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Diao S, Chen C, Benani A, Magnan C, Van Steenwinckel J, Gressens P, Cruciani-Guglielmacci C, Jacquens A, Bokobza C. Preterm birth: A neuroinflammatory origin for metabolic diseases? Brain Behav Immun Health 2024; 37:100745. [PMID: 38511150 PMCID: PMC10950814 DOI: 10.1016/j.bbih.2024.100745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/16/2024] [Accepted: 02/21/2024] [Indexed: 03/22/2024] Open
Abstract
Preterm birth and its related complications have become more and more common as neonatal medicine advances. The concept of "developmental origins of health and disease" has raised awareness of adverse perinatal events in the development of diseases later in life. To explore this concept, we propose that encephalopathy of prematurity (EoP) as a potential pro-inflammatory early life event becomes a novel risk factor for metabolic diseases in children/adolescents and adulthood. Here, we review epidemiological evidence that links preterm birth to metabolic diseases and discuss possible synergic roles of preterm birth and neuroinflammation from EoP in the development of metabolic diseases. In addition, we explore theoretical underlying mechanisms regarding developmental programming of the energy control system and HPA axis.
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Affiliation(s)
- Sihao Diao
- Université Paris Cité, Inserm, NeuroDiderot, 75019, Paris, France
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, 201102, China
- Key Laboratory of Neonatal Diseases, National Health Commission, China
| | - Chao Chen
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, 201102, China
- Key Laboratory of Neonatal Diseases, National Health Commission, China
| | - Alexandre Benani
- CSGA, Centre des Sciences du Goût et de l'Alimentation, UMR 6265 CNRS, INRAE, Institut Agro Dijon, Université Bourgogne Franche-Comté, Dijon, France
| | | | | | - Pierre Gressens
- Université Paris Cité, Inserm, NeuroDiderot, 75019, Paris, France
| | | | - Alice Jacquens
- Université Paris Cité, Inserm, NeuroDiderot, 75019, Paris, France
- Department of Anesthesia and Critical Care, APHP-Sorbonne University, Hôpital La Pitié- Salpêtrière, Paris, France
| | - Cindy Bokobza
- Université Paris Cité, Inserm, NeuroDiderot, 75019, Paris, France
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Tsaitlin-Mor L, Cahen-Peretz A, Bentov Y, Ben-Shushan T, Levine H, Walfisch A. Long-term Risk for Type 1 Diabetes and Obesity in Early Term Born Offspring: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2024; 109:1393-1401. [PMID: 38079466 DOI: 10.1210/clinem/dgad715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Indexed: 04/21/2024]
Abstract
CONTEXT Prematurity increases the long-term risks for endocrine and metabolic morbidity of offspring, but there is uncertainty regarding the risks for early-term deliveries (370/7-386/7 weeks of gestation). OBJECTIVE We aim to evaluate whether early-term deliveries increase the long-term risk for type 1 diabetes and obesity of offspring up to the age of 18 years compared with full-term children. PubMed, Medline, and EMBASE were searched. Observational cohort studies addressing the association between early-term delivery and long-term risk for type 1 diabetes and obesity, were included. Two independent reviewers extracted data and assessed risk of bias. Pooled relative risks (RRs) and heterogeneity were determined. Publication bias was assessed by funnel plots with Egger's regression line and contours, and sensitivity analyses were performed. RESULTS Eleven studies were included following a screen of 7500 abstracts. All studies were scored as high quality according to the Newcastle-Ottawa Quality Assessment Scale. Early-term delivery was significantly associated with an increased risk for type 1 diabetes (RR 1.19, 1.13-1.25), while the association was weaker for overweight and obesity (RR 1.05, 0.97-1.12). It is challenging to determine whether the association between early-term births and long-term morbidity represents a cause and effect relationship or is attributable to confounders. Most of the included studies adjusted for at least some possible confounders. CONCLUSION Compared with full-term offspring, early-term delivery poses a modest risk for long-term pediatric type 1 diabetes. Our analysis supports that, whenever medically possible, elective delivery should be avoided before 39 completed weeks of gestation.
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Affiliation(s)
- Lilah Tsaitlin-Mor
- Obstetrics and Gynecology Department, Hadassah Mount Scopus Medical Center, Jerusalem, PC 9851328, Israel
- Faculty of Medicine, Hadassah-Hebrew University, Jerusalem, PC 9112102, Israel
| | - Adva Cahen-Peretz
- Obstetrics and Gynecology Department, Hadassah Mount Scopus Medical Center, Jerusalem, PC 9851328, Israel
- Faculty of Medicine, Hadassah-Hebrew University, Jerusalem, PC 9112102, Israel
| | - Yaakov Bentov
- Obstetrics and Gynecology Department, Hadassah Mount Scopus Medical Center, Jerusalem, PC 9851328, Israel
| | - Tomer Ben-Shushan
- Braun School of Public Health and Community Medicine, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, PC 9112102, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, PC 9112102, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Rabin Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, PC 4941492, Israel
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Vinther JL, Ekstrøm CT, Sørensen TIA, Cederkvist L, Lawlor DA, Andersen AMN. Gestational age and trajectories of body mass index and height from birth through adolescence in the Danish National Birth Cohort. Sci Rep 2023; 13:3298. [PMID: 36843043 PMCID: PMC9968714 DOI: 10.1038/s41598-023-30123-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/16/2023] [Indexed: 02/27/2023] Open
Abstract
Preterm birth is associated with smaller body dimensions at birth. The impact on body size in later life, measured by body mass index (BMI) and height, remains unclear. A prospective register-based cohort study with 62,625 singletons from the Danish National Birth Cohort born 1996-2003 for whom information on gestational age (GA) at birth, length or weight at birth, and at least two growth measurements scheduled at the ages of 5 and 12 months, and 7, 11 and 18 years were available. Linear mixed effects with splines, stratified by sex, and adjusted for confounders were used to estimate standardised BMI and height. GA was positively associated with BMI in infancy, but differences between preterm and term children declined with age. By age 7, preterm children had slightly lower BMI than term children, whereas no difference was observed by adolescence (mean difference in BMI z-score - 0.28 to 0.15). GA was strongly associated with height in infancy, but mean differences between individuals born preterm and term declined during childhood. By adolescence, the most preterm individuals remained shorter than their term peers (mean difference in height z-score from - 1.00 to - 0.28). The lower BMI in preterm infants relative to term infants equalizes during childhood, such that by adolescence there is no clear difference. Height is strongly positively associated with GA in early childhood, whilst by end of adolescence individuals born preterm remain slightly shorter than term peers.
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Affiliation(s)
- Johan L. Vinther
- grid.5254.60000 0001 0674 042XSection of Epidemiology, Department of Public Health, University of Copenhagen, Bartholinsgade 6Q, 2nd Fl., 1356 Copenhagen, Denmark
| | - Claus T. Ekstrøm
- grid.5254.60000 0001 0674 042XSection of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thorkild I. A. Sørensen
- grid.5254.60000 0001 0674 042XSection of Epidemiology, Department of Public Health, University of Copenhagen, Bartholinsgade 6Q, 2nd Fl., 1356 Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XNovo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Luise Cederkvist
- grid.5254.60000 0001 0674 042XSection of Epidemiology, Department of Public Health, University of Copenhagen, Bartholinsgade 6Q, 2nd Fl., 1356 Copenhagen, Denmark
| | - Deborah A. Lawlor
- grid.5337.20000 0004 1936 7603Population Health Science, Bristol Medical School, Bristol, BS8 2BN UK ,grid.5337.20000 0004 1936 7603MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, BS8 2BN UK
| | - Anne-Marie Nybo Andersen
- grid.5254.60000 0001 0674 042XSection of Epidemiology, Department of Public Health, University of Copenhagen, Bartholinsgade 6Q, 2nd Fl., 1356 Copenhagen, Denmark
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Lee S. Parenting experiences of mothers of moderate-to-late preterm children in South Korea: a qualitative study. CHILD HEALTH NURSING RESEARCH 2022; 28:247-258. [PMID: 36379601 PMCID: PMC9672526 DOI: 10.4094/chnr.2022.28.4.247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/18/2022] [Accepted: 08/29/2022] [Indexed: 11/19/2023] Open
Abstract
PURPOSE This study investigated the parenting experiences of mothers of young children born moderate-to-late preterm (MLPT) in South Korea. METHODS In this qualitative study, semi-structured focus group interviews were conducted with 10 mothers of MLPT children from infancy to preschool age. The interviews were video-recorded, transcribed verbatim, and analyzed using qualitative content analysis. RESULTS Four categories resulted from the analysis of parenting experiences of mothers with young MLPT children, as follows: "becoming a mother of an early-born child", "difficulties as the primary caregiver for a high-risk child", "helpful social support, but still a lack of professional support for parenting a high-risk child", and "mothers and children growing together". CONCLUSION Mothers of young MLPT children experienced difficulties due to concerns about their child's health, growth and development, and insufficient child-rearing support. Therefore, social support systems should be strengthened and more aggressive nursing strategies should be adopted for mothers of young MLPT children.
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Affiliation(s)
- Sangmi Lee
- Associate Professor, Department of Nursing, Dongyang University, Yeongu, Korea
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Baran J, Weres A, Baran R, Czenczek-Lewandowska E, Leszczak J, Wyszyńska J. Preterm Birth and the Type of Birth and Their Impact on the Incidence of Overweight and Obesity in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912042. [PMID: 36231343 PMCID: PMC9566099 DOI: 10.3390/ijerph191912042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 05/02/2023]
Abstract
The purpose of the study was to evaluate the influence of the type of birth and preterm birth on the risk of overweight and obesity in the children studied. The study involved 749 children of pre-school and school age, between 4 and 15 years of age. Information about the type of delivery and the potential preterm birth came from the child's health book and the mother's pregnancy card. The authors assessed the body height and body weight of each child. The analysis showed that on average every six children were born before due date (before the end of 37 weeks of gestation) and slightly more than 40% of the children were born by cesarean section (CS). A statistical analysis was performed, including descriptive statistics and Spearman's correlation, and to evaluate the differences in the analyzed groups, nonparametric tests and chi-square independence tests were used: the Mann-Whitney test, and the Kruskal-Wallis test due to the lack of a normalized distribution. The incidence of overweight and obesity was higher in 7-11-year-old boys born with CS vs. vaginal birth (VD) (p = 0.026). There were no statistically significant differences between BMI centile value and preterm birth. Cesarean section birth significantly increases the percentage of boys with overweight and obesity in early school age and may be associated with higher percentile values of children with BMI in this age group.
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Affiliation(s)
- Joanna Baran
- Institute of Health Sciences, Medical College, University of Rzeszów, 35-310 Rzeszów, Poland
- Natural and Medical Center for Innovative Research, 35-310 Rzeszów, Poland
- Correspondence:
| | - Aneta Weres
- Institute of Health Sciences, Medical College, University of Rzeszów, 35-310 Rzeszów, Poland
| | - Rafał Baran
- Institute of Health Sciences, Medical College, University of Rzeszów, 35-310 Rzeszów, Poland
- SOLUTION-Statistical Analysis, 35-120 Rzeszów, Poland
| | - Ewelina Czenczek-Lewandowska
- Institute of Health Sciences, Medical College, University of Rzeszów, 35-310 Rzeszów, Poland
- Natural and Medical Center for Innovative Research, 35-310 Rzeszów, Poland
| | - Justyna Leszczak
- Institute of Health Sciences, Medical College, University of Rzeszów, 35-310 Rzeszów, Poland
- Natural and Medical Center for Innovative Research, 35-310 Rzeszów, Poland
| | - Justyna Wyszyńska
- Institute of Health Sciences, Medical College, University of Rzeszów, 35-310 Rzeszów, Poland
- Natural and Medical Center for Innovative Research, 35-310 Rzeszów, Poland
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Chen J, Jin L, Wang F, Huang K, Wu W, Chen R, Maimaiti M, Chen S, Cao B, Zhu M, Wang C, Su Z, Liang Y, Yao H, Wei H, Zheng R, Du H, Luo F, Li P, Yu Y, Wang E, Dorazio RM, Fu J. Risk factors for obesity and overweight in Chinese children: a nationwide survey. Obesity (Silver Spring) 2022; 30:1842-1850. [PMID: 35918882 PMCID: PMC9545785 DOI: 10.1002/oby.23515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to analyze a comprehensive set of potential risk factors for obesity and overweight among Chinese children with a full range of ages and with wide geographical coverage. METHODS In the Prevalence and Risk Factors for Obesity and Diabetes in Youth (PRODY) study (2017-2019), the authors analyzed 193,997 children aged 3 to 18 years from 11 provinces, autonomous regions, and municipalities that are geographically representative of China. All participants underwent physical examinations, and their caregivers completed questionnaires including dietary, lifestyle, familial, and perinatal information of participants. A multilevel multinomial logistic regression model was used to evaluate the potential risk factors. RESULTS Among the actionable risk factors that were measured, higher consumption frequencies of animal offal (odds ratios [OR] for an additional time/day = 0.91, 95% CI: 0.88-0.95, same unit for OR below unless specified otherwise), dairy products (0.91, 95% CI: 0.88-0.94), freshwater products (0.94, 95% CI: 0.91-0.96), staple foods (0.94, 95% CI: 0.92-0.96), and coarse food grain (OR for every day vs. rarely = 0.92, 95% CI: 0.86-0.98) were associated with lower relative risk of obesity. However, higher restaurant-eating frequency (OR for >4 times/month vs. rarely = 1.21, 95% CI: 1.15-1.29) and longer screen-viewing duration (OR for >2 hours vs. <30 minutes = 1.16, 95% CI: 1.10-1.22) were associated with higher relative risk of obesity. Increased exercise frequency was associated with the lowest relative risk of obesity (OR for every day vs. rarely = 0.72, 95% CI: 0.68-0.77). CONCLUSIONS Changes in lifestyle and diet of Chinese children may help relieve their obesity burden.
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Affiliation(s)
- JingNan Chen
- Department of Endocrinology, The Children's HospitalZhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
| | - Lu Jin
- Department of Endocrinology, The Children's HospitalZhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
| | - FengLei Wang
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Ke Huang
- Department of Endocrinology, The Children's HospitalZhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
| | - Wei Wu
- Department of Endocrinology, The Children's HospitalZhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
| | - RuiMin Chen
- Department of Endocrinology, Genetics and MetabolismFuzhou Children's HospitalFuzhouChina
| | - Mireguli Maimaiti
- Department of Endocrinology, Genetics and MetabolismThe First Affiliated Hospital of Xinjiang Medical UniversityUrumqiChina
| | - ShaoKe Chen
- Department of PediatricsNanning Women and Children's HospitalNanningChina
| | - BingYan Cao
- Department of Endocrinology, Beijing Children's HospitalCapital Medical UniversityBeijingChina
| | - Min Zhu
- Department of EndocrinologyThe Children's Hospital of Chongqing Medical UniversityChongqingChina
| | - ChunLin Wang
- Department of Pediatrics, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Zhe Su
- Department of EndocrinologyShenzhen Children's HospitalShenzhenChina
| | - Yan Liang
- Department of PediatricsTongji Medical College of Huazhong University of Science and TechnologyWuhanChina
| | - Hui Yao
- Department of EndocrinologyWuhan Women and Children's Health Care CenterWuhanChina
| | - HaiYan Wei
- Department of Endocrinology, Genetics and MetabolismZhengzhou Children's HospitalZhengzhouChina
| | - RongXiu Zheng
- Department of PediatricsTianjin Medical University General HospitalTianjinChina
| | - HongWei Du
- Department of PediatricsThe First Bethune Hospital of Jilin UniversityJilinChina
| | - FeiHong Luo
- Department of Endocrinology, Genetics and MetabolismChildren's Hospital of Fudan UniversityShanghaiChina
| | - Pin Li
- Department of EndocrinologyChildren's Hospital of ShanghaiShanghaiChina
| | - YunXian Yu
- School of Public HealthZhejiang UniversityHangzhouChina
| | - Ergang Wang
- Department of Biomedical EngineeringDuke UniversityDurhamNorth CarolinaUSA
| | - Robert M. Dorazio
- Department of Endocrinology, The Children's HospitalZhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
| | - Junfen Fu
- Department of Endocrinology, The Children's HospitalZhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
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Massara P, Spiegel-Feld C, Hamilton J, Maguire JL, Birken C, Bandsma R, Comelli EM. Association between gut MIcrobiota, GROWth and Diet in peripubertal children from the TARGet Kids! cohort (The MiGrowD) study: protocol for studying gut microbiota at a community-based primary healthcare setting. BMJ Open 2022; 12:e057989. [PMID: 35534076 PMCID: PMC9086606 DOI: 10.1136/bmjopen-2021-057989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The gut microbiota interacts with diet to affect body health throughout the life cycle. Critical periods of growth, such as infancy and puberty, are characterised by microbiota remodelling and changes in dietary habits. While the relationship between gut microbiota and growth in early life has been studied, our understanding of this relationship during puberty remains limited. Here, we describe the MIcrobiota, GROWth and Diet in peripubertal children (The MiGrowD) study, which aims to assess the tripartite growth-gut microbiota-diet relationship at puberty. METHODS AND ANALYSIS The MiGrowD study will be a cross-sectional, community-based study involving children 8-12 years participating in the TARGet Kids! COHORT TARGet Kids! is a primary healthcare practice-based research network in Canada. Children will be asked to provide a stool sample, complete two non-consecutive 24-hour dietary recalls and a pubertal self-assessment based on Tanner Stages. Anthropometry will also be conducted. The primary outcome is the association between gut microbiota composition and longitudinal growth from birth until entry into the study. Anthropometrics data from birth will be from the data collected prospectively through TARGet Kids!. Body mass index z-scores will be calculated according to WHO. The secondary outcome is the association between gut microbiota, diet and pubertal stage. ETHICS AND DISSEMINATION Ethics approval has been obtained by the Hospital for Sick Children and St. Michael's Hospital-Unity Health, and the University of Toronto. Results will be disseminated in the public and academic sector, including participants, TARGet Kids! primary healthcare physicians teams, scientists via participation in the TARGet Kids! science and physician meetings, conferences and publications in peer-reviewed journals. The MiGrowD study results will help researchers understand the relationships underlying growth, gut microbiota and pubertal maturation in children.
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Affiliation(s)
- Paraskevi Massara
- Department of Nutritional Sciences, University of Toronto, Temerty Faculty of Medicine, Ontario, Toronto, Canada
- Translational Medicine Program, The Hospital for Sick Children, Ontario, Toronto, Canada
| | - Carolyn Spiegel-Feld
- Translational Medicine Program, The Hospital for Sick Children, Ontario, Toronto, Canada
| | - Jill Hamilton
- Department of Pediatrics, University of Toronto, Temerty Faculty of Medicine, Ontario, Toronto, Canada
- Division of Endocrinology, The Hospital for Sick Children, Ontario, Toronto, Canada
| | - Jonathon L Maguire
- Department of Nutritional Sciences, University of Toronto, Temerty Faculty of Medicine, Ontario, Toronto, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Ontario, Toronto, Canada
| | - Catherine Birken
- Department of Nutritional Sciences, University of Toronto, Temerty Faculty of Medicine, Ontario, Toronto, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Joannah and Brian Lawson Center for Child Nutrition, University of Toronto, Ontario, Toronto, Canada
- Pediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Robert Bandsma
- Department of Nutritional Sciences, University of Toronto, Temerty Faculty of Medicine, Ontario, Toronto, Canada
- Translational Medicine Program, The Hospital for Sick Children, Ontario, Toronto, Canada
| | - Elena M Comelli
- Department of Nutritional Sciences, University of Toronto, Temerty Faculty of Medicine, Ontario, Toronto, Canada
- Joannah and Brian Lawson Center for Child Nutrition, University of Toronto, Ontario, Toronto, Canada
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Yoshida‐Montezuma Y, Stone E, Iftikhar S, De Rubeis V, Andreacchi AT, Keown‐Stoneman C, Mbuagbaw L, Brown HK, de Souza RJ, Anderson LN. The association between late preterm birth and cardiometabolic conditions across the life course: A systematic review and meta-analysis. Paediatr Perinat Epidemiol 2022; 36:264-275. [PMID: 34806197 PMCID: PMC9299497 DOI: 10.1111/ppe.12831] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/23/2021] [Accepted: 09/26/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The effect of being born late preterm (34-36 weeks gestation) on cardiometabolic outcomes across the life course is unclear. OBJECTIVES To systematically review the association between being born late preterm (spontaneous or indicated), compared to the term and cardiometabolic outcomes in children and adults. DATA SOURCES EMBASE(Ovid), MEDLINE(Ovid), CINAHL. STUDY SELECTION AND DATA EXTRACTION Observational studies up to July 2021 were included. Study characteristics, gestational age, cardiometabolic outcomes, risk ratios (RRs), odds ratios (ORs), hazard ratios (HRs), mean differences and 95% confidence intervals (CIs) were extracted. SYNTHESIS We pooled converted RRs using random-effects meta-analyses for diabetes, hypertension, ischemic heart disease (IHD) and body mass index (BMI) with subgroups for children and adults. The risk of bias was assessed using the Newcastle-Ottawa scale and certainty of the evidence was assessed using the grading of recommendations, assessment, development and evaluation (GRADE) approach. RESULTS Forty-one studies were included (41,203,468 total participants; median: 5.0% late preterm). Late preterm birth was associated with increased diabetes (RR 1.24, 95% CI 1.17, 1.32; nine studies; n = 6,056,511; incidence 0.9%; I2 51%; low certainty) and hypertension (RR 1.21, 95% CI 1.13, 1.30; 11 studies; n = 3,983,141; incidence 3.4%; I2 64%; low certainty) in children and adults combined. Late preterm birth was associated with decreased BMI z-scores in children (standard mean difference -0.38; 95% CI -0.67, -0.09; five studies; n = 32,602; proportion late preterm 8.3%; I2 96%; very low certainty). There was insufficient evidence that late preterm birth was associated with increased IHD risk in adults (HR 1.20, 95% CI 0.89, 1.62; four studies; n = 2,706,806; incidence 0.3%; I2 87%; very low certainty). CONCLUSIONS Late preterm birth was associated with an increased risk of diabetes and hypertension. The certainty of the evidence was low or very low. Inconsistencies in late preterm and term definitions, confounding variables and outcome age limited the comparability of studies.
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Affiliation(s)
- Yulika Yoshida‐Montezuma
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Erica Stone
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Saman Iftikhar
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Vanessa De Rubeis
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Alessandra T. Andreacchi
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Charles Keown‐Stoneman
- Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoOntarioCanada,Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada,Biostatistics UnitFather Sean O’Sullivan Research CentreSt Joseph’s Healthcare HamiltonHamiltonOntarioCanada,Centre for the Development of Best Practices in HealthYaoundéCameroon,Department of Global HealthStellenbosch UniversityStellenboschSouth Africa
| | - Hilary K. Brown
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada,Department of Health & SocietyUniversity of Toronto ScarboroughTorontoOntarioCanada,Women’s College Research InstituteTorontoOntarioCanada
| | - Russell J. de Souza
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada,Population Health Research InstituteHamilton Health Sciences CorporationHamiltonOntarioCanada
| | - Laura N. Anderson
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada,Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoOntarioCanada
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9
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Bortolotto CC, Santos IS, Dos Santos Vaz J, Matijasevich A, Barros AJD, Barros FC, Santos LP, Munhoz TN. Prematurity and body composition at 6, 18, and 30 years of age: Pelotas (Brazil) 2004, 1993, and 1982 birth cohorts. BMC Public Health 2021; 21:321. [PMID: 33563247 PMCID: PMC7871570 DOI: 10.1186/s12889-021-10368-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/31/2021] [Indexed: 11/24/2022] Open
Abstract
Background We aimed to investigate the association between preterm birth and body composition at 6, 18, and 30 years of age using data from three population-based birth cohort studies. Methods Gestational age (GA), defined by the date of the last menstrual period (categorized in ≤33, 34–36, and ≥ 37 weeks), was gathered in the first 24-h after delivery for all live births occurring in the city of Pelotas, Brazil, in 2004, 1993 and 1982. Body composition was assessed by air-displacement plethysmography. Outcomes included fat mass (FM, kg), percent FM (%FM), FM index (FMI, kg/m2), fat-free mass (FFM, kg); percent FFM (%FFM), FFM index (FFMI, kg/m2), body mass index (BMI, kg/m2 at 18 years in the 1993 cohort and 30 years in the 1982 cohort), and BMI Z-score (at 6 years in the 2004 cohort). We further explored the association of birth weight for GA with body composition indicators and BMI. Crude and adjusted linear regressions provided beta coefficients with 95% confidence intervals (95%CI). Results A total of 3036, 3027, and 3369 participants, respectively, from the 2004, 1993, and 1982 cohorts were analyzed. At 6 years, preterm boys (born at 34–36 weeks) presented lower adjusted mean of FM (β = − 0.80 kg, − 1.45;-0.16, p = 0.046), %FM (β = − 2.39%, − 3.90;-0.88, p = 0.008), FMI (β = − 0.70 kg/m2, − 1.13;-0.27, p = 0.004) as well as lower FFM (β = − 0.4 kg, − 0.77; − 0.12, p = 0.010) and FFMI (β = − 0.3 kg/m2, − 0.46;-0.10, p < 0.001), and BMI Z-score (β = − 0.69,; − 0.99;-0.40, p < 0.001); but higher %FFM (β = 2.4%, 0.87;-3.90, p = 0.008), when compared to boys born at term (≥37). At 30 years, FM (15.7 kg, 0.25;31.1, p = 0.102) was higher among males born at ≤33 weeks. No association was observed for females from the three cohorts and for 18-year-old males. The association of birth weight for GA with body composition and BMI was not significant in any cohort. At 6 years, SGA boys had lower FFMI than boys AGA. Conclusions Our results suggest that preterm birth is associated with decreased body fat and fat-free mass in childhood but higher fat mass in adulthood. Nevertheless, results were only significant for males. SGA boys also showed lower FFMI. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10368-w.
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Affiliation(s)
- Caroline Cardozo Bortolotto
- Federal University of Pelotas (UFPel). Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160 - 3° Piso. Bairro Centro, Cep: 96020-220, Pelotas, RS, Caixa Postal 464, Brazil.
| | - Iná S Santos
- Federal University of Pelotas (UFPel). Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160 - 3° Piso. Bairro Centro, Cep: 96020-220, Pelotas, RS, Caixa Postal 464, Brazil.,Pontifical Catholic University of Rio Grande do Sul, Program of Pediatrics and Child Health, Porto Alegre, Brazil
| | - Juliana Dos Santos Vaz
- Federal University of Pelotas (UFPel). Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160 - 3° Piso. Bairro Centro, Cep: 96020-220, Pelotas, RS, Caixa Postal 464, Brazil.,Federal University of Pelotas, Faculty of Nutrition, Pelotas, 96010610, Brazil
| | - Alicia Matijasevich
- Federal University of Pelotas (UFPel). Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160 - 3° Piso. Bairro Centro, Cep: 96020-220, Pelotas, RS, Caixa Postal 464, Brazil.,Faculdade de Medicina FMUSP, Departamento de Medicina Preventiva, Universidade de São Paulo, São Paulo, 01246-903, Brazil
| | - Aluísio J D Barros
- Federal University of Pelotas (UFPel). Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160 - 3° Piso. Bairro Centro, Cep: 96020-220, Pelotas, RS, Caixa Postal 464, Brazil.,Federal University of Pelotas, International Center for Equity in Health, Graduate Program in Epidemiology, Pelotas, 96020220, Brazil
| | - Fernando C Barros
- Federal University of Pelotas (UFPel). Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160 - 3° Piso. Bairro Centro, Cep: 96020-220, Pelotas, RS, Caixa Postal 464, Brazil.,Catholic University of Pelotas, Medicine School, 96010-280, Pelotas, Brazil
| | - Leonardo Pozza Santos
- Federal University of Pampa (Unipampa), Nutrition College, Itaqui, 97650-000, Brazil
| | - Tiago Neuenfeld Munhoz
- Federal University of Pelotas (UFPel). Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160 - 3° Piso. Bairro Centro, Cep: 96020-220, Pelotas, RS, Caixa Postal 464, Brazil.,Federal University of Pelotas, Faculty of Psychology, Pelotas, 96030-001, Brazil
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10
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Cardiovascular risk factors in those born preterm - systematic review and meta-analysis. J Dev Orig Health Dis 2020; 12:539-554. [PMID: 33028453 DOI: 10.1017/s2040174420000914] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Emerging evidence demonstrates a link between preterm birth (PTB) and later life cardiovascular disease (CVD). We conducted a systematic review and meta-analysis to compare conventional CVD risk factors between those born preterm and at term. PubMed, CINAHL, SCOPUS, and EMBASE databases were searched. The review protocol is registered in PROSPERO (CRD42018095005). CVD risk factors including systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index, lipid profile, blood glucose, and fasting insulin among those born preterm (<37 weeks' gestation) were compared with those born at term (≥37 weeks' gestation). Subgroup analyses based on gender, age, gestational at birth (<32 weeks' gestation and <28 weeks' gestation), and PTB associated with small for gestational age or average for gestational age were also performed. Fifty-six studies provided data on 308,987 individuals. Being born preterm was associated with 3.26 mmHg (95% confidence interval [CI] 2.08 to 4.44) higher mean SBP and 1.32 mmHg (95% CI: 0.61 to 2.04) higher mean DBP compared to being born at term. Subgroup analyses demonstrated that SBP was higher among (a) preterm compared to term groups from early adolescence until adulthood; (b) females born preterm but not among males born preterm compared to term controls; and (c) those born at <32 weeks or <28 weeks compared to term. Our meta-analyses demonstrate higher SBP and DBP among those born preterm compared to term. The difference in SBP is evident from early adolescence until adulthood.
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11
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Goss KN, Haraldsdottir K, Beshish AG, Barton GP, Watson AM, Palta M, Chesler NC, Francois CJ, Wieben O, Eldridge MW. Association Between Preterm Birth and Arrested Cardiac Growth in Adolescents and Young Adults. JAMA Cardiol 2020; 5:910-919. [PMID: 32432648 DOI: 10.1001/jamacardio.2020.1511] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Premature birth is associated with substantially higher lifetime risk for cardiovascular disease, including arrhythmia, ischemic disease, and heart failure, although the underlying mechanisms are poorly understood. Objective To characterize cardiac structure and function in adolescents and young adults born preterm using cardiac magnetic resonance imaging (MRI). Design, Setting, and Participants This cross-sectional cohort study at an academic medical center included adolescents and young adults born moderately to extremely premature (20 in the adolescent cohort born from 2003 to 2004 and 38 in the young adult cohort born in the 1980s and 1990s) and 52 age-matched participants who were born at term and underwent cardiac MRI. The dates of analysis were February 2016 to October 2019. Exposures Premature birth (gestational age ≤32 weeks) or birth weight less than 1500 g. Main Outcomes and Measures Main study outcomes included MRI measures of biventricular volume, mass, and strain. Results Of 40 adolescents (24 [60%] girls), the mean (SD) age of participants in the term and preterm groups was 13.3 (0.7) years and 13.0 (0.7) years, respectively. Of 70 adults (43 [61%] women), the mean (SD) age of participants in the term and preterm groups was 25.4 (2.9) years and 26.5 (3.5) years, respectively. Participants from both age cohorts who were born prematurely had statistically significantly smaller biventricular cardiac chamber size compared with participants in the term group: the mean (SD) left ventricular end-diastolic volume index was 72 (7) vs 80 (9) and 80 (10) vs 92 (15) mL/m2 for adolescents and adults in the preterm group compared with age-matched participants in the term group, respectively (P < .001), and the mean (SD) left ventricular end-systolic volume index was 30 (4) vs 34 (6) and 32 (7) vs 38 (8) mL/m2, respectively (P < .001). Stroke volume index was also reduced in adolescent vs adult participants in the preterm group vs age-matched participants in the term group, with a mean (SD) of 42 (7) vs 46 (7) and 48 (7) vs 54 (9) mL/m2, respectively (P < .001), although biventricular ejection fractions were preserved. Biventricular mass was statistically significantly lower in adolescents and adults born preterm: the mean (SD) left ventricular mass index was 39.6 (5.9) vs 44.4 (7.5) and 40.7 (7.3) vs 49.8 (14.0), respectively (P < .001). Cardiac strain analyses demonstrated a hypercontractile heart, primarily in the right ventricle, in adults born prematurely. Conclusions and Relevance In this cross-sectional study, adolescents and young adults born prematurely had statistically significantly smaller biventricular cardiac chamber size and decreased cardiac mass. Although function was preserved in both age groups, these morphologic differences may be associated with elevated lifetime cardiovascular disease risk after premature birth.
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Affiliation(s)
- Kara N Goss
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Kristin Haraldsdottir
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Kinesiology, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Arij G Beshish
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Gregory P Barton
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Andrew M Watson
- Department of Orthopedic and Rehabilitation Medicine, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Mari Palta
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Naomi C Chesler
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Biomedical Engineering, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Chris J Francois
- Department of Biomedical Engineering, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Oliver Wieben
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Biomedical Engineering, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Marlowe W Eldridge
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Kinesiology, School of Medicine and Public Health, University of Wisconsin-Madison.,Department of Biomedical Engineering, School of Medicine and Public Health, University of Wisconsin-Madison
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12
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Ou-Yang MC, Sun Y, Liebowitz M, Chen CC, Fang ML, Dai W, Chuang TW, Chen JL. Accelerated weight gain, prematurity, and the risk of childhood obesity: A meta-analysis and systematic review. PLoS One 2020; 15:e0232238. [PMID: 32369502 PMCID: PMC7199955 DOI: 10.1371/journal.pone.0232238] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 04/10/2020] [Indexed: 12/28/2022] Open
Abstract
The purpose of this systematic review and meta-analysis of the literature was to analyze and evaluate the impact of prematurity and accelerated weight gain on the risk of childhood and adolescent obesity. CINAHL, Embase, PubMed, and Web of Science databases were searched until December 2019 which yielded 19 studies with a total of 169,439 children enrolled were systematically reviewed. The results revealed that preterm infants had a greater likelihood of childhood obesity (defined as BMI ≥95th percentile for age-sex), than term infants (OR = 1.19, 95% CI [1.13, 1.26]). However, no difference of childhood obesity was found between "small for gestational age"(SGA) and "appropriate for gestational age"(AGA) among preterms. Accelerated weight gain (defined as weight gain velocity during first two years after birth) significantly increased the likelihood of subsequent childhood obesity among preterms (aOR = 1.87, 95% CI [1.57, 2.231]). In conclusion, accelerated weight gain at infancy among preterm children may be a critical contributor to obesity in later life. Establishing optimal growth trajectories and timely referral to health care providers may be of clinical importance.
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Affiliation(s)
- Mei-Chen Ou-Yang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Yao Sun
- Department of Pediatrics, University of California, San Francisco, California, United States of America
| | - Melissa Liebowitz
- Department of Pediatrics, University of California, San Francisco, California, United States of America
| | - Chih-Cheng Chen
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Min-Lin Fang
- Medicine Library and Center for Knowledge Management, University of California, San Francisco, California, United States of America
| | - Weiwei Dai
- Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Tang-Wei Chuang
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Liouying, Taiwan
| | - Jyu-Lin Chen
- School of Nursing, University of California, San Francisco, California, United States of America
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13
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Chin PY, Dorian C, Sharkey DJ, Hutchinson MR, Rice KC, Moldenhauer LM, Robertson SA. Toll-Like Receptor-4 Antagonist (+)-Naloxone Confers Sexually Dimorphic Protection From Inflammation-Induced Fetal Programming in Mice. Endocrinology 2019; 160:2646-2662. [PMID: 31504393 PMCID: PMC6936318 DOI: 10.1210/en.2019-00493] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/21/2019] [Indexed: 12/21/2022]
Abstract
Inflammation elicited by infection or noninfectious insults during gestation induces proinflammatory cytokines that can shift the trajectory of development to alter offspring phenotype, promote adiposity, and increase susceptibility to metabolic disease in later life. In this study, we use mice to investigate the utility of a small molecule Toll-like receptor (TLR)4 antagonist (+)-naloxone, the nonopioid isomer of the opioid receptor antagonist (-)-naloxone, for mitigating altered fetal metabolic programming induced by a modest systemic inflammatory challenge in late gestation. In adult progeny exposed to lipopolysaccharide (LPS) challenge in utero, male but not female offspring exhibited elevated adipose tissue, reduced muscle mass, and elevated plasma leptin at 20 weeks of age. Effects were largely reversed by coadministration of (+)-naloxone following LPS. When given alone without LPS, (+)-naloxone elicited accelerated postweaning growth and elevated muscle and fat mass in adult male but not female offspring. LPS induced expression of inflammatory cytokines Il1a, Il1b, Il6, Tnf, and Il10 in fetal brain, placental, and uterine tissues, and (+)-naloxone suppressed LPS-induced cytokine expression. Fetal sex-specific regulation of cytokine expression was evident, with higher Il1a, Il1b, Il6, and Il10 induced by LPS in tissues associated with male fetuses, and greater suppression by (+)-naloxone of Il6 in females. These data demonstrate that modulating TLR4 signaling with (+)-naloxone provides protection from inflammatory diversion of fetal developmental programming in utero, associated with attenuation of gestational tissue cytokine expression in a fetal sex-specific manner. The results suggest that pharmacologic interventions targeting TLR4 warrant evaluation for attenuating developmental programming effects of fetal exposure to maternal inflammatory mediators.
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Affiliation(s)
- Peck Yin Chin
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Camilla Dorian
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - David J Sharkey
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Mark R Hutchinson
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, Adelaide, South Australia, Australia
| | - Kenner C Rice
- Drug Design and Synthesis Section, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Lachlan M Moldenhauer
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Sarah A Robertson
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Correspondence: Sarah A. Robertson, PhD, Robinson Research Institute and the Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, South Australia 5005, Australia. E-mail:
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14
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Paz Levy D, Sheiner E, Wainstock T, Sergienko R, Landau D, Walfisch A. Evidence that children born at early term (37-38 6/7 weeks) are at increased risk for diabetes and obesity-related disorders. Am J Obstet Gynecol 2017; 217:588.e1-588.e11. [PMID: 28729012 DOI: 10.1016/j.ajog.2017.07.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/19/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Prematurity is known to be associated with high rates of endocrine and metabolic complications in the offspring. Offspring born early term (37-38 6/7 weeks' gestation) were also shown to exhibit long-term morbidity resembling that of late preterm, in several health categories. OBJECTIVE We aimed to determine whether early term delivery impacts on the long-term endocrine and metabolic health of the offspring. STUDY DESIGN A population-based cohort analysis was performed, including all term singleton deliveries occurring from 1991 through 2013 at a single regional tertiary medical center. Congenital malformations and multiple pregnancies were excluded. Gestational age upon delivery was subdivided into early term deliveries and deliveries occurring at full term and later (≥39 weeks' gestation, comparison group). Endocrine and metabolic morbidity (including diabetes, obesity, hypoglycemia, hyperlipidemia, and hypothyroidism) of the offspring, up to the age of 18 years, was evaluated according to hospitalization files. Kaplan-Meier survival curves were used to compare cumulative morbidity incidence. A Weibull parametric survival model was used to control for time to event, siblings, and other confounders. RESULTS During the study period 225,260 term deliveries met the inclusion criteria. Of them, 24% (n = 54,073) occurred at early term. Endocrine and metabolic morbidity was significantly more common in the early term group (0.51% vs 0.41%, P = .003). Specifically, overweight and obesity were more common among the early term group (P = .002). Differences were more prominent among children >5 years, who exhibited higher rates of type 1 diabetes mellitus, as well as obesity, when born at early term (P < .05). The survival curves demonstrated higher cumulative incidence of total endocrine and metabolic morbidity in the early term group. Using the Weibull parametric survival model, while controlling for siblings, maternal diabetes, hypertension, labor induction, and Apgar score, early term delivery exhibited an independent association with long-term childhood endocrine and metabolic morbidity of the offspring (adjusted hazard ratio, 1.17; 95% confidence interval, 1.01-1.34) and more so for age >5 years (adjusted hazard ratio, 1.30; 95% confidence interval, 1.08-1.56). CONCLUSION Deliveries occurring at early term are associated with higher rates of long-term pediatric endocrine and metabolic morbidity of the offspring as compared with deliveries occurring at a later gestational age. This association may be due to absence of full maturity of the hormonal axis in early term neonates or, alternatively, suggest an underlying fetal endocrine dysfunction as the initial mechanism responsible for spontaneous early term delivery.
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15
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Goss KN, Kumari S, Tetri LH, Barton G, Braun RK, Hacker TA, Eldridge MW. Postnatal Hyperoxia Exposure Durably Impairs Right Ventricular Function and Mitochondrial Biogenesis. Am J Respir Cell Mol Biol 2017; 56:609-619. [PMID: 28129517 PMCID: PMC5449491 DOI: 10.1165/rcmb.2016-0256oc] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/22/2016] [Indexed: 12/17/2022] Open
Abstract
Prematurity complicates 12% of births, and young adults with a history of prematurity are at risk to develop right ventricular (RV) hypertrophy and impairment. The long-term risk for pulmonary vascular disease, as well as mechanisms of RV dysfunction and ventricular-vascular uncoupling after prematurity, remain poorly defined. Using an established model of prematurity-related lung disease, pups from timed-pregnant Sprague Dawley rats were randomized to normoxia or hyperoxia (fraction of inspired oxygen, 0.85) exposure for the first 14 days of life. After aging to 1 year in standard conditions, rats underwent hemodynamic assessment followed by tissue harvest for biochemical and histological evaluation. Aged hyperoxia-exposed rats developed significantly greater RV hypertrophy, associated with a 40% increase in RV systolic pressures. Although cardiac index was similar, hyperoxia-exposed rats demonstrated a reduced RV ejection fraction and significant RV-pulmonary vascular uncoupling. Hyperoxia-exposed RV cardiomyocytes demonstrated evidence of mitochondrial dysregulation and mitochondrial DNA damage, suggesting potential mitochondrial dysfunction as a cause of RV dysfunction. Aged rats exposed to postnatal hyperoxia recapitulate many features of young adults born prematurely, including increased RV hypertrophy and decreased RV ejection fraction. Our data suggest that postnatal hyperoxia exposure results in mitochondrial dysregulation that persists into adulthood with eventual RV dysfunction. Further evaluation of long-term mitochondrial function is warranted in both animal models of premature lung disease and in human adults who were born preterm.
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MESH Headings
- Aging/pathology
- Animals
- Animals, Newborn
- Autophagy
- Body Weight
- DNA Damage
- DNA, Mitochondrial/metabolism
- Female
- Fibrosis
- Gene Expression Profiling
- Hemodynamics
- Hyperoxia/complications
- Hyperoxia/diagnostic imaging
- Hyperoxia/metabolism
- Hyperoxia/physiopathology
- Hypertrophy, Right Ventricular/diagnostic imaging
- Hypertrophy, Right Ventricular/etiology
- Hypertrophy, Right Ventricular/genetics
- Hypertrophy, Right Ventricular/physiopathology
- Male
- Myocardium/pathology
- Myocytes, Cardiac/metabolism
- Myocytes, Cardiac/pathology
- Organ Size
- Organelle Biogenesis
- Rats, Sprague-Dawley
- Ventricular Function, Right
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Affiliation(s)
- Kara N. Goss
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine
- Rankin Laboratory of Pulmonary Medicine, and
| | - Santosh Kumari
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine
- Rankin Laboratory of Pulmonary Medicine, and
| | - Laura H. Tetri
- Division of Pediatric Critical Care, Department of Pediatrics
- Rankin Laboratory of Pulmonary Medicine, and
| | - Greg Barton
- Division of Pediatric Critical Care, Department of Pediatrics
- Rankin Laboratory of Pulmonary Medicine, and
| | - Rudolf K. Braun
- Division of Pediatric Critical Care, Department of Pediatrics
- Rankin Laboratory of Pulmonary Medicine, and
| | - Timothy A. Hacker
- Cardiovascular Research Center, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Marlowe W. Eldridge
- Division of Pediatric Critical Care, Department of Pediatrics
- Rankin Laboratory of Pulmonary Medicine, and
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16
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Chin PY, Dorian CL, Hutchinson MR, Olson DM, Rice KC, Moldenhauer LM, Robertson SA. Novel Toll-like receptor-4 antagonist (+)-naloxone protects mice from inflammation-induced preterm birth. Sci Rep 2016; 6:36112. [PMID: 27819333 PMCID: PMC5098167 DOI: 10.1038/srep36112] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 10/11/2016] [Indexed: 12/29/2022] Open
Abstract
Toll-like receptor 4 (TLR4) activation by bacterial infection, or by sterile inflammatory insult is a primary trigger of spontaneous preterm birth. Here we utilize mouse models to investigate the efficacy of a novel small molecule TLR4 antagonist, (+)-naloxone, the non-opioid isomer of the opioid receptor antagonist (−)-naloxone, in infection-associated preterm birth. Treatment with (+)-naloxone prevented preterm delivery and alleviated fetal demise in utero elicited by i.p. LPS administration in late gestation. A similar effect with protection from preterm birth and perinatal death, and partial correction of reduced birth weight and postnatal mortality, was conferred by (+)-naloxone administration after intrauterine administration of heat-killed E. coli. Local induction by E. coli of inflammatory cytokine genes Il1b, Il6, Tnf and Il10 in fetal membranes was suppressed by (+)-naloxone, and cytokine expression in the placenta, and uterine myometrium and decidua, was also attenuated. These data demonstrate that inhibition of TLR4 signaling with the novel TLR4 antagonist (+)-naloxone can suppress the inflammatory cascade of preterm parturition, to prevent preterm birth and perinatal death. Further studies are warranted to investigate the utility of small molecule inhibition of TLR-driven inflammation as a component of strategies for fetal protection and delaying preterm birth in the clinical setting.
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Affiliation(s)
- Peck Yin Chin
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Camilla L Dorian
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Mark R Hutchinson
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia.,Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, Adelaide, SA, 5005, Australia
| | - David M Olson
- Departments of Obstetrics &Gynecology, Pediatrics and Physiology, University of Alberta, Edmonton, Alberta T6G2S2, Canada
| | - Kenner C Rice
- Chemical Biology Research Branch, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, MD 20892, USA
| | - Lachlan M Moldenhauer
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Sarah A Robertson
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
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