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Evanchuk JL, Kozyrskyj A, Vaghef-Mehrabani E, Lamers Y, Giesbrecht GF, Letourneau N, Aghajafari F, Dewey D, Leung B, Bell RC, Field CJ. Maternal Iron and Vitamin D Status during the Second Trimester Is Associated with Third Trimester Depression Symptoms among Pregnant Participants in the APrON Cohort. J Nutr 2024; 154:174-184. [PMID: 37984742 DOI: 10.1016/j.tjnut.2023.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/21/2023] [Accepted: 10/16/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The maternal status of multiple micronutrients during pregnancy and postpartum and their potential associations with maternal health outcomes are largely undescribed. OBJECTIVES This study aimed to examine associations between maternal iron and vitamin D status, individually and in combination, on depression symptoms in pregnant individuals. METHODS The Alberta Pregnancy Outcomes and Nutrition cohort study included pregnant participants and their children from Calgary and Edmonton, Canada. Iron biomarkers (serum ferritin [SF], soluble transferrin receptor, and hepcidin) were measured via immunoassays and vitamin D [25-hydroxyvitamin D3 (25(OH)D3) and 3-epi-25-hydoxyvitamin D3 (3-epi-25(OH)D3)] metabolites were quantifed using liquid chromatography with tandem mass spectroscopy. Four categories of maternal iron and vitamin D status during the second trimester were conceptualized using concentrations of SF and total 25-hydoxyvitamin D [25(OH)D], respectively. Maternal Edinburgh Postnatal Depression Scale (EPDS) scores during the third trimester (n = 1920) and 3 mo postpartum (n = 1822) were obtained. RESULTS Concentrations of maternal 25(OH)D3, 3-epi-25(OH)D3, and the ratio of both metabolites were significantly higher during the second trimester compared with their status at 3 mo postpartum. Higher second trimester maternal concentrations of SF (β: -0.8; 95% confidence interval [CI]: -1.5, -0.01), hepcidin (β: -0.5; 95% CI: -0.9, -0.2), and 25(OH)D3 (β: -0.01; 95% CI: -0.02, -0.004) predicted lower maternal EPDS scores during the third trimester. Pregnant individuals with a low iron (SF <15 μg/L) and replete vitamin D (25(OH)D ≥75 nmol/L) (β: 1.1; 95% CI: 0.03, 2.1) or low iron (SF <15 μg/L) and vitamin D (25(OH)D <75 nmol/L) (β: 2.2; 95% CI: 0.3, 4.2) status during midpregnancy had higher third trimester EPDS scores compared with those that were replete in both micronutrients. CONCLUSIONS A higher midpregnancy maternal iron and vitamin D status, independently or in combination, predicted fewer maternal depression symptoms in the third trimester. Concentrations of maternal 25(OH)D3 and 3-epi-25(OH)D3 may be lower in the postpartum period compared with midpregnancy.
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Affiliation(s)
- Jenna L Evanchuk
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Anita Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Yvonne Lamers
- Food, Nutrition and Health Program, University of British Columbia, Vancouver, BC, Canada; British Columbia's Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Gerald F Giesbrecht
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Nicole Letourneau
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Fariba Aghajafari
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Deborah Dewey
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Brenda Leung
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada.
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Evanchuk JL, Kozyrskyj A, Hanas N, Goruk S, Vaghef-Mehrabani E, Archundia-Herrera CM, O'Brien KO, Letourneau NL, Giesbrecht GF, Bell RC, Field CJ. Maternal Iron Status Is Dynamic Throughout Pregnancy and Might Predict Birth Outcomes in a Sex Dependent Manner: Results from the Alberta Pregnancy Outcomes and Nutrition (APrON) Cohort Study. J Nutr 2023; 153:2585-2597. [PMID: 37393033 DOI: 10.1016/j.tjnut.2023.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/05/2023] [Accepted: 06/22/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Developmental responses to nutrient deprivation may differ by fetal sex. Despite this, relationships between maternal prenatal iron biomarkers and birth outcomes when stratifying by offspring sex are poorly described, especially in healthy cohorts. OBJECTIVES This study aimed to determine associations between maternal iron biomarkers and birth weights (BWs) and birth head circumferences (BHCs) among female and male newborns to assess whether the potential predictive ability of iron biomarkers on birth outcomes differs by offspring sex. METHODS The Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study recruited 2189 pregnant individuals from Calgary and Edmonton, Canada. Maternal blood was drawn at each trimester and 3 mo postpartum. Maternal serum ferritin (SF) concentrations were measured using chemiluminescent immunoassays and erythropoietin (EPO), hepcidin, and soluble transferrin receptor (sTfR) using enzyme-linked immunosorbent assays. Ratios of sTfR:SF and hepcidin:EPO were calculated and birth outcomes accessed through delivery records. Directed acyclic graphs informed multivariate regression models. RESULTS The risk of maternal iron deficiency increased throughout pregnancy because ∼61% showed depleted iron stores (SF < 15 μg/L) by the third trimester. Maternal hepcidin, SF, sTfR, and sTfR:SF concentrations changed across time (P < 0.01), and participants carrying female fetuses consistently (across 6 biomarkers) showed a lower iron status during the third trimester compared with those with male fetuses (P < 0.05). Higher maternal SF and hepcidin:EPO during the third trimester was associated with lower BWs in males (P = 0.006 for SF; P = 0.03 for hepcidin:EPO) and females (P = 0.02 for SF; P = 0.02 for hepcidin:EPO). There were additional inverse associations between BWs and third trimester maternal hepcidin (P = 0.03) and hemoglobin (P = 0.004) and between BHCs and maternal SF (second trimester; P < 0.05) and Hb (third trimester P = 0.02) but only in males. CONCLUSIONS Relationships between maternal iron biomarkers and BWs and BHCs may depend on the timing of pregnancy and offpsring sex. There was a high risk of third trimester iron storage depletion among generally healthy pregnant individuals.
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Affiliation(s)
- Jenna L Evanchuk
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Anita Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Natalie Hanas
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Goruk
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Kimberly O O'Brien
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Nicole L Letourneau
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Gerald F Giesbrecht
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.
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Reardon AJF, Hajihosseini M, Dinu I, Field CJ, Kinniburgh DW, MacDonald AM, Dewey D, England-Mason G, Martin JW. Maternal co-exposure to mercury and perfluoroalkyl acid isomers and their associations with child neurodevelopment in a Canadian birth cohort. ENVIRONMENT INTERNATIONAL 2023; 178:108087. [PMID: 37454627 DOI: 10.1016/j.envint.2023.108087] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Perfluoroalkyl acids (PFAAs) within the broader class of per- and polyfluoroalkyl substances (PFAS) are present in human serum as isomer mixtures, but epidemiological studies have yet to address isomer-specific associations with child development and behavior. OBJECTIVES To examine associations between prenatal exposure to 25 PFAAs, including perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA) isomers, and child neurodevelopment among 490 mother-child pairs in a prospective Canadian birth cohort, the Alberta Pregnancy Outcomes and Nutrition (APrON) study. To consider the influence of a classic neurotoxicant, total mercury (THg), based on its likelihood of co-exposure with PFAAs from common dietary sources. METHODS Maternal blood samples were collected in the second trimester and child neurodevelopment was assessed at 2 years of age using the Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley-III). Linear or curvilinear multiple regression models were used to examine associations between exposures and neurodevelopment outcomes. RESULTS Select PFAAs were associated with lower Cognitive composite scores, including perfluoroheptanoate (PFHpA) (β = -0.88, 95% confidence interval (CI): -1.7, -0.06) and perfluorododecanoate (PFDoA) (β = -2.0, 95% CI: -3.9, -0.01). Non-linear relationships revealed associations of total PFOS (β = -4.4, 95% CI: -8.3, -0.43), and linear-PFOS (β = -4.0, 95% CI: -7.5, -0.57) and 1m-PFOS (β = -1.8, 95% CI: -3.3, -0.24) isomers with lower Language composite scores. Although there was no effect modification, including THg interaction terms in PFAA models revealed negative associations between perfluorononanoate (PFNA) and Motor (β = -3.3, 95% CI: -6.2, -0.33) and Social-Emotional (β = -3.0, 95% CI: -5.6, -0.40) composite scores. DISCUSSION These findings reinforce previous reports of adverse effects of maternal PFAA exposure during pregnancy on child neurodevelopment. The unique hazards posed from isomers of PFOS justify isomer-specific analysis in future studies. To control for possible confounding, mercury co-exposure may be considered in studies of PFAAs.
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Affiliation(s)
- Anthony J F Reardon
- Division of Analytical and Environmental Toxicology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Irina Dinu
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - David W Kinniburgh
- Alberta Centre for Toxicology, University of Calgary, Calgary, Alberta, Canada
| | - Amy M MacDonald
- Alberta Centre for Toxicology, University of Calgary, Calgary, Alberta, Canada
| | - Deborah Dewey
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Owerko Centre at the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Science, University of Calgary, Calgary, Alberta, Canada
| | - Gillian England-Mason
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Owerko Centre at the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan W Martin
- Division of Analytical and Environmental Toxicology, University of Alberta, Edmonton, Alberta, Canada; Science for Life Laboratory, Department of Environmental Sciences, Stockholm University, Stockholm, Sweden
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Caffrey A, Lamers Y, Murphy MM, Letourneau N, Irwin RE, Pentieva K, Ward M, Tan A, Rojas‐Gómez A, Santos‐Calderón LA, Canals‐Sans J, Leung BMY, Bell R, Giesbrecht GF, Dewey D, Field CJ, Kobor M, Walsh CP, McNulty H. Epigenetic effects of folate and related B vitamins on brain health throughout life: Scientific substantiation and translation of the evidence for health improvement strategies. NUTR BULL 2023; 48:267-277. [PMID: 36807740 PMCID: PMC10946506 DOI: 10.1111/nbu.12611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/15/2023] [Accepted: 01/23/2023] [Indexed: 02/23/2023]
Abstract
Suboptimal status of folate and/or interrelated B vitamins (B12 , B6 and riboflavin) can perturb one-carbon metabolism and adversely affect brain development in early life and brain function in later life. Human studies show that maternal folate status during pregnancy is associated with cognitive development in the child, whilst optimal B vitamin status may help to prevent cognitive dysfunction in later life. The biological mechanisms explaining these relationships are not clear but may involve folate-related DNA methylation of epigenetically controlled genes related to brain development and function. A better understanding of the mechanisms linking these B vitamins and the epigenome with brain health at critical stages of the lifecycle is necessary to support evidence-based health improvement strategies. The EpiBrain project, a transnational collaboration involving partners in the United Kingdom, Canada and Spain, is investigating the nutrition-epigenome-brain relationship, particularly focussing on folate-related epigenetic effects in relation to brain health outcomes. We are conducting new epigenetics analysis on bio-banked samples from existing well-characterised cohorts and randomised trials conducted in pregnancy and later life. Dietary, nutrient biomarker and epigenetic data will be linked with brain outcomes in children and older adults. In addition, we will investigate the nutrition-epigenome-brain relationship in B vitamin intervention trial participants using magnetoencephalography, a state-of-the-art neuroimaging modality to assess neuronal functioning. The project outcomes will provide an improved understanding of the role of folate and related B vitamins in brain health, and the epigenetic mechanisms involved. The results are expected to provide scientific substantiation to support nutritional strategies for better brain health across the lifecycle.
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Affiliation(s)
- A. Caffrey
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical SciencesUlster UniversityColeraineUK
| | - Y. Lamers
- British Columbia Children's Hospital Research Institute, Food Nutrition and Health Program, Faculty of Land and Food SystemsThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - M. M. Murphy
- Unit of Preventive Medicine & Public Health, Department of Basic Medical Sciences, Faculty of Medicine & Health SciencesUniversitat Rovira i Virgili, IISPVReusSpain
- CIBEROBN, ISCIIIMadridSpain
| | - N. Letourneau
- Faculty of Nursing and Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - R. E. Irwin
- Genomic Medicine Group, School of Biomedical SciencesUlster UniversityColeraineUK
| | - K. Pentieva
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical SciencesUlster UniversityColeraineUK
| | - M. Ward
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical SciencesUlster UniversityColeraineUK
| | - A. Tan
- British Columbia Children's Hospital Research Institute, Food Nutrition and Health Program, Faculty of Land and Food SystemsThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - A. Rojas‐Gómez
- Unit of Preventive Medicine & Public Health, Department of Basic Medical Sciences, Faculty of Medicine & Health SciencesUniversitat Rovira i Virgili, IISPVReusSpain
| | - L. A. Santos‐Calderón
- Unit of Preventive Medicine & Public Health, Department of Basic Medical Sciences, Faculty of Medicine & Health SciencesUniversitat Rovira i Virgili, IISPVReusSpain
| | - J. Canals‐Sans
- Department of Psychology, Faculty of Educational Sciences and PsychologyUniversitat Rovira i VirgiliTarragonaSpain
| | - B. M. Y. Leung
- Faulty of Health SciencesUniversity of LethbridgeLethbridgeAlbertaCanada
| | - R. Bell
- Faculty of Agricultural, Life and Environment ScienceUniversity of AlbertaEdmontonAlbertaCanada
| | - G. F. Giesbrecht
- Faculty of Nursing and Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - D. Dewey
- Faculty of Nursing and Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - C. J. Field
- Faculty of Agricultural, Life and Environment ScienceUniversity of AlbertaEdmontonAlbertaCanada
| | - M. Kobor
- British Columbia Children's Hospital Research Institute, Food Nutrition and Health Program, Faculty of Land and Food SystemsThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - C. P. Walsh
- Genomic Medicine Group, School of Biomedical SciencesUlster UniversityColeraineUK
| | - H. McNulty
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical SciencesUlster UniversityColeraineUK
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Jibat N, Rana R, Negesse A, Abera M, Abdissa A, Girma T, Haile A, Barthorp H, McGrath M, Grijalva-Eternod CS, Kerac M, Berhane M. Carers’ and health workers’ perspectives on malnutrition in infants aged under six months in rural Ethiopia: A qualitative study. PLoS One 2022; 17:e0271733. [PMID: 35862411 PMCID: PMC9302717 DOI: 10.1371/journal.pone.0271733] [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] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/06/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives
Supporting small and nutritionally at-risk (potentially malnourished) infants under six months is a global health priority, albeit with a weak evidence-base. To inform policy and research in this area, we aimed to assess the perceptions and understanding of infant malnutrition and its management among carers, communities, and healthcare workers in rural Ethiopia.
Methods
We conducted in-depth and key-informant interviews, from May-August 2020 in Jimma Zone and Deder District, Ethiopia. We used purposive sampling to recruit the participants. Interviews were transcribed into Amharic or Afaan Oromo and then translated into English. Atlas ti-7 was used to support data analysis. Findings were narrated based on the different themes arising from the interviews.
Results
Carers/community members and healthcare workers reported on five different themes: 1) Perceptions about health and well-being: an ‘ideal infant’ slept well, fed well, was active and looked ‘fat’; 2)Perceptions of feeding: overall knowledge of key recommendations like exclusive breastfeeding was good but practices were suboptimal, notably a cultural practice to give water to young infants; 3)Awareness about malnutrition: a key limitation was knowledge of exactly how to identify small and nutritionally at-risk infants; 4) Reasons for malnutrition: levels of understanding varied and included feeding problems and caregiver’s work pressures resulting in the premature introduction of complementary feeds; 5) Perceptions about identification & treatment: carers prefer treatment close to home but were concerned about the quality of community-based services.
Conclusion
To succeed, research projects that investigate programes that manage small and nutritionally at-risk infants under six months should understand and be responsive to the culture and context in which they operate. They should build on community strengths and tackle misunderstandings and barriers. Interventions beyond just focusing on knowledge and attitude of the carers and health workers are necessary to tackle the challenges around infants under 6 months of age at risk of malnutrition. Moreover, stakeholders beyond the health sector should also be involved in order to support the infants under 6 months and their mothers as some of the key reasons behind the at-risk infants are just beyond the capacity of the health sector or health system. Our list of themes could be used to inform infant nutrition work not just in Ethiopia but also in many others.
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Affiliation(s)
- Nega Jibat
- Department of Sociology, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Ritu Rana
- GOAL Global, Dublin, Ireland
- Indian Institute of Public Health, Gandhinagar, India
| | - Ayenew Negesse
- Department of Human Nutrition, Debre Markos University, Debre Markos, Ethiopia
| | - Mubarek Abera
- Department of Psychiatry, Jimma University, Jimma, Ethiopia
| | - Alemseged Abdissa
- Department of Laboratory and Microbiology, Jimma University, Jimma, Ethiopia
- Armaeur Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Tsinuel Girma
- Department of Paediatrics and Child Health, Jimma University, Jimma, Ethiopia
- Harvard Chan School of Public Health, Addis Ababa, Ethiopia
| | | | | | | | - Carlos S. Grijalva-Eternod
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- UCL Institute for Global Health, London, United Kingdom
| | - Marko Kerac
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Melkamu Berhane
- Department of Paediatrics and Child Health, Jimma University, Jimma, Ethiopia
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Letourneau N, Aghajafari F, Bell RC, Deane AJ, Dewey D, Field C, Giesbrecht G, Kaplan B, Leung B, Ntanda H. The Alberta Pregnancy Outcomes and Nutrition (APrON) longitudinal study: cohort profile and key findings from the first three years. BMJ Open 2022; 12:e047503. [PMID: 35131812 PMCID: PMC8823238 DOI: 10.1136/bmjopen-2020-047503] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The objectives of the ongoing Canadian longitudinal cohort called the Alberta Pregnancy Outcomes and Nutrition (APrON) study are to: (1) determine the relationship between maternal nutrient intake and status before, during, after pregnancy, and (a) maternal mental health, (b) pregnancy and birth outcomes, and (c) infant/child neurodevelopment and behavior; (2) identify maternal mental health and nutrient predictors of child behaviour; and (3) establish a DNA biobank to explore genomic predictors of children's neurodevelopment and behavior. The purpose of this paper is to describe the participants, measures, and key findings on maternal and paternal mental health, maternal nutrition, and child outcomes to when children are 3 years of age. PARTICIPANTS Participants included mothers and their children (n=2189) and mothers' partners (usually fathers; n=1325) from whom data were collected during the period from pregnancy to when children were 3 years of age, in Alberta, Canada. More than 88% of families have been retained to take part in completed data collection at 8 years of age. FINDINGS TO DATE Data comprise: questionnaires completed by pregnant women/mothers and their partners on mothers', fathers' and children's health; dietary interviews; clinical assessments; linkage to hospital obstetrical records; and biological samples such as DNA. Key findings on mental health, nutrition and child outcomes are presented. APrON women who consumed more selenium and omega-3 were less likely to develop symptoms of perinatal depression. Higher prenatal consumption of choline rich foods such as eggs and milk were recommended as was vitamin D supplementation for both mothers and children to meet guidelines. Couples in which both mothers and fathers were affected by perinatal depression reported lower incomes and higher maternal prenatal depressive symptoms and lower support from fathers postnatally and their children presented with the most behavioural problems. Maternal experiences of early adversity predicted increased likelihood of perinatal depression and anxiety and children's behavioural problems. FUTURE PLANS The APrON cohort offers a unique opportunity to advance understanding of the developmental origins of health and disease. There is a planned follow-up to collect data at 12 years of age.
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Affiliation(s)
- Nicole Letourneau
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine (Departments of Paediatrics, Psychiatry & Community Health Sciences), University of Calgary, Calgary, Alberta, Canada
| | - Fariba Aghajafari
- Cumming School of Medicine (Family Medicine & Community Health Sciences), University of Calgary, Calgary, Alberta, Canada
| | - Rhonda C Bell
- Faculty of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea J Deane
- Cumming School of Medicine (Pediatrics), University of Calgary, Calgary, Alberta, Canada
| | - Deborah Dewey
- Cumming School of Medicine (Pediatrics), University of Calgary, Calgary, Alberta, Canada
| | - Catherine Field
- Faculty of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Gerald Giesbrecht
- Cumming School of Medicine (Pediatrics & Community Health Sciences), University of Calgary, Calgary, Alberta, Canada
| | - Bonnie Kaplan
- Cumming School of Medicine (Pediatrics & Community Health Sciences), University of Calgary, Calgary, Alberta, Canada
| | - Brenda Leung
- Health Science - Public Health Program, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Henry Ntanda
- Cumming School of Medicine (Pediatrics), University of Calgary, Calgary, Alberta, Canada
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Moore SR, Merrill SM, Sekhon B, MacIsaac JL, Kobor MS, Giesbrecht GF, Letourneau N. Infant DNA methylation: an early indicator of intergenerational trauma? Early Hum Dev 2022; 164:105519. [PMID: 34890904 DOI: 10.1016/j.earlhumdev.2021.105519] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 10/18/2021] [Accepted: 11/24/2021] [Indexed: 11/03/2022]
Abstract
Exposure to adverse childhood experiences (ACEs) increases risk for mental and physical health problems. Intergenerationally, mothers' ACEs predict children's health problems including neurodevelopmental and behavioural problems and poorer physical health. Theories of intergenerational trauma suggest that ACEs experienced in one generation negatively affect the health and well-being of future generations, with DNA methylation (DNAm) being one of several potential biological explanations. To begin exploring this hypothesis, we tested whether infant DNA methylation associated with intergenerational trauma. Secondary analysis employed data from the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Subsample data were collected from mothers during pregnancy and postpartum on measures of distress, stress and ACEs and from infants at 3 months of age on DNAm from blood (n = 92) and buccal epithelial cells (BECs; n = 124; primarily nonoverlapping individuals between tissues). Blood and BECs were examined in separate analyses. Preliminary associations identified in blood and BECs suggest that infant DNAm patterns may relate to maternal ACEs. For the majority of ACE-related DNAm sites, neither maternal perinatal distress, nor maternal cortisol awakening response (CAR; a measure of hypothalamic-pituitary-adrenocortical axis function), substantially reduced associations between maternal ACEs and infant DNAm. However, accounting for maternal perinatal distress and cortisol substantially changed the effect of ACEs in a greater proportion of blood DNAm sites than BEC DNAm sites in the top ACEs-associated correlated methylated regions (CMRs), as well as across all CMRs and all remaining CpGs (that did not fall into CMRs). Possible DNAm patterns in infants, thus, might capture a signature of maternal intergenerational trauma, and this effect appears to be more dependent on maternal perinatal distress and CAR in blood relative to BECs.
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Affiliation(s)
- Sarah R Moore
- BC Children's Hospital Research Institute and Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah M Merrill
- BC Children's Hospital Research Institute and Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bikram Sekhon
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Julia L MacIsaac
- BC Children's Hospital Research Institute and Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael S Kobor
- BC Children's Hospital Research Institute and Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gerald F Giesbrecht
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics & Owerko Centre at the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Letourneau
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics & Owerko Centre at the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada; Department of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
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8
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Riis JL, Cook SH, Letourneau N, Campbell T, Granger DA, Giesbrecht GF. Characterizing and Evaluating Diurnal Salivary Uric Acid Across Pregnancy Among Healthy Women. Front Endocrinol (Lausanne) 2022; 13:813564. [PMID: 35370953 PMCID: PMC8971544 DOI: 10.3389/fendo.2022.813564] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/14/2022] [Indexed: 11/26/2022] Open
Abstract
Uric acid levels during pregnancy have been examined as a potential indicator of risk for gestational diabetes mellites, hypertension, and related adverse birth outcomes. However, evidence supporting the utility of serum uric acid levels in predicting poor maternal and fetal health has been mixed. The lack of consistent findings may be due to limitations inherent in serum-based biomeasure evaluations, such as minimal repeated assessments and variability in the timing of these assessments. To address these gaps, we examined repeated measurements of diurnal salivary uric acid (sUA) levels in a sample of 44 healthy women across early-mid and late pregnancy. We assessed potential covariates and confounds of sUA levels and diurnal trajectories, as well as associations between maternal weight gain and blood pressure during pregnancy and sUA concentrations. Using multilevel linear models, we found sUA increased across pregnancy and displayed a robust diurnal pattern with the highest concentrations at waking, a steep decline in the early morning, and decreasing levels across the day. Maternal pre-pregnancy BMI, age, prior-night sleep duration, and fetal sex were associated with sUA levels and/or diurnal slopes. Maternal blood pressure and gestational weight gain also showed significant associations with sUA levels across pregnancy. Our results expand upon those found with serum UA measurements. Further, they demonstrate the feasibility of using at-home, minimally-invasive saliva sampling procedures to track UA levels across pregnancy with potential applications for the long-term monitoring of maternal cardiometabolic risk.
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Affiliation(s)
- Jenna L. Riis
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, Irvine, CA, United States
- Department of Psychological Science, School of Social Ecology, University of California, Irvine, Irvine, CA, United States
- *Correspondence: Jenna L. Riis,
| | - Stephanie H. Cook
- Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
- Biostatistics, School of Global Public Health, New York University, New York, NY, United States
| | - Nicole Letourneau
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Tavis Campbell
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Douglas A. Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, Irvine, CA, United States
- Department of Psychological Science, School of Social Ecology, University of California, Irvine, Irvine, CA, United States
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Gerald F. Giesbrecht
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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9
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Letourneau N, McDonald S, MacKay LJ, Bell RC, Hetherington E, Deane AJ, Dewey D, Edwards S, Field CJ, Giesbrecht GF, Graham S, Lebel C, Leung B, Madigan S, McArthur BA, McMorris C, Racine N, Ross KM, Wu M, Tough SC. Cross-Sectional Study Protocol for the COVID-19 Impact Survey of Mothers and Their 7-11 Year Old Children in Alberta, Canada. Front Psychiatry 2021; 12:597759. [PMID: 34239455 PMCID: PMC8260076 DOI: 10.3389/fpsyt.2021.597759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 05/14/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Our aim is to understand the effect of the COVID-19 pandemic on families who have been followed longitudinally in two cohorts studied in Alberta, Canada. We will examine household infections during the COVID-19 pandemic, financial impact, domestic violence, substance use, child school and daily life and relationships in the home. We will identify risk and protective factors for maternal mental health outcomes using longitudinal data that can inform policy and government resource allocation in future disasters. Methods: Mothers who are currently participating in two longitudinal studies, Alberta Pregnancy Outcomes and Nutrition (APrON; N = 1,800) and All Our Families (AOF: N = 2,534) were eligible to participate. Mothers were invited to complete the baseline COVID-19 Impact Survey (20-30 min) within 4 months of March 15, 2020, which was when the province of Alberta, Canada, implemented school closures and physical-distancing measures to prevent the spread of COVID-19. Mothers were asked to report on their own, their child's and their family's functioning. Mothers were re-surveyed at 6 months after completion of the initial COVID-19 Impact Survey, and will be re-surveyed again at 12 months. Results: Responses from participants in both cohorts will be examined in harmonized analyses as well as separately. Descriptive, multivariable analysis will be undertaken to examine risk and resiliency over time and factors that predict mental health and well-being. Conclusions: This study will provide timely information on the impact of COVID-19 for Albertan families. It will identify risk and protective factors for mental health and well-being among contemporary urban families supported by a publicly funded health care system to inform allocation of resources to support those most vulnerable during a global pandemic.
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Affiliation(s)
- Nicole Letourneau
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Owerko Centre at the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sheila McDonald
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Rhonda C. Bell
- Faculty of Agricultural, Life and Environmental Science, University of Alberta, Edmonton, AB, Canada
| | - Erin Hetherington
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrea J. Deane
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Owerko Centre at the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Deborah Dewey
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Owerko Centre at the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Sarah Edwards
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Catherine J. Field
- Faculty of Agricultural, Life and Environmental Science, University of Alberta, Edmonton, AB, Canada
| | - Gerald F. Giesbrecht
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Susan Graham
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Catherine Lebel
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brenda Leung
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Public Health Program, Faculty Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
| | - Sheri Madigan
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Brae Anne McArthur
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Carly McMorris
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | - Nicole Racine
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Kharah M. Ross
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, AB, Canada
- Psychology, Centre for Social Sciences, Athabasca University, Athabasca, AB, Canada
| | - Muci Wu
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Suzanne C. Tough
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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10
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England-Mason G, Liu J, Martin JW, Giesbrecht GF, Letourneau N, Dewey D. Postnatal BPA is associated with increasing executive function difficulties in preschool children. Pediatr Res 2021; 89:686-693. [PMID: 32408341 PMCID: PMC7666018 DOI: 10.1038/s41390-020-0922-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 03/30/2020] [Accepted: 04/09/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Early bisphenol exposure may have consequences for executive function development, but less is known about potential sex effects. We hypothesized that early bisphenol A (BPA) and bisphenol S (BPS) exposures would be associated with sex-dependent changes in preschool executive function. METHODS A subsample of the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort (n = 312) provided maternal second trimester (prenatal) and 3-month postpartum (postnatal) urine samples, from which BPA and BPS concentrations were quantified. When children were age 2 and 4, mothers completed the Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P). Changes in standardized T scores on the BRIEF-P indexes of inhibitory self-control, flexibility, and emergent metacognition were investigated. RESULTS Adjusted multivariate regression analyses showed that child sex modified the associations between maternal postnatal BPA and changes in executive function. Higher maternal postnatal BPA concentrations predicted increasing difficulties from age 2 to 4 in the domains of inhibitory self-control and emergent metacognition in female, but not male children. The other bisphenol concentrations were not associated with changes in executive function. CONCLUSION Due to the ubiquity of BPA exposure among breastfeeding women, these findings justify further investigation on the effects of postnatal bisphenol exposure on child cognitive development. IMPACT Higher concentrations of maternal BPA at 3-month postpartum were associated with increasing difficulties in inhibitory self-control and emergent metacognition from age 2 to 4 in girls, but not boys. Prenatal BPA and prenatal/postnatal BPS were not significant predictors of changes in executive function in boys and girls. The current study extends previous research to show that maternal postnatal BPA could also impact child executive function. Due to the ubiquity of BPA exposure among breastfeeding women, the current findings suggest that additional precautions may be needed to protect infants' neurodevelopment from indirect exposure to BPA.
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Affiliation(s)
- Gillian England-Mason
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada,Owerko Centre, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Jiaying Liu
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Jonathan W. Martin
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada,Science for Life Laboratory, Department of Analytical Chemistry and Environmental Sciences, Stockholm University, Stockholm, Sweden
| | - Gerald F. Giesbrecht
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada,Owerko Centre, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada,Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Canada
| | - Nicole Letourneau
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada,Owerko Centre, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada,Faculty of Nursing, University of Calgary, Calgary, Canada,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Deborah Dewey
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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11
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Scott HD, Buchan M, Chadwick C, Field CJ, Letourneau N, Montina T, Leung BMY, Metz GAS. Metabolic dysfunction in pregnancy: Fingerprinting the maternal metabolome using proton nuclear magnetic resonance spectroscopy. Endocrinol Diabetes Metab 2021; 4:e00201. [PMID: 33532625 PMCID: PMC7831222 DOI: 10.1002/edm2.201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/30/2020] [Accepted: 10/24/2020] [Indexed: 12/28/2022] Open
Abstract
Aims Maternal metabolic disorders place the mother at risk for negative pregnancy outcomes with potentially long-term health impacts for the child. Metabolic syndrome, a cluster of features associated with increased risk of metabolic disorders, such as cardiovascular disease, diabetes and stroke, affects roughly one in five Canadians. Metabolomics is a relatively new technique that may be a useful tool to identify women at risk of metabolic disorders. This study set out to characterize urinary metabolic biomarkers of pregnant women with obesity and of pregnant women who later developed gestational diabetes mellitus (pre-GDM), compared to controls. Methods and Materials Second trimester urine samples were collected through the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort and examined with 1H nuclear magnetic resonance (NMR) spectroscopy. Multivariate analysis was used to examine group differences, and machine learning feature selection tools identified the metabolites contributing to separation. Results Obesity and pre-GDM metabolomes were distinct from controls and from each other. In each comparison, the glycine, serine and threonine pathways were the most impacted. Pantothenate, formic acid and glycine were downregulated by obesity, while formic acid, dimethylamine and galactose were downregulated in pre-GDM. The three most impacted metabolites for the comparison of obesity versus pre-GDM groups were upregulated creatine/caffeine, downregulated sarcosine/dimethylamine and upregulated maltose/sucrose in individuals who later developed GDM. Conclusion These findings suggest a role for urinary metabolomics in the prediction of GDM and metabolic marker identification for potential diagnostics and prognostics in women at risk.
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Affiliation(s)
- Hannah D. Scott
- Canadian Centre for Behavioural NeuroscienceDepartment of NeuroscienceUniversity of LethbridgeLethbridgeABCanada
| | - Marrissa Buchan
- Canadian Centre for Behavioural NeuroscienceDepartment of NeuroscienceUniversity of LethbridgeLethbridgeABCanada
- Department of Chemistry and BiochemistryUniversity of LethbridgeLethbridgeABCanada
| | - Caylin Chadwick
- Canadian Centre for Behavioural NeuroscienceDepartment of NeuroscienceUniversity of LethbridgeLethbridgeABCanada
| | - Catherine J. Field
- Department of Agriculture, Food and Nutritional ScienceUniversity of AlbertaEdmontonABCanada
| | - Nicole Letourneau
- Faculty of Nursing and Cumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Tony Montina
- Department of Chemistry and BiochemistryUniversity of LethbridgeLethbridgeABCanada
- Southern Alberta Genome Sciences CentreUniversity of LethbridgeLethbridgeABCanada
| | - Brenda M. Y. Leung
- Public Health ProgramFaculty of Health SciencesUniversity of LethbridgeLethbridgeABCanada
| | - Gerlinde A. S. Metz
- Canadian Centre for Behavioural NeuroscienceDepartment of NeuroscienceUniversity of LethbridgeLethbridgeABCanada
- Southern Alberta Genome Sciences CentreUniversity of LethbridgeLethbridgeABCanada
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12
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Reardon AJF, Khodayari Moez E, Dinu I, Goruk S, Field CJ, Kinniburgh DW, MacDonald AM, Martin JW. Longitudinal analysis reveals early-pregnancy associations between perfluoroalkyl sulfonates and thyroid hormone status in a Canadian prospective birth cohort. ENVIRONMENT INTERNATIONAL 2019; 129:389-399. [PMID: 31150980 PMCID: PMC6859374 DOI: 10.1016/j.envint.2019.04.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/20/2019] [Accepted: 04/09/2019] [Indexed: 05/20/2023]
Abstract
Serum perfluoroalkyl acids (PFAAs) have been linked to disruption of maternal thyroid hormone homeostasis, but results have varied between studies which we hypothesized was due to timing of the thyroid hormone measurements, variability in PFAA isomer patterns, or presence of other stressors. In a longitudinal study design, we investigated the time-dependency of associations between PFAA isomers and thyroid hormones during pregnancy and post-partum while considering thyroid peroxidase antibody (TPOAb) status and mercury (Hg) co-exposure. In participants of a prospective Canadian birth cohort (n = 494), free thyroxine (FT4), free triiodothyronine (FT3), thyroid stimulating hormone (TSH) and TPOAb were quantified in maternal plasma collected in each trimester and 3-months postpartum, and 25 PFAAs (15 linear and 10 branched) and Hg were quantified in samples collected during the second trimester. Perfluorohexane sulfonate (PFHxS) and total branched isomers of perfluorooctane sulfonate (PFOS) were positively associated with TSH in mixed-effect models, with strongest associations early in gestation. Throughout pregnancy and post-partum, PFHxS was inversely associated with FT4, consistent with elevated TSH, while Hg was inversely associated with FT3. In TPOAb-positive women, negative associations were found between PFUnA and FT4, and 1m-PFOS and TSH, supporting previous studies that thyroid disorder could increase susceptibility to PFAA-mediated hormone dysregulation. Hg did not confound associations but was a significant interaction term, revealing further positive associations between PFOS isomers (∑3m+4m-PFOS) and TSH. Higher perfluoroalkyl sulfonate exposures were associated with higher TSH and/or lower FT4, strongly suggestive that PFHxS and branched PFOS isomers are risk factors for subclinical maternal hypothyroidism. Isomer-specific analysis is important in future studies, as crude measures of 'total-PFOS' masked the associations of branched isomers. A concerning result was for PFHxS which had consistent negative associations with FT4 at all time points and a positive association with TSH in early pregnancy when fetal development is most sensitive to disruption.
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Affiliation(s)
- Anthony J F Reardon
- Division of Analytical and Environmental Toxicology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Irina Dinu
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Goruk
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - David W Kinniburgh
- Alberta Centre for Toxicology, University of Calgary, Calgary, Alberta, Canada
| | - Amy M MacDonald
- Alberta Centre for Toxicology, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan W Martin
- Division of Analytical and Environmental Toxicology, University of Alberta, Edmonton, Alberta, Canada; Science for Life Laboratory, Department of Environmental Sciences and Analytical Chemistry, Stockholm University, Stockholm, Sweden.
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13
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Nickel NC, Warda L, Kummer L, Chateau J, Heaman M, Green C, Katz A, Paul J, Perchuk C, Girard D, Larocque L, Enns JE, Shaw S. Protocol for establishing an infant feeding database linkable with population-based administrative data: a prospective cohort study in Manitoba, Canada. BMJ Open 2017; 7:e017981. [PMID: 29061626 PMCID: PMC5665324 DOI: 10.1136/bmjopen-2017-017981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Breast feeding is associated with many health benefits for mothers and infants. But despite extensive public health efforts to promote breast feeding, many mothers do not achieve their own breastfeeding goals; and, inequities in breastfeeding rates persist between high and low-income mother-infant dyads. Developing targeted programme to support breastfeeding dyads and reduce inequities between mothers of different socioeconomic status are a priority for public health practitioners and health policy decision-makers; however, many jurisdictions lack the timely and comprehensive population-level data on infant-feeding practices required to monitor trends in breastfeeding initiation and duration. This protocol describes the establishment of a population-based infant-feeding database in the Canadian province of Manitoba, providing opportunities to develop and evaluate breastfeeding support programme. METHODS AND ANALYSIS Routinely collected administrative health data on mothers' infant-feeding practices will be captured during regular vaccination visits using the Teleform fax tool, which converts handwritten information to an electronic format. The infant-feeding data will be linked to the Manitoba Population Research Data Repository, a comprehensive collection of population-based information spanning health, education and social services domains. The linkage will allow us to answer research questions about infant-feeding practices and to evaluate how effective current initiatives promoting breast feeding are. ETHICS AND DISSEMINATION Approvals have been granted by the Health Research Ethics Board at the University of Manitoba. Our integrative knowledge translation approach will involve disseminating findings through government and community briefings, presenting at academic conferences and publishing in scientific journals.
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Affiliation(s)
- Nathan Christopher Nickel
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, Universityof Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lynne Warda
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, Universityof Manitoba, Winnipeg, Manitoba, Canada
- Injury Prevention and Child Health, Public Health Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Leslie Kummer
- Academic General Pediatrics, Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joanne Chateau
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, Universityof Manitoba, Winnipeg, Manitoba, Canada
| | - Maureen Heaman
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chris Green
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, Universityof Manitoba, Winnipeg, Manitoba, Canada
- Population & Public Health, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Alan Katz
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, Universityof Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julia Paul
- Field Services Training Unit, Health Security Infrastructure Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Carolyn Perchuk
- Population & Public Health, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Darlene Girard
- Population & Public Health, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Lorraine Larocque
- Department of Public Health, Northern Health Region, Thompson, Manitoba, Canada
| | - Jennifer Emily Enns
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, Universityof Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Souradet Shaw
- Department of Surveillance and Epidemiology, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
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14
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Leung B, Letourneau N, Bright K, Giesbrecht GF, Ntanda H, Gagnon L. Appraisal of the Psychiatric Diagnostic Screening Questionnaire in a perinatal cohort: The APrON study. Scand J Public Health 2017; 45:658-665. [PMID: 28707502 DOI: 10.1177/1403494817717835] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Depression and anxiety are routinely screened as part of perinatal care. However, other Axis 1 disorders and specific anxiety disorders are less likely to be screened or assessed as part of obstetric care. The objective of this study was to determine whether the Psychiatric Diagnostic Screening Questionnaire (PDSQ) is a potentially useful tool to screen for psychiatric conditions in pregnant and postpartum women in a community setting. METHODS We compared the prevalence of DSM Axis I disorders obtained on the PDSQ with: (1) the prevalence of these disorders reported in previous studies of pregnant and postpartum women, and (2) scores obtained on the Edinburgh Postpartum Depression Scale (EPDS) and the Symptom Checklist-90-Revised (SCL-90R) anxiety scale. Data were obtained from the Alberta Pregnancy Outcomes and Nutrition (APrON) study. RESULTS The PDSQ was completed by 1575 women prenatally and 1481 postnatally. The three most prevalent PDSQ conditions were social phobia, somatic disorder, and obsessive-compulsive disorder (OCD). The prevalence of social phobia, alcohol disorder, OCD and psychosis were higher in the APrON cohort compared with statistics in the literature. The proportion of women meeting depression and anxiety cut-offs on the PDSQ were lower than for the EPDS and the SCL-90R. The Cohens Kappa index ( k) indicated poor to fair agreement between the measures in classifying pregnant women as depressed or anxious. CONCLUSIONS The PDSQ subscales may not be appropriate for the pregnant population. Research into instruments more specific to pregnant and postpartum women are needed to determine the prevalence of psychiatric disorders in this population.
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Affiliation(s)
- Brenda Leung
- 1 Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada.,2 Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Nicole Letourneau
- 3 Faculty of Nursing and Cumming School of Medicine (Paediatrics & Psychiatry), Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Katherine Bright
- 3 Faculty of Nursing and Cumming School of Medicine (Paediatrics & Psychiatry), Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Gerald F Giesbrecht
- 2 Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada.,4 Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Henry Ntanda
- 3 Faculty of Nursing and Cumming School of Medicine (Paediatrics & Psychiatry), Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Lisa Gagnon
- 5 Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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15
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Letourneau NL, Kozyrskyj AL, Cosic N, Ntanda HN, Anis L, Hart MJ, Campbell TS, Giesbrecht GF. Maternal sensitivity and social support protect against childhood atopic dermatitis. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2017; 13:26. [PMID: 28559916 PMCID: PMC5446757 DOI: 10.1186/s13223-017-0199-4] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/17/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Many studies have identified associations between qualities of maternal-child relationships and childhood asthma, but few have examined associations with childhood atopic dermatitis (AD), a common precursor to asthma. Moreover, maternal psychological distress, including prenatal and postnatal depression, anxiety and stress, may increase risk, while social support from partners may reduce risk for childhood AD. We sought to uncover the association between maternal-infant relationship qualities (maternal sensitivity towards infant behavioral signals, controlling behavior, and unresponsiveness) and child AD after accounting for risk (i.e., prenatal and postnatal maternal depression, anxiety and stress) and protective (i.e., social support) factors. METHODS We conducted a secondary analysis of data collected on a subsample of 242 women and their infants enrolled during pregnancy in the ongoing Alberta Pregnancy Outcomes and Nutrition cohort study. Inclusion criteria required mothers to be >16 years of age, English speaking and <22 weeks gestational age at enrollment. Data on depression, anxiety and stress in the prenatal and postnatal periods and physician diagnosis of childhood AD at 18 months were gathered via maternal report. Maternal sensitivity, unresponsiveness and controlling behaviours were assessed via videotaped observations using the Child-Adult Relationship Experimental (CARE)-Index at 6 months of infant age. RESULTS Higher maternal sensitivity, or the inability of the mother to appropriately understand and respond to infant needs based on behavioral signals, predicted reduced odds of AD independent of and in combination with low prenatal and postnatal anxiety and high paternal support. After adjustment, higher maternal controlling behaviours and unresponsiveness also predicted greater odds of AD. CONCLUSIONS Low maternal sensitivity is a risk factor for childhood AD, independently and in combination with perinatal anxiety and low social support. Thus, interventions that improve maternal-infant relationship quality, especially sensitivity, reduce anxiety and improve social support from partners could reduce odds of childhood AD.
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Affiliation(s)
- Nicole L. Letourneau
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4 Canada
- Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB T2N 4N1 Canada
- Child Development Centre, ACHRI Owerko Centre, 3rd Floor, 2888 Shaganappi Trail, Calgary, AB T3B 6A8 Canada
| | - Anita L. Kozyrskyj
- Departments of Pediatrics, Obstetrics & Gynecology, Faculty of Medicine and Dentistry, and School of Public Health, University of Alberta, Edmonton, AB T6G 2R3 Canada
| | - Nela Cosic
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4 Canada
- Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB T2N 4N1 Canada
- Child Development Centre, ACHRI Owerko Centre, 3rd Floor, 2888 Shaganappi Trail, Calgary, AB T3B 6A8 Canada
| | - Henry N. Ntanda
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4 Canada
- Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB T2N 4N1 Canada
- Child Development Centre, ACHRI Owerko Centre, 3rd Floor, 2888 Shaganappi Trail, Calgary, AB T3B 6A8 Canada
| | - Lubna Anis
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4 Canada
- Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB T2N 4N1 Canada
- Child Development Centre, ACHRI Owerko Centre, 3rd Floor, 2888 Shaganappi Trail, Calgary, AB T3B 6A8 Canada
| | - Martha J. Hart
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4 Canada
- Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB T2N 4N1 Canada
- Child Development Centre, ACHRI Owerko Centre, 3rd Floor, 2888 Shaganappi Trail, Calgary, AB T3B 6A8 Canada
| | - Tavis S. Campbell
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4 Canada
| | - Gerald F. Giesbrecht
- Cumming School of Medicine, Department of Pediatrics & Community Health Sciences, University of Calgary, Calgary, AB T2N 4N1 Canada
- Child Development Centre, ACHRI Owerko Centre, 3rd Floor, 2888 Shaganappi Trail, Calgary, AB T3B 6A8 Canada
| | - The APrON Team
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4 Canada
- Cumming School of Medicine, Departments of Pediatrics & Psychiatry, University of Calgary, Calgary, AB T2N 4N1 Canada
- Departments of Pediatrics, Obstetrics & Gynecology, Faculty of Medicine and Dentistry, and School of Public Health, University of Alberta, Edmonton, AB T6G 2R3 Canada
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4 Canada
- Cumming School of Medicine, Department of Pediatrics & Community Health Sciences, University of Calgary, Calgary, AB T2N 4N1 Canada
- Child Development Centre, ACHRI Owerko Centre, 3rd Floor, 2888 Shaganappi Trail, Calgary, AB T3B 6A8 Canada
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Giesbrecht GF, Liu J, Ejaredar M, Dewey D, Letourneau N, Campbell T, Martin JW. Urinary bisphenol A is associated with dysregulation of HPA-axis function in pregnant women: Findings from the APrON cohort study. ENVIRONMENTAL RESEARCH 2016; 151:689-697. [PMID: 27640068 DOI: 10.1016/j.envres.2016.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/30/2016] [Accepted: 09/09/2016] [Indexed: 05/23/2023]
Abstract
BACKGROUND Bisphenol A (BPA) is associated with dysregulation of hypothalamic-pituitary-adrenal (HPA) axis activity in rodents, but evidence in humans is lacking. OBJECTIVE To determine whether BPA exposure during pregnancy is associated with dysregulation of the HPA-axis, we examined the association between urinary BPA concentrations and diurnal salivary cortisol in pregnant women. Secondary analyses investigated whether the association between BPA and cortisol was dependent on fetal sex. METHODS Diurnal salivary cortisol and urinary BPA were collected during pregnancy from 174 women in a longitudinal cohort study, the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Associations between BPA and daytime cortisol and the cortisol awakening response (CAR) were estimated using mixed models after adjusting for covariates. RESULTS Higher concentrations of total BPA uncorrected for urinary creatinine were associated with dysregulation of the daytime cortisol pattern, including reduced cortisol at waking, β=-.055, 95% CI (-.100, -.010) and a flatter daytime pattern, β=.014, 95% CI (.006, .022) and β=-.0007 95% CI (-.001, -.0002) for the linear and quadratic slopes, respectively. Effect sizes in creatinine corrected BPA models were slightly smaller. None of the interactions between fetal sex and BPA were significant (all 95% CI's include zero). CONCLUSIONS These findings provide the first human evidence suggesting that BPA exposure is associated with dysregulation of HPA-axis function during pregnancy.
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Affiliation(s)
- Gerald F Giesbrecht
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Jiaying Liu
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Maede Ejaredar
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Deborah Dewey
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Letourneau
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada; Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Tavis Campbell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan W Martin
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
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