg or placebo twice daily for 6 months. After a wash-out period of 3 months participants received the alternate treatment for 6 months. The changes in the measured parameters were analysed by intention-to-treat and per protocol.

RESULTS

There were no changes in menstrual frequency. In the intention-to-treat analysis, weight and systolic BP were reduced on metformin treatment (p=0.009 and 0.047, respectively), while high-density lipoprotein (HDL) increased (p=0.001). On placebo, weight and FPG increased (p<0.05). Post-hoc subgrouping according to BMI revealed reductions in testosterone (p=0.013), FPG (p=0.018), insulin (p=0.045) and HOMA-index (p=0.022) in obese women. Per protocol analysis showed the following differences between the changes on placebo and metformin (mean (5 - 95 % percentiles): weight (-4.2 (-7.0, -1.9) kg, p<0.001), FPG (-0.23 (-0.44, -0.01) mmol/l, p=0.041), insulin (-4.17 (-8.10, -0.23) mIU/l, p=0.039) and HOMA index (-1.50 (-2.53, -0.47) mIU/l*mmol/l, p=0.006). Weight, FPG and HOMA index were lower after metformin than after placebo.

CONCLUSIONS

Metformin treatment lowered weight and systolic blood pressure and increased HDL in women with PCOS. In post-hoc analysis it increased insulin sensitivity and lowered testosterone in obese women. Non-obese women did not benefit from metformin.

Binge drinking in pregnancy--frequency and methodology

Independent of average alcohol intake, the effect of binge drinking on adverse pregnancy outcomes in humans is only sporadically reported, but most studies in humans have found little or no effect of binge drinking on several adverse pregnancy outcomes. In a representative sample of 371 pregnant Danish women, the agreement between two different measures of binge drinking during the first half of pregnancy obtained from interviews and questionnaires was assessed, and the frequency and pattern of binge drinking were described. The percentage of agreement between the methods ranged between 81% and 86%. The proportion of women who reported binge drinking depended on the definition of pregnancy, but the proportion peaked in week 3 measured from the last menstrual period and thereafter declined to approximately 1 percent in week 7. On the basis of this 1998 study, it is suggested that most human studies on binge drinking in pregnancy may have failed to find any association because of methodological problems. It is suggested that future studies should take into account the number of binge episodes as well as the time of binge drinking. This information may easily be obtained from most pregnant women by asking two questions in interviews or questionnaires.

Self reported alcohol intake in pregnancy: comparison between four methods

STUDY OBJECTIVE

To assess the agreement between four different measures of alcohol intake in pregnancy.

DESIGN AND SETTING

Danish speaking pregnant women referred to the Midwife Centre in Aarhus, Denmark, for routine antenatal care were contacted at their first visit at approximately 15-16 weeks gestation from October to December 1998. The women were interviewed about current average alcohol intake and intake within the previous week, and subsequently filled in a two week diary on alcohol intake. When booking for delivery at the end of the first trimester the women were also asked to complete a questionnaire including a one item question on current average alcohol intake.

PARTICIPANTS

Participants were 441 pregnant women.

MAIN RESULTS

Per cent agreement +/- 1 category ranged between 73 and 82. Mean (SD) intake ranged between 1.09 (1.35) drinks/week for diaries, and 0.69 (0.85) for questionnaires. Mean differences between methods were all close to zero. Three of the four measures yielded comparable distributions of average alcohol intake, but reports of intake within the past seven days seemed to be an inappropriate measure of average intake, yielding three times as many abstainers as expected when combining the methods.

CONCLUSIONS

When assessing the distribution of alcohol intake in pregnancy or when studying adverse pregnancy outcomes that are probably caused mainly by sustained exposure it seems that for pregnant women with low to moderate alcohol intake diaries or an average measure from interviews or a simple one item questionnaire may be applied. A measure of intake for the previous week seems to be a relevant measure only when studying adverse pregnancy outcomes that are most probably caused by binge-like exposure.

An increasing proportion of infants weigh more than 4000 grams at birth

BACKGROUND

To investigate how mean birthweight has changed in the past decade, and to describe changes in the proportion of infants with a birthweight above 4000 grams (g).

METHODS

We analyzed data on 43,561 singleton infants born between 1990 and 1999 at Aarhus University Hospital, Denmark. Information on birthweight, gestational age, stillbirths, malformations, mode of delivery, prelabor intervention, and maternal diabetes was obtained from birth registration forms.

RESULTS

For all infants mean birthweight increased by 45 g (95% CI: 20-70 g) from 3474 g in 1990 to 3519 g in 1999. For infants born at term the mean increase was 62 g (95% CI: 41-83 g). During the same period the percentage of infants born with a birthweight above 4000 g increased from 16.7% in 1990 to 20.0% in 1999 (p<0.05). Simultaneously we found a decrease in gestational age and an increase in the frequency of induction of labor. There was a statistically significantly higher risk of giving birth to an infant with a birthweight above 4000 g throughout the decade, when gestational age and prelabor intervention was taken into account.

CONCLUSIONS

In Denmark mean birthweight has risen during the past decade independently of gestational age and prelabor intervention. Simultaneously the risk of having a baby with a birthweight above 4000 g has increased. Further studies on potential risk factors for birth of large infants are needed.

[Does alcohol increase the risk of preterm delivery?]

INTRODUCTION

The aim was to assess the association between alcohol intake during pregnancy and preterm delivery.

MATERIALS AND METHODS

Women attending routine antenatal care at Aarhus University Hospital, Denmark, from 1989-1991 and 1992-1996 were eligible for the study. Our analyses included 18,228 singleton pregnancies. We obtained prospective information on alcohol intake at about 16 and 30 weeks of gestation, other lifestyle factors, maternal characteristics, and obstetrical risk factors from questionnaires completed by the women and hospital files.

RESULTS

For women with an alcohol intake of 1-2, 3-4, 5-9, and > or = 10 drinks/week, the risk ratio (RR) of preterm delivery was 0.91 (95% CI: 0.76-1.08), 0.86 (0.64-1.15), 0.89 (0.52-1.52), and 2.93 (1.52-5.63) respectively, compared with an intake of < 1 drink/week at about 16 weeks of gestation, and 0.69 (0.56-0.86), 0.82 (0.60-1.13), 0.97 (0.58-1.64), and 3.56 (1.78-7.13) at about 30 weeks. Adjustment for smoking habits, caffeine intake, age, height, prepregnant weight, marital status, occupational status, education, parity, chronic diseases, previous preterm delivery, mode of initiation of labour, and sex of the child did not alter the conclusions, nor did restriction of the highest intake group to women drinking 10-14 drinks/week (RR = 3.41 (1.71-6.81) at 16 weeks and RR = 3.47 (1.64-7.35) at 30 weeks).

DISCUSSION

The association between alcohol intake and preterm delivery appeared to be J-shaped, with a threshold for adverse effect at a level of about 10-14 drinks/week.

Exposure to tobacco smoke in utero and the risk of stillbirth and death in the first year of life

The authors examined the association between exposure to tobacco smoke in utero and the risk of stillbirth and infant death in a cohort of 25,102 singleton children of pregnant women scheduled to deliver at Aarhus University Hospital, Aarhus, Denmark, from September 1989 to August 1996. Exposure to tobacco smoke in utero was associated with an increased risk of stillbirth (odds ratio = 2.0, 95% confidence interval: 1.4, 2.9), and infant mortality was almost doubled in children born to women who had smoked during pregnancy compared with children of nonsmokers (odds ratio = 1.8, 95% confidence interval: 1.3, 2.6). Among children of women who stopped smoking during the first trimester, stillbirth and infant mortality was comparable with that in children of women who had been nonsmokers from the beginning of pregnancy. Conclusions were not changed after adjustment in a logistic regression model for the sex of the child; parity; or maternal age, height, weight, marital status, years of education, occupational status, and alcohol and caffeine intake during pregnancy. Approximately 25% of all stillbirths and 20% of all infant deaths in a population with 30% pregnant smokers could be avoided if all pregnant smokers stopped smoking by the sixteenth week of gestation.

A randomized study comparing IVF in the unstimulated cycle with IVF following clomiphene citrate

The efficiency of IVF in unstimulated cycles was compared with that following ovarian stimulation with clomiphene citrate in a simple protocol with ultrasound monitoring only. A total of 132 couples with no previous IVF attempts, selected by female age <35 years, indication for intracytoplasmic sperm injection or infertility caused by tubal factor or unexplained infertility were randomized to the two protocols. Randomization yielded two comparable groups. The clomiphene group (68 couples) performed significantly better than the unstimulated group (64 couples) in terms of number of cycles with oocyte harvest (90/111 or 81% versus 65/114 or 57%; chi(2) = 9.21, P < 0.002), embryo transfers per started cycle (59/111 or 53% versus 29/114 or 25%; chi(2) = 18.14, P < 0.0001), live intrauterine pregnancy rate per started cycle (20/111 or 18% versus 4/114 or 4%; chi(2) = 12.42, P < 0.0001), live intrauterine pregnancy rate per embryo transfer (20/59 or 34% versus 4/29 or 14%; chi(2) = 3.96, P = 0.047), but not in terms of implantation rate (22/85 or 26% versus 4/29 or 14%; chi(2) = 1.65). Only two twin pregnancies occurred. Modest side-effects were recorded following clomiphene. Accordingly, a simple clomiphene citrate protocol, but not IVF in unstimulated cycles, seems compatible with the concept of 'friendly IVF', yielding a fair pregnancy rate both per cycle started and per embryo transfer in selected patients. The results do not substantiate any important negative anti-oestrogenic effects of clomiphene.

A prospective study of smoking during pregnancy and SIDS

AIMS

To study the association between smoking during pregnancy and sudden infant death syndrome (SIDS) using prospectively collected data, making it possible to account for a number of potential confounders.

DESIGN

Prospective follow up study (n = 24 986).

RESULTS

The overall rate of SIDS was 0.80 per 1000 live births (n = 20). Children of smokers had more than three times the risk of SIDS compared with children of non-smokers (OR = 3.5; 95% CI 1.4-8.7), and the risk of SIDS increased with the number of cigarettes smoked per day (p < 0.05). Adjustment for parity, alcohol, and caffeine intake during pregnancy, maternal height and weight before pregnancy, years of school, occupational status, marital status, and number of antenatal care visits did not change the results. Adjustment for mother's age marginally reduced the risk of SIDS associated with smoking (OR = 3.0; 95% CI 1.2-7.3).

CONCLUSIONS

Given the prospective nature of the study, the number of deaths is small; however, if our results reflect a true association between smoking during pregnancy and SIDS, approximately 30-40% of all cases of SIDS could be avoided if all pregnant women stopped smoking in a population with 30% pregnant smokers. Our study adds to earlier evidence for an association between smoking during pregnancy and SIDS. The strengths of the study are the possibility to adjust for a number of potential confounders and the fact that information about smoking habits during pregnancy was prospectively collected.

Does alcohol increase the risk of preterm delivery?

We evaluated the association between alcohol intake during pregnancy and preterm delivery. Women attending routine antenatal care at Aarhus University Hospital, Denmark, from 1989-1991 and 1992-1996 were eligible. We included 18,228 singleton pregnancies in the analyses. We obtained prospective information on alcohol intake at 16 and 30 weeks of gestation, other lifestyle factors, maternal characteristics, and obstetrical risk factors from self-administered questionnaires and hospital files. For women with alcohol intake of 1-2, 3-4, 5-9, and > or =10 drinks/week the risk ratio (RR) of preterm delivery was 0.91 (95% CI = 0.76-1.08), 0.86 (95% CI = 0.64-1.15), 0.89 (95% CI = 0.52-1.52), and 2.93 (95% CI = 1.52-5.63), respectively, compared with intake of <1 drink/week at 16 weeks gestation, and 0.69 (95% CI = 0.56-0.86), 0.82 (95% CI = 0.60-1.13), 0.97 (95% CI = 0.58-1.64), and 3.56 (95% CI = 1.78-7.13) at 30 weeks. Adjustment for smoking habits, caffeine intake, age, height, pre-pregnant weight, marital status, occupational status, education, parity, chronic diseases, previous preterm delivery, mode of initiation of labor, and sex of the child did not change the conclusions, nor did restriction of the highest intake group to women drinking 10-14 drinks/week (RR = 3.41 (1.71-6.81) at 16 weeks and RR = 3.47 (1.64-7.35) at 30 weeks).

[Alcohol and pregnancy]

For a number of years the Danish National Board of Health has recommended that pregnant women should avoid alcohol during pregnancy. In recent years it has consistently been shown that one drink/day or more increases the risk of spontaneous abortion, intrauterine growth retardation and low birth weight. Increasing intake may reduce birth length and head circumference, cause preterm birth, reduced Apgar score at one and five minutes, stillbirth and malformations as well as long term effects such as reduced IQ, learning disabilities, hyperactivity, cognitive, behavioural and psychosocial problems, and in the most severe cases foetal alcohol syndrome. It is recommended that in the future pregnant women are given the following information: If you drink, drink no more than one drink per day; do not drink every day. The National Board of Health adds the following recommendation: Avoid alcohol in pregnancy if possible. Interactions between alcohol and drugs are poorly studied in pregnancy, and the recommendations do probably not apply when taking drugs that interfere with alcohol metabolism.

Smoking habits among pregnant Danish women: reliability of information recorded after delivery

STUDY OBJECTIVE

To compare recall of smoking habits during pregnancy 0.5-3 years after delivery across groups defined by recall time (5 six month periods) and pregnancy outcome (pre-eclampsia, pregnancy induced hypertension, intrauterine growth retardation, preterm or post-term delivery compared with controls).

DESIGN

Case-control nested in cohort study.

SETTING AND PARTICIPANTS

A subsample of 503 women from a cohort of 6347 women established between 1989 and 1991 in Aarhus University Hospital.

MAIN RESULTS

Measures of agreement between concurrent and retrospective data on smoking status varied between 0.93 and 1.0 (sensitivity), 0.90 and 0.98 (specificity), and 0.79 and 0.98 (kappa). Spearman's correlation coefficients for number of cigarettes smoked/day varied between 0.87 and 0.97; mean differences were all close to zero. Accuracy of recall tended to diminish with increasing alcohol intake, particularly among women smoking > or = 10 cigarettes/day.

CONCLUSIONS

Information on smoking habits could be accurately obtained retrospectively independent of recall time and the pregnancy outcomes studied here. Accuracy diminished with increasing alcohol intake, particularly among heavy smokers.

Marine n-3 fatty acid and calcium intake in relation to pregnancy induced hypertension, intrauterine growth retardation, and preterm delivery. A case-control study

OBJECTIVE

To evaluate whether low intakes in pregnancy of marine n-3 fatty acids or calcium increase the risk of preeclampsia, pregnancy induced hypertension, intrauterine growth retardation, or preterm delivery and whether high intakes of the above nutrients increase the risk of postterm delivery.

DESIGN

A case-control nested in cohort study.

SUBJECTS AND METHODS

Between 1989 and 1991 a cohort of 9,434 pregnant women was established. Forty-three preeclamptics, 179 women with pregnancy induced hypertension, 182 with intrauterine growth retardation, 153 delivering preterm, and 189 delivering postterm together with 256 controls were sampled for this study. Dietary information was obtained retrospectively between six months and 3 1/2 years after delivery using a semiquantitative food frequency questionnaire, whilst information on potential confounders was obtained from the cohort data base and analyzed by multiple logistic regression. Questions regarding marine n-3 fatty acids and calcium intake provided the basis for categorization into three and five intake groups respectively.

RESULTS

For all five pregnancy outcomes and both nutritional factors, none of the confounder-adjusted odds ratios comparing higher intake levels with the lowest intake level were significant. Neither were chi 2-tests for trend calculated for each pregnancy outcome statistically significant (p > 0.20). Odds ratios for highest versus lowest intake levels were for n-3 fatty acids 0.79 ((0.27 to 2.34 (95% CI)) for pregnancy induced hypertension, 1.00 (0.34 to 2.95) for intrauterine growth retardation, and 0.99 (0.35 to 2.74) for preterm delivery; for calcium they were 0.92 (0.33 to 2.60) for pregnancy induced hypertension, 0.77 (0.25 to 2.42) for intrauterine growth retardation, and 1.05 (0.36 to 3.10) for preterm delivery.

CONCLUSIONS

No associations could be detected in these data between calcium or fish intake and adverse pregnancy outcome.