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Quinones S, Lin S, Tian L, Mendola P, Novignon J, Adamba C, Palermo T. The dose-response association between LEAP 1000 and birthweight - no clear mechanisms: a structural equation modeling approach. BMC Pregnancy Childbirth 2023; 23:364. [PMID: 37208642 DOI: 10.1186/s12884-023-05707-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/16/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Birthweight is an important indicator of maternal and fetal health globally. The multifactorial origins of birthweight suggest holistic programs that target biological and social risk factors have great potential to improve birthweight. In this study, we examine the dose-response association of exposure to an unconditional cash transfer program before delivery with birthweight and explore the potential mediators of the association. METHODS Data for this study come from the Livelihood Empowerment Against Poverty (LEAP) 1000 impact evaluation conducted between 2015 and 2017 among a panel sample of 2,331 pregnant and lactating women living in rural households of Northern Ghana. The LEAP 1000 program provided bi-monthly cash transfers and premium fee waivers to enroll in the National Health Insurance Scheme (NHIS). We used adjusted and unadjusted linear and logistic regression models to estimate the associations of months of LEAP 1000 exposure before delivery with birthweight and low birthweight, respectively. We used covariate-adjusted structural equation models (SEM) to examine mediation of the LEAP 1000 dose-response association with birthweight by household food insecurity and maternal-level (agency, NHIS enrollment, and antenatal care) factors. RESULTS Our study included a sample of 1,439 infants with complete information on birthweight and date of birth. Nine percent of infants (N = 129) were exposed to LEAP 1000 before delivery. A 1-month increase in exposure to LEAP 1000 before delivery was associated with a 9-gram increase in birthweight and 7% reduced odds of low birthweight, on average, in adjusted models. We found no mediation effect by household food insecurity, NHIS enrollment, women's agency, or antenatal care visits. CONCLUSIONS LEAP 1000 cash transfer exposure before delivery was positively associated with birthweight, though we did not find any mediation by household- or maternal-level factors. The results of our mediation analyses may serve to inform program operations and improve targeting and programming to optimize health and well-being among this population. TRIAL REGISTRATION The evaluation is registered in the International Initiative for Impact Evaluation's (3ie) Registry for International Development Impact Evaluations (RIDIESTUDY- ID-55942496d53af) and in the Pan African Clinical Trial Registry (PACTR202110669615387).
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Affiliation(s)
- Sarah Quinones
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, 14214, USA.
| | - Shao Lin
- Department of Environmental Health Sciences, One University Place, 212D University at Albany, State University of New York, Rensselaer, NY, 12144, USA
- Department of Epidemiology and Biostatistics, One University Place, 212D University at Albany, State University of New York, Rensselaer, NY, 12144, USA
| | - Lili Tian
- Department of Biostatistics, State University of New York, 717 Kimball Tower University at Buffalo, Buffalo, NY, 14214, USA
| | - Pauline Mendola
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, 14214, USA
| | - Jacob Novignon
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Clement Adamba
- Institute of Statistical, Social and Economic Research, University of Ghana-Legon, P.O. Box LG 74, Legon-Accra, Ghana
| | - Tia Palermo
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, 14214, USA
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Carlsen EØ, Wilcox AJ, Magnus MC, Hanevik HI, Håberg SE. Reproductive outcomes in women and men conceived by assisted reproductive technologies in Norway: prospective registry based study. BMJ MEDICINE 2023; 2:e000318. [PMID: 37051028 PMCID: PMC10083741 DOI: 10.1136/bmjmed-2022-000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/27/2023] [Indexed: 03/16/2023]
Abstract
ObjectivesTo determine whether the perinatal outcomes of women or men who were conceived by assisted reproductive technologies are different compared with their peers who were naturally conceived.DesignProspective registry based study.SettingMedical Birth Registry of Norway.ParticipantsPeople born in Norway between 1984 and 2002 with a registered pregnancy by the end of 2021.ExposurePeople who were conceived by assisted reproductive technologies and have had a registered pregnancy.Main outcome measuresComparing pregnancies and births of people who were conceived by assisted reproductive technologies and people who were naturally conceived, we assessed mean birth weight, gestational age, and placental weight by linear regression, additionally, the odds of congenital malformations, a low 5 min Apgar score (<7), transfer to a neonatal intensive care unit, delivery by caesarean section, use of assisted reproductive technologies, hypertensive disorders of pregnancy and pre-eclampsia, preterm birth, and offspring sex, by logistic regression. The occurrence of any registered pregnancy from people aged 14 years until age at the end of follow-up was assessed using Cox proportional regression for both groups.ResultsAmong 1 092 151 people born in Norway from 1984 to 2002, 180 652 were registered at least once as mothers, and 137 530 as fathers. Of these, 399 men and 553 women were conceived by assisted reproductive technologies. People who were conceived by assisted reproductive technologies had little evidence of increased risk of adverse outcomes in their own pregnancies, increased use of assisted reproductive technologies, or any difference in mean birth weight, placental weight, or gestational age. The only exception was for an increased risk of the neonate having a low Apgar score at 5 min (adjusted odds ratio 1.86 (95% confidence interval 1.20 to 2.89)) among women who were conceived by assisted reproductive technologies. Odds were slightly decreased of having a boy among mothers conceived by assisted reproductive technologies (odds ratio 0.79 (95% confidence interval 0.67 to 0.93)). People conceived by assisted reproductive technologies were slightly less likely to have a registered pregnancy within the follow-up period (women, adjusted hazard ratio 0.88 (95% CI 0.81 to 0.96); men, 0.91 (0.83 to 1.01)).ConclusionsPeople conceived by assisted reproductive technologies were not at increased risk of obstetric or perinatal complications when becoming parents. The proportion of people conceived by assisted reproductive technologies with a registered pregnancy was lower than among people who were naturally conceived, but a longer follow-up is required to fully assess their fertility and reproductive history.
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Affiliation(s)
- Ellen Øen Carlsen
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine, University of Oslo, Oslo, Norway
| | - Allen J Wilcox
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | | | - Hans Ivar Hanevik
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Fertility, Telemark Hospital Trust, Porsgrunn, Norway
| | - Siri Eldevik Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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Oliveira RR, da Silva EP, Flores TR, Gigante DP. Intergenerational transmission of birth weight: a systematic review and meta-analysis. Br J Nutr 2022; 129:1-13. [PMID: 36102244 DOI: 10.1017/s0007114522002938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The objectives of this study were (1) to systematically review the literature on the association between birth weight in children born in the first and second generation and (2) to quantify this association by performing a meta-analysis. A systematic review was carried out in six databases (PubMed, Science Direct, Web of Science, Embase, Scopus, CINAHL and LILACS), in January 2021, for studies that recorded the birth weight of parents and children. A meta-analysis using random effects to obtain a pooled effect of the difference in birth weight and the association of low birth weight (LBW) between generations was performed. Furthermore, univariable meta-regression was conducted to assess heterogeneity. Egger's tests were used to possible publication biases. Of the 9878 identified studies, seventy were read in full and twenty were included in the meta-analysis (ten prospective cohorts and ten retrospective cohorts), fourteen studies for difference in means and eleven studies for the association of LBW between generations (twenty-three estimates). Across all studies, there was no statistically significant mean difference (MD) birth weight between first and second generation (MD 19·26, 95 % CI 28·85, 67·36; P = 0·43). Overall, children of LBW parents were 69 % more likely to have LBW (pooled effect size 1·69, 95 % CI (1·46, 1·95); I2:85·8 %). No source of heterogeneity was identified among the studies and no publication bias. The average birth weight of parents does not influence the average birth weight of children; however, the proportion of LBW among the parents seems to affect the offspring's birth weight.
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Affiliation(s)
| | | | - Thaynã Ramos Flores
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Gyselaers W, Lees C. Maternal Low Volume Circulation Relates to Normotensive and Preeclamptic Fetal Growth Restriction. Front Med (Lausanne) 2022; 9:902634. [PMID: 35755049 PMCID: PMC9218216 DOI: 10.3389/fmed.2022.902634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
This narrative review summarizes current evidence on the association between maternal low volume circulation and poor fetal growth. Though much work has been devoted to the study of cardiac output and peripheral vascular resistance, a low intravascular volume may explain why high vascular resistance causes hypertension in women with preeclampsia (PE) that is associated with fetal growth restriction (FGR) and, at the same time, presents with normotension in FGR itself. Normotensive women with small for gestational age babies show normal gestational blood volume expansion superimposed upon a constitutionally low intravascular volume. Early onset preeclampsia (EPE; occurring before 32 weeks) is commonly associated with FGR, and poor plasma volume expandability may already be present before conception, thus preceding gestational volume expansion. Experimentally induced low plasma volume in rodents predisposes to poor fetal growth and interventions that enhance plasma volume expansion in FGR have shown beneficial effects on intrauterine fetal condition, prolongation of gestation and birth weight. This review makes the case for elevating the maternal intravascular volume with physical exercise with or without Nitric Oxide Donors in FGR and EPE, and evaluating its role as a potential target for prevention and/or management of these conditions.
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Affiliation(s)
- Wilfried Gyselaers
- Department of Obstetrics, Ziekenhuis Oost Limburg, Genk, Belgium.,Department of Physiology, Hasselt University, Hasselt, Belgium
| | - Christoph Lees
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.,Department of Metabolism, Digestion and Reproduction, Institute for Reproductive and Developmental Biology, Imperial College London, London, United Kingdom.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, London, United Kingdom
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Jensen PM, Sørensen M, Weiner J. Human total fertility rate affected by ambient temperatures in both the present and previous generations. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:1837-1848. [PMID: 33990870 DOI: 10.1007/s00484-021-02140-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 03/26/2021] [Accepted: 04/23/2021] [Indexed: 06/12/2023]
Abstract
Elevated temperatures negatively affect human reproduction through several processes that regulate nutrient uptake and resource allocation in pregnant women. These can interfere with foetal development, resulting in low birth weight neonates with altered development trajectories. Temperatures that affect the current generation could, therefore, also have an impact on the following generation. We asked whether heat stress affected offspring fertility by asking if current and past ambient temperatures influenced total fertility rates (TFR) in human populations distributed across the world. We analysed time series data in 65 countries using simple regression analyses based on maximum temperatures and temperature amplitudes over 55 years. Supplemental longer time series (up to 100 years) provided information on response patterns in Northern Europe and Greenland's colder climates. There were clear and strong effects of temperatures on the TFR in the concurrent and the previous generation. Our temperature-based models account for 71-95% of the variation in TRF in European countries and Greenland, and 56-99% of the variation in 65 countries worldwide. Our findings are consistent with studies of seasonal variation in fertility and suggest that increased temperatures will negatively influence populations subjected to monthly maximum temperatures above 15-20 °C, while fertility in colder climates benefits from elevated temperatures. Our results provide strong evidence that ambient temperatures have important effects on human fertility, and that these effects persist into the following generation.
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Affiliation(s)
- Per M Jensen
- Department of Plant and Environmental Sciences, University of Copenhagen, Frederiksberg, Denmark.
| | - Marten Sørensen
- Department of Plant and Environmental Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Jacob Weiner
- Department of Plant and Environmental Sciences, University of Copenhagen, Frederiksberg, Denmark
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Abstract
Purpose of Review To review the effects of early-life, preconception, and prior-generation exposures on reproductive health in women. Recent Findings Women’s early-life factors can affect reproductive health by contributing to health status or exposure level on entering pregnancy. Alternately, they can have permanent effects, regardless of later-life experience. Nutrition, social class, parental smoking, other adverse childhood experiences, environmental pollutants, infectious agents, and racism and discrimination all affect reproductive health, even if experienced in childhood or in utero. Possible transgenerational effects are now being investigated through three- or more-generation studies. These effects occur with mechanisms that may include direct exposure, behavioral, endocrine, inflammatory, and epigenetic pathways. Summary Pregnancy is increasingly understood in a life course perspective, but rigorously testing hypotheses on early-life effects is still difficult. In order to improve the health outcomes of all women, we need to expand our toolkit of methods and theory. Supplementary Information The online version contains supplementary material available at 10.1007/s40471-021-00279-0.
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