Pregnancy during adolescence has lasting adverse effects on blood lipids: a 10-year longitudinal study of black and white females

Individual, Family, and Social Factors Associated with Gestational Weight Gain in Adolescents: A Scoping Review

About 56% to 84% of pregnant adolescents have inappropriate (insufficient or excessive) gestational weight gain (GWG); however, the factors associated with GWG in this age group have not been systematically identified. This scoping review aimed to synthesize the available scientific evidence on the association of individual, family, and social factors with inappropriate gestational weight gain in pregnant adolescents. To carry out this review, the MEDLINE, Scopus, Web of Science, and Google Scholar databases were searched for articles from recent years. The evidence was organized according to individual, family, and social factors. The analyzed studies included 1571 adolescents from six retrospective cohorts, 568 from three prospective cohorts, 165 from a case-control study, 395 from a cross-sectional study, and 78,001 from two national representative samples in the USA. At the individual level, in approximately half of the studies, the pre-pregnancy body mass index (pBMI) was positively associated with the GWG recommended by the Institute of Medicine of the USA (IOM). The evidence was insufficient for the other factors (maternal age, number of deliveries, and family support) to determine an association. According to the review, we concluded that pBMI was positively associated with the GWG. More quality studies are needed to assess the association between GWG and individual, family, and social factors.

Roles of maternal HDL during pregnancy

BACKGROUND

High density lipoproteins (HDL) were first linked to cardiovascular disease (CVD) over 30 years ago when an inverse relationship was shown between CVD and HDL-cholesterol levels. It is now apparent that HDL composition and function, not cholesterol levels, are the pertinent measurements describing HDL's role in various disease processes, especially those with subclinical or overt inflammation.

SCOPE OF REVIEW

Pregnancy is also an inflammatory state. When inflammation becomes excessive during pregnancy, there is an increased risk for adverse outcomes that affect the health of the mother and fetus, including preterm birth and preeclampsia. Though studies on HDL during pregnancy are limited, recent evidence demonstrates that HDL composition and function change during pregnancy and in women with adverse outcomes.

GENERAL SIGNIFICANCE

In this review, we will discuss how HDL may play a role in maintaining a healthy pregnancy and how impairments in function could lead to pregnancies with adverse outcomes.

Untangling the roots of the West Virginia opioid crisis: relationships in adolescent pregnancy, drug misuse, and future outcomes

Context

West Virginia (WV) is afflicted by high rates of teenage pregnancy and births, opioid usage during pregnancy, and Neonatal Abstinence Syndrome births. Current efforts are ineffective at reducing teenage pregnancy and opioid misuse. While pregnancy and opioid usage may appear to be separate issues, a number of associations suggest adolescent pregnancy, opioid use, and other health-related outcomes are part of a cluster of negative health conditions that should be addressed holistically.

Objective

To determine whether there is an association between teenage pregnancy and negative health outcomes, including opioid misuse, among WV adolescent girls.

Methods

This study was conducted from July 2018 to March 2019. We obtained the most recently-available aggregate data at the county level for each of the 55 WV counties from the WV Department of Health and Human Resources (WVDHHR) on July 30, 2018, and we analyzed it during the fall of 2018. Raw data regarding pregnancy-related outcomes included WV girls between the ages of 15 and 19, was acquired between 2014 and 2017 by county, and was provided by the WVDHHR as a mean taken across all four years. Raw data regarding opioid misuse outcomes and heart-health variables included WV girls and women of all ages, was collected between 2014 and 2017 by county, and was provided by the WVDHHR as a mean taken across all four years, unless stated otherwise. Pearson correlation analysis was utilized to examine the associations between the teenage pregnancy and birth rates, opioid misuse, pregnancy, and heart-health-related statistics, as well as environmental variables.

Results

Teenage pregnancy and birth rates were positively associated with fetal death rates (r=0.308, p<0.05 and r=0.261, p<0.10, respectively). The rate of fetal death among mothers aged 15-19 years was higher in counties with higher teenage pregnancy and birth rates. As the pregnancy and birth rates increased, the rate of abortion increased even more (r=0.434 and r=0.304 respectively, both p<0.05). Teenage pregnancy and birth rates were associated with opioid overdose death rates for all WV girls and women (Pearson correlations, r=0.444 and 0.418 respectively, both p<0.01). WV counties with higher pregnancy and birth rates among girls aged 15-19 years had a greater proportion of women dying from opioid overdose. Teenage pregnancy and birth rates were both positively correlated with obesity, physical inactivity, high cholesterol, and high blood pressure (all r>0.39, all p<0.05). Neither the high-school dropout rate nor the number of WVDHHR listed clinics were associated with teenage pregnancy or birth rates (p>0.10).

Conclusion

Reduction of unintended teenage pregnancy may be viewed as a nontraditional, holistic, method of ameliorating the opioid misuse crisis in the state of WV. This recommendation should be part of a multi-pronged approach to mitigating the opioid epidemic in WV and all of Appalachia.

Longitudinal changes in HDL-cholesterol concentration are associated with different risk factors in primiparous and nulliparous young women: The NHLBI Growth and Health Study (NGHS)

BACKGROUND

Previous studies report that first pregnancy is associated with persistent decreases in HDL-cholesterol (HDL-C) concentrations.

OBJECTIVE

This study evaluated factors associated with declines in HDL-C concentration in parous and nulliparous young women.

METHODS

This study leverages data from African-American and white women from the NHLBI Growth and Health Study. Parity-related changes in lipids, BMI and percent body fat were assessed longitudinally. A subset of primiparous and nulliparous women with paired lipid measurements were analyzed regarding changes in HDL-C concentrations.

RESULTS

Among 870 women in longitudinal analyses, African-American women had higher parity (p<0.0001), with baseline measurements of each parity group being similar. HDL-C concentration decreased significantly and remained lower after the first pregnancy, while BMI and percent body fat increased with increasing parity. In the subset of 401 women, HDL-C concentration decreased among primiparous women (-4.81 ± 0.93 mg/dl), with no overall change in nulliparous (p = 0.003). In both groups, greater HDL-C concentration declines were independently associated with higher initial HDL-C concentration and greater increases in BMI (both p<0.0001). Among primiparous women, younger delivery age (p = 0.0001) and birth control use (p = 0.004) were associated with greater HDL-C concentration decline. Nulliparous white women's HDL-C concentration increased over time, with no change in African-American women (p = 0.008); no racial difference was seen in primiparous women.

CONCLUSION

Persistent decreases in HDL-C concentration were associated with the first pregnancy, and were greater with higher initial HDL-C concentration. Racial differences in HDL-C concentration emerged over time in nulliparous women, but not primiparous women. Potential impacts of these findings on women's long-term cardiometabolic health should be evaluated.

Reproductive History and Cognitive Aging: The Bogalusa Heart Study

BACKGROUND

Although it has become increasingly clear that pregnancy-related health predicts later-life cardiometabolic health, the relationship between reproductive history and cognitive health is less frequently studied. Although some research has identified associations between parity or hypertensive disorders of pregnancy and cognitive changes, the evidence is mixed.

OBJECTIVE

To examine the association between reproductive history and midlife cognition in a community-based population.

STUDY DESIGN

Seven hundred and thirty midlife women in the Bogalusa Heart Study completed a brief cognitive battery (memory, attention, executive function, and processing speed) and were interviewed about their reproductive history. Reproductive history (parity, age at first pregnancy, and breastfeeding) and pregnancy complications (low birthweight, preterm birth, hypertensive disorders, and miscarriage) were examined as predictors of cognitive function, with adjustment for potential confounders.

RESULTS

Nulliparous women had an overall lower cognitive score (adjusted beta -1.50, standard error [SE]: 0.41). Adolescent birth was associated with a somewhat better performance on the Trail Making Test (beta -0.31, SE: 0.15 for birth <16 years), while high parity was not strongly associated with any of the cognitive measures. History of pregnancy complications was not strongly associated with cognitive function, whereas history of miscarriage was associated with better cognitive function, as was a history of breastfeeding (beta overall score 0.90, SE: 0.29), particularly noticeable for semantic memory and in those with more total breastfeeding time (beta for overall score among those with >24 weeks lifetime breastfeeding, beta 1.21, SE: 0.44).

CONCLUSION

Nulliparity and breastfeeding are associated with midlife cognition in women. Future studies should examine possible mechanisms by which these associations are created.

Lipid levels after childbirth and association with number of children: A population-based cohort study

OBJECTIVE

Low parity women are at increased risk of cardiovascular mortality. Unfavourable lipid profiles have been found in one-child mothers years before they conceive. However, it remains unclear whether unfavourable lipid profiles are evident in these women also after their first birth. The aim was to estimate post-pregnancy lipid levels in one-child mothers compared to mothers with two or more children and to assess these lipid's associations with number of children.

METHODS

We used data on 32 618 parous women (4 490 one-child mothers and 28 128 women with ≥2 children) examined after first childbirth as part of Cohort of Norway (1994-2003) with linked data on reproduction and number of children from the Medical Birth Registry of Norway (1967-2008). Odds ratios (ORs) with 95% confidence intervals (CIs) for one lifetime pregnancy (vs. ≥2 pregnancies) by lipid quintiles were obtained by logistic regression and adjusted for age at examination, year of first birth, body mass index, oral contraceptive use, smoking and educational level.

RESULTS

Compared to women with the lowest quintiles, ORs for one lifetime pregnancy for the highest quintiles of LDL and total cholesterol were 1.30 (95%CI: 1.14-1.45) and 1.43 (95%CI: 1.27-1.61), respectively. Sensitivity analysis (women <40 years) showed no appreciable change in our results. In stratified analyses, estimates were slightly stronger in overweight/obese, physically inactive and women with self-perceived bad health.

CONCLUSIONS

Mean lipid levels measured after childbirth in women with one child were significantly higher compared to mothers with two or more children and were associated with higher probability of having only one child. These findings corroborate an association between serum lipid levels and one lifetime pregnancy (as a feature of subfecundity), emphasizing that these particular women may be a specific predetermined risk group for cardiovascular related disease and death.

History of adolescent birth and diabetes in adulthood: a cross-sectional study of a nationally representative sample of American women

Background: In the USA, 12-14% have type 2 diabetes mellitus and the incidence is rising. Adolescent birth has been shown to be associated with significant gestational weight gain and obesity in adulthood.Objective: We sought to evaluate the association between the history of adolescent birth and diabetes in adulthood.Study design: We conducted a cross-sectional study of the National Health and Nutrition Examination Survey (NHANES) data, examining 2-year cycles from 2005 to 2014. In a population of adult women who had experienced at least one live birth and who were not currently pregnant, we examined the prevalence of type 2 diabetes mellitus by the history of adolescent birth (live birth prior to 20 years of age). Sample characteristics were compared using survey-weighted chi-square tests. Multivariate logistic regression was used to examine the association between diabetes mellitus and adolescent birth history, with progressive adjustments for birth cohort, race/ethnicity, education level, and body mass index (BMI).Results: In a survey sample of 6507 individuals, we found that 38% of the women had experienced adolescent birth. Significant differences were found between those who had experienced adolescent birth and those who had not by birth cohort, race/ethnicity, federal poverty level, education attainment, parity, and BMI (p < .001 for all). The prevalence of type 2 diabetes was higher in women with a history of adolescent birth in adulthood than in women without a history of adolescent birth (17.2 versus 12.1%, p < .001; BMI-adjusted odds ratio = 1.27; 95% confidence interval, 1.03-1.58, p = .03).Conclusion: American women with a history of adolescent birth are at a significantly higher risk of type 2 diabetes mellitus in adulthood. Greater attention must be paid to preventing metabolic disease in women who experience early parity.

Does pregnancy alter life-course lipid trajectories? Evidence from the HUNT Study in Norway

We examined the association between pregnancy and life-course lipid trajectories. Linked data from the Nord-Trøndelag Health Study and the Medical Birth Registry of Norway yielded 19,987 parous and 1,625 nulliparous women. Using mixed-effects spline models, we estimated differences in nonfasting lipid levels from before to after first birth in parous women and between parous and nulliparous women. HDL cholesterol (HDL-C) dropped by -4.2 mg/dl (95% CI: -5.0, -3.3) from before to after first birth in adjusted models, a 7% change, and the total cholesterol (TC) to HDL-C ratio increased by 0.18 (95% CI: 0.11, 0.25), with no change in non-HDL-C or triglycerides. Changes in HDL-C and the TC/HDL-C ratio associated with pregnancy persisted for decades, leading to altered life-course lipid trajectories. For example, parous women had a lower HDL-C than nulliparous women at the age of 50 years (-1.4 mg/dl; 95% CI: -2.3, -0.4). Adverse changes in lipids were greatest after first birth, with small changes after subsequent births, and were larger in women who did not breastfeed. Findings suggest that pregnancy is associated with long-lasting adverse changes in HDL-C, potentially setting parous women on a more atherogenic trajectory than prior to pregnancy.

Adolescent Childbirth Is Associated With Greater Framingham Risk Scores for Cardiovascular Disease Among Participants of the IMIAS (International Mobility in Aging Study)

BACKGROUND

Previous studies observe associations between lifetime parity and cardiovascular disease, but relatively fewer investigate age at first childbirth (AFB). Herein, we examine the association of AFB with a summary cardiovascular risk measure (Framingham Risk Score [FRS]).

METHODS AND RESULTS

As part of the IMIAS (International Mobility in Aging Study), data were collected in 2012 among 1047 women, aged 65 to 74 years, from Canada, Albania, Colombia, and Brazil. FRSs were calculated to describe cardiovascular risk profiles, and linear regression analyses were performed, adjusting for early life and socioeconomic variables. Women with an AFB of <20 years were compared with women with an AFB of 20 to 24, 25 to 29, and ≥30 years, as well as nulliparous women. We also compared FRS between combinations of AFB and parity categories: nulliparous women, parity 1 to 3 combined with AFB <20 years, parity ≥4 with AFB <20 years, parity 1 to 3 with AFB ≥20 years, and parity ≥4 with AFB ≥20 years. Women with an AFB of <20 years had a higher mean FRS compared with all other AFB groups. Compared with the lowest AFB risk group (25-29 years), women with an AFB of <20 years had a 5.8-point higher mean FRS (95% confidence interval, 3.4-8.3 points). Nulliparous women presented the lowest mean FRS in all analyses. The analysis comparing combinations of AFB and parity categories showed no meaningful differences in FRS between women who had 1 to 3 childbirths and those who had ≥4 childbirths within the stratum of AFB <20 years, and in the stratum of AFB ≥20 years.

CONCLUSIONS

Our analyses suggest that nulliparity and AFB, rather than increasing parity, drive the association with cardiovascular disease risk.

Intergenerational Effects of Childhood Trauma: Evaluating Pathways Among Maternal ACEs, Perinatal Depressive Symptoms, and Infant Outcomes

Maternal adverse childhood experiences (ACEs) have been associated with negative physical and mental health outcomes in adulthood. Less is known regarding how maternal ACEs relate to perinatal depressive symptoms or the intergenerational effect of maternal childhood trauma history on birth outcomes and infant functioning. To address this gap, an at-risk sample of 398 pregnant women was recruited from Women, Infants, and Children health clinics. Participants completed a prenatal ( M = 4.84 months before due date) and postnatal ( M = 6.76 months after birth) assessment and provided birth outcome data. At the prenatal assessment, mothers completed an ACEs measure which assessed experiences of childhood maltreatment and household dysfunction. Self-report measures of maternal depressive symptoms were obtained at both time points. Mothers reported on infant socioemotional functioning at 6 months. Maternal ACEs predicted higher levels of prenatal depressive symptoms. Childhood maltreatment experiences, in particular, predicted higher postnatal depressive symptoms and a smaller reduction in depressive symptoms across the perinatal period. Regarding intergenerational associations, maternal childhood maltreatment directly predicted higher levels of maladaptive infant socioemotional symptoms, whereas maternal household dysfunction indirectly related to infant socioemotional symptoms through maternal age at first pregnancy and infant birth weight. Limitations and future directions are discussed.

Reproductive Risk Factors and Coronary Heart Disease in the Women's Health Initiative Observational Study

BACKGROUND

Reproductive factors provide an early window into a woman's coronary heart disease (CHD) risk; however, their contribution to CHD risk stratification is uncertain.

METHODS AND RESULTS

In the Women's Health Initiative Observational Study, we constructed Cox proportional hazards models for CHD including age, pregnancy status, number of live births, age at menarche, menstrual irregularity, age at first birth, stillbirths, miscarriages, infertility ≥1 year, infertility cause, and breastfeeding. We next added each candidate reproductive factor to an established CHD risk factor model. A final model was then constructed with significant reproductive factors added to established CHD risk factors. Improvement in C statistic, net reclassification index (or net reclassification index with risk categories of <5%, 5 to <10%, and ≥10% 10-year risk of CHD), and integrated discriminatory index were assessed. Among 72 982 women (CHD events, n=4607; median follow-up,12.0 [interquartile range, 8.3-13.7] years; mean [standard deviation] age, 63.2 [7.2] years), an age-adjusted reproductive risk factor model had a C statistic of 0.675 for CHD. In a model adjusted for established CHD risk factors, younger age at first birth, number of still births, number of miscarriages, and lack of breastfeeding were positively associated with CHD. Reproductive factors modestly improved model discrimination (C statistic increased from 0.726 to 0.730; integrated discriminatory index, 0.0013; P<0.0001). Net reclassification for women with events was not improved (net reclassification index events, 0.007; P=0.18); and, for women without events, net reclassification was marginally improved (net reclassification index nonevents, 0.002; P=0.04) CONCLUSIONS: Key reproductive factors are associated with CHD independently of established CHD risk factors, very modestly improve model discrimination, and do not materially improve net reclassification.

Gestational Weight Gain and Health Outcomes 18 Years Later in Urban Black Women

OBJECTIVES

Excessive gestational weight gain (GWG) is associated with higher body mass index (BMI) later in life. Increased BMI is associated with health problems, but there is limited evidence linking GWG directly to later health in black women. We examined the association between GWG and health conditions 18 years after a first birth.

METHODS

This study was a secondary data analysis of 467 urban black women, enrolled during pregnancy (1990-1991). GWG was the difference between self-reported pre-pregnancy weight and measured weight at delivery. Hypertension, diabetes, obesity, and self-reported health were assessed with self-report and measurements of blood pressure, height, and weight, approximately 18 years after first childbirth.

RESULTS

Higher pre-pregnancy BMI was associated with increased probability of each health condition. Higher GWG was associated with hypertension for women with a pre-pregnancy BMI under 21.3 kg/m(2) (P < .05) and obesity for women with a pre-pregnancy BMI under 25.9 kg/m(2) (P < .05). Diabetes and poor health were not associated with GWG.

CONCLUSIONS

GWG may impact a mother's hypertension and obesity status 18 years after childbirth for underweight and normal weight women.

Violence against women and gastroschisis: a case-control study

BACKGROUND

Gastroschisis, a birth defect characterized by herniated fetal abdominal wall, occurs more commonly in infants born to teenage and young mothers. Ischemia of the vascular vitelline vessels is the likely mechanism of pathogenesis. Given that chronic stress and violence against women are risk factors for cardiovascular disease we explored whether these may represent risk factors for gastroschisis, when they occur during pregnancy. A case-control study was conducted, with 15 incident cases of children born with gastroschisis in the Region of Murcia, Spain, from December 2007 to June 2013. Forty concurrent controls were recruited at gestation weeks 20-24 or post-partum. All mothers of cases and controls completed a comprehensive, in-person, 'green sheet' questionnaire on environmental exposures.

RESULTS

Mothers of children with gastroschisis were younger, smoked more cigarettes per week relative to controls, were exposed to higher amounts of illegal drugs, and suffered from domestic violence more frequently than the controls. Multivariable logistic regression analysis highlights periconceptional 'gender-related violence' (OR: 16.6, 95% CI 2.7 to 101.7) and younger maternal age (OR 1.1, 95% CI 1.0-1.3).

CONCLUSIONS

Violence against pregnant women is associated with birth defects, and should be studied in more depth as a cause-effect teratogenic. Psychosocial risk factors, including gender-based violence, are important for insuring the health and safety of the pregnant mother and the fetus.