Birthweight and mortality in adulthood: a systematic review and meta-analysis

Women born with very low birth weight have similar menstrual cycle pattern, pregnancy rates and hormone profiles compared with women born at term

BACKGROUND

Individuals born very preterm or with very low birth weight (VLBW) have a reduced likelihood to reproduce according to population-based register studies. Extremely low-birth weight born adults had a lower reproduction rate for both men and women in a follow-up study.

AIM

To investigate if being born with VLBW is associated with differences in the reproductive health, i.e. age of menarche, menstrual cycle pattern, pregnancy rates and hormone profile compared with women born at term.

METHODS

A prospective long-term follow-up of a cohort of live-born VLBW children and their controls studied repeatedly since birth and now assessed at 26-28 years of age. Of the totally 80 girls enrolled from birth 49 women (24 VLBW women and 25 controls) participated in the current follow-up. The women's anthropometric data and serum hormone levels were analysed.

RESULTS

The reproductive hormone levels, including Anti-Mullerian Hormone, did not differ significantly between VLBW women and their controls. Both groups reported menstrual cycle irregularities and pregnancies to the same extent but the VLBW women reported 1.5 years later age of menarche. The VLBW subjects had a catch-up growth within 18 months of birth but remained on average 5 cm shorter in adult height. There were no significant differences in BMI, sagittal abdominal diameter, blood pressure or in their answers regarding life style between the VLBW women and the controls.

CONCLUSION

No differences in the reproductive hormone levels were found between VLBW women and their controls. Although age at menarche was somewhat higher in the VLBW group menstrual cycles and pregnancy rates were similar in the VLBW and control groups. Further follow-up studies are required to elucidate the health outcomes of being born VLBW.

Meta-analysis of epigenome-wide association studies in neonates reveals widespread differential DNA methylation associated with birthweight

Birthweight is associated with health outcomes across the life course, DNA methylation may be an underlying mechanism. In this meta-analysis of epigenome-wide association studies of 8,825 neonates from 24 birth cohorts in the Pregnancy And Childhood Epigenetics Consortium, we find that DNA methylation in neonatal blood is associated with birthweight at 914 sites, with a difference in birthweight ranging from -183 to 178 grams per 10% increase in methylation (PBonferroni < 1.06 x 10-7). In additional analyses in 7,278 participants, <1.3% of birthweight-associated differential methylation is also observed in childhood and adolescence, but not adulthood. Birthweight-related CpGs overlap with some Bonferroni-significant CpGs that were previously reported to be related to maternal smoking (55/914, p = 6.12 x 10-74) and BMI in pregnancy (3/914, p = 1.13x10-3), but not with those related to folate levels in pregnancy. Whether the associations that we observe are causal or explained by confounding or fetal growth influencing DNA methylation (i.e. reverse causality) requires further research.

Association between prenatal exposure to multiple persistent organic pollutants (POPs) and growth indicators in newborns

Despite the fact that many of persistent organic pollutants (POPs) have been banned for decades, they still constitute a group of harmful substances to human health. Prenatal exposure can have adverse effects on one's health as well as on their newborns. The present cross-sectional study, which includes 87% of the births registered in La Palma Island (Canary Islands, Spain) during 2016 (n = 447), aims to evaluate the potential adverse health effects exerted by a wide range of POPs on newborns. We quantified blood cord levels of twenty organochlorine pesticides, eighteen polychlorinated biphenyls (PCBs), eight bromodiphenyl ethers (BDEs), and sixteen polycyclic aromatic hydrocarbons (PAHs) using the method of gas chromatography-mass spectrometry. By groups, p,p'-DDE, PCB-28, BDE-47, and phenanthrene were the most frequently detected compounds (median values = 0.148, 0.107, 0.065, and 0.380 ng/mL, respectively). p,p'-DDE was found to be significantly associated with an increase in neonatal birth weight, with a special emphasis on girls. An inverse association between PCB-28 and PCB-52 with birth weight was observed, and these associations were determined by the gender. A similar trend was obtained for BDE-47 but not for any of the PAHs. When assessing the effect of mixtures, boys exhibiting ≥ 3 OCPs were at lower risk of having higher birth weight (OR = 0.25; 95% CI = 0.07 - 0.89; P = 0.032). The effect of these pollutants on birth weight does not go in the same direction, a fact that is conditioned by several factors, including the chemical nature of the substance or the gender of the newborn. Additional research is needed to understand the role of POPs on fetal development.

Fetal and maternal factors are associated with mortality due to circulatory system disorders in children

OBJECTIVE

To analyze the association of characteristics recorded at the time of birth, including weight, occurrence of asphyxia, gestation duration, maternal age and education level, with death from diseases or malformations of the circulatory system in children under 18 years of age.

METHODS

The Brazilian Information System on Live Births and Information System on Mortality databases were linked and evaluated following a longitudinal cohort analysis strategy. The following independent variables were evaluated: characteristics recorded at the time of birth, including weight, occurrence of asphyxia, gestation duration, maternal age and education level. Dependent variables were death from diseases or malformations of the circulatory system in children under 18 years of age. Crude relative risks were estimated and relative risks were adjusted for the variables.

RESULTS

6,380 deaths were linked to 4,282,260 birth records, yielding 5,062 pairs considered as true. Low birth weight (RR = 2.26), asphyxia at 1 (RR = 1.72) and 5 minutes (RR = 1.51), prematurity (RR = 1.50), maternal age ≥ 40 years (RR = 2.06), and low maternal education level (RR = 1.45) increased the probability of death caused by circulatory system diseases. In the association with death by malformations of the circulatory system, the predictive variables showed the same association profile, but with greater intensity.

CONCLUSIONS

Fetal and maternal factors are associated with increased mortality due to diseases and malformations of the circulatory system. Measures to control these factors and improve access to their diagnosis and treatment would contribute to reducing the number of deaths caused by diseases and malformations of the circulatory system. However, the identification of environmental influences during gestation and birth on the risk of death should be carefully considered due to being influenced by genetic factors.

Assessment of 22 inorganic elements in human amniotic fluid: a cross-sectional study conducted in Canary Islands (Spain)

We conducted a cross-sectional study in the Hospital Universitario de Canarias (Tenerife, Canary Islands, Spain) measuring 22 inorganic elements in amniotic fluid (AF) samples obtained from 65 pregnant women. ICP-MS was used for quantification of inorganic elements. Newborn parameters at delivery were all within the normal range. Concentrations of all elements were detected in measurable amounts in AF. The concentration of elements was similar to those reported in the literature. The concentrations of the most dangerous heavy metals - Cd, Cr, Ni, Hg and Pb - were lower than those reported by other authors. This study demonstrates that toxic inorganic elements pass into and accumulate in AF. The presence of such pollutants in contact with developing embryos from the intrauterine period could exert adverse health effects that deserve future investigations.

The Genetic Basis of Metabolic Disease

Recent developments in genetics and genomics are providing a detailed and systematic characterization of the genetic underpinnings of common metabolic diseases and traits, highlighting the inherent complexity within systems for homeostatic control and the many ways in which that control can fail. The genetic architecture underlying these common metabolic phenotypes is complex, with each trait influenced by hundreds of loci spanning a range of allele frequencies and effect sizes. Here, we review the growing appreciation of this complexity and how this has fostered the implementation of genome-scale approaches that deliver robust mechanistic inference and unveil new strategies for translational exploitation.

Healthy Body Weight may Modify Effect of Abnormal Birth Weight on Metabolic Syndrome in Adolescents

OBJECTIVE

This study aimed to examine the association between birth weight (BW) and metabolic syndrome (MetS) in adolescents and to further investigate whether having a healthy body weight could modify the potential adverse influence of abnormal BW on MetS risk.

METHODS

A total of 6,206 participants aged 10 to 17 years were recruited using data from a Chinese national survey conducted in 2012. Gestational age-specific BW percentiles were used to classify small for gestational age (SGA), appropriate for gestational age, and large for gestational age (LGA). Fractional polynomial regression, logistic regression, and population-attributable risk (PAR) were used to assess the relationship between BMI and BW with MetS.

RESULTS

MetS risk increased by 73% (OR = 1.73, 95% CI: 1.06-2.84) in SGA adolescents with overweight or obesity, but not in those without overweight, compared with their counterparts with BW appropriate for gestational age. A huge difference between PAR percent of MetS because of SGA and PAR percent because of overweight or obesity was detected. For example, PAR percent of SGA was 2.4% (95% CI: 0.1%-4.6%) in adolescents with overweight or obesity, while PAR percent of overweight or obesity was 44.2% (95% CI: 33.3%-53.2%) in those who were SGA infants.

CONCLUSIONS

These findings suggest that healthy body weight could relieve the adverse impact of SGA on MetS in adolescents.

Age at adiposity rebound in childhood is associated with PCOS diagnosis and obesity in adulthood-longitudinal analysis of BMI data from birth to age 46 in cases of PCOS

Background:

Adiposity rebound (AR), the second BMI rise in childhood at around the age of 6 years, is associated with obesity and metabolic alteration in later life. Given that polycystic ovary syndrome (PCOS) has a strong metabolic component, early life growth patterns could reveal a risk of PCOS. Thus, we aimed to investigate the associations between age at AR and PCOS diagnosis and BMI later in life.

Materials and methods:

This study is part of a prospective, population-based longitudinal study, where women with PCOS diagnosis by age 46 (n = 280) were compared with asymptomatic women (CTRLs, n = 1573). Weight and height data from birth to age 13 years, at age at menarche, and at ages 31 and 46 years were analyzed

Results:

Women with PCOS had lower birth weight (3357 ± 477 vs. 3 445 ± 505 g, p < 0.001), earlier age at AR (5.2 ± 1.0 vs. 5.6 ± 0.90 years, p < 0.001) and higher BMI from AR onwards compared with controls. Early timing of AR was associated with PCOS diagnosis independently of BMI (OR 1.62, 95% Cl 1.37–1.92). Women with PCOS and early AR had higher BMI at 31 and 46 years when compared to controls with early AR. The age at AR did not associate with T levels at ages 31 or 46 years.

Conclusions:

Early AR was associated with PCOS diagnosis and high BMI in adulthood. Adolescent girls with early AR and persisting obesity should be screened for PCOS symptoms, such as persistent irregular cycles and hirsutism.

The Barker hypothesis confirmed: association of low birth weight with all-cause natural deaths in young adult life in a remote Australian Aboriginal community

Barker et al. proposed that low birth weight predisposes to higher death rates in adult life. We previously confirmed this fact in a cohort of young adults who were born in a remote Australian Aboriginal community between 1956 and 1985. We now present data in these same people with four more years of follow-up and a greater number of deaths. The fates of participants were documented from age 15 years until death, start of dialysis, or until the end of 2010 and causes of death were derived from clinic narratives and dialysis records. Rates of natural deaths were compared by birth cohorts and birth weight, and hazard ratios were calculated using Cox proportional hazards methods, by birth weight and adjusted for birth cohort and sex. Over follow-up of 19,661 person-years, 61 people died of natural causes between age 15 and the censor date. Low birth weights (<2.5 kg) were associated with higher rates of natural death, with HR (95% CI) 1.76 (1.1-2.9, P=0.03), after adjustment for year of birth and sex. The effect was particularly prominent for deaths at <41 years of age, and with deaths from respiratory conditions/sepsis and unusual causes. A predisposing effect of low birth weight on adult deaths was confirmed. This phenomenon, occurring in the context of dramatically improved survivals of lower birth weight infants and children since the early 1960s, helps explain the current epidemic of chronic disease in Aboriginal people. Birth weights continue to improve, so excess deaths from this source should progressively be minimized.

Seasonal analyses of the association between prenatal ambient air pollution exposure and birth weight for gestational age in Guangzhou, China

Ambient air pollution has been linked to small for gestational age (SGA); however, the relationship with large for gestational age (LGA) is unclear and very few studies have investigated seasonal effects on the association between air pollution and SGA or LGA. Using birth registry data of 506,000 singleton live births from 11 districts in Guangzhou, China between January 2015 and July 2017, we examined associations between ambient air pollutants (PM_2.5, PM₁₀, NO₂, SO₂, and O₃) and SGA/LGA, and further assessed the modification effect of season. Daily concentrations of air pollutants from 11 monitoring stations were used to estimate district-specific exposures for each participant based on their district of residence during pregnancy. Two-level binary logistic regression models were used to evaluate associations between air pollution and SGA/LGA. Stratified analyses by season and a Cochran Q test were performed to assess the modification of season. Exposure to PM_2.5, NO₂, SO₂, and O₃ was significantly associated with increased risk of SGA, especially for exposure during the second and third trimester. For an interquartile range (IQR) increase in PM_2.5 (6.5 μg/m³), NO₂ (12.7 μg/m³), SO₂ (2.8 μg/m³) and O₃ (20.8 μg/m³) during the entire pregnancy, SGA risk increased by 2% (OR = 1.02, 95% CI: 1.00-1.04), 8% (OR = 1.08, 95% CI: 1.04-1.12), 2% (OR = 1.02, 95% CI: 1.01-1.03), and 14% (1.14, 1.11-1.17), respectively. A decreased risk of LGA was found for PM_2.5, PM₁₀, SO₂, and O₃ during the first trimester or entire pregnancy. When examined by season, significant associations between air pollutants and SGA were observed for women who conceived during summer or fall, and the patterns were consistent for all pollutants. Our study suggests that conception during different seasons might modify the association between ambient air pollution and SGA.

Genome-wide association study of offspring birth weight in 86 577 women identifies five novel loci and highlights maternal genetic effects that are independent of fetal genetics

Genome-wide association studies of birth weight have focused on fetal genetics, whereas relatively little is known about the role of maternal genetic variation. We aimed to identify maternal genetic variants associated with birth weight that could highlight potentially relevant maternal determinants of fetal growth. We meta-analysed data on up to 8.7 million SNPs in up to 86 577 women of European descent from the Early Growth Genetics (EGG) Consortium and the UK Biobank. We used structural equation modelling (SEM) and analyses of mother–child pairs to quantify the separate maternal and fetal genetic effects. Maternal SNPs at 10 loci (MTNR1B, HMGA2, SH2B3, KCNAB1, L3MBTL3, GCK, EBF1, TCF7L2, ACTL9, CYP3A7) were associated with offspring birth weight at P < 5 × 10⁻⁸. In SEM analyses, at least 7 of the 10 associations were consistent with effects of the maternal genotype acting via the intrauterine environment, rather than via effects of shared alleles with the fetus. Variants, or correlated proxies, at many of the loci had been previously associated with adult traits, including fasting glucose (MTNR1B, GCK and TCF7L2) and sex hormone levels (CYP3A7), and one (EBF1) with gestational duration. The identified associations indicate that genetic effects on maternal glucose, cytochrome P450 activity and gestational duration, and potentially on maternal blood pressure and immune function, are relevant for fetal growth. Further characterization of these associations in mechanistic and causal analyses will enhance understanding of the potentially modifiable maternal determinants of fetal growth, with the goal of reducing the morbidity and mortality associated with low and high birth weights.

Maternal Lifetime Trauma and Birthweight: Effect Modification by In Utero Cortisol and Child Sex

OBJECTIVES

To evaluate associations between maternal lifetime traumatic stress and offspring birthweight and examine modifying effects of third trimester cortisol and fetal sex.

STUDY DESIGN

Analyses included 314 mother-infant dyads from an ethnically mixed pregnancy cohort. Maternal lifetime trauma was reported via the Life Stressor Checklist-Revised. Fenton birthweight for gestational age z-scores (BWGA-z) were calculated. A 3-cm scalp-nearest maternal hair segment collected at birth was assayed to reflect cumulative third trimester cortisol secretion. Multivariable regression was used to investigate associations between maternal lifetime trauma and BWGA-z and examine 2- and 3-way interactions with cortisol and fetal sex. Because subjects with low or high cortisol levels could represent susceptible populations, varying coefficient models that relax the linearity assumption on cortisol level were used to assess the modification of maternal lifetime trauma associations with BWGA-z as a function of cortisol.

RESULTS

Women were primarily minorities (41% Hispanic, 26% black) with ≤12 years education (63%); 63% reported ≥1 traumatic event. Prenatal cortisol modified the association between maternal lifetime trauma and birthweight. Women with higher lifetime trauma and increased cortisol had significantly lower birthweight infants in males; among males exposed to the 90th percentile of cortisol, a 1-unit increase in trauma score was associated with a 0.19-unit decrease in BWGA-z (95% CI, -0.34 to -0.04). Associations among females were nonsignificant, regardless of cortisol level.

CONCLUSIONS

These findings underscore the need to consider complex interactions among maternal trauma, disrupted in utero cortisol production, and fetal sex to fully elucidate intergenerational effects of maternal lifetime trauma.

Children Born Small for Gestational Age: Differential Diagnosis, Molecular Genetic Evaluation, and Implications

Children born small for gestational age (SGA), defined as a birth weight and/or length below -2 SD score (SDS), comprise a heterogeneous group. The causes of SGA are multifactorial and include maternal lifestyle and obstetric factors, placental dysfunction, and numerous fetal (epi)genetic abnormalities. Short-term consequences of SGA include increased risks of hypothermia, polycythemia, and hypoglycemia. Although most SGA infants show catch-up growth by 2 years of age, ∼10% remain short. Short children born SGA are amenable to GH treatment, which increases their adult height by on average 1.25 SD. Add-on treatment with a gonadotropin-releasing hormone agonist may be considered in early pubertal children with an expected adult height below -2.5 SDS. A small birth size increases the risk of later neurodevelopmental problems and cardiometabolic diseases. GH treatment does not pose an additional risk.

Low birth weight of institutional births in Cambodia: Analysis of the Demographic and Health Surveys 2010-2014

BACKGROUND

Low birth weight (LBW), an important risk factor for early childhood mortality and morbidity, is a major public health concern in developing countries including Cambodia. This study examined the prevalence of LBW across provinces in Cambodia and changes over time, and identified the factors associated with such condition.

METHODS

We used children datasets from Cambodia Demographic and Health Survey (CDHS) 2010 and 2014. There were 3,522 children and 4,991 children in both surveys. Maps illustrating provincial variation in LBW prevalence were constructed. Then, multivariate analyses were conducted to assess factors independently associated with LBW in CDHS 2014.

RESULTS

LBW prevalence remained stable between 2010 and 2014, at around 7.0% 95% CI: 5.8-8.1). all institutional births, but within significant variation across provinces. Factors independently associated with LBW included mother's no education compared with those whose mothers had secondary or higher education (AOR = 1.6, 95% CI: 1.0-2.6), babies born to mothers with < 4 antenatal care (ANC) visits during the pregnancy compared with those whose mothers had at least 4 ANC visits (AOR = 2.0, 95% CI: 1.5-2.8). Also, first-born babies were at greater risk of LBW compared with second-born babies (AOR = 1.4, 95% CI: 1.0-2.0).

CONCLUSION

The study points to key sub-populations at greater risk and regions where LBW is particularly prevalent. Programs should target provinces where LBW prevalence remains high. Illiterate women, especially those pregnant for the first time should be the program priority. The current national program policy, which recommends that pregnant women have ≥ 4 ANC visits during pregnancy should be further reinforced and implemented. Program design should consider ways to communicate the importance of making the recommended number of ANC visits among women with no formal education.

Maternal Factors and Utilization of the Antenatal Care Services during Pregnancy Associated with Low Birth Weight in Rural Nepal: Analyses of the Antenatal Care and Birth Weight Records of the MATRI-SUMAN Trial

Low birth weight (LBW) remains a major public health problem in developing countries, including Nepal. This study was undertaken to examine the association between LBW and maternal factors and antenatal care service utilization, in rural Nepal, using data obtained for a capacity-building and text-messaging intervention, designed to enhance maternal and child health service utilization among pregnant women, in rural Nepal ("MATRI-SUMAN"). The study used a clustered randomized controlled design and was conducted during 2015⁻2016. We investigated maternal and antenatal care service utilization determinants of LBW, using a logistic regression model. Of the four hundred and two singleton babies, included in the present study, seventy-eight (19.4%) had an LBW (mean (SD), 2210.64 (212.47)) grams. It was found that Dalit caste/ethnicity, illiteracy, manual labor, a female baby, and having more than four family members were significantly positively associated with LBW. In addition, mothers who did not visit an antenatal care (ANC) unit, visited an ANC < 4 times, did not take iron and folic acid (IFA), de-worming tablets, and mothers that did not consume additional food, during pregnancy, were more likely to have an LBW baby, than their counterparts. The MATRI-SUMAN intervention and availability of a kitchen garden at home, were found to reduce the risk of LBW. Nepalese child survival policies and programs should pay attention to these maternal and antenatal care service utilization factors, while designating preventive strategies to improve child health outcomes.

Associations of birth characteristics with perimenopausal disorders: a prospective cohort study

Perimenopausal disorders (PDs) are prevalent and importantly affect quality of life among middle-aged women. Yet, very little is known about the developmental origins of these disorders. The objective of this study was to investigate the associations of birth characteristics with PDs. This cohort study is based on archived birth records for birth weight and gestational age, and followed prospectively in Swedish inpatient and outpatient registers for 8 years (n=3212). The main outcomes were menopausal and climacteric states (e.g. flushing, sleeplessness), perimenopausal bleeding and other PDs (e.g. atrophic vaginitis). Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) for three subtypes of PDs separately. During the follow-up, 218 women had PDs, among whom 125 had menopausal and climacteric states, 61 had perimenopausal bleeding and 58 had other PDs as first recorded disorder. Birth weight was linearly associated with incidence rate of menopausal and climacteric states [HR=1.66 per 1 kg increase, 95% confidence interval (95% CI)=1.14-2.41]. Gestational age (rather than birth weight) was associated with incidence rate of other PDs (HR=0.87 per 1 week increase, 95% CI=0.79-0.95). Neither birth weight nor gestational age was associated with perimenopausal bleeding. Similar results were found after adjustment for other early-life and adult socio-demographic characteristics. This observational study provides, for the first time, evidence regarding the developmental origins of PDs. Future research is required to investigate the underlying causal mechanisms, which may shed further light on the etiology of this class of disorders.

Determinants of low birth weight in the context of maternal nutrition education in urban informal settlements, Kenya

Inadequate knowledge in maternal nutrition is one of the determinants of low birth weight. However, little evidence is available on whether maternal nutrition counselling alone can influence birth weight among women from low socioeconomic households. This study assessed the effect of prenatal maternal nutritional counselling on birth weight and examined the related risk factors. A cluster randomized controlled trial was conducted to assess the effectiveness of home-based maternal nutritional counselling on nutritional outcomes, morbidity, breastfeeding, and infant feeding practices by the African Population and Health Research Center in two urban informal settlements of Nairobi. The intervention group received monthly antenatal and nutritional counselling from trained community health volunteers; meanwhile, the control group received routine antenatal care. A total of 1001 participants were included for analysis. Logistic regression was applied to determine associations between low birth weight and maternal characteristics. A higher prevalence of low birth weight was observed in the control group (6.7%) than in the intervention group (2.5%; P&lt;0.001). Logistic regression identified significant associations between birth weight and intervention group (adjusted odds ratio (AOR)=0.26; 95% confidence interval (CI), 0.10-0.64); maternal height &lt;154.5 cm (AOR=3.33; 95% CI, 1.01-10.96); last antenatal care visits at 1st or 2nd trimesters (AOR=9.48; 95% CI, 3.72-24.15); pre-term delivery (AOR=3.93; 95% CI, 1.93-7.98); maternal mid-upper arm circumference &lt;23 cm (AOR=2.57; 95% CI, 1.15-5.78); and cesarean delivery (AOR=2.27; 95% CI, 1.04-4.94). Nutrition counselling during pregnancy reduced low birth weight and preterm births, which was determined by women of short stature, early stoppage of antenatal visit, and cesarean delivery.

Factors affecting height velocity in normal prepubertal children

PURPOSE

To analyze the effects of clinical and laboratory factors, including insulinlike growth factor (IGF) levels, on the height velocity of normal prepubertal children.

METHODS

Ninety-five healthy prepubertal children (33 boys, 62 girls) were enrolled. The mean chronological age was 6.3±1.4 years, with a height standard deviation score (SDS) of -0.88±0.70. IGF-1, IGF binding protein-3 (IGFBP-3), SDS for anthropometric measurements, and changes in SDS for anthropometric measurements were analyzed for 1 year, and their associations with 1-year height velocity were investigated.

RESULTS

The group of children with a 1-year height velocity of ≥6 cm were chronologically younger than the group with a 1-year height velocity of &lt;6 cm (5.9±1.3 years vs. 6.7±1.3 years, P=0.004), with a lesser increase of SDS for body mass index (BMI) over 1 year (-0.18±0.68 vs. 0.13±0.53, P=0.014). There were no differences between the 2 groups in IGF-1 SDS and IGFBP-3 SDS. Multiple linear regression showed that baseline chronological age (r=0.243, P=0.026) and height SDS (r=0.236, P=0.030) were positively associated with IGF-1 SDS. Binomial logistic regression showed that an older chronologic age at referral (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.47-0.99) and an increase of BMI SDS over 1 year (OR, 0.41; 95% CI, 0.18-0.89) were associated with a decreased growth possibility of an above-average height velocity (≥6 cm/yr).

CONCLUSION

Height velocity of normal prepubertal children is affected by an increase of BMI SDS and chronological age. Prepubertal IGF-1 SDS reflects height SDS at the time of measurement but is not associated with subsequent height velocity.

The Impact of Being Born Preterm or Small for Gestational Age on Early Vascular Aging in Adolescents

OBJECTIVE

To assess the impact of being born preterm or small for gestational age (SGA) on early vascular aging (EVA) in a cohort of healthy Tyrolean adolescents.

STUDY DESIGN

This study is part of an ongoing clinical trial, EVA Tyrol, a regional cohort study being conducted in western Austria. EVA was assessed in adolescents (mean age, 16 years) by means of carotid-femoral pulse wave velocity (PWV), carotid intima-media thickness (cIMT), and blood pressure measurements. Adolescents were grouped as either term or preterm. Subsequently, being born SGA was taken into consideration in subgroup analysis. Complete data on gestational age and birth weight were available for 930 adolescents.

RESULTS

Systolic blood pressure and diastolic blood pressure were significantly higher in the preterm (mean gestational age, 34.8 ± 2.3 weeks) and appropriate for gestational age (AGA) group than in the term and AGA group (P < .05). This finding remained significant in linear regression analysis after adjustment for covariables in all models. PWV was significantly higher in the term-SGA group than in the term-AGA group (6.67 ± 1.73 m/s vs 6.07 ± 1.09 m/s; P < .05). In the linear regression analysis, this finding remained significant in all models. There were no differences in cIMT between study groups.

CONCLUSION

Being born preterm or SGA might render persons susceptible to EVA. Long-term follow-up of preterm and SGA individuals is warranted to confirm these results.

Lack of partner impacts newborn health through maternal depression: A pilot study of low-income immigrant Latina women

INTRODUCTION

Latina women have a high burden of depression and other mental health issues, particularly in the perinatal period. Suboptimal maternal mental health can have adverse developmental and physiological impacts on child growth. The present study examines the impact of unplanned pregnancy and pregnancy relationship status on prenatal maternal depression in a sample of low-income Latina women. We hypothesized that the association between these prenatal stressors and newborn health would be mediated through prenatal depression.

METHOD

The present study included a sample 201 Latina mothers and their children recruited from prenatal clinics during their second or third trimesters. Depression symptomology, relationship status were collected prenatally. At birth, several indices of newborn health were examined, including head circumference percentile and birthweight. Finally, planned pregnancy status was retrospectively collected when the child was between 1 and 2 years old.

RESULTS

Structural equation modelling revealed that single women, compared to partnered women, had higher levels of depression. Higher levels of depression, in turn, predicted poorer newborn health. Unplanned pregnancy was not significantly associated with newborn health.

DISCUSSION

These results suggest that relationship status may be an important screening question for medical examiners to ask to pregnant Latina women during prenatal visits. These results are consistent with past research investigating the effects of maternal mental health on adverse birth outcomes that propose that stressful early environments shape developmental trajectories.

Lipid-based nutrient supplements for maternal, birth, and infant developmental outcomes

BACKGROUND

Ready-to-use lipid-based nutrient supplements (LNS) are a highly nutrient-dense supplement, which could be a good source of macro- and micronutrients for pregnant women who need to supplement their nutrient intake.

OBJECTIVES

To assess the effects of LNS for maternal, birth and infant outcomes in pregnant women. Secondary objectives were to explore the most appropriate composition, frequency and duration of LNS administration.

SEARCH METHODS

In May 2018, we searched CENTRAL, MEDLINE, Embase, 22 other databases and two trials registers for any published and ongoing studies. We also checked the reference lists of included studies and relevant reviews, and we contacted the authors of included studies and other experts in the field to identify any studies we may have missed, including any unpublished studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and quasi-RCTs that compared LNS given in pregnancy to no intervention, placebo, iron folic acid (IFA), multiple micronutrients (MMN) or nutritional counselling.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane procedures.

MAIN RESULTS

We included four studies in 8018 pregnant women. All four studies took place in stable community settings in low- and middle-income countries: Bangladesh, Burkina Faso, Ghana and Malawi. None were in emergency settings. The oldest trial was published in 2009. Of the four included studies, one compared LNS to IFA, one compared LNS to MMN, and two compared LNS to both IFA and MMN.We considered the included studies to be of medium to high quality, and we rated the quality of the evidence as moderate using the GRADE approach.LNS versus IFAMaternal outcomes: there was no difference between the LNS and IFA groups as regards maternal gestational weight gain per week (standard mean difference (SMD) 0.46, 95% confidence interval (CI) -0.44 to 1.36; 2 studies, 3539 participants). One study (536 participants) showed a two-fold increase in the prevalence of maternal anaemia in the LNS group compared to the IFA group, but no difference between the groups as regards adverse effects. There was no difference between the two groups for maternal mortality (risk ratio (RR) 0.53, 95% CI 0.12 to 2.41; 3 studies, 5628 participants).Birth and infant outcomes: there was no difference between the LNS and IFA groups for low birth weight (LBW) (RR 0.87, 95% CI 0.72 to 1.05; 3 studies, 4826 participants), though newborns in the LNS group had a slightly higher mean birth weight (mean difference (MD) 53.28 g, 95% CI 28.22 to 78.33; 3 studies, 5077 participants) and birth length (cm) (MD 0.24 cm, 95% CI 0.11 to 0.36; 3 studies, 4986 participants). There was a reduction in the proportion of infants who were small for gestational age (SGA) (RR 0.94, 95% CI 0.89 to 0.99; 3 studies, 4823 participants) and had newborn stunting (RR 0.82, 95% CI 0.71 to 0.94; 2 studies, 4166 participants) in the LNS group, but no difference between the LNS and IFA groups for preterm delivery (RR 0.94, 95% CI 0.80 to 1.11; 4 studies, 4924 participants), stillbirth (RR 1.14; 95% CI 0.52 to 2.48; 3 studies, 5575 participants) or neonatal death (RR 0.96, 95% CI 0.14 to 6.51). The current evidence for child developmental outcomes is not sufficient to draw any firm conclusions.LNS versus MMNMaternal outcomes: one study (662 participants) showed no difference between the LNS and MMN groups as regards gestational weight gain per week or adverse effects. Another study (557 participants) showed an increased risk of maternal anaemia in the LNS group compared to the MMN group.Birth and infant outcomes: there was no difference between the LNS and MMN groups for LBW (RR 0.92, 95% CI 0.74 to 1.14; 3 studies, 2404 participants), birth weight (MD 23.67 g, 95% CI -10.53 to 57.86; 3 studies, 2573 participants), birth length (MD 0.20 cm, 95% CI -0.02 to 0.42; 3 studies, 2567 participants), SGA (RR 0.95, 95% CI 0.84 to 1.07; 3 studies, 2393 participants), preterm delivery (RR 1.15, 95% CI 0.93 to 1.42; 3 studies, 2630 participants), head circumference z score (MD 0.10, 95% CI -0.01 to 0.21; 2 studies, 1549 participants) or neonatal death (RR 0.88, 95% CI 0.36 to 2.15; 1 study, 1175 participants).

AUTHORS' CONCLUSIONS

Findings from this review suggest that LNS supplementation has a slight, positive effect on weight at birth, length at birth, SGA and newborn stunting compared to IFA. LNS and MMN were comparable for all maternal, birth and infant outcomes. Both IFA and MMN were better at reducing maternal anaemia when compared to LNS. We did not find any trials for LNS given to pregnant women in emergency settings.Readers should interpret the beneficial findings of the review with caution since the evidence comes from a small number of trials, with one-large scale study (conducted in community settings in Bangladesh) driving most of the impact. In addition, effect sizes are too small to propose any concrete recommendation for practice.

Exercise in Pregnancy and Children's Cardiometabolic Risk Factors: a Systematic Review and Meta-Analysis

BACKGROUND

Maternal metabolic health during the prenatal period is an established determinant of cardiometabolic disease risk. Many studies have focused on poor offspring outcomes after exposure to poor maternal health, while few have systematically appraised the evidence surrounding the role of maternal exercise in decreasing this risk. The aim of this study is to characterize and quantify the specific impact of prenatal exercise on children's cardiometabolic health markers, at birth and in childhood.

METHODS

A systematic review of Scopus, MEDLINE, EMBASE, CENTRAL, CINAHL, and SPORTDiscus up to December 2017 was conducted. Randomized controlled trials (RCTs) and prospective cohort studies of prenatal aerobic exercise and/or resistance training reporting eligible offspring outcomes were included. Four reviewers independently identified eligible citations and extracted study-level data. The primary outcome was birth weight; secondary outcomes, specified a priori, included large-for-gestational age status, fat and lean mass, dyslipidemia, dysglycemia, and blood pressure. We included 73 of the 9804 citations initially identified. Data from RCTs was pooled using random effects models. Statistical heterogeneity was quantified using the I2 test. Analyses were done between June and December 2017 and the search was updated in December 2017.

RESULTS

Fifteen observational studies (n = 290,951 children) and 39 RCTs (n = 6875 children) were included. Observational studies were highly heterogeneous and had discrepant conclusions, but globally showed no clinically relevant effect of exercise on offspring outcomes. Meta-analyzed RCTs indicated that prenatal exercise did not significantly impact birth weight (mean difference [MD] - 22.1 g, 95% confidence interval [CI] - 51.5 to 7.3 g, n = 6766) or large-for-gestational age status (risk ratio 0.85, 95% CI 0.51 to 1.44, n = 937) compared to no exercise. Sub-group analyses showed that prenatal exercise reduced birth weight according to timing (starting after 20 weeks of gestation, MD - 84.3 g, 95% CI - 142.2, - 26.4 g, n = 1124), type of exercise (aerobic only, MD - 58.7 g, 95% CI - 109.7, - 7.8 g; n = 2058), pre-pregnancy activity status (previously inactive, MD - 34.8 g, 95% CI - 69.0, - 0.5 g; n = 2829), and exercise intensity (light to moderate intensity only, MD - 45.5 g, 95% CI - 82.4, - 8.6 g; n = 2651). Fat mass percentage at birth was not altered by prenatal exercise (0.19%, 95% CI - 0.27, 0.65%; n = 130); however, only two studies reported this outcome. Other outcomes were too scarcely reported to be meta-analyzed.

CONCLUSIONS

Prenatal exercise does not causally impact birth weight, fat mass, or large-for-gestational-age status in a clinically relevant way. Longer follow up of offspring exposed to prenatal exercise is needed along with measures of relevant metabolic variables (e.g., fat and lean mass).

PROTOCOL REGISTRATION

Protocol registration number: CRD42015029163 .

Associations between maternal exposure to air pollution and birth outcomes: a retrospective cohort study in Taizhou, China

Previous studies from Western country settings had shown correlation between maternal exposure to air pollution and pregnancy outcomes; however, the evidence is difficult to clearly interpret. We aimed to investigate the association of maternal exposure to air pollution expressed as particulate matter (PM2.5, PM10) and nitrogen dioxide (NO2). The exposure was assessed for the 1st, 2nd, and 3rd trimester and related to the birth outcomes. During each trimester of gestation, the effect of PM2.5, PM10, and NO2 exposure as well as the entire pregnancy on the preterm birth, low birth weight, and term babies' birth weight was explored. The dataset of 26,998 delivered live births between January 1, 2013 and May 31, 2016, were collected from the Taizhou Maternal and Child Care Service Center. Air monitoring data were collected from the Taizhou Municipal Environmental Monitoring Center for the same period. We used multi-variable logistic and linear regression analyses to investigate the correlation of air pollution to maternal and outcomes of birth. In models of adjusted single pollutant for second trimester, NO2 concentration was positively correlated with term low birth weight and preterm birth [aRR for an interquartile range increase: 1.59 (1.44, 1.75); 1.27 (1.12, 1.44)]; likewise, a 1 μg/m3 increase in NO2 was correlated with a reduction in birth weight 2.94 g (P < 0.001) in linear models. Each of PM2.5 and PM10 concentration was also associated with preterm birth [aRR for an interquartile range increase 1.30 (1.21, 1.38); 1.39 (1.27, 1.52)]. In co-pollutant models, the results were similar. Maternal exposure to air pollutant in Taizhou was associated with an increased risk of preterm birth and reduction in birth weight. We reported a potential link between maternal exposure to air pollution and negative outcomes of birth in Taizhou, China.

Admixture mapping and fine-mapping of birth weight loci in the Black Women's Health Study

Several genome-wide association studies (GWAS) have identified genetic variants associated with birth weight. To date, however, most GWAS of birth weight have focused primarily on European ancestry samples even though prevalence of low birth weight is higher among African-Americans. We conducted admixture mapping using 2918 ancestral informative markers in 2596 participants of the Black Women's Health Study, with the goal of identifying novel genomic regions where local African ancestry is associated with birth weight. In addition, we performed a replication analysis of 11 previously identified index single nucleotide polymorphisms (SNPs), and fine-mapped those genetic loci to identify better or new genetic variants associated with birth weight in African-Americans. We found that high African ancestry at 12q14 was associated with low birth weight, and we identified multiple independent birth weight-lowering variants in this genomic region. We replicated the association of a previous GWAS SNP in ADRB1 and our fine-mapping efforts suggested the presence of new birth weight-associated variants in ADRB1, HMGA2, and SLC2A4. Further studies are needed to determine whether birth weight-associated loci can in part explain race-associated birth weight disparities.

Lower birthweight and left-/mixed-handedness are associated with intensified age-related sex steroid decline in men. Findings from the Men's Health 40+ Study

In males, age‐related decline in free testosterone (T) and dehydroepiandrosterone (DHEA) by 2–3% per year has been reported. Estradiol (E2) and progesterone (P) seem to decrease as well, but to a lesser extent. Lower sex steroid levels in men have been related to physical and mental symptoms. Low birthweight and left‐/mixed‐handedness (L/MH) are indicators of an adverse fetal environment during pregnancy, and both have been linked to morbidity in later life. The aim of this study is to examine the relationship between lower birthweight as well as L/MH and age‐related sex steroid decline. In a cross‐sectional study design, saliva samples were collected under standardized conditions from healthy men for subsequent steroid hormone analysis using standard luminescence immunoassays. T (M = 67.57 pg/mL), DHEA (M = 247.91 pg/mL), E2 (M = 1.29 pg/mL), and P (M = 28.20 pg/mL) have been quantified leading to a final sample of 256 men providing complete data on sex hormones (M_Age=57.8; SD_Age = 10.8). Information on participants’ birthweight was obtained from birth reports (N = 134), and participants were asked about their handedness (right‐handed, left‐handed, mixed‐handed) (N = 256). Multivariate‐adjusted linear regression models relating each sex hormone individually and the principal component of declining steroid hormones (DSH)—an integrated hormonal parameter—with handedness and birthweight did not identify significant associations except for handedness and E2. Moderation analysis using robust regression accounting for bias due to influential data points detected a significant association between age and DSH for handedness (β = −0.0314, p = 0.040) but only a trend for birthweight (β = 0.0309, p = 0.073). For lower birthweight, a trend toward intensified age‐related sex steroid decline in men was observed, while for L/MH, a significant association with intensified age‐related sex steroid decline was identified. These results indicate that L/MH and potentially also lower birthweight might be considered as early risk factors for endocrine health in later life.

Occurrence of 44 elements in human cord blood and their association with growth indicators in newborns

There is growing concern about environmental pollution produced by elements, including "emerging" contaminants, such as rare earth elements (REE) and other trace elements (TE), which are extensively and increasingly employed in the manufacture of consumer electronics. Previous research has shown that prenatal exposure to some elements (mainly heavy metals) may be associated with decreased fetal growth and other adverse birth outcomes. Recent studies have also shown that environmental exposure to REE and TE may be related to adverse effects on human health. This cross-sectional study, which included nearly 92% of the births in 2016 in La Palma (Canary Islands, Spain; n = 471), aimed to evaluate the potential adverse health effects exerted by a wide range of elements on newborns. We quantified the levels of 44 elements (including 26 REE and TE) in their umbilical cord blood. Our results showed low or very low levels of most elements. We found an inverse association between antimony (Sb) and birth weight (Spearman's r = -0.106, p = 0.021). A similar trend was observed between nickel (Ni) and birth weight and between chromium (Cr) and birth length, although in this case the significance was borderline. Bismuth appeared as a risk factor for having a birth weight below the tenth percentile in the univariate (OR = 3.30; 95% CI = 1.25-8.78; p = 0.017) and multivariate analyses (OR = 5.20; 95% CI = 1.29-20.91; p = 0.020). When assessing the effect of element mixtures, the sum of Cr, Ni, and Sb appeared as a risk factor for having a birth weight below the tenth percentile in the univariate (OR = 2.41; 95% CI = 1.08-5.35; p = 0.031) and multivariate analyses (OR = 3.84; 95% CI = 1.42-10.39; p = 0.008). Our findings suggest that some inorganic elements-isolated or in mixture-are associated to a lower fetal growth. Additional research is needed to understand the role of inorganic pollutants on fetal development.

Validation of maternal reports for low birthweight and preterm birth indicators in rural Nepal

Background

Tracking progress towards global newborn health targets depends largely on maternal reported data collected through large, nationally representative surveys. We evaluated the validity, across a range of recall period lengths (1 to 24 months post-delivery), of maternal report of birthweight, birth size and length of pregnancy.

Methods

We compared maternal reports to reference standards of birthweights measured within 72 hours of delivery and gestational age generated from reported first day of the last menstrual period (LMP) prospectively collected as part of a population-based study (n = 1502). We calculated sensitivity, specificity, area the under the receiver operating curve (AUC) as a measure of individual-level accuracy, and the inflation factor (IF) to quantify population-level bias for each indicator. We assessed if length of recall period modified accuracy by stratifying measurements across time bins and using a modified Poisson regression with robust error variance to estimate the relative risk (RR) of correctly classifying newborns as low birthweight (LBW) or preterm, adjusting for child sex, place of delivery, maternal age, maternal education, parity, and ethnicity.

Results

The LBW indicator using maternally reported birthweight in grams had low individual-level accuracy (AUC = 0.69) and high population-level bias (inflation factor IF = 0.62). LBW using maternally reported birth size and the preterm birth indicator had lower individual-level accuracy (AUC = 0.58 and 0.56, respectively) and higher population-level bias (IF = 0.28 and 0.35, respectively) up to 24 months following birth. Length of recall time did not affect accuracy of LBW indicators. For the preterm birth indicator, accuracy did not change with length of recall up to 20 months after birth and improved slightly beyond 20 months.

Conclusions

The use of maternal reports may underestimate and bias indicators for LBW and preterm birth. In settings with high prevalence of LBW and preterm births, these indicators generated from maternal reports may be more vulnerable to misclassification. In populations where an important proportion of births occur at home or where weight is not routinely measured, mothers perhaps place less importance on remembering size at birth. Further work is needed to explore whether these conclusions on the validity of maternal reports hold in similar rural and low-income settings.

Non-communicable disease risk factor profile among public employees in a regional city in northern Ethiopia

The burden of non-communicable diseases (NCDs) is increasing in Ethiopia. This study aims to describe the prevalence of NCD risk factors of public employees in a regional city in northern Ethiopia. We conducted a cross-sectional epidemiological study targeting men and women aged 25-64 years employed by public offices in Mekelle. The prevalence was age-standardized to the Ethiopian 2007 population. Among the 1380 subjects (823 men and 557 women), 68.7% had less than 1 serving of fruits and vegetables per day, 41.0% were physically inactive, and 57.3% observed religious fast. The age-standardised prevalence of abdominal obesity was 29.3% in men and 58.5% in women, but that of metabolic syndrome was comparable between men (39.2%) and women (39.0%). The prevalence of diabetes was underestimated if only fasting blood glucose (FBG) was used for the diagnosis compared to combination of FBG and glycated haemoglobin (HbA1c) (6.7% in men and 3.8% in women vs. 12.1% in men and 5.6% in women). More than a quarter (26.1%) of men and 8.7% of women had estimated 10-year risk of cardiovascular disease of 10% or more. This study revealed the high prevalence of NCD metabolic risk factors among the urban public employees in the highland of Ethiopia.

Pathways linking socioeconomic status to small-for-gestational-age (SGA) infants among primiparae: a birth cohort study in China

OBJECTIVES

Evidence about the relationship between socioeconomic status (SES) and small-for-gestational-age (SGA) infants was insufficient among Chinese primiparae. In addition, factors that may mediate this relationship are poorly understood. The purpose of this study was to investigate the risk of and mediators between SES and SGA.

DESIGN

Retrospective cohort study.

SETTING

Wuhan, Hubei, China.

METHOD

Participants were recruited from patients who gave birth in the maternity care hospital of Wuhan between September 2012 and October 2014. Logistic regression models were used to estimate the association between SES and SGA. Pathway analysis was performed to examine the contribution of maternal lifestyles and pregnancy-induced hypertension syndrome (PIH) to the relationship between SES and SGA. Total effect, direct effect and indirect effect of SES on SGA were measured. Effect sizes were evaluated by unstandardised estimates (B) and standardised estimates (ß).

RESULTS

Among 8737 primiparae, 927 (10.61%) pregnant women had babies with SGA. High SES was inversely associated with risk of SGA (OR 0.856; 95% CI 0.737 to 0.995) after adjustment for potential confounders. Maternal obstetric characteristics, lifestyles and PIH completely mediated SES and SGA (indirect effect: B=-0.067, 95% CI -0.108 to -0.026). The indirect effect of SES was strengthened by PIH (B=-0.029), a multivitamin supplement (B=-0.021), prepregnancy body mass index (BMI) ≥18.50 (B=-0.009) and prepregnancy BMI ≥18.50 to gestational weight gain (GWG) not below the Institute of Medicine (IOM) recommendations (B=-0.003).

CONCLUSIONS

Women from high SES predicted lower risk of PIH, more chances to take a multivitamin supplement during early pregnancy, keeping prepregnancy BMI ≥18.50 kg/cm² and gaining adequate gestational weight which was not below IOM recommendations. Furthermore, lower risk of PIH, more chances to take a multivitamin supplement, prepregnancy BMI ≥18.50 kg/cm² and GWG not below IOM recommendations were associated with a lower risk of SGA infants.

Birth weight, gestational age and late adolescent liver function using twin status as instrumental variable in a Hong Kong Chinese birth cohort: "Children of 1997"

Birth weight (BW) is inversely associated with diabetes and liver function in Mendelian Randomization studies. Observationally, lower BW is usually also associated with poorer liver function. However, these studies could be confounded by socioeconomic position. Here we assessed if BW is associated with liver function in a unique population with little socio-economic patterning of BW, using both instrumental variable and an observational analysis. We used instrumental variable analysis (IVA) to assess the association of BW with liver function (alanine transaminase (ALT), alkaline phosphatase (ALP), bilirubin, and albumin) at ~17 years with twin status as an instrumental variable in the prospective population-representative "Children of 1997" birth cohort (n = 8327). We also conducted an observational analysis adjusted for sex, maternal age, maternal migrant status, smoking and parental socio-economic position. A generalized linear model with gamma family was used for ALT, ALP, and bilirubin because they are not normally distributed. Using IVA, BW was not associated with ALT, ALP or bilirubin, but was possibly negatively associated with albumin (-1.12 g/L, 95% confidence interval (CI) -2.08 to -0.16). Observationally, BW was negatively associated with ALT (-1.23 IU/L, 95% CI -2.16 to -0.30), ALP (-1.72 IU/L, 95% CI -3.43 to -0.01) and higher albumin (-0.23 g/L, 95% CI -0.40 to -0.06). Poor liver function may be a pathway by which the risks of lower BW are actuated. This insight might help identify post-natal targets of intervention to mitigate the adverse health effects of lower birth weight.

Diesel, children and respiratory disease

Air pollution generated in urban areas is a global public health burden since half of the world's population live in either cities, megacities or periurban areas. Its direct effects include initiating and exacerbating disease, with indirect effects on health mediated via climate change putting the basic needs of water, air and food at risk.

Allostatic load: A theoretical model for understanding the relationship between maternal posttraumatic stress disorder and adverse birth outcomes

BACKGROUND

Adverse birth outcomes such as preterm birth and low birth weight are significant public health concerns and contribute to neonatal morbidity and mortality. Studies have increasingly been exploring the predictive effects of maternal posttraumatic stress disorder (PTSD) on adverse birth outcomes. However, the biological mechanisms by which maternal PTSD affects birth outcomes are not well understood. Allostatic load refers to the cumulative dysregulations of the multiple physiological systems as a response to multiple social-ecological levels of chronic stress. Allostatic load has been well documented in relation to both chronic stress and adverse health outcomes in non-pregnant populations. However, the mediating role of allostatic load is less understood when it comes to maternal PTSD and adverse birth outcomes.

OBJECTIVE

To propose a theoretical model that depicts how allostatic load could mediate the impact of maternal PTSD on birth outcomes.

METHOD

We followed the procedures for theory synthesis approach described by Walker and Avant (2011), including specifying focal concepts, identifying related factors and relationships, and constructing an integrated representation. We first present a theoretical overview of the allostatic load theory and the other 4 relevant theoretical models. Then we provide a brief narrative review of literature that empirically supports the propositions of the integrated model. Finally, we describe our theoretical model.

FINDINGS/CONCLUSIONS

The theoretical model synthesized has the potential to advance perinatal research by delineating multiple biomarkers to be used in future. After it is well validated, it could be utilized as the theoretical basis for health care professionals to identify high-risk women by evaluating their experiences of psychosocial and traumatic stress and to develop and evaluate service delivery and clinical interventions that might modify maternal perceptions or experiences of stress and eliminate their impacts on adverse birth outcomes.

Prenatal exposure to maternal depression and anxiety on imprinted gene expression in placenta and infant neurodevelopment and growth

BackgroundDepression and/or anxiety during pregnancy have been associated with impaired fetal growth and neurodevelopment. Because placental imprinted genes play a central role in fetal development and respond to environmental stressors, we hypothesized that imprinted gene expression would be affected by prenatal depression and anxiety.MethodsPlacental gene expression was compared between mothers with prenatal depression and/or anxiety/obsessive compulsive disorder/panic and control mothers without psychiatric history (n=458) in the Rhode Island Child Health Study.ResultsTwenty-nine genes were identified as being significantly differentially expressed between placentae from infants of mothers with both depression and anxiety (n=54), with depression (n=89), or who took perinatal psychiatric medications (n=29) and control mother/infant pairs, with most genes having decreased expression in the stressed group. Among placentae from infants of mothers with depression, we found no differences in expression by medication use, indicating that our results are related to the stressor rather than the treatments. We did not find any relationship between the stress-associated gene expression and neonatal neurodevelopment, as measured using the Neonatal Intensive Care Unit Network Neurobehavioral Scale.ConclusionsThis variation in expression may be part of an adaptive mechanism by which the placenta buffers the infant from the effects of maternal stress.

Macronutrient and fibre intake of young Spanish children with reference to their in utero growth status: Are they eating a healthy diet?

AIM

To compare macronutrient and fibre intake by pre-school children born with intra-uterine growth restriction (IUGR) or as appropriate for gestational age (AGA) and to compare their intake with paediatric nutritional recommendations for identification of potential areas of modification during early life.

METHODS

A parental 3-day dietary record was obtained for children of age 1-6 years, born at Hospital Clinic, Barcelona, Spain (2002-2007) with IUGR (n = 37) or AGA (n = 53). Mean nutrient intake (adjusted for body mass index), nutrient adequacy ratios (NAR) and percentage of energy intake (EI%) were compared.

RESULTS

Macronutrient and fibre intake of the two groups did not differ significantly. However, IUGR children showed significantly higher than the recommended levels of protein EI% (18 (95% confidence interval (CI) 16-19)), NAR for saturated fatty acids (SFAs) (1.2 (95% CI 1.1-1.5)) and NAR for carbohydrate (1.4 (95% CI 1.2-1.6)) and significantly lower than the recommended levels of NAR for unsaturated fatty acids (UFAs) (0.6 (95% CI 0.5-0.8)) and for fibre (0.6 (95% CI 0.5-0.8)). Likewise, children born with AGA showed similar pattern compared to the recommended levels for protein EI% (17 (95% CI 16-18)), NAR for SFAs (1.3 (95% CI 1.2-1.4)), NAR for UFAs (0.6 (95% CI 0.5-0.7)) and NAR for fibre (0.8 (95% CI 0.7-0.9)).

CONCLUSION

Spanish pre-school children consume proteins and SFAs in abundance and UFAs and fibre in moderation. Reinforcement of healthy eating is recommended for long-term health benefits, especially for at-risk children born with IUGR, whose consumption of carbohydrate is additionally greater than that recommended.

Birth weight trends in England and Wales (1986-2012): babies are getting heavier

INTRODUCTION

Birth weight is a strong predictor of infant mortality, morbidity and later disease risk. Previous work from the 1980s indicated a shift in the UK towards heavier births; this descriptive analysis looks at more recent trends.

METHODS

Office for National Statistics (ONS) registration data on 17.2 million live, single births from 1986 to 2012 were investigated for temporal trends in mean birth weight, potential years of birth weight change and changes in the proportions of very low (<1500 g), low (<2500 g) and high (≥4000 g) birth weight. Analysis used multiple linear and logistic regression adjusted for maternal age, marital status, area-level deprivation and ethnicity. Additional analyses used the ONS NHS Numbers for Babies data set for 2006-2012, which has information on individual ethnicity and gestational age.

RESULTS

Over 27 years there was an increase in birth weight of 43 g (95% CI 42 to 44) in females and 44 g (95% CI 43 to 45) in males, driven by birth weight increases between 1986-1990 and 2007-2012. There was a concurrent decreased risk of having low birth weight but an 8% increased risk in males and 10% increased risk in females of having high birth weight. For 2006-2012 the birth weight increase was greater in preterm as compared with term births.

CONCLUSIONS

Since 1986 the birth weight distribution of live, single births in England and Wales has shifted towards heavier births, partly explained by increases in maternal age and non-white ethnicity, as well as changes in deprivation levels. Other potential influences include increases in maternal obesity and reductions in smoking prevalence particularly following the introduction of legislation restricting smoking in public places in 2007.

Birth size, body composition, and adrenal androgens as determinants of bone mineral density in mid-childhood

BackgroundBirth weight has an impact on adult bone mass. Higher birth weight is associated with greater bone mineral content (BMC) and children born small for gestational age (SGA) are at an increased risk for impaired accrual of bone mass. Our aim was to study whether the impact of birth size or early childhood growth on bone mass is visible already in mid-childhood.MethodsWe studied 49 children born large for gestational age (LGA), 56 children born appropriate for gestational age (AGA), and 23 children born SGA at 5.0-8.7 years of age. Body composition was assessed by whole-body dual-energy X-ray absorptiometry. Fasting blood samples and anthropometric data were collected.ResultsThe children born SGA had lower bone mineral density (BMD) Z-score (P<0.001) and age- and sex-adjusted BMD (P<0.005) than the LGA and AGA children. Adjusted BMC, muscle mass, and body fat percentage (%BF) did not differ between the study groups. Muscle mass, BMI SD score (SDS), %BF, and serum dehydroepiandrosterone sulfate (DHEAS) concentration were the strongest predictors of high BMD in mid-childhood.ConclusionSGA-born children had lower BMD in mid-childhood compared with AGA- and LGA-born ones. Muscle mass or BMI SDS, %BF, and DHEAS were significant predictors of childhood BMD.

Birth size and gestational age in opposite-sex twins as compared to same-sex twins: An individual-based pooled analysis of 21 cohorts

It is well established that boys are born heavier and longer than girls, but it remains unclear whether birth size in twins is affected by the sex of their co-twin. We conducted an individual-based pooled analysis of 21 twin cohorts in 15 countries derived from the COllaborative project of Development of Anthropometrical measures in Twins (CODATwins), including 67,850 dizygotic twin individuals. Linear regression analyses showed that boys having a co-twin sister were, on average, 31 g (95% CI 18 to 45) heavier and 0.16 cm (95% CI 0.045 to 0.274) longer than those with a co-twin brother. In girls, birth size was not associated (5 g birth weight; 95% CI −8 to −18 and −0.089 cm birth length; 95% CI −0.202 to 0.025) with the sex of the co-twin. Gestational age was slightly shorter in boy-boy pairs than in boy-girl and girl-girl pairs. When birth size was standardized by gestational age, the magnitude of the associations was attenuated in boys, particularly for birth weight. In conclusion, boys with a co-twin sister are heavier and longer at birth than those with a co-twin brother. However, these differences are modest and partly explained by a longer gestation in the presence of a co-twin sister.

Increased risk of asthma in overweight children born large for gestational age

BACKGROUND

Being born large for gestational age (LGA) is a marker of increased growth velocity in fetal life and a risk factor for childhood overweight. Both being born LGA and childhood overweight may influence the development of asthma, although the role of overweight in the association between LGA and childhood asthma is unclear. Importantly, recent studies have suggested that the association between overweight and asthma may be related to non-allergic pathways. If this also applies to the association between LGA and asthma, the association between being born LGA and asthma may be different for atopic and non-atopic children.

OBJECTIVE

We investigated the association of being LGA with the prevalence of asthma at age 8 in atopic and non-atopic children and the role of overweight in this association.

METHODS

Complete data on asthma, anthropometry and atopy at age of 8 years, and potential confounders were available for 1608 participants of the PIAMA birth cohort. Odds ratios for the association between LGA and asthma in atopic and non-atopic children were estimated by logistic regression analysis adjusting for potential confounders. Overweight was assessed as a potential modifier of the association between LGA and asthma.

RESULTS

Being born LGA was not significantly associated with asthma at age of 8 in atopic and non-atopic children. However, overweight at age of 8 years modified the association between asthma at age of 8 and LGA. In non-atopic children, children who were born LGA and were overweight at age of 8 years had a significantly increased odds of asthma compared to non-LGA, non-overweight children (adj OR 7.04; 95% CI 2.2-24).

CONCLUSIONS

We observed that non-atopic children born LGA, who were overweight by 8 years have an increased risk of asthma. If confirmed, these findings suggest that non-atopic children born LGA may be identified early in life as a high-risk group for asthma.

Birth weight predicts aging trajectory: A hypothesis

Increasing evidence suggests that risk for age-related disease and longevity can be programmed early in life. In human populations, convincing evidence has been accumulated indicating that intrauterine growth restriction (IUGR) resulting in low birth weight (<2.5 kg) followed by postnatal catch-up growth is associated with various aspects of metabolic syndrome, type 2 diabetes and cardiovascular disease in adulthood. Fetal macrosomia (birth weight > 4.5 kg), by contrast, is associated with high risk of non-diabetic obesity and cancers in later life. Developmental modification of epigenetic patterns is considered to be a central mechanism in determining such developmentally programmed phenotypes. Growth hormone/insulin-like growth factor (GH/IGF) axis is likely a key driver of these processes. In this review, evidence is discussed that suggests that different aging trajectories can be realized depending on developmentally programmed life-course dynamics of IGF-1. In this hypothetical scenario, IUGR-induced deficit of IGF-1 causes "diabetic" aging trajectory associated with various metabolic disorders in adulthood, while fetal macrosomia-induced excessive levels of IGF-1 lead to "cancerous" aging trajectory. If the above reasoning is correct, then both low and high birth weights are predictors of short life expectancy, while the normal birth weight is a predictor of "normal" aging and maximum longevity.

Evaluation of Mineral Concentrations in Maternal Serum Before and After Birth and in Newborn Cord Blood Postpartum-Preliminary Study

The mineral levels in maternal serum change during pregnancy and may be correlated with those of newborn cord blood. The aim of this study was to evaluate the concentrations of calcium (Ca), magnesium (Mg), zinc (Zn), iron (Fe), and copper (Cu) in maternal blood before and after delivery and in umbilical cord vein and artery serum. The study was carried out in 64 Caucasian pregnant women who delivered in a district hospital in Greater Poland region, aged 28.1 ± 5.4 years, with a mean gestational age of 39.2 ± 1.3 weeks. Blood samples were taken from women 2-8 h before delivery and immediately after childbirth. The umbilical cord artery and vein blood of newborns was obtained immediately after childbirth. The levels of minerals in serum were determined by flame atomic absorption spectrometry. A significant drop in the concentrations of Mg (17.71 ± 1.51 vs 17.07 ± 1.61 μg/ml; p < 0.007), Fe (1.08 ± 0.46 vs 0.82 ± 0.35 μg/ml; p < 0.0004), and Zn (0.63 ± 0.17 vs 0.46 ± 0.16; p < 0.0001) in maternal serum was found after delivery. Moreover, higher levels of Ca, Fe, and Zn and lower levels of Cu were observed in the umbilical vein (Ca: 102.80 ± 7.80 μg/ml; p < 0.0001, Fe: 1.96 ± 0.43 μg/ml; p < 0.0001, Zn: 0.65 ± 0.16 μg/ml; p < 0.0001, Cu: 0.36 ± 0.09 μg/ml; p < 0.0001) and in the umbilical artery cord blood (Ca: 98.07 ± 8.18 μg/ml; p < 0.0001, Fe: 1.63 ± 0.30 μg/ml; p < 0.0001, Zn: 0.65 ± 0.15 μg/ml; p < 0.0001, and Cu: 0.36 ± 0.10 μg/ml; p < 0.0001) compared to the maternal serum (Ca: 85.05 ± 10.76 μg/ml, Fe: 0.82 ± 0.35 μg/ml, Zn: 0.46 ± 0.16 μg/ml, and Cu: 1.90 ± 0.35 μg/ml). Fe levels in the cord artery serum negatively correlated with blood loss during delivery (R = -0.48; p = 0.01), while the Ca concentration in the maternal serum after birth decreased with the age of the women (R = -0.25; p = 0.03). In conclusion, it seems that the process of birth alters the mineral levels in pregnant women's blood. Moreover, it was found that blood loss and the age of the mother are associated with mineral concentrations in the maternal serum and cord artery blood.

Subclinical Changes in Maternal Thyroid Function Parameters in Pregnancy and Fetal Growth

CONTEXT

Overt thyroid disease in pregnancy is a known risk factor for abnormal fetal growth and development. Data on the effects of milder forms of variation in maternal thyroid function on intrauterine growth are less well examined.

OBJECTIVE

We explored these associations using repeated thyroid hormone and ultrasound measurements.

DESIGN, SETTING, AND PARTICIPANTS

Data were obtained from 439 pregnant women without diagnosed thyroid disease who were participants in a case-control study of preterm birth nested within an ongoing prospective birth cohort in Boston, Massachusetts.

MAIN OUTCOME MEASURES

Ultrasound and delivery indices of fetal growth were standardized to those measured in a larger population.

RESULTS

At median 10, 18, and 26 weeks of gestation, we observed significant inverse associations between free thyroxine (FT4) and birth weight z scores, with the strongest association detected at median 10 weeks, at which time a 10% increase in FT4 was associated with a 0.02 z score decrease (∼8.5 g) in birth weight (β = -0.41 for ln-transformed FT4; 95% confidence interval, -0.64 to -0.18). FT4 was also inversely associated with repeated measurements of estimated fetal weight, head circumference, and abdominal circumference. We observed weaker inverse associations for total T4 and a positive relationship between total triiodothyronine and birth weight z scores. We did not observe any associations for thyroid-stimulating hormone.

CONCLUSION

In pregnant women without overt thyroid disease, subclinical changes in thyroid function parameters may influence fetal growth.

Sleep duration of 24 h is associated with birth weight in nulli- but not multiparous women

OBJECTIVES

This study aimed to evaluate the association between nightly, napping, and 24-h sleep duration throughout pregnancy and birth weight z-score among nulli- and multiparous women.

METHODS

Nightly,napping, and 24-h sleep duration and birth weight z-score (calculated on thebasis of the International Fetal and Newborn Growth Consortium for the 21st century standards) were studied in a cohort of 176 pregnant women from Brazil. Linear mixed-effect analyses were performed to assess the longitudinal evolution of sleep duration and the best unbiased linear predictors of the random coefficients were estimated. The best unbiased linear predictor estimates of sleep duration intercept and slope were included in the linear regression models with birth weight z-score as the outcome.

RESULTS

The mean hours of nightly sleep decreased during pregnancy in nulliparous women (β = -0.55; 95% confidence interval [CI], -0.83 to -0.27) but the decrease was not statistically significant in multiparous women (β = -0.19; 95% CI, -0.30 to 0.01). Twenty-four hour sleep duration decreased during pregnancy in both multiparous (β = -0.50; 95% CI, -0.76 to -0.25) and nulliparous women (β = 0.77; 95% CI, -1.06 to -0.48). Napping sleep duration did not change in either group. Among the nulliparous women, both first-trimester 24-h sleep duration and its change throughout pregnancy were inversely associated with birth weight (β = -0.44; 95% CI, -0.68 to -0.21; β = -1.75; 95% CI, -3.17 to -0.30, respectively). No associations were detected in multiparous women for nightly and napping sleep duration.

CONCLUSIONS

Nulliparous women with greater decreases in sleep duration throughout their pregnancy gave birth to newborns with lower birth weight z-scores.

Respiratory morbidity through the first decade of life in a national cohort of children born extremely preterm

BACKGROUND

Advances in perinatal care have markedly increased the prospects of survival for infants born extremely preterm (EP). The aim of this study was to investigate hospitalisation rates and respiratory morbidity from five to 11 years of age in a prospective national cohort of EP children born in the surfactant era.

METHODS

This was a national prospective cohort study of all children born in Norway during 1999 and 2000 with gestational age (GA) < 28 weeks or birth weight < 1000 grams, and of individually matched term-born controls recruited for a regional subsample. Data on hospital admissions, respiratory symptoms, and use of asthma medication was obtained by parental questionnaires at 11 years of age.

RESULTS

Questionnaires were returned for 232/372 (62%) EP-born and 57/61 (93%) regional term-born controls. Throughout the study period, 67 (29%) EP-born and seven (13%) term-born controls were admitted to hospital (odds ratio (OR) 2.90, 95% confidence interval (CI): 1.25, 6.72). Admissions were mainly due to surgical procedures, with only 12% due to respiratory causes, and were not influenced by neonatal bronchopulmonary dysplasia (BPD) or low GA(≤ 25 weeks). Respiratory symptoms, asthma and use of asthma medication tended to be more common for EP-born, significantly so for medication use and wheeze on exercise. Neonatal BPD was a risk factor for medication use, but not for current wheeze. In multivariate regression models, home oxygen after discharge (OR 4.84, 95% CI: 1.38, 17.06) and parental asthma (OR 4.38, 95% CI: 1.69, 11.38) predicted current asthma, but neither BPD nor low GA were associated with respiratory symptoms at 11 years of age.

CONCLUSIONS

Hospitalisation rates five to 11 years after EP birth were low, but twice those of term-born controls, and unrelated to neonatal BPD and low GA. Respiratory causes were rare. Respiratory complaints were more common in children born EP, but the burden of symptoms had declined since early childhood.

Analysis of low birth weight and its co-variants in Bangladesh based on a sub-sample from nationally representative survey

BACKGROUND

Low birth weight (LBW) remains a leading global cause of childhood morbidity and mortality. This study leverages a large national survey to determine current prevalence and socioeconomic, demographic and heath related factors associated with LBW in Bangladesh.

METHODS

Data from the Multiple Indicator Cluster Survey (MICS) 2012-13 of Bangladesh were analyzed. A total of 2319 women for whom contemporaneous birth weight data was available and who had a live birth in the two years preceding the survey were sampled for this study. However, this analysis only was able to take advantage of 29% of the total sample with 71% missing birth weight for newborns. The indicator, LBW (< 2500 g) of infants, was examined as the outcome variable in association with different socioeconomic, demographic and health-related covariates. Mixed-effects logistic regression was performed to identify possible factors related to LBW.

RESULTS

In the selected sub-sample, about 20% of infants were born with LBW, with lowest rates observed in Rajshahi (11%) and highest rates in Rangpur (28%). Education of mothers (adjusted odds ratio [AOR] 0.52, 95% confidence interval [CI] 0.39-0.68 for secondary or higher educated mother) and poor antenatal care (ANC) (AOR 1.40, 95% CI 1.04-1.90) were associated with LBW after adjusting for mother's age, parity and cluster effects. Mothers from wealthier families were less likely to give birth to an LBW infant. Further indicators that wealth continues to play a role in LBW were that place of delivery, ANC and delivery assistance by quality health workers were significantly associated with LBW. However there has been a notable fall in LBW prevalence in Bangladesh since the last comparable survey (prevalence 36%), and an evidence of possible elimination of rural/urban disparities.

CONCLUSIONS

Low birth weight remains associated with key indicators not just of maternal poverty (notably adequate maternal education) but also markers of structural poverty in health care (notably quality ANC). Results based on this sub-sample indicate LBW is still a public health concern in Bangladesh and an integrated effort from all stakeholders should be continued and interventions based on the study findings should be devised to further reduce the risk of LBW.

Metabolic signatures of birthweight in 18 288 adolescents and adults

BACKGROUND

Lower birthweight is associated with increased susceptibility to cardiometabolic diseases in adulthood, but the underlying molecular pathways are incompletely understood. We examined associations of birthweight with a comprehensive metabolic profile measured in adolescents and adults.

METHODS

High-throughput nuclear magnetic resonance metabolomics and biochemical assays were used to quantify 87 circulating metabolic measures in seven cohorts from Finland and the UK, comprising altogether 18 288 individuals (mean age 26 years, range 15-75). Metabolic associations with birthweight were assessed by linear regression models adjusted for sex, gestational age and age at blood sampling. The metabolic associations with birthweight were compared with the corresponding associations with adult body mass index (BMI).

RESULTS

Lower birthweight adjusted for gestational age was adversely associated with cardiometabolic biomarkers, including lipoprotein subclasses, fatty acids, amino acids and markers of inflammation and impaired liver function (P < 0.0015 for 46 measures). Associations were consistent across cohorts with different ages at metabolic profiling, but the magnitudes were weak. The pattern of metabolic deviations associated with lower birthweight resembled the metabolic signature of higher adult BMI (R² = 0.77) assessed at the same time as the metabolic profiling. The resemblance indicated that 1 kg lower birthweight is associated with similar metabolic aberrations as caused by 0.92 units higher BMI in adulthood.

CONCLUSIONS

Lower birthweight adjusted for gestational age is associated with adverse biomarker aberrations across multiple metabolic pathways. Coherent metabolic signatures between lower birthweight and higher adult adiposity suggest that shared molecular pathways may potentially underpin the metabolic deviations. However, the magnitudes of metabolic associations with birthweight are modest in comparison to the effects of adiposity, implying that birthweight is only a weak indicator of the metabolic risk profile in adulthood.

Correlates of ideal cardiovascular health in European adolescents: The HELENA study

BACKGROUND AND AIMS

The ideal cardiovascular health (iCVH) construct consists of 4 health behaviors (smoking status, body mass index, physical activity and diet) and 3 health factors (total cholesterol, blood pressure and fasting glucose). A greater number of iCVH components in adolescence are related to better cardiovascular health, but little is known about the correlates of iCVH in adolescents. Thus, the aim of the study was to examine correlates of iCVH in European adolescents.

METHODS AND RESULTS

The study comprised 637 European adolescents with complete iCVH data. Participants were part of the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional, multicenter study conducted in 9 different European countries. Correlates investigated were sex and age, family affluence scale, maternal education, geographic location, sleep time, television viewing, duration of pregnancy, birth weight and breastfeeding. Younger adolescents, those whose mothers had medium/high education or those who watched television less than 2 h per day had a greater number of iCVH components compared to those who were older, had a mother with low education or watched television 2 h or more daily (P ≤ 0.01).

CONCLUSION

Since in our study older adolescents had worse iCVH than younger adolescents, early promotion of cardiovascular health may be important. Future studies may also investigate the usefulness of limiting television viewing to promote iCVH. Finally, since adolescents of mothers with low education had poorer iCVH, it may be of special interest to tailor public health promotion to adolescents from families with low socioeconomic status.

New Insights into Cardiac and Vascular Natriuretic Peptides: Findings from Young Adults Born with Very Low Birth Weight

BACKGROUND

In community studies, plasma B-type natriuretic peptide (BNP) is positively associated with cardiovascular disorders. Those born with very low birth weight (VLBW) have increased risk of metabolic and vascular disorders in later life, but plasma concentrations of natriuretic peptides have not been studied. The objectives here were to evaluate BNP and C-type natriuretic peptide (CNP)—a putative marker of vascular risk—in young adults born with VLBW.

METHODS

In all, 220 VLBW cases and 97 matched controls were studied 28 years after birth during a 2-day period at 1 research center. Aminoterminal (NT) products (NTproBNP, NTproCNP) and a range of conventional vascular risk factors including echocardiographic indices were measured along with genetic polymorphisms known to increase plasma NTproBNP.

RESULTS

VLBW individuals were smaller, had smaller hearts, reduced stroke volume and endothelial function, and higher systolic blood pressure and arterial elastance. Of the many humoral vascular and metabolic risk factors measured, including NTproBNP, only plasma NTproCNP (higher in VLBW individuals) differed significantly. Across all individuals, associations of NTproCNP with each of 7 conventional risk factors, as well as with arterial elastance, were positive, whereas associations of NTproBNP with risk were all inverse. In multivariate analysis, the genetic variant rs198358 was independently associated with NTproBNP.

CONCLUSIONS

In young adults at increased risk of cardiovascular disease, higher NTproCNP likely reflects a compensatory vascular response to vascular stress, whereas the negative link with NTproBNP likely reflects beneficial genetic mutations. The ratio of NTproBNP to NTproCNP may provide a novel index of ideal cardiovascular health.