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Yoshii K, Morisaki N, Piedvache A, Nakada S, Arima K, Aoyagi K, Nakashima H, Yasuda N, Muraki I, Yamagishi K, Saito I, Kato T, Tanno K, Yamaji T, Iwasaki M, Inoue M, Tsugane S, Sawada N. Association Between Birth Weight and Prevalence of Cardiovascular Disease and Other Lifestyle-related Diseases Among the Japanese Population: The JPHC-NEXT Study. J Epidemiol 2024; 34:307-315. [PMID: 37981322 PMCID: PMC11167263 DOI: 10.2188/jea.je20230045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/29/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND An association between birth weight and cardiovascular disease (CVD) in adulthood has been observed in many countries; however, only a few studies have been conducted in Asian populations. METHODS We used data from the baseline survey (2011-2016) of the Japan Public Health Center-based Prospective Study for the Next Generation Cohort, which included 114,105 participants aged 40-74 years. Adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were calculated from the prevalence of present and past histories of CVD and other lifestyle-related diseases, including hypertension, diabetes, hyperlipidemia, and gout, by birth weight, using Poisson regression. RESULTS The prevalence of CVD increased with lower birth weight, with the highest prevalence among those with birth weight under 1,500 grams (males 4.6%; females 1.7%) and the lowest one among those with birth weight at or over 4,000 g (males 3.7%: females 0.8%). Among 88,653 participants (41,156 males and 47,497 females) with complete data on possible confounders, birth weight under 1,500 g was associated with a higher prevalence of CVD (aPR 1.76; 95% CI, 1.37-2.26), hypertension (aPR 1.29; 95% CI, 1.17-1.42), and diabetes (aPR 1.53; 95% CI, 1.26-1.86) when a birth weight of 3,000-3,999 grams was used as the reference. Weaker associations were observed for birth weight of 1,500-2,499 grams and 2,500-2,999 grams, while no significant associations were observed for birth weight at or over 4,000 grams. The association between birth weight and the prevalence of hyperlipidemia was less profound, and no significant association was observed between birth weight and gout. CONCLUSION Lower birth weight was associated with a higher prevalence of CVD, hypertension, and diabetes in the Japanese population.
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Affiliation(s)
- Keisuke Yoshii
- Division of Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Aurélie Piedvache
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Shinya Nakada
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kazuhiko Arima
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kiyoshi Aoyagi
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroki Nakashima
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Nobufumi Yasuda
- Department of Public Health, Kochi University Medical School, Kohasu, Kochi, Japan
| | - Isao Muraki
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
- Ibaraki Western Medical Center, Ibaraki, Japan
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University, Oita, Japan
| | - Tadahiro Kato
- Division of Life Span Development and Clinical Psychology, Graduate School of Education, Ehime University, Matsuyama, Japan
| | - Kozo Tanno
- Department of Hygiene and Preventive Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Taiki Yamaji
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Motoki Iwasaki
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Manami Inoue
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- Division of Prevention, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Shoichiro Tsugane
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
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Faa G, Fanos V, Manchia M, Van Eyken P, Suri JS, Saba L. The fascinating theory of fetal programming of adult diseases: A review of the fundamentals of the Barker hypothesis. J Public Health Res 2024; 13:22799036241226817. [PMID: 38434579 PMCID: PMC10908242 DOI: 10.1177/22799036241226817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 12/27/2023] [Indexed: 03/05/2024] Open
Abstract
The theory of fetal programming of adult diseases was first proposed by David J.P. Barker in the eighties of the previous century, to explain the higher susceptibility of some people toward the development of ischemic heart disease. According to his hypothesis, poor maternal living conditions during gestation represent an important risk factor for the onset of atherosclerotic heart disease later in life. The analysis of the early phases of fetal development is a fundamental tool for the risk stratification of children and adults, allowing the identification of susceptible or resistant subjects to multiple diseases later in life. Here, we provide a narrative summary of the most relevant evidence supporting the Barker hypothesis in multiple fields of medicine, including neuropsychiatric disorders, such as Parkinson disease and Alzheimer disease, kidney failure, atherosclerosis, coronary heart disease, stroke, diabetes, cancer onset and progression, metabolic syndrome, and infectious diseases including COVID-19. Given the consensus on the role of body weight at birth as a practical indicator of the fetal nutritional status during gestation, every subject with a low birth weight should be considered an "at risk" subject for the development of multiple diseases later in life. The hypothesis of the "physiological regenerative medicine," able to improve fetal organs' development in the perinatal period is discussed, in the light of recent experimental data indicating Thymosin Beta-4 as a powerful growth promoter when administered to pregnant mothers before birth.
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Affiliation(s)
- Gavino Faa
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA, USA
| | - Vassilios Fanos
- Unit of Neonatology and NICU Center, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Peter Van Eyken
- Department of Pathology, UZ Genk Regional Hospital, Genk, Belgium
| | - Jasjit S. Suri
- Stroke Diagnostic and Monitoring Division, Atheropoint, Roseville, CA, USA
| | - Luca Saba
- Unit of Radiology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Chaudhary M, Balu V, Sapkota P, Kamei S, Devi YS. Effectiveness of SMART heart package on knowledge and practice regarding prevention of coronary artery disease among high-risk adults in selected urban community at Bangalore. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:415. [PMID: 38333169 PMCID: PMC10852168 DOI: 10.4103/jehp.jehp_260_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/24/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Coronary artery disease is the most common cause of cardiovascular disease. Smoking is one of the triggering factors for CAD, which increases mortality and morbidity rates. The aim of this study was to assess the impact of the SMART heart package on high-risk adults' knowledge and practice of coronary artery disease prevention. MATERIAL AND METHOD A quasi-experimental research study was conducted in India from March 25 to April 23, 2022, through a house-to-house survey. This survey was conducted among 200 adults out of 159 high-risk adults who were identified by a screening tool, using a systematic random sampling technique to select 60 subjects for the study. A SMART heart package intervention was administered for selected high-risk adults. The pre-test and the post-test were conducted using self-administered structured questionnaires for knowledge and a non-observation checklist for practice. The data had been analyzed by the Statistical Package for Social Science (SPSS) version 20.0. RESULTS The findings show that at the baseline level of knowledge and practice, the majority of the subjects had inadequate knowledge 43 (71.7%) and 51 (85.0%) had poor practice, whereas after administration of the SMART heart package, 29 (48.3%) of subjects had moderately adequate knowledge and 29 (48.3%) had average practice. At baseline, the mean score was 41.5%, which increased to 79.1% on knowledge and 37.2% to 72.5% on practice after the implementation of the intervention, which was statistically significant (P < 0.001). CONCLUSION Hence, the SMART heart package was effective in increasing the level of knowledge and practice of CAD prevention among high-risk adults.
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Affiliation(s)
- Manisha Chaudhary
- Department of Medical Surgical Nursing, Padmashree Institute of Nursing, Bangalore, Karnataka, India
| | - Venkatesan Balu
- Department of Medical Surgical Nursing, GITAM Institute of Nursing, GITAM (Deemed to be University), Visakhapatnam, Andhra Pradesh, India
| | - Pratima Sapkota
- Department of Medical Surgical Nursing, JMD Institute of Nursing, Gandhi Nagar, Gujarat, India
| | - Sonia Kamei
- Department of Medical Surgical Nursing, Padmashree Institute of Nursing, Bangalore, Karnataka, India
| | - Yumnam Sushma Devi
- Department of Medical Surgical Nursing, Padmashree Institute of Nursing, Bangalore, Karnataka, India
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Kalra A, Jose AP, Prabhakaran P, Kumar A, Agrawal A, Roy A, Bhargava B, Tandon N, Prabhakaran D. The burgeoning cardiovascular disease epidemic in Indians - perspectives on contextual factors and potential solutions. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 12:100156. [PMID: 37384064 PMCID: PMC10305862 DOI: 10.1016/j.lansea.2023.100156] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/05/2023] [Accepted: 01/18/2023] [Indexed: 06/30/2023]
Abstract
Cardiovascular diseases (CVD) are the leading cause of death and disability in India. The CVD epidemic in Indians is characterized by a higher relative risk burden, an earlier age of onset, higher case fatality and higher premature deaths. For decades, researchers have been trying to understand the reason for this increased burden and propensity of CVD among Indians. It can partly be explained by population-level changes and the remaining by increased inherent biological risk. While increased biological risk can be attributed to phenotypic changes caused by early life influences, six major transitions can be considered largely responsible for the population-level changes in India-epidemiological, demographic, nutritional, environmental, social-cultural and economic. Although conventional risk factors explain substantial population attributable risk, the thresholds at which these risk factors operate are different among Indians compared with other populations. Therefore, alternate explanations for these ecological differences have been sought and multiple hypotheses have been proposed over the years. Prenatal factors that include maternal and paternal influences on the offspring, and postnatal factors, ranging from birth through childhood, adolescence and young adulthood, as well as inter-generational influences have been explored using the life course approach to chronic disease. In addition to this, recent research has illustrated the importance of the role of inherent biological differences in lipid metabolism, glucose metabolism, inflammatory states, genetic predispositions and epigenetic influences for the increased risk. A multifaceted and holistic approach to CVD prevention that takes into consideration population-level as well as biological risk factors would be needed to control the burgeoning CVD epidemic among Indians.
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Affiliation(s)
- Ankur Kalra
- Cardiovascular Institute, Kalra Hospitals, New Delhi, India
| | - Arun Pulikkottil Jose
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, Haryana, India
| | - Poornima Prabhakaran
- Centre for Environmental Health, Public Health Foundation of India, Gurugram, Haryana, India
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Ohio, USA
| | - Anurag Agrawal
- Trivedi School of Biosciences, Ashoka University, New Delhi, India
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, Haryana, India
- London School of Hygiene and Tropical Medicine, London, UK
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The Long-Term Effects of Prenatal Hypoxia on Coronary Artery Function of the Male and Female Offspring. Biomedicines 2022; 10:biomedicines10123019. [PMID: 36551775 PMCID: PMC9776081 DOI: 10.3390/biomedicines10123019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022] Open
Abstract
Prenatal hypoxia predisposes the offspring to the development of cardiovascular (CV) dysfunction in adult life. Using a rat model, we assessed the effect of prenatal hypoxia on vasoconstrictive and vasodilative mechanisms in left anterior descending coronary arteries of 4- and 9.5-month-old offspring. Endothelium-dependent relaxation to methylcholine and vasoconstriction responses to endothelin-1 (ET-1) were assessed by wire myography. Prenatal hypoxia impaired endothelium-dependent vasodilation in 4- and 9.5-month-old offspring. Inhibition of nitric oxide (NO) synthase prevented coronary artery relaxation in all groups. Inhibition of prostaglandin H synthase (PGHS) improved relaxation in prenatally hypoxic males and tended to improve vasorelaxation in females, suggesting that impaired vasodilation was mediated via increased PGHS-dependent vasoconstriction. An enhanced contribution of endothelium-dependent hyperpolarization to coronary artery vasodilation was observed in prenatally hypoxic males and females. No changes in endothelial NO synthase (eNOS) and PGHS-1 expressions were observed, while PGHS-2 expression was decreased in only prenatally hypoxic males. At 4 months, ET-1 responses were similar between groups, while ETB inhibition (with BQ788) tended to decrease ET-1-mediated responses in only prenatally hypoxic females. At 9.5 months, ET-1-mediated responses were decreased in only prenatally hypoxic females. Our data suggest that prenatal hypoxia has long-term similar effects on the mechanisms of impaired endothelium-dependent vasodilation in coronary arteries from adult male and female offspring; however, coronary artery contractile capacity is impaired only in prenatally hypoxic females. Understanding the mechanistic pathways involved in the programming of CV disease may allow for the development of therapeutic interventions.
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Programming by maternal obesity: a pathway to poor cardiometabolic health in the offspring. Proc Nutr Soc 2022; 81:227-242. [DOI: 10.1017/s0029665122001914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is an ever increasing prevalence of maternal obesity worldwide such that in many populations over half of women enter pregnancy either overweight or obese. This review aims to summarise the impact of maternal obesity on offspring cardiometabolic outcomes. Maternal obesity is associated with increased risk of adverse maternal and pregnancy outcomes. However, beyond this exposure to maternal obesity during development also increases the risk of her offspring developing long-term adverse cardiometabolic outcomes throughout their adult life. Both human studies and those in experimental animal models have shown that maternal obesity can programme increased risk of offspring developing obesity and adipose tissue dysfunction; type 2 diabetes with peripheral insulin resistance and β-cell dysfunction; CVD with impaired cardiac structure and function and hypertension via impaired vascular and kidney function. As female offspring themselves are therefore likely to enter pregnancy with poor cardiometabolic health this can lead to an inter-generational cycle perpetuating the transmission of poor cardiometabolic health across generations. Maternal exercise interventions have the potential to mitigate some of the adverse effects of maternal obesity on offspring health, although further studies into long-term outcomes and how these translate to a clinical context are still required.
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Choorakuttil RM, Rajalingam B, Satarkar SR, Sharma LK, Gupta A, Baghel A, Jain N, Palanisamy D, Shenoy R, Senthilvel K, Dhankar S, Aneja K, Dwivedi S, Nagar S, Soni SK, Chhajer G, Pradeep S, Onkar PM, Skandhan AK, Rajput E, Sharma R, Shentar S, Saboo S, Antony A, Nair MB, Patekar TY, Ahuja B, Patel H, Kunnumal M, Sodani RK, Rao MK, Bhatele P, Kavthale S, Patkar D, Singh R, Chelladurai A, Nirmalan PK. Reducing Perinatal Mortality in India: Two-Years Results of the IRIA Fetal Radiology Samrakshan Program. Indian J Radiol Imaging 2022; 32:30-37. [PMID: 35722649 PMCID: PMC9200467 DOI: 10.1055/s-0041-1741087] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Abstract
Aim The aim of the study is to determine improvements in perinatal mortality at the end of the first 2 years from the initiation of the Samrakshan program of the Indian Radiological and Imaging Association.
Methods Samrakshan is a screening program of pregnant women that uses trimester-specific risk assessment protocols including maternal demographics, mean arterial pressure, and fetal Doppler studies to classify women as high risk or low risk for preterm preeclampsia (PE) and fetal growth restriction (FGR). Low dose aspirin 150 mg daily once at bedtime was started for pregnant women identified as high risk in the 11–136/7 weeks screening. The third-trimester screening focused on the staging of FGR and protocol-based management for childbirth and risk assessment for PE. Outcomes of childbirth including gestational age at delivery, development of PE, and perinatal mortality outcomes were collected.
Results Radiologists from 38 districts of 16 states of India participated in the Samrakshan program that screened 2,816 first trimester, 3,267 second trimester, and 3,272 third trimester pregnant women, respectively. At 2 years, preterm PE was identified in 2.76%, preterm births in 19.28%, abnormal Doppler study in 25.76% of third trimester pregnancies, and 75.32% of stage 1 FGR delivered at term. The neonatal mortality rate was 9.86/1,000 live births, perinatal mortality rate was 18.97/1,000 childbirths, and maternal mortality was 58/100,000 live births compared with 29.5, 36, and 113, respectively in 2016.
Conclusion Fetal Doppler integrated antenatal ultrasound studies in Samrakshan led to a significant reduction in preterm PE rates, preterm birth rates, and a significant improvement in mean birth weights. Perinatal, neonatal, and maternal mortality rates are significantly better than the targets for 2030 set by the Sustainable Development Goals-3.
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Affiliation(s)
- Rijo M. Choorakuttil
- Department of Radiodiagnosis, AMMA Center for Diagnosis and Preventive Medicine Pvt Ltd, Kochi, Kerala, India
| | - Bavaharan Rajalingam
- Department of Radiodiagnosis, Fetocare Magnum Imaging and Diagnostics, Trichy, Tamil Nadu, India
| | - Shilpa R. Satarkar
- Department of Radiodiagnosis, Antarang Sonography and Colour Doppler Center, Satarkar Hospital, Aurangabad, Maharashtra, India
| | - Lalit K. Sharma
- Department of Radiodiagnosis, Raj Sonography & X-Ray Clinic, Baiju Choraha, Nayapura, Guna, Madhya Pradesh, India
| | - Anjali Gupta
- Department of Radiodiagnosis, Anjali Ultrasound and Colour Doppler Centre, 2nd floor, Shanti Madhuban Plaza, Delhi Gate, Agra, Uttar Pradesh, India
| | - Akanksha Baghel
- Department of Radiodiagnosis, Baghel Sonography Center, Harda, Madhya Pradesh, India
| | - Neelam Jain
- Department of Radiodiagnosis, Jain Ultrasound Centre, Sonari, Jamshedpur, Jharkhand, India
| | - Devarajan Palanisamy
- Department of Radiodiagnosis, Nethra Scans and Genetic Clinic, Tiruppur, Tamil Nadu, India
| | - Ramesh Shenoy
- Department of Radiodiagnosis, Consultant Radiologist, Lisie Hospital, Ernakulam, Kerala, India
| | | | - Sandhya Dhankar
- Department of Radiodiagnosis, Faith Diagnostic Center, Chandigarh, India
| | - Kavita Aneja
- Department of Radiodiagnosis, Images Ultrasound Center, Naveda Healthcare Centre, New Delhi, India
| | - Somya Dwivedi
- Department of Radiodiagnosis, Qura Diagnostics & Research Center, Bhopal, Madhya Pradesh, India
| | - Shweta Nagar
- Department of Radiodiagnosis, Dr. Shweta Nagar's Ultrasound Clinic & Imaging Centre, Indore, Madhya Pradesh, India
| | - Sonali Kimmatkar Soni
- Department of Radiodiagnosis, Navya Diagnostic Center, Near Nissan Motors, Walmiki statue, Gawal mandi, Putlighar, Amritsar, Punjab, India
| | - Gulab Chhajer
- Department of Radiodiagnosis, Kushal Imaging & Diagnostic Center, Sumerpur, Pali, Rajasthan, India
| | | | | | | | - Eesha Rajput
- Department of Radiology, INHS Dhanvantari, Minnie Bay, Port Blair, Andaman & Nicobar Islands, India
| | - Renu Sharma
- Department of Radiodiagnosis, Dr Renu's Diagnostic Center, Sikar, Rajasthan, India
| | - Srinivas Shentar
- Department of Radiodiagnosis, Delta Diagnostic Services, Basavanagudi, Bengaluru, Karnataka, India
| | - Suresh Saboo
- Department of Radiology, JIJU, IIMS Medical College, Jalna, Maharashtra, India
| | - Amel Antony
- Department of Radiology, Lisie Hospital, Kochi, Ernakulam, Kerala, India
| | | | - Tejashree Y. Patekar
- Department of Radiology, Innovision Sonography and Imaging Center, Gangapur, Nashik, India
| | - Bhupendra Ahuja
- Department of Radiodiagnosis, Dr. Ahuja Ultrasonography and Colour Doppler Center, Delhi Gate, Agra, (Dr. Sarkar Market), Uttar Pradesh, India
| | - Hemant Patel
- Department of Radiodiagnosis, Gujarat Imaging Center, Navrangpura, Ahmedabad, Gujarat, India
| | - Mohanan Kunnumal
- Vice Chancellor, Kerala University of Health Sciences, Thrissur, Kerala, India
| | - Rajendra K. Sodani
- Department of Radiodiagnosis, Sampurna Sodani Diagnostic Clinic, Indore, Madhya Pradesh, India
| | - M.V. Kameswar Rao
- Department of Radiodiagnosis, MKCG Medical College, Berhampur, Odisha, India
| | - Pushparaj Bhatele
- Department of Radiodiagnosis, MRI Centre, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Sandeep Kavthale
- Department of Radiodiagnosis, Indian Radiological and Imaging Association (IRIA), India & Vision Diagnostic Center, Maharashtra, India
| | - Deepak Patkar
- Department of Radiodiagnosis, Nanavati Super Speciality Hospital, Mumbai, Maharashtra, India
| | - Rajeev Singh
- Department of Radiodiagnosis, Radiodiagnosis, Jaipur, Rajasthan, India
| | - Amarnath Chelladurai
- Department of Radiodiagnosis, Stanley Medical College, Chennai, Tamil Nadu, India
| | - Praveen K. Nirmalan
- Department of Research, AMMA Education and Research Foundation, AMMA Healthcare Research Gurukul, Kochi, Kerala, India
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8
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Nongmaithem SS, Beaumont RN, Dedaniya A, Wood AR, Ogunkolade BW, Hassan Z, Krishnaveni GV, Kumaran K, Potdar RD, Sahariah SA, Krishna M, Di Gravio C, Mali ID, Sankareswaran A, Hussain A, Bhowmik BW, Khan AKA, Knight BA, Frayling TM, Finer S, Fall CHD, Yajnik CS, Freathy RM, Hitman GA, Chandak GR. Babies of South Asian and European Ancestry Show Similar Associations With Genetic Risk Score for Birth Weight Despite the Smaller Size of South Asian Newborns. Diabetes 2022; 71:821-836. [PMID: 35061033 PMCID: PMC7612532 DOI: 10.2337/db21-0479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022]
Abstract
Size at birth is known to be influenced by various fetal and maternal factors, including genetic effects. South Asians have a high burden of low birth weight and cardiometabolic diseases, yet studies of common genetic variations underpinning these phenotypes are lacking. We generated independent, weighted fetal genetic scores (fGSs) and maternal genetic scores (mGSs) from 196 birth weight-associated variants identified in Europeans and conducted an association analysis with various fetal birth parameters and anthropometric and cardiometabolic traits measured at different follow-up stages (5-6-year intervals) from seven Indian and Bangladeshi cohorts of South Asian ancestry. The results from these cohorts were compared with South Asians in UK Biobank and the Exeter Family Study of Childhood Health, a European ancestry cohort. Birth weight increased by 50.7 g and 33.6 g per SD of fGS (P = 9.1 × 10-11) and mGS (P = 0.003), respectively, in South Asians. A relatively weaker mGS effect compared with Europeans indicates possible different intrauterine exposures between Europeans and South Asians. Birth weight was strongly associated with body size in both childhood and adolescence (P = 3 × 10-5 to 1.9 × 10-51); however, fGS was associated with body size in childhood only (P < 0.01) and with head circumference, fasting glucose, and triglycerides in adults (P < 0.01). The substantially smaller newborn size in South Asians with comparable fetal genetic effect to Europeans on birth weight suggests a significant role of factors related to fetal growth that were not captured by the present genetic scores. These factors may include different environmental exposures, maternal body size, health and nutritional status, etc. Persistent influence of genetic loci on size at birth and adult metabolic syndrome in our study supports a common genetic mechanism that partly explains associations between early development and later cardiometabolic health in various populations, despite marked differences in phenotypic and environmental factors in South Asians.
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Affiliation(s)
- Suraj S Nongmaithem
- Genomic Research on Complex diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
- Human Genetics, Wellcome Sanger Institute, Hinxton, CB10 1SA, UK
| | - Robin N Beaumont
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Akshay Dedaniya
- Genomic Research on Complex diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Andrew R Wood
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Babatunji-William Ogunkolade
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Zahid Hassan
- Dept of Physiology and Molecular Biology, Bangladesh University of Health Sciences, Dhaka, Bangladesh
| | | | - Kalyanaraman Kumaran
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | | | - Murali Krishna
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
- Foundation for Research and Advocacy in Mental Health (FRAMe) Mysore. India
| | - Chiara Di Gravio
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Inder D Mali
- Genomic Research on Complex diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Alagu Sankareswaran
- Genomic Research on Complex diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Akhtar Hussain
- Centre of Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh
- Faculty of Health Sciences, Nord University, Norway
| | - Biswajit W Bhowmik
- Centre of Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Abdul Kalam A Khan
- Centre of Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Bridget A Knight
- NIHR Exeter Clinical Research Facility, University of Exeter, Exeter, UK
- RD&E NHS Foundation Trust, Royal Devon & Exeter Hospital, Exeter, UK
| | - Timothy M Frayling
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sarah Finer
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Caroline HD Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | - Rachel M Freathy
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Graham A Hitman
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Giriraj R Chandak
- Genomic Research on Complex diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
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Yallapragada SG, Savani RC, Goss KN. Cardiovascular impact and sequelae of bronchopulmonary dysplasia. Pediatr Pulmonol 2021; 56:3453-3463. [PMID: 33756045 DOI: 10.1002/ppul.25370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 12/14/2022]
Abstract
The development, growth, and function of the cardiac, pulmonary, and vascular systems are closely intertwined during both fetal and postnatal life. In utero, placental, environmental, and genetic insults may contribute to abnormal pulmonary alveolarization and vascularization that increase susceptibility to the development of bronchopulmonary dysplasia (BPD) in preterm infants. However, the shared milieu of stressors may also contribute to abnormal cardiac or vascular development in the fetus and neonate, leading to the potential for cardiovascular dysfunction. Further, cardiac or pulmonary maladaptation can potentiate dysfunction in the other organ, amplify the risk for BPD in the neonate, and increase the trajectory for overall neonatal morbidity. Beyond infancy, there is an increased risk for systemic and pulmonary vascular disease including hypertension, as well as potential cardiac dysfunction, particularly within the right ventricle. This review will focus on the cardiovascular antecedents of BPD in the fetus, cardiovascular consequences of preterm birth in the neonate including associations with BPD, and cardiovascular impact of prematurity and BPD throughout the lifespan.
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Affiliation(s)
- Sushmita G Yallapragada
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rashmin C Savani
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kara N Goss
- Division of Pulmonary and Critical Care, Departments of Medicine and Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Krishna M, Krishnaveni GV, Sargur V, Kumaran K, Kumar M, Nagaraj K, Coakley P, Karat SC, Chandak GR, Varghese M, Prince M, Osmond C, Fall CHD. Size at birth, lifecourse factors, and cognitive function in late life: findings from the MYsore study of Natal effects on Ageing and Health (MYNAH) cohort in South India. Int Psychogeriatr 2021; 34:1-14. [PMID: 34666849 DOI: 10.1017/s1041610221001186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine if smaller size at birth, an indicator of growth restriction in utero, is associated with lower cognition in late life, and whether this may be mediated by impaired early life brain development and/or adverse cardiometabolic programming. DESIGN Longitudinal follow-up of a birth cohort. SETTING CSI Holdsworth Memorial Hospital (HMH), Mysore South India. PARTICIPANTS 721 men and women (55-80 years) whose size at birth was recorded at HMH. Approximately 20 years earlier, a subset (n = 522) of them had assessments for cardiometabolic disorders in mid-life. MEASUREMENTS Standardized measurement of cognitive function, depression, sociodemographic, and lifestyle factors; blood tests and assessments for cardiometabolic disorders. RESULTS Participants who were heavier at birth had higher composite cognitive scores (0.12 SD per SD birth weight [95% CI 0.05, 0.19] p = 0.001) in late life. Other lifecourse factors independently positively related to cognition were maternal educational level and participants' own educational level, adult leg length, body mass index, and socioeconomic position, and negatively were diabetes in mid-life and current depression and stroke. The association of birth weight with cognition was independent cardiometabolic risk factors and was attenuated after adjustment for all lifecourse factors (0.08 SD per SD birth weight [95% CI -0.01, 0.18] p = 0.07). CONCLUSIONS The findings are consistent with positive effects of early life environmental factors (better fetal growth, education, and childhood socioeconomic status) on brain development resulting in greater long-term cognitive function. The results do not support a pathway linking poorer fetal development with reduced late life cognitive function through cardiometabolic programming.
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Affiliation(s)
- Murali Krishna
- CSI Holdsworth Memorial Hospital, Mandimohalla, Mysore, India
- Foundation for Research and Advocacy in Mental Health Mysore, Mysore, India
| | | | - Veena Sargur
- CSI Holdsworth Memorial Hospital, Mandimohalla, Mysore, India
| | - Kalyanaraman Kumaran
- CSI Holdsworth Memorial Hospital, Mandimohalla, Mysore, India
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Mohan Kumar
- CSI Holdsworth Memorial Hospital, Mandimohalla, Mysore, India
| | - Kiran Nagaraj
- CSI Holdsworth Memorial Hospital, Mandimohalla, Mysore, India
| | - Patsy Coakley
- Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | | | - Mathew Varghese
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Martin Prince
- Institute of Psychiatry, Kings College London, London, UK
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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11
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Bar J, Weiner E, Levy M, Gilboa Y. The thrifty phenotype hypothesis: The association between ultrasound and Doppler studies in fetal growth restriction and the development of adult disease. Am J Obstet Gynecol MFM 2021; 3:100473. [PMID: 34481995 DOI: 10.1016/j.ajogmf.2021.100473] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 12/13/2022]
Abstract
Barker pioneered the idea that the epidemic of coronary heart disease in Western countries in the 20th century, which paradoxically coincided with improved standards of living and nutrition, has its origin in fetal life. Indeed, there is substantial evidence associating low birthweight because of fetal growth restriction with an increased risk of vascular disease in later adult life. These conclusions led to the second part of the Barker hypothesis, the thrifty phenotype, in which adaptation to undernutrition in fetal life leads to permanent metabolic and endocrine changes. Such changes are beneficial if the undernutrition persists after birth but may predispose the individual to obesity and impaired glucose tolerance if conditions improve. The hypothesis assumes that a poor nutrient supply during a critical period of in utero life may "program" a permanent structural or functional change in the fetus, thereby altering the distribution of cell types, gene expression, or both. The fetus, in response to placental undernutrition and to maintain sufficient vascular supply to the brain, decreases resistance to blood flow in the middle cerebral artery. Simultaneously, because of the limited blood supply to the fetus, the arterial redistribution process is accompanied by increased resistance to flow to other fetal vital organs, such as the heart, kidneys, liver, and pancreas. It may explain why individuals exposed to ischemic changes in utero develop dyslipidemia, lower nephron number, and impaired glucose tolerance, all factors contributing to metabolic syndrome later in life. Nevertheless, support for the hypotheses comes mainly from studies in rodents and retrospective epidemiologic studies. This review focused on ultrasound and Doppler studies of human fetal growth restriction in several fetal organs: the placenta, fetal circulation, brain, heart, kidneys, adrenal glands, liver, and pancreas. Support for the hypothesis was provided by animal studies involving conditions that create fetuses with growth restriction with effects on various fetal organs and by human studies that correlate impaired fetal circulation with the in utero development and function of fetal organs.
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Affiliation(s)
- Jacob Bar
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel (Dr. Bar, Dr Weiner, and Dr. Levy); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr. Bar, Dr. Weiner, Dr. Levy, and Dr. Gilboa)
| | - Eran Weiner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel (Dr. Bar, Dr Weiner, and Dr. Levy); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr. Bar, Dr. Weiner, Dr. Levy, and Dr. Gilboa).
| | - Michal Levy
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel (Dr. Bar, Dr Weiner, and Dr. Levy)
| | - Yinon Gilboa
- Ultrasound Unit, Helen Schneider Comprehensive Women's Health Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel (Dr. Gilboa); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr. Bar, Dr. Weiner, Dr. Levy, and Dr. Gilboa)
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12
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Effect of Preterm Birth on Cardiac and Cardiomyocyte Growth and the Consequences of Antenatal and Postnatal Glucocorticoid Treatment. J Clin Med 2021; 10:jcm10173896. [PMID: 34501343 PMCID: PMC8432182 DOI: 10.3390/jcm10173896] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 12/18/2022] Open
Abstract
Preterm birth coincides with a key developmental window of cardiac growth and maturation, and thus has the potential to influence long-term cardiac function. Individuals born preterm have structural cardiac remodelling and altered cardiac growth and function by early adulthood. The evidence linking preterm birth and cardiovascular disease in later life is mounting. Advances in the perinatal care of preterm infants, such as glucocorticoid therapy, have improved survival rates, but at what cost? This review highlights the short-term and long-term impact of preterm birth on the structure and function of the heart and focuses on the impact of antenatal and postnatal glucocorticoid treatment on the immature preterm heart.
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13
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Obesity and Metabolic Care of Children of South Asian Ethnicity in Western Society. CHILDREN-BASEL 2021; 8:children8060447. [PMID: 34070381 PMCID: PMC8228459 DOI: 10.3390/children8060447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/13/2021] [Accepted: 05/22/2021] [Indexed: 11/17/2022]
Abstract
South Asians constitute one-fourth of the world’s population and are distributed significantly in western countries. With exponentially growing numbers, childhood obesity is of global concern. Children of South Asian ancestry have a higher likelihood of developing obesity and associated metabolic risks. The validity of commonly used measures for quantifying adiposity and its impact on metabolic outcomes differ by race and ethnicity. In this review we aim to discuss the validity of body mass index (BMI) and other tools in screening for adiposity in South Asian children. We also discuss the prevalence of overweight and obesity amongst South Asian children in western countries and the differences in body fat percentage, adiposity distribution, and metabolic risks specific to these children compared to Caucasian children. South Asian children have a characteristic phenotype: lower lean mass and higher body fat percentage favoring central fat accumulation. Hence, BMI is a less reliable predictor of metabolic status in these children than it is for Caucasian children. Furthermore, the relatively lower birth weight and rapid growth acceleration in early childhood of South Asian children increase the risk of their developing cardiometabolic disorders at a younger age than that of Caucasians. We emphasize the need to use modified tools for assessment of adiposity, which take into consideration the ethnic differences and provide early and appropriate intervention to prevent obesity and its complications.
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Uemura O, Ishikura K, Kaneko T, Hirano D, Hamasaki Y, Ogura M, Mikami N, Gotoh Y, Sahashi T, Fujita N, Yamamoto M, Hibino S, Nakano M, Wakano Y, Honda M. Perinatal factors contributing to chronic kidney disease in a cohort of Japanese children with very low birth weight. Pediatr Nephrol 2021; 36:953-960. [PMID: 33068163 PMCID: PMC7910374 DOI: 10.1007/s00467-020-04791-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/22/2020] [Accepted: 09/18/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Developmental programming of chronic kidney disease (CKD) in young adults is linked to preterm birth and intrauterine growth restriction (IUGR). Which confers a higher risk of progression to chronic kidney damage in children with very low birth weight (VLBW; born weighing < 1500 g): prematurity or IUGR? METHODS This is a national historical cohort study of children with VLBW cared for in perinatal medical centers in Japan. Predictive factors included three latent variables (prematurity, IUGR, stress during neonatal period) and eight observed variables (gestational age, birth weight Z-score, maternal age, duration of treatment with antibiotics and diuretics, maternal smoking, late-onset circulatory collapse, kidney dysfunction) during the perinatal period. The primary endpoint was estimated glomerular filtration rate (eGFR) at age ≥ 3 years. A structural equation model was used to examine the pathologic constitution. RESULTS The 446 children with VLBW included 253 boys and 193 girls, of mean age 5.8 ± 2.6 years and mean eGFR 111.7 ml/min/1.73 m2 at last encounter. Pathway analyses showed intrauterine malnutrition (β = 0.85) contributed more to chronic kidney damage than stress during the neonatal period (β = - 0.19) and prematurity (β = 0.12), and kidney dysfunction and late-onset circulatory collapse were important observed variables in stress during the neonatal period. CONCLUSIONS IUGR was more harmful to future kidneys of VLBW neonates. Neonatal kidney dysfunction and late-onset circulatory collapse were important risk factors for subsequent CKD development. This emphasizes the need for obstetricians to monitor for fetal growth restriction and neonatologists to minimize neonatal stress to prevent CKD in later life.
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Affiliation(s)
- Osamu Uemura
- Department of Clinical Medicine, Japanese Red Cross Toyota College of Nursing, Toyota, Japan. .,Department of Pediatrics, Ichinomiya Medical Treatment & Habilitation Center, 1679-2 Tomida-nagaresuji, Ichinomiya-city, Aichi, 494-0018, Japan. .,Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Science, Nagoya, Japan.
| | - Kenji Ishikura
- grid.63906.3a0000 0004 0377 2305Division of Nephology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan ,grid.410786.c0000 0000 9206 2938Department of Pediatrics, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tetsuji Kaneko
- grid.417084.e0000 0004 1764 9914Department of Clinical Research, Tokyo Metropolitan Children’s Medical Center, Fuchu, Japan
| | - Daishi Hirano
- grid.411898.d0000 0001 0661 2073Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuko Hamasaki
- grid.265050.40000 0000 9290 9879Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Masao Ogura
- grid.63906.3a0000 0004 0377 2305Division of Nephology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Naoaki Mikami
- grid.417084.e0000 0004 1764 9914Department of Pediatric Nephrology, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
| | - Yoshimitsu Gotoh
- grid.413410.3Department of Pediatric Nephrology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Takeshi Sahashi
- Department of Pediatrics, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Naoya Fujita
- Department of Pediatric Nephrology, Aichi Children’s Health and Medical Center, Nagoya, Japan
| | - Masaki Yamamoto
- grid.415466.40000 0004 0377 8408Department of Pediatrics, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Satoshi Hibino
- Department of Pediatric Nephrology, Aichi Children’s Health and Medical Center, Nagoya, Japan
| | - Masaru Nakano
- grid.417241.50000 0004 1772 7556Department of Pediatrics, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Yasuhiro Wakano
- Department of Pediatrics, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Masataka Honda
- grid.417084.e0000 0004 1764 9914Department of Pediatric Nephrology, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
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15
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Bansal M, Ranjan S, Kasliwal RR. Cardiovascular Risk Calculators and their Applicability to South Asians. Curr Diabetes Rev 2021; 17:e100120186497. [PMID: 33023452 DOI: 10.2174/1573399816999201001204020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Estimation of absolute cardiovascular disease (CVD) risk and tailoring therapies according to the estimated risk is a fundamental concept in the primary prevention of CVD is assessed in this study. Numerous CVD risk scores are currently available for use in various populations but unfortunately, none exist for South Asians who have much higher CVD risk as compared to their western counterparts. METHODS A literature search was done using PubMed and Google search engines to prepare a narrative review on this topic. RESULTS Various currently available CVD risk scores and their pros and cons are summarized. The studies performed in native as well as migrant South Asians evaluating the accuracy of these risk scores for estimation of CVD risk are also summarized. The findings of these studies have generally been inconsistent, but it appears that the British risk scores (e.g. QRISK versions) may be more accurate because of inclusion of migrant South Asians in the derivation of these risk scores. However, the lack of any prospective study precludes our ability to draw any firm conclusions. Finally, the potential solution to these challenges, including the role of recalibration and subclinical atherosclerosis imaging, is also discussed. CONCLUSION This review highlights the need to develop large, representative, prospectively followed databases of South Asians providing information on various CVD risk factors and their contribution to incident CVD. Such databases will not only allow the development of validated CVD risk scores for South Asians but will also enable application of machine-learning approaches to provide personalized solutions to CVD risk assessment and management in these populations.
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Affiliation(s)
- Manish Bansal
- Clinical and Preventive Cardiology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Shraddha Ranjan
- Department of Cardiology, Medanta- The Medicity, Gurgaon, India
| | - Ravi R Kasliwal
- Clinical and Preventive Cardiology, Medanta- The Medicity, Gurgaon, Haryana, India
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16
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Bansal M, Misra A. Cardiovascular Disease and Diabetes in South Asians: The Twin Epidemic. Curr Diabetes Rev 2021; 17:e122820189512. [PMID: 33371854 DOI: 10.2174/1573399817666201228121145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Manish Bansal
- Clinical and Preventive Cardiology Medanta- The Medicity Gurgaon, India
| | - Anoop Misra
- Fortis-CDOC Hospital for Diabetes and Allied Sciences President, Diabetes Foundation (India), and President National Diabetes Obesity and Cholesterol Foundation (NDOC), India
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17
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Saeed A, Virani SS, Mulukutla S, Chow CK. Dyslipidemia and Cardiovascular Disease Prevention in South Asians: A Review and Discussion of Causes, Challenges and Management Strategies. Curr Diabetes Rev 2021; 17:e011221190238. [PMID: 33438542 DOI: 10.2174/1573399817999210112192419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/29/2020] [Accepted: 10/03/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND South Asians are at a significantly increased risk of atherosclerotic cardiovascular disease (ASCVD). For a major portion of the South Asian population, the cardiovascular disease events occur at a relatively younger age, are associated with worse outcomes, and have potentially more severe socioeconomic implications compared to their western counterparts. METHODS The term "South Asian" typically constitutes individuals from India, Pakistan, Nepal, Bhutan, Bangladesh, Sri Lanka, and Maldives, including expatriates as well as their families from these countries. Based on this, South Asians form approximately 25% of the world's population, with a high ASCVD burden in this group. In this review, we discuss the pathophysiological factors underlying ASCVD in South Asians, the dyslipidemia types and management, and discuss approaches to improve the overall ASCVD prevention efforts in this large subset population of the world. Although the pathophysiological mechanisms underlying the excess risk of cardiovascular disease in South Asians are multifactorial, dyslipidemia is a primary risk factor for the incidence and prevalence of this disease. The traditional "South Asian" dyslipidemia pattern includes levels of low-density lipoprotein cholesterol (LDL-C) in the normal range with a high concentration of LDL particles, elevated triglycerides, low levels of high-density lipoprotein cholesterol (HDL-C) with dysfunctional HDL particles, and high levels of lipoprotein(a). CONCLUSION While combined efforts to study the expatriate South Asians in western countries have been able to identify South Asian specific dyslipidemias, causal associations and optimal management remain relatively less explored. Larger scale studies are needed to better quantify the relationship of each lipid parameter with ASCVD risk among South Asians as well as optimal lipid targets and management strategies to reduce morbidity and mortality in this high-risk group.
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Affiliation(s)
- Anum Saeed
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Salim S Virani
- Department of Health Policy, Quality and Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Suresh Mulukutla
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Department of Cardiology, Westmead Hospital, The George Institute, Sydney, Australia
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Mehta A, Singh S, Saeed A, Mahtta D, Bittner VA, Sperling LS, Virani SS. Pathophysiological Mechanisms Underlying Excess Risk for Diabetes and Cardiovascular Disease in South Asians: The Perfect Storm. Curr Diabetes Rev 2021; 17:e070320183447. [PMID: 32619174 DOI: 10.2174/1573399816666200703182458] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND South Asians are at a significantly increased risk of type 2 diabetes (T2D) and cardiovascular disease (CVD), are diagnosed at relatively younger ages, and exhibit more severe disease phenotypes as compared with other ethnic groups. The pathophysiological mechanisms underlying T2D and CVD risk in South Asians are multifactorial and intricately related. METHODS A narrative review of the pathophysiology of excess risk of T2D and CVD in South Asians. RESULTS T2D and CVD have shared risk factors that encompass biological factors (early life influences, impaired glucose metabolism, and adverse body composition) as well as behavioral and environmental risk factors (diet, sedentary behavior, tobacco use, and social determinants of health). Genetics and epigenetics also play a role in explaining the increased risk of T2D and CVD among South Asians. Additionally, South Asians harbor several lipid abnormalities including high concentration of small-dense low-density lipoprotein (LDL) particles, elevated triglycerides, low high-density lipoprotein (HDL)- cholesterol levels, dysfunctional HDL particles, and elevated lipoprotein(a) that predispose them to CVD. CONCLUSION In this comprehensive review, we have discussed risk factors that provide insights into the pathophysiology of excess risk of T2D and CVD in South Asians.
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Affiliation(s)
- Anurag Mehta
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, Georgia
| | - Sumitabh Singh
- Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Anum Saeed
- Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, PA, United States
| | - Dhruv Mahtta
- Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, TX, United States
| | - Vera A Bittner
- Division of Cardiovascular Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Laurence S Sperling
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, Georgia
| | - Salim S Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, TX, United States
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Gent J, Bullough S, Harrold J, Jackson R, Woolfall K, Andronis L, Kenny L, Cornforth C, Heazell AEP, Benbow E, Alfirevic Z, Sharp A. The PLANES study: a protocol for a randomised controlled feasibility study of the placental growth factor (PlGF) blood test-informed care versus standard care alone for women with a small for gestational age fetus at or after 32 + 0 weeks' gestation. Pilot Feasibility Stud 2020; 6:179. [PMID: 33292754 PMCID: PMC7677818 DOI: 10.1186/s40814-020-00722-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Stillbirth remains a major concern across the globe and in some high-resource countries, such as the UK; efforts to reduce the rate have achieved only modest reductions. One third of stillborn babies are small for gestational age (SGA), and these pregnancies are also at risk of neonatal adverse outcomes and lifelong health problems, especially when delivered preterm. Current UK clinical guidance advocates regular monitoring and early term delivery of the SGA fetus; however, the most appropriate regimen for surveillance of these babies remains unclear and often leads to increased intervention for a large number of these women. This pilot trial will determine the feasibility of a large-scale trial refining the risk of adverse pregnancy outcome in SGA pregnancies using biomarkers of placental function sFlt-1/PlGF, identifying and intervening in only those deemed at highest risk of stillbirth. Methods PLANES is a randomised controlled feasibility study of women with an SGA fetus that will be conducted at two tertiary care hospitals in the UK. Once identified on ultrasound, women will be randomised into two groups in a 3:1 ratio in favour of sFlt-1/PlGF ratio led management vs standard care. Women with an SGA fetus and a normal sFlt-1/PlGF ratio will have a repeat ultrasound and sFlt-1/PlGF ratio every 2 weeks with planned birth delayed until 40 weeks. In those women with an SGA fetus and an abnormal sFlt-1/PlGF ratio, we will offer birth from 37 weeks or sooner if there are other concerning features on ultrasound. Women assigned to standard care will have an sFlt-1/PlGF ratio taken, but the results will be concealed from the clinical team, and the woman’s pregnancy will be managed as per the local NHS hospital policy. This integrated mixed method study will also involve a health economic analysis and a perspective work package exploring trial feasibility through interviews and questionnaires with participants, their partners, and clinicians. Discussion Our aim is to determine feasibility through the assessment of our ability to recruit and retain participants to the study. Results from this pilot study will inform the design of a future large randomised controlled trial that will be adequately powered for adverse pregnancy outcome. Such a study would provide the evidence needed to guide future management of the SGA fetus. Trial registration ISRCTN58254381. Registered on 4 July 2019
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Affiliation(s)
- Joanna Gent
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - Sian Bullough
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - Jane Harrold
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - Richard Jackson
- Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - Kerry Woolfall
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Lazaros Andronis
- Division of Health Sciences and Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Louise Kenny
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | | | - Alexander E P Heazell
- Maternal and Fetal Research Centre, School of Medical Sciences, University of Manchester, Manchester Academic Health Science Centre, 5th Floor (Research), St Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Emily Benbow
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - Zarko Alfirevic
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - Andrew Sharp
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK.
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Abstract
Birthweight is a well-known predictor of adult-onset chronic disease. The placenta plays a necessary role in regulating fetal growth and determining birth size. Maternal stressors that affect placental function and prenatal growth include maternal overnutrition and undernutrition, toxic social stress, and exposure to toxic chemicals. These stressors lead to increased vulnerability to disease within any population. This vulnerability arises from placental and fetal exposure to stressors during fetal life. The biological drivers linking various social determinants of health to compromised placental function and fetal development have been little studied.
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Salmi I, Hannawi S. Birthweight predicts adult cardiovascular disorders: Population based cross sectional survey. Clin Cardiol 2020; 43:1133-1141. [PMID: 32725822 PMCID: PMC7534004 DOI: 10.1002/clc.23419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/25/2020] [Accepted: 06/28/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the primary cause of death in the developed-countries and mostly in the poorer areas of the country, and in lower income-groups. HYPOTHESIS Birthweight predicts adult development of angina, coronary heart disease, stroke, and combination of all CVD. METHODS The AusDiab is a cross-sectional study of Australians aged 25 years or over. Data on age, sex, previous-CVD, smoking-status, alcohol-intake, time-spent on watching television and physical-activity, total house-income, dwelling-type and education-level were collected by interviewer- administered-questionnaires. RESULTS Four thousand five hundred and two had birthweights (mean (SD) of 3.4(0.7) kg). Females in the lowest birthweight-quintile were at least 1.23, 1.48, 1.65, and 1.23 times more likely to have angina, CAD, stroke, and CVS compared to the referent group ≥3.72 kg with P = .123, .09, .099, and 0.176, respectively. Similarly, males in the lowest-birthweight-quintile were 1.23, 1.30, 1.39, and 1.26 times more likely to have angina, CAD, stroke, and CVS compared to the referent-group ≥4.05 kg with P = .231, .087, .102, and .123, respectively. Females with low birth weight (LBW) were at least 1.39, 1.40, 2.30, and 1.47 times more likely to have angina, CAD, stroke and CVS compared to those ≥2.5 kg with P = .06, .19, .03, and .13, respectively. Similarly, males with LBW were 1.76, 1.48, 3.34, and 1.70 times more likely to have angina, CAD, stroke, and CVS compared to those ≥2.5 kg with P = .14, .13, .03, and .08, respectively. CONCLUSION there was a negative relationship between birth weight and angina, CAD, stroke, and the overall CVS. It would be prudent, to adopt policies of intensified whole of life surveillance of lower-birthweight people, anticipating this risk.
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Affiliation(s)
- Issa Salmi
- The Medicine DepartmentThe Royal HospitalMuscatOman
- Oman Medical Specialty BoardMuscatOman
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Galin S, Wainstock T, Sheiner E, Landau D, Walfisch A. Elective cesarean delivery and long-term cardiovascular morbidity in the offspring - a population-based cohort analysis. J Matern Fetal Neonatal Med 2020; 35:2708-2715. [PMID: 32731780 DOI: 10.1080/14767058.2020.1797668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the impact of cesarean delivery (CD) on offspring risk for long-term cardiovascular morbidity. STUDY DESIGN A population-based cohort analysis was performed, including all singleton term deliveries occurring between 1991 and 2014 at a single tertiary medical center. A comparison was performed between children delivered via CD and those delivered vaginally. Fetuses with cardiac or other congenital malformations were excluded, as were cases of urgent CD and pregnancies involving preeclampsia, gestational diabetes, placenta previa, labor induction, fetal growth restriction, preterm PROM, and instrumental deliveries. Hospitalizations of the offspring up to 18 years of age involving cardiovascular morbidity were compared between the two study groups. A Kaplan-Meier survival curve compared cumulative cardiovascular morbidity incidence and a Cox regression model controlled for confounders. RESULTS Of the 132,054 term deliveries who met the inclusion criteria; 8.9% were CDs (n = 11,746) and 91.1% (n = 120,308) were vaginal deliveries. Cardiovascular hospitalization incidence per 1000 person follow up years was 0.742 in the CD group and 0.054 in the comparison group (HR = 1.3, 95%CI 1.051-1.710, p = .018). The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of cardiovascular morbidity following CD (log rank p = .018). In the Cox proportional hazards model, CD was noted as an independent risk factor for offspring long-term pediatric cardiovascular morbidity (adjusted HR = 1.295, CI 1.005-1.668, p = .04) when controlling for maternal age, obesity, ethnicity, gestational age, newborn gender, low birthweight, maternal preexisting cardiovascular disease, and deliveries occurring after 2008. CONCLUSION Singletons delivered by CD at term have an increased risk of long-term cardiovascular morbidity.
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Affiliation(s)
- Shaked Galin
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniella Landau
- Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Nyasordzi J, Penczynski K, Remer T, Buyken AE. Early life factors and their relevance to intima-media thickness of the common carotid artery in early adulthood. PLoS One 2020; 15:e0233227. [PMID: 32428029 PMCID: PMC7237005 DOI: 10.1371/journal.pone.0233227] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/30/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Early life factors may predispose an offspring to cardiovascular disease in later life; relevance of these associations may extend to ‟healthy" people in Western populations. We examined the prospective associations between early life factors and adult carotid intima-media thickness (IMT), a surrogate marker of atherosclerosis, in a healthy German population. METHODS We studied term participants (n = 265) of the DONALD Study, with bilateral sonographic measurements of IMT (4-8 measurements on both left and right carotid artery) at age 18-40 years and prospectively collected data on early life factors (maternal and paternal age at child birth, birth weight, gestational weight gain and full breastfeeding (>17weeks). Mean IMT values were averaged from mean values of both sides. Associations between early life factors and adult IMT were analyzed using multivariable linear regression models with adjustment for potential confounders. RESULTS Adult mean IMT was 0.56mm, SD 0.03, (range: 0.41 mm-0.78 mm). Maternal age at child birth was of relevance for adult IMT, which was sex specific: Advanced maternal age at child birth was associated with an increased adult IMT among female offspring only (β 0.03, SE 0.009 mm/decade, P = 0.003), this was not affected by adult waist circumference, BMI or blood pressure. Other early life factors were not relevant for IMT levels in males and females. CONCLUSION This study suggests that advanced maternal age at child birth is of prospective relevance for adult IMT levels in a healthy German population and this association may be of adverse relevance for females only.
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Affiliation(s)
- Juliana Nyasordzi
- Department of Sports and Health, Institute of Nutrition, Consumption and Health, Paderborn University, Paderborn, Germany
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Katharina Penczynski
- Department of Sports and Health, Institute of Nutrition, Consumption and Health, Paderborn University, Paderborn, Germany
| | - Thomas Remer
- DONALD Study Dortmund, Department of Nutrition and Food Sciences (IEL), Nutritional Epidemiology, University of Bonn, Dortmund, Germany
| | - Anette E. Buyken
- Department of Sports and Health, Institute of Nutrition, Consumption and Health, Paderborn University, Paderborn, Germany
- * E-mail:
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Mohseni R, Mohammed SH, Safabakhsh M, Mohseni F, Monfared ZS, Seyyedi J, Mejareh ZN, Alizadeh S. Birth Weight and Risk of Cardiovascular Disease Incidence in Adulthood: a Dose-Response Meta-analysis. Curr Atheroscler Rep 2020; 22:12. [DOI: 10.1007/s11883-020-0829-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Aneesh M, Ghugre PS. Anthropometry, body fat and central adiposity in LBW and NBW Indian children aged 3.5 to 4 years. Early Hum Dev 2019; 139:104885. [PMID: 31518866 DOI: 10.1016/j.earlhumdev.2019.104885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/02/2019] [Accepted: 09/04/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND India has a high prevalence of low birth weight. Evidence indicates that poor fetal growth and rapid postnatal weight gain are associated with adiposity. OBJECTIVES (i) To study the differences between the anthropometry, body fat measures of LBW and NBW children and (ii) To find out if there is any relationship between birth weight, change in weight SD and body fat measures of these children. STUDY DESIGN Cross-sectional study. SUBJECTS We studied 396 children aged between 3.5 and 4 years who were beneficiaries of government-run anganwadis in urban slums of Mumbai city, India. OUTCOME MEASURES Birth weight, current weight, height, skinfold thicknesses and waist circumference. Change in weight SD and body fat (%) were calculated. WHOAnthro was used to compute the z scores. Parent's education, income and breastfeeding history was recorded. RESULTS The mean change in weight SD of LBW and NBW groups were 1.01 ± 1.4 and -0.73 ± 1.13 respectively (p < 0.001). LBW children were lighter and shorter than NBW ones but had similar body fat (%) and central adiposity measures. In LBW and NBW children, birth weight Z score and change in weight SD were positively related to body fat (%) and waist circumference. CONCLUSION Children in this study belonged to low socioeconomic section. Despite this, LBW displayed a tendency towards accumulating body fat particularly, abdominal fat for lower body weight. Birth weight and postnatal weight change predict body fat and waist circumference in LBW and NBW children.
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Affiliation(s)
- Mitravinda Aneesh
- Department of Food Science and Nutrition, S.N.D.T. Women's University, Mumbai, Maharashtra, India.
| | - Padmini S Ghugre
- Department of Food Science and Nutrition, S.N.D.T. Women's University, Mumbai, Maharashtra, India
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Knop MR, Geng TT, Gorny AW, Ding R, Li C, Ley SH, Huang T. Birth Weight and Risk of Type 2 Diabetes Mellitus, Cardiovascular Disease, and Hypertension in Adults: A Meta-Analysis of 7 646 267 Participants From 135 Studies. J Am Heart Assoc 2019; 7:e008870. [PMID: 30486715 PMCID: PMC6405546 DOI: 10.1161/jaha.118.008870] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Low birth weight has been associated with increased risk of type 2 diabetes mellitus, cardiovascular disease, and hypertension, but the risk at high birth weight levels remains uncertain. This systematic review and meta-analysis aimed to clarify the shape of associations between birth weight and aforementioned diseases in adults and assessed sex-specific risks. Methods and Results We systematically searched PubMed, EMBASE , and Web of Science for studies published between 1980 and October 2016. Studies of birth weight and type 2 diabetes mellitus (T2 DM ), cardiovascular disease ( CVD ), and hypertension were included. Random-effects models were used to derive the summary relative risks and corresponding 95% confidence intervals.We identified 49 studies with 4 053 367 participants assessing the association between birth weight and T2 DM , 33 studies with 5 949 477 participants for CVD , and 53 studies with 4 335 149 participants for hypertension and high blood pressure. Sex-specific binary analyses showed that only females had an increased risk of T2 DM and CVD at the upper tail of the birth weight distribution. While categorical analyses of 6 birth weight groups and dose-response analyses showed J-shaped associations of birth weight with T2 DM and CVD , the association was inverse with hypertension. The lowest risks for T2 DM , CVD , and hypertension were observed at 3.5 to 4.0, 4.0 to 4.5, and 4.0 to 4.5 kg, respectively. Conclusions These findings indicate that birth weight is associated with risk of T2 DM and CVD in a J-shaped manner and that this is more pronounced among females.
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Affiliation(s)
- Marianne Ravn Knop
- 1 Epidemiology Domain Saw Swee Hock School of Public Health National University of Singapore
| | - Ting-Ting Geng
- 1 Epidemiology Domain Saw Swee Hock School of Public Health National University of Singapore
| | - Alexander Wilhelm Gorny
- 1 Epidemiology Domain Saw Swee Hock School of Public Health National University of Singapore
| | - Renyu Ding
- 2 Department of Otolaryngology The First Hospital of China Medical University Shenyang China
| | - Changwei Li
- 3 Department of Epidemiology & Biostatistics College of Public Health University of Georgia Athens GA
| | - Sylvia H Ley
- 4 Department of Nutrition Harvard School of Public Health Boston MA
| | - Tao Huang
- 5 Department of Epidemiology and Biostatistics School of Public Health Peking University Beijing China
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Luyckx VA, Brenner BM. Clinical consequences of developmental programming of low nephron number. Anat Rec (Hoboken) 2019; 303:2613-2631. [PMID: 31587509 DOI: 10.1002/ar.24270] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/30/2019] [Accepted: 07/24/2019] [Indexed: 12/12/2022]
Abstract
Nephron number in humans varies up to 13-fold, likely reflecting the impact of multiple factors on kidney development, including inherited body size and ethnicity, as well as maternal health and nutrition, fetal exposure to gestational diabetes or preeclampsia and other environmental factors, which may potentially be modifiable. Such conditions predispose to low or high offspring birth weight, growth restriction or preterm birth, which have all been associated with increased risks of higher blood pressures and/or kidney dysfunction in later life. Low birth weight, preterm birth, and intrauterine growth restriction are associated with reduced nephron numbers. Humans with hypertension and chronic kidney disease tend to have fewer nephrons than their counterparts with normal blood pressures or kidney function. A developmentally programmed reduction in nephron number therefore enhances an individual's susceptibility to hypertension and kidney disease in later life. A low nephron number at birth may not lead to kidney dysfunction alone except when severe, but in the face of superimposed acute or chronic kidney injury, a kidney endowed with fewer nephrons may be less able to adapt, and overt kidney disease may develop. Given that millions of babies are born either too small, too big or too soon each year, the population impact of altered renal programming is likely to be significant. Many gestational exposures are modifiable, therefore urgent attention is required to implement public health measures to optimize maternal, fetal, and child health, to prevent or mitigate the consequences of developmental programming, to improve the health future generations.
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Affiliation(s)
- Valerie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Switzerland
| | - Barry M Brenner
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Sharp A, Jackson R, Cornforth C, Harrold J, Turner MA, Kenny L, Baker PN, Johnstone ED, Khalil A, von Dadelszen P, Papageorghiou AT, Alfirevic Z. A prediction model for short-term neonatal outcomes in severe early-onset fetal growth restriction. Eur J Obstet Gynecol Reprod Biol 2019; 241:109-118. [PMID: 31499415 DOI: 10.1016/j.ejogrb.2019.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/11/2019] [Accepted: 08/15/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Severe early-onset fetal growth restriction (FGR) predisposes to fetal death, neonatal death, neonatal morbidity and neurodisability. The use of placental biomarkers has been proposed for risk stratification in pre-eclampsia, but they could be equally useful in fetal growth restriction in aiding management. OBJECTIVE To determine the efficacy of angiogenic biomarkers at predicting adverse pregnancy outcome in severe early-onset fetal growth restriction. STUDY DESIGN This is a secondary analysis of the multicentre, placebo-controlled STRIDER UK randomised controlled trial of singleton pregnancies with severe early-onset fetal growth restriction. Women with FGR pregnancies between 22+0 and 29+6 weeks of gestation were randomly assigned to receive either sildenafil 25 mg three times daily or placebo until 32+0 weeks' gestation or delivery. We developed prediction models based upon maternal demographics (age, parity, blood pressure, preeclampsia, gestational hypertension), fetal biometric (estimated fetal weight) and Doppler measurements (Middle Cerebral Artery (MCA), Umbilical Artery (UA)) and maternal angiogenic biomarkers [placental growth factor (PlGF), soluble endoglin (sEng), soluble fms-like tyrosine kinase 1 (sFlt-1) and sFlt-1:PlGF ratio) using both univariate and multivariate analysis. RESULTS A complete data set was available for 105 of 135 randomised women. Multivariate regression analysis identified estimated fetal weight (EFW) and sFlt-1:PlGF as independent predictors of livebirth (EFW OR: 1.01 (1.008, 1.021); p < 0.001 and lower sFlt-1:PlGF ratio OR: 0.53 (0.284, 0.994); p = 0.048) and overall survival (EFW OR: 1.01 (1.006, 1.015); p < 0.001 and lower sFlt-1/PlGF ratio OR: 0.51 (0.286, 0.904); p = 0.021). EFW was a consistent predictor for all outcomes other than gestation at delivery. sFlt-1:PlGF ratio was a consistent predictor for all outcomes other than neonatal morbidity. CONCLUSIONS In severe early-onset FGR pregnancies livebirth and overall survival can be predicted using a model involving EFW and sFlt-1:PlGF ratio. This model require validation in a larger cohort but may allow informed decision making about pregnancy management, especially in previable cases.
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Affiliation(s)
- Andrew Sharp
- Department of Women's and Children's Health, University of Liverpool and The Liverpool Women's Hospital, Members of Liverpool Health Partners, United Kingdom.
| | - Richard Jackson
- Liverpool Clinical Trials Unit, University of Liverpool, United Kingdom
| | | | - Jane Harrold
- Liverpool Clinical Trials Unit, University of Liverpool, United Kingdom
| | - Mark A Turner
- Department of Women's and Children's Health, University of Liverpool and The Liverpool Women's Hospital, Members of Liverpool Health Partners, United Kingdom
| | - Louise Kenny
- Department of Women's and Children's Health, University of Liverpool and The Liverpool Women's Hospital, Members of Liverpool Health Partners, United Kingdom
| | - Philip N Baker
- College of Life Sciences, University of Leicester, United Kingdom
| | - Edward D Johnstone
- Maternal & Fetal Health Research Centre, School of Medical Sciences, Faculty of Medicine Biology and Health, University of Manchester, United Kingdom
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, University of London, United Kingdom; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
| | - Peter von Dadelszen
- Department of Women's and Children's Health, School of Life Course Sciences, King's College London, United Kingdom
| | - Aris T Papageorghiou
- Fetal Medicine Unit, St George's Hospital, University of London, United Kingdom; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
| | - Zarko Alfirevic
- Department of Women's and Children's Health, University of Liverpool and The Liverpool Women's Hospital, Members of Liverpool Health Partners, United Kingdom
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Karagol BS, Kundak AA, Örün UA. Comparison of the diameter of coronary arteries between small for gestational age (SGA) and appropriate for gestational age (AGA) newborn infants. J Matern Fetal Neonatal Med 2019; 34:907-912. [PMID: 31113241 DOI: 10.1080/14767058.2019.1622668] [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: 10/26/2022]
Abstract
AIM For the small for gestational age (SGA) infants born at the normal birth time but whose birth weights were below the 10th percentile and for the appropriate for gestational age (AGA) infants born in normal birth weights according to gestational week, the diameters of right and left coronary arteries were echocardiographically measured in three separate time intervals with their body weights, heights and body surface area parameters. The aim of this study is to compare the progression of coronary artery diameters of SGA infants with AGA infants over time and the effects of coronary artery diameters on the clinical and hemodynamic parameters of SGA babies. MATERIAL AND METHODS Term 55 SGA babies were compared with 200 AGA infants at birth, first and sixth months of ages for both growth parameters and coronary artery diameters measurements. RESULTS In comparison of SGA and AGA groups at birth, first and sixth months of ages on body weight, height and body surface area, aortic annulus and left coronary artery and right coronary artery diameters, it was seen that SGA group could not catch up the AGA group in all time periods on both anthropometric and coronary artery diameters data even if they have an increased growth (p<.05). Although SGA infants appeared to be far away from SGA criteria in body weight measurements at 6th months. These infants maintained a significant deficit in height and coronary artery measurements according to the AGA group (p<.05). CONCLUSIONS In the evaluation of growth indices and coronary artery diameters at birth, first and sixth months of ages in SGA babies, it is clear that impaired fetal growth of these babies has lasting-effects on coronary artery diameters and cardiac structure.
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Affiliation(s)
- Belma Saygili Karagol
- Gülhane Medical Faculty, Department of Pediatrics, Division of Neonatology, Sağlik Bilimleri University, Ankara, Turkey
| | - Ahmet Afsin Kundak
- Department of Pediatrics, Division of Neonatology, Afyonkarahisar Sağlik Bilimleri University, Afyonkarahisar, Turkey
| | - Utku Arman Örün
- Division of Pediatric Cardiology, Sağlik Bilimleri University, Dr. Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey
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The Density of Cell Nuclei at the Materno-Fetal Exchange Barrier is Sexually Dimorphic in Normal Placentas, but not in IUGR. Sci Rep 2019; 9:2359. [PMID: 30787322 PMCID: PMC6382753 DOI: 10.1038/s41598-019-38739-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/09/2019] [Indexed: 02/05/2023] Open
Abstract
Placental sexual dimorphism is of special interest in prenatal programming. Various postnatal diseases with gender dependent incidence, especially neuropsychiatric disorders like schizophrenia and autism spectrum disorders, have prenatal risk factors established. However, the functional relevance of placental microarchitecture in prenatal programming is poorly investigated, mainly due to a lack of statistically efficient methods. We hypothesized that the recently established 3D microscopic analysis of villous trees would be able to identify microscopic structural correlates of human placental sexual dimorphism. We analyzed the density of cell nuclei of villous trophoblast, i.e. the materno-fetal exchange barrier, in placentas from term pregnancies. The cell nuclei were grouped into proliferative and non-proliferative nuclei by detection of a proliferation marker (PCNA). Normal female placentas showed a higher density of non-proliferating nuclei (PCNA-negative) in villous trophoblast than normal male placentas. The density of PCNA-negative cell nuclei was higher in placentas of pregnancies with intrauterine growth retardation (IUGR) than in control placentas. The data of the present study shows that the density of non-proliferative cell nuclei in the syncytial layer of villous trophoblast is influenced by fetal sex and by IUGR, while proliferation remains unchanged. A novel concept of post-fusion regulation of syncytial structure and function is proposed.
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Krishnaveni GV, Srinivasan K. Maternal Nutrition and Offspring Stress Response-Implications for Future Development of Non-Communicable Disease: A Perspective From India. Front Psychiatry 2019; 10:795. [PMID: 31736810 PMCID: PMC6829676 DOI: 10.3389/fpsyt.2019.00795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 10/04/2019] [Indexed: 01/08/2023] Open
Abstract
Psychological stress is recognized as a major modifiable risk factor for adult non-communicable disease (NCD) that includes depression, type 2 diabetes mellitus, and cardiovascular disease. Dysregulation of hypothalamic-pituitary-adrenal (HPA) axis activity resulting in either exaggerated or blunted cortisol responses, and altered autonomic cardiovascular control have been thought to underlie this association. The developmental origins hypothesis proposes that impaired nutrition during fetal and early postnatal growth is associated with a higher NCD risk later in life. Maternal nutrients are vital for fetal growth and development, and both maternal undernutrition and over nutrition as in the case of gestational diabetes are associated with higher NCD risk markers in the offspring. Recent studies suggest that fetal exposure to maternal nutritional imbalances may permanently alter cortisol and cardio-sympathetic stress-responsiveness, which may link early life nutrition with adult disease risk. A few recent studies that examined the association between low birth weight as a marker of fetal undernutrition and stress response in humans showed that lower birth weight was associated with an altered HPA axis and cardiovascular sympathetic nervous system responses to stress in adults as well as in children. In addition, altered stress responses in relation to gestational diabetes have been noted. In this paper, we present available evidence from India for the association between maternal nutrition and offspring stress responsiveness against the backdrop of global evidence, and discuss its role in the escalating NCD rates in this population. We also discuss the scope for future studies in India and other transitioning countries.
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Li X, Feng X, Lu L, He A, Liu B, Zhang Y, Shi R, Liu Y, Chen X, Sun M, Xu Z. Prenatal hypoxia plus postnatal high-fat diet exacerbated vascular dysfunction via up-regulated vascular Cav1.2 channels in offspring rats. J Cell Mol Med 2018; 23:1183-1196. [PMID: 30556291 PMCID: PMC6349350 DOI: 10.1111/jcmm.14020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/10/2018] [Accepted: 10/20/2018] [Indexed: 12/13/2022] Open
Abstract
Background This study aimed to examine whether and how postnatal high‐fat diet had additional impact on promoting vascular dysfunction in the offspring exposed to prenatal hypoxia. Methods and Results Pregnant Sprague‐Dawley rats were randomly assigned to hypoxia (10.5% oxygen) or normoxia (21% O2) groups from gestation days 5‐21. A subset of male offspring was placed on a high‐fat diet (HF, 45% fat) from 4‐16 weeks of age. Prenatal hypoxia induced a decrease in birth weight. In offspring‐fed HF diet, prenatal hypoxia was associated with increased fasting plasma triglyceride, total cholesterol, free fatty acids, and low‐density lipoprotein‐cholesterol. Compared with the other three groups, prenatal hypoxic offspring with high‐fat diet showed a significant increase in blood pressure, phenylephrine‐mediated vasoconstrictions, L‐type voltage‐gated Ca2+ (Cav1.2) channel currents, and elevated mRNA and protein expression of Cav1.2 α1 subunit in mesenteric arteries or myocytes. The large‐conductance Ca2+‐activated K+ (BK) channels currents and the BK channel units (β1, not α‐subunits) were significantly increased in mesenteric arteries or myocytes in HF offspring independent of prenatal hypoxia factor. Conclusion The results demonstrated that prenatal hypoxia followed by postnatal HF caused vascular dysfunction through ion channel remodelling in myocytes.
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Affiliation(s)
- Xiang Li
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Xueqin Feng
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Likui Lu
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Axin He
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Bailin Liu
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Yingying Zhang
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Ruixiu Shi
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Yanping Liu
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Xueyi Chen
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Miao Sun
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Zhice Xu
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China.,Center for Perinatal Biology, Loma Linda University, Loma Linda, California
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Maternal psychological distress during pregnancy and childhood health outcomes: a narrative review. J Dev Orig Health Dis 2018; 10:274-285. [PMID: 30378522 DOI: 10.1017/s2040174418000557] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Maternal psychological distress is common in pregnancy and may influence the risk of adverse outcomes in children. Psychological distress may cause a suboptimal intrauterine environment leading to growth and developmental adaptations of the fetus and child. In this narrative review, we examined the influence of maternal psychological distress during pregnancy on fetal outcomes and child cardiometabolic, respiratory, atopic and neurodevelopment-related health outcomes. We discussed these findings from an epidemiological and life course perspective and provided recommendations for future studies. The literature in the field of maternal psychological distress and child health outcomes is extensive and shows that exposure to stress during pregnancy is associated with multiple adverse child health outcomes. Because maternal psychological distress is an important and potential modifiable factor during pregnancy, it should be a target for prevention strategies in order to optimize fetal and child health. Future studies should use innovative designs and strategies in order to address the issue of causality.
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Sharp A, Duong C, Agarwal U, Alfirevic Z. Screening and management of the small for gestational age fetus in the UK: A survey of practice. Eur J Obstet Gynecol Reprod Biol 2018; 231:220-224. [PMID: 30415129 DOI: 10.1016/j.ejogrb.2018.10.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/18/2018] [Accepted: 10/20/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Antenatal detection of the small for gestational (SGA) fetus has become an important indicator of quality of antenatal care in the UK. This has been driven by a desire to reduce stillbirth in this at risk group. METHODS We conducted a postal survey of 187 NHS consultant units within the UK to determine what the current practice for the detection and subsequent management of the suspected SGA fetus was following the guidance from the Royal College of Obstetricians and Gynaecologists (RCOG) in 2013. RESULTS The survey was performed in 3 rounds between 2016 and 2017 with a response rate of 65%. 85% of units assessed risk factors for SGA at booking. 81% of units used a customized symphysis fundal height (SFH) chart to screen for SGA with 95% of them using a cut off of <10th centile to refer for ultrasound assessment. When ultrasound is used to detect SGA, 80% of units used estimated fetal weight (EFW), with 89% of these using a cut off of <10th centile to diagnose SGA. Umbilical artery (UA) Doppler monitoring was undertaken in 97% of management and 94% delivered after 37 weeks. Only 24% of units had a dedicated fetal growth clinic, whilst 48% of units were able to offer computerised CTG to monitor the SGA fetus. CONCLUSIONS Overall there is consistency in the screening methods for SGA (customised SFH charts) and identification of suspected SGA (SFH <10th centile, EFW <10th centile, UA monitoring and induction of labour at term). There was a low uptake of computerized CTG to monitor SGA babies and a low number of specialised fetal growth clinics.
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Affiliation(s)
- A Sharp
- Department of Women's and Children's Health, University of Liverpool, United Kingdom; Liverpool Women's Hospital, Crown Street, Liverpool, L8 7SS, United Kingdom.
| | - C Duong
- Department of Women's and Children's Health, University of Liverpool, United Kingdom
| | - U Agarwal
- Liverpool Women's Hospital, Crown Street, Liverpool, L8 7SS, United Kingdom
| | - Z Alfirevic
- Department of Women's and Children's Health, University of Liverpool, United Kingdom; Liverpool Women's Hospital, Crown Street, Liverpool, L8 7SS, United Kingdom
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Rashid A, Park T, Macneal K, Iannotti L, Ross W. Maternal Diet and Morbidity Factors Associated with Low Birth Weight in Haiti: A Case-Control Study. Health Equity 2018; 2:139-144. [PMID: 30283860 PMCID: PMC6071792 DOI: 10.1089/heq.2017.0063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective: A matched, case–control study was conducted to examine the association between development of low birth weight (LBW) and maternal factors, including dietary intake, comorbidities, and socioeconomic factors, among women in Cap Haitien, Haiti. Design: Mothers who delivered LBW babies; defined as ≤2.5 kg, were identified by review of the medical record and matched to mothers of similar age, parity, with normal birth weight (NBW) babies. A survey was administered consisting of Women's Dietary Diversity Score (WDDS), maternal reporting of comorbidities, income, and educational level. Subjects: Women were eligible if they delivered and had newborns weighed within the last 2 years. Total study participants consisted of 32 cases and 34 controls matched for age, parity, and month of delivery. Results: Mothers who consume eggs were 78% less likely to have given birth to a LBW infant (OR 0.22 (95% CI: 0.05–0.87). Mothers with NBW babies had a nonsignificant trend towards higher WDDS. The prevalence of hypertension in mothers who were seen in the clinic at least once over the past 2 years was found to be 27%, and 78% of mothers were not aware of their diagnosis. Conclusion: Enhancing maternal nutrition during pregnancy has broad implications for reducing LBW, improving fetal health and reducing fetal predilection for chronic diseases in adulthood. Longitudinal prospective studies are needed to evaluate the selective benefit of eggs and other high-quality foods in protecting fetal growth. Efforts to improve knowledge and awareness of hypertension in Haiti should be undertaken.
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Affiliation(s)
- Abdirahim Rashid
- Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri
| | - Thomas Park
- Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri
| | - Kenneth Macneal
- University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Lora Iannotti
- Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - Will Ross
- Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri
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Rodríguez-Rodríguez P, Ramiro-Cortijo D, Reyes-Hernández CG, López de Pablo AL, González MC, Arribas SM. Implication of Oxidative Stress in Fetal Programming of Cardiovascular Disease. Front Physiol 2018; 9:602. [PMID: 29875698 PMCID: PMC5974054 DOI: 10.3389/fphys.2018.00602] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/03/2018] [Indexed: 12/20/2022] Open
Abstract
Lifestyle and genetic background are well known risk factors of cardiovascular disease (CVD). A third contributing factor is suboptimal fetal development, due to nutrient or oxygen deprivation, placental insufficiency, or exposure to toxic substances. The fetus adapts to adverse intrauterine conditions to ensure survival; the immediate consequence is low birth weight (LBW) and the long-term effect is an increased susceptibility to develop CVD in adult life. This process is known as Developmental Origins of Health and Disease (DOHaD) or fetal programming of CVD. The influence of fetal life for the future cardiovascular health of the individual has been evidenced by numerous epidemiologic studies in populations suffering from starvation during intrauterine life. Furthermore, experimental animal models have provided support and enabled exploring the underlying mechanisms. Oxidative stress seems to play a central role in fetal programming of CVD, both in the response of the feto-placental unit to the suboptimal intrauterine environment and in the alterations of physiologic systems of cardiovascular control, ultimately leading to disease. This review aims to summarize current knowledge on the alterations in oxidative balance in response to fetal stress factors covering two aspects. Firstly, the evidence from human studies of the implication of oxidative stress in LBW induced by suboptimal conditions during intrauterine life, emphasizing the role of the placenta. In the second part we summarize data on specific redox alterations in key cardiovascular control organs induced by exposure to known stress factors in experimental animals and discuss the emerging role of the mitochondria.
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Affiliation(s)
| | - David Ramiro-Cortijo
- Departamento de Fisiología, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Angel L López de Pablo
- Departamento de Fisiología, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Carmen González
- Departamento de Fisiología, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Silvia M Arribas
- Departamento de Fisiología, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
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37
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Duan L, Liu W, Zhang P, Liu S, Liu X, Sang M, Liu L, Lin H, Sang Z. Salt Intake of Lactating Women as Assessed by Modified Food Weighted Records. J Am Coll Nutr 2018; 37:614-619. [PMID: 29667517 DOI: 10.1080/07315724.2018.1454354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE High salt intake among lactating women can increase the risk of hypertension and cardiovascular disease in infants/offspring. However, considering the limited salt intake data in lactating women, the aims of this study were to compare the salt intake assessed by modified food weighted records (FWR) with that estimated by 24-h urinary sodium excretion and to investigate the salt intake of lactating women. METHODS In total, 30 lactating women aged 20-39 years who were 2 to 4 months postpartum were recruited from the cities of Tianjin and Luoyang in China. The household salt intakes of the lactating women were collected by modified FWR for 3 days. Information on the gender, age, eating behaviours and labour intensity of the family members and guests dining at home during the 3 days was recorded. Meanwhile, 24-h urine samples of lactating women were collected. RESULTS The salt intakes of the lactating women estimated by modified FWR and 24-h urinary sodium excretion were 8.50 ± 5.32 g/d and 9.34±3.74 g/d (t=-1.29, P=0.207), respectively, which exceeded the WHO recommendation of 5 g/d. There was a significant correlation (r=0.628, P < 0.001) between the salt intakes assessed by the two methods. A Bland-Altman plot showed no significant mean difference between the two methods (salt intake measured by 24-h urinary sodium excretion-salt intake assessed by modified FWR=0.46 g/d, P=0.207). CONCLUSIONS The modified FWR is a reliable tool to assess the salt intake of lactating women. The salt intake of lactating women in China remains higher than the WHO recommendation and should be restricted through further efforts.
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Affiliation(s)
- Lijun Duan
- a Department of endocrinology , Tianjin First Center Hospital , Tianjin , China
| | - Wendi Liu
- b Department of Nutrition and Food Hygiene , School of Public Health, Tianjin Medical University , Tianjin , China
| | - Peng Zhang
- b Department of Nutrition and Food Hygiene , School of Public Health, Tianjin Medical University , Tianjin , China
| | - Shiyan Liu
- b Department of Nutrition and Food Hygiene , School of Public Health, Tianjin Medical University , Tianjin , China
| | - Xiaotong Liu
- b Department of Nutrition and Food Hygiene , School of Public Health, Tianjin Medical University , Tianjin , China
| | - Maocheng Sang
- b Department of Nutrition and Food Hygiene , School of Public Health, Tianjin Medical University , Tianjin , China
| | - Lu Liu
- b Department of Nutrition and Food Hygiene , School of Public Health, Tianjin Medical University , Tianjin , China
| | - Haiyue Lin
- b Department of Nutrition and Food Hygiene , School of Public Health, Tianjin Medical University , Tianjin , China
| | - Zhongna Sang
- b Department of Nutrition and Food Hygiene , School of Public Health, Tianjin Medical University , Tianjin , China
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Vasan SK, Roy A, Samuel VT, Antonisamy B, Bhargava SK, Alex AG, Singh B, Osmond C, Geethanjali FS, Karpe F, Sachdev H, Agrawal K, Ramakrishnan L, Tandon N, Thomas N, Premkumar PS, Asaithambi P, Princy SFX, Sinha S, Paul TV, Prabhakaran D, Fall CHD. IndEcho study: cohort study investigating birth size, childhood growth and young adult cardiovascular risk factors as predictors of midlife myocardial structure and function in South Asians. BMJ Open 2018; 8:e019675. [PMID: 29643156 PMCID: PMC5898335 DOI: 10.1136/bmjopen-2017-019675] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION South Asians have high rates of cardiovascular disease (CVD) and its risk factors (hypertension, diabetes, dyslipidaemia and central obesity). Left ventricular (LV) hypertrophy and dysfunction are features of these disorders and important predictors of CVD mortality. Lower birth and infant weight and greater childhood weight gain are associated with increased adult CVD mortality, but there are few data on their relationship to LV function. The IndEcho study will examine associations of birth size, growth during infancy, childhood and adolescence and CVD risk factors in young adulthood with midlife cardiac structure and function in South Asian Indians. METHODS AND ANALYSIS We propose to study approximately 3000 men and women aged 43-50 years from two birth cohorts established in 1969-1973: the New Delhi Birth Cohort (n=1508) and Vellore Birth Cohort (n=2156). They had serial measurements of weight and height from birth to early adulthood. CVD risk markers (body composition, blood pressure, glucose tolerance and lipids) and lifestyle characteristics (tobacco and alcohol consumption, physical activity, socioeconomic status) were assessed at age ~30 years. Clinical measurements in IndEcho will include anthropometry, blood pressure, biochemistry (glucose, fasting insulin and lipids, urinary albumin/creatinine ratio) and body composition by dual energy X-ray absorptiometry and bioelectrical impedance. Outcomes are LV mass and indices of LV systolic and diastolic function assessed by two-dimensional and Doppler echocardiography, carotid intimal-media thickness and ECG indicators of ischaemia. Regression and conditional growth models, adjusted for potential confounders, will be used to study associations of childhood and young adult exposures with these cardiovascular outcomes. ETHICS AND DISSEMINATION The study has been approved by the Health Ministry Steering Committee, Government of India and institutional ethics committees of participating centres in India and the University of Southampton, UK. Results will be disseminated through scientific meetings and peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN13432279; Pre-results.
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Affiliation(s)
- Senthil K Vasan
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- Oxford Center for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Ambuj Roy
- Centre for Chronic Disease Control, New Delhi, India
- Department of Cardiology, All-India Institute of Medical Sciences, New Delhi, India
| | - Viji Thomson Samuel
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Belavendra Antonisamy
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Anoop George Alex
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Bhaskar Singh
- Department of Paediatrics, Sunder Lal Jain Hospital, New Delhi, India
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Finney S Geethanjali
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Fredrik Karpe
- Oxford Center for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Harshpal Sachdev
- Department of Paediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Kanhaiya Agrawal
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Lakshmy Ramakrishnan
- Department of Cardiology, All-India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Cardiology, All-India Institute of Medical Sciences, New Delhi, India
| | - Nihal Thomas
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Prasanna S Premkumar
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Prrathepa Asaithambi
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sneha F X Princy
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sikha Sinha
- Department of Paediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Thomas Vizhalil Paul
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, New Delhi, India
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
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Botting KJ, Loke XY, Zhang S, Andersen JB, Nyengaard JR, Morrison JL. IUGR decreases cardiomyocyte endowment and alters cardiac metabolism in a sex- and cause-of-IUGR-specific manner. Am J Physiol Regul Integr Comp Physiol 2018; 315:R48-R67. [PMID: 29561647 DOI: 10.1152/ajpregu.00180.2017] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Intrauterine growth restriction (IUGR) increases the risk of ischemic heart disease in adulthood. Studies in rats suggest cardiac vulnerability is more pronounced in males and in offspring that were exposed to hypoxia in utero. Therefore, we aimed to test the hypotheses that 1) IUGR adolescent males, but not females, have fewer cardiomyocytes and altered expression of cardiometabolic genes compared with controls; and 2) IUGR due to hypoxia has a greater effect on these parameters compared with IUGR due to nutrient restriction. IUGR was induced in guinea pigs by maternal hypoxia (MH; 10% O2, n = 9) or maternal nutrient restriction (MNR; ~30% reduction in food intake, n = 9) in the second half of pregnancy and compared with control ( n = 11). At 120 days of age, postmortem was performed and the left ventricle perfusion fixed for stereological determination of cardiomyocyte number or snap frozen to determine the abundance of cardiometabolic genes and proteins by quantitative RT-PCR and Western blotting, respectively. MH reduced the number of cardiomyocytes in female ( P < 0.05), but not male or MNR, adolescent offspring. Furthermore, IUGR males had decreased expression of genes responsible for fatty acid activation in the sarcoplasm ( FACS) and transport into the mitochondria ( AMPK-a2 and ACC; P < 0.05) and females exposed to MH had increased activation/phosphorylation of AMP-activated protein kinase-α ( P < 0.05). We postulate that the changes in cardiomyocyte endowment and cardiac gene expression observed in the present study are a direct result of in utero programming, as offspring at this age did not suffer from obesity, hypertension, or left ventricular hypertrophy.
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Affiliation(s)
- K J Botting
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia , Adelaide, South Australia , Australia.,Discipline of Physiology, School of Medical Science, The University of Adelaide , Adelaide, South Australia , Australia
| | - X Y Loke
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia , Adelaide, South Australia , Australia
| | - S Zhang
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia , Adelaide, South Australia , Australia
| | - J B Andersen
- Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Centre for Stochastic Geometry and Advanced Bioimaging, Aarhus University , Aarhus , Denmark
| | - J R Nyengaard
- Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Centre for Stochastic Geometry and Advanced Bioimaging, Aarhus University , Aarhus , Denmark
| | - J L Morrison
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia , Adelaide, South Australia , Australia.,Discipline of Physiology, School of Medical Science, The University of Adelaide , Adelaide, South Australia , Australia
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41
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Crispi F, Miranda J, Gratacós E. Long-term cardiovascular consequences of fetal growth restriction: biology, clinical implications, and opportunities for prevention of adult disease. Am J Obstet Gynecol 2018; 218:S869-S879. [PMID: 29422215 DOI: 10.1016/j.ajog.2017.12.012] [Citation(s) in RCA: 200] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 02/07/2023]
Abstract
In the modern world, cardiovascular disease is a leading cause of death for both men and women. Epidemiologic studies consistently have suggested an association between low birthweight and/or fetal growth restriction and increased rate of cardiovascular mortality in adulthood. Furthermore, experimental and clinical studies have demonstrated that sustained nutrient and oxygen restriction that are associated with fetal growth restriction activate adaptive cardiovascular changes that might explain this association. Fetal growth restriction results in metabolic programming that may increase the risk of metabolic syndrome and, consequently, of cardiovascular morbidity in the adult. In addition, fetal growth restriction is strongly associated with fetal cardiac and arterial remodeling and a subclinical state of cardiovascular dysfunction. The cardiovascular effects ocurring in fetal life, includes cardiac morphology changes, subclinical myocardial dysfunction, arterial remodeling, and impaired endothelial function, persist into childhood and adolescence. Importantly, these changes have been described in all clinical presentations of fetal growth restriction, from severe early- to milder late-onset forms. In this review we summarize the current evidence on the cardiovascular effects of fetal growth restriction, from subcellular to organ structure and function as well as from fetal to early postnatal life. Future research needs to elucidate whether and how early life cardiovascular remodeling persists into adulthood and determines the increased cardiovascular mortality rate described in epidemiologic studies.
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Myatt L, Thornburg KL. Effects of Prenatal Nutrition and the Role of the Placenta in Health and Disease. Methods Mol Biol 2018; 1735:19-46. [PMID: 29380305 DOI: 10.1007/978-1-4939-7614-0_2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Epidemiologic studies identified the linkage between exposures to stresses, including the type and plane of nutrition in utero with development of disease in later life. Given the critical roles of the placenta in mediating transport of nutrients between the mother and fetus and regulation of maternal metabolism, recent attention has focused on the role of the placenta in mediating the effect of altered nutritional exposures on the development of disease in later life. In this chapter we describe the mechanisms of nutrient transport in the placenta, the influence of placental metabolism on this, and how placental energetics influence placental function in response to a variety of stressors. Further the recent "recognition" that the placenta itself has a sex which affects its function may begin to help elucidate the mechanisms underlying the well-known dimorphism in development of disease in adult life.
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Affiliation(s)
- Leslie Myatt
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA. .,Bob and Charlee Moore Institute for Nutrition & Wellness, Oregon Health & Science University, Portland, OR, USA.
| | - Kent L Thornburg
- Bob and Charlee Moore Institute for Nutrition & Wellness, Oregon Health & Science University, Portland, OR, USA.,Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
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Silveira PP, Pokhvisneva I, Gaudreau H, Atkinson L, Fleming AS, Sokolowski MB, Steiner M, Kennedy JL, Dubé L, Levitan RD, Meaney MJ. Fetal growth interacts with multilocus genetic score reflecting dopamine signaling capacity to predict spontaneous sugar intake in children. Appetite 2018; 120:596-601. [DOI: 10.1016/j.appet.2017.10.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/05/2017] [Accepted: 10/12/2017] [Indexed: 01/25/2023]
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Cheng TS, Loy SL, Cheung YB, Godfrey KM, Gluckman PD, Kwek K, Saw SM, Chong YS, Lee YS, Yap F, Yen Chan JK, Lek N. Demographic Characteristics, Health Behaviors Before and During Pregnancy, and Pregnancy and Birth Outcomes in Mothers with Different Pregnancy Planning Status. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2017; 17:960-969. [PMID: 27577198 DOI: 10.1007/s11121-016-0694-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Studies on pregnancy intentions and their consequences have yielded mixed results. Here, we comprehensively analyzed the maternal characteristics, health behaviors before and during pregnancy, as well as pregnancy and birth outcomes, across three different pregnancy planning status in 861 women participating in an ongoing Asian mother-offspring cohort study. At 26-28 weeks' gestation, the women's intention and enthusiasm toward their pregnancy were used to classify their pregnancy into planned or unplanned, and unplanned pregnancy was further subdivided into mistimed or unintended. Data on maternal characteristics, health behaviors, and pregnancy outcomes up to that stage were recorded. After delivery, birth outcomes of the offspring were recorded. Linear and logistic regression analyses were performed. Overall, 56 % had a planned pregnancy, 39 % mistimed, and 5 % unintended. Compared to women who planned their pregnancy, women with mistimed pregnancy had higher body mass index and were more likely to have cigarette smoke exposure and less likely to have folic acid supplementation. At 26-28 weeks' gestation, unintended pregnancy was associated with increased anxiety. Neonates of mistimed pregnancy had shorter birth length compared to those of planned pregnancy, even after adjustment for maternal baseline demographics. These findings suggest that mothers who did not plan their pregnancy had less desirable characteristics or health behaviors before and during pregnancy and poorer pregnancy and birth outcomes. Shorter birth length in mistimed pregnancy may be attributed to maternal behaviors before or in the early stages of pregnancy, therefore highlighting the importance of preconception health promotion and screening for women of child-bearing age.
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Affiliation(s)
- Tuck Seng Cheng
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - See Ling Loy
- KK Research Centre, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | - Yin Bun Cheung
- Center for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore.,Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Kenneth Kwek
- Department of Maternal Foetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Seang Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yap-Seng Chong
- Department of Obstetrics & Gynaecology, Yong Loo Ling School of Medicine, National University of Singapore, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Fabian Yap
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | - Jerry Kok Yen Chan
- KK Research Centre, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore.,Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore
| | - Ngee Lek
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore
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Sharp A, Cornforth C, Jackson R, Harrold J, Turner MA, Kenny LC, Baker PN, Johnstone ED, Khalil A, von Dadelszen P, Papageorghiou AT, Alfirevic Z. Maternal sildenafil for severe fetal growth restriction (STRIDER): a multicentre, randomised, placebo-controlled, double-blind trial. THE LANCET CHILD & ADOLESCENT HEALTH 2017; 2:93-102. [PMID: 30169244 DOI: 10.1016/s2352-4642(17)30173-6] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/27/2017] [Accepted: 11/07/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Severe early-onset fetal growth restriction can lead to a range of adverse outcomes including fetal or neonatal death, neurodisability, and lifelong risks to the health of the affected child. Sildenafil, a phosphodiesterase type 5 inhibitor, potentiates the actions of nitric oxide, which leads to vasodilatation of the uterine vessels and might improve fetal growth in utero. METHODS We did this superiority, placebo-controlled randomised trial in 19 fetal medicine units in the UK. We used random computer allocation (1:1) to assign women with singleton pregnancies between 22 weeks and 0 days' gestation and 29 weeks and 6 days' gestation and severe early-onset fetal growth restriction to receive either sildenafil 25 mg three times daily or placebo until 32 weeks and 0 days' gestation or delivery. We stratified women by site and by their gestational age at randomisation (before week 26 and 0 days or at week 26 and 0 days or later). We defined fetal growth restriction as a combination of estimated fetal weight or abdominal circumference below tenth percentile and absent or reversed end-diastolic blood flow in the umbilical artery on Doppler velocimetry. The primary outcome was the time from randomisation to delivery, measured in days. This study is registered with BioMed Central, number ISRCTN 39133303. FINDINGS Between Nov 21, 2014, and July 6, 2016, we recruited 135 women and randomly assigned 70 women to sildenafil and 65 women to placebo. We found no difference in the median randomisation to delivery interval between women assigned to sildenafil (17 days [IQR 7-24]) and women assigned to placebo (18 days [8-28]; p=0·23). Livebirths (relative risk [RR] 1·06, 95% CI 0·84 to 1·33; p=0·62), fetal deaths (0·89, 0·54 to 1·45; p=0·64), neonatal deaths (1·33, 0·54 to 3·28; p=0·53), and birthweight (-14 g,-100 to 126; p=0·81) did not differ between groups. No differences were found for any other secondary outcomes. Eight serious adverse events were reported during the course of the study (six in the placebo group and two in the sildenafil group); none of these were attributed to sildenafil. INTERPRETATION Sildenafil did not prolong pregnancy or improve pregnancy outcomes in severe early-onset fetal growth restriction and therefore it should not be prescribed for this indication outside of research studies with explicit participants' consent. FUNDING National Institute for Health Research and Medical Research Council.
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Affiliation(s)
- Andrew Sharp
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | | | - Richard Jackson
- Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - Jane Harrold
- Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - Mark A Turner
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Louise C Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - Philip N Baker
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Edward D Johnstone
- Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, University of London, London, UK
| | - Peter von Dadelszen
- Department of Women's and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | | | - Zarko Alfirevic
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.
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Lock MC, Botting KJ, Tellam RL, Brooks D, Morrison JL. Adverse Intrauterine Environment and Cardiac miRNA Expression. Int J Mol Sci 2017; 18:ijms18122628. [PMID: 29210999 PMCID: PMC5751231 DOI: 10.3390/ijms18122628] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/10/2017] [Accepted: 11/28/2017] [Indexed: 12/23/2022] Open
Abstract
Placental insufficiency, high altitude pregnancies, maternal obesity/diabetes, maternal undernutrition and stress can result in a poor setting for growth of the developing fetus. These adverse intrauterine environments result in physiological changes to the developing heart that impact how the heart will function in postnatal life. The intrauterine environment plays a key role in the complex interplay between genes and the epigenetic mechanisms that regulate their expression. In this review we describe how an adverse intrauterine environment can influence the expression of miRNAs (a sub-set of non-coding RNAs) and how these changes may impact heart development. Potential consequences of altered miRNA expression in the fetal heart include; Hypoxia inducible factor (HIF) activation, dysregulation of angiogenesis, mitochondrial abnormalities and altered glucose and fatty acid transport/metabolism. It is important to understand how miRNAs are altered in these adverse environments to identify key pathways that can be targeted using miRNA mimics or inhibitors to condition an improved developmental response.
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Affiliation(s)
- Mitchell C Lock
- Early Origins of Adult Health Research Group; School of Pharmacy & Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5001, Australia.
| | - Kimberley J Botting
- Early Origins of Adult Health Research Group; School of Pharmacy & Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5001, Australia.
| | - Ross L Tellam
- Early Origins of Adult Health Research Group; School of Pharmacy & Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5001, Australia.
- CSIRO Agriculture, 306 Carmody Rd, St. Lucia, QLD 4067, Australia.
| | - Doug Brooks
- Mechanisms in Cell Biology and Disease Research Group School of Pharmacy & Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5001, Australia.
| | - Janna L Morrison
- Early Origins of Adult Health Research Group; School of Pharmacy & Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5001, Australia.
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Affiliation(s)
- S. M. Robinson
- MRC Lifecourse Epidemiology Unit; University of Southampton; Southampton UK
- NIHR Southampton Biomedical Research Centre; Southampton UK
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Abstract
Prenatal exposure to famine is associated with an increased risk of metabolic and cardiovascular diseases in the offspring at adult age. The aim of this study was to assess whether prenatal exposure to undernutrition increases the risk of stroke. This study was performed in the Dutch famine birth cohort, which consist of 2414 members who were born between 1943 and 1947 in the Netherlands. In a subsample of 1177 individuals, interviews were conducted using standardized questionnaires to obtain information about medical history (which included specific questions regarding stroke) and lifestyle. Information on stroke-related mortality was collected by linking the cohort with Statistics Netherlands. A Cox's proportional hazard analysis was performed to calculate hazard ratios (HRs) comparing the incidence of non-fatal stroke between participants who were exposed, subdivided into early, mid and late gestation, and unexposed to famine prenatally. Three cohort members died of stroke. Of the 1177 subjects who responded to the questionnaires 49 (4.2%) survived a stroke. Unadjusted and adjusted HRs for the risk of non-fatal stroke did not show a significant difference between the unexposed and exposed subjects: HR 1.23 (95% CI 0.53-2.83), HR 1.23 (95% CI 0.53-2.82), HR 1.12 (95% CI 0.46-2.71) for those exposed in late, mid and early gestation, respectively. We were unable to find evidence for a major effect of prenatal exposure to famine on the risk of stroke in later life, although one should be aware that this study was underpowered and the study population too selected and young to identify smaller risks.
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49
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Kellie FJ. Vasodilators for treating intrauterine growth restriction. Hippokratia 2017. [DOI: 10.1002/14651858.cd011978.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Frances J Kellie
- The University of Liverpool; Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health; First Floor, Liverpool Women's NHS Foundation Trust Crown Street Liverpool UK L8 7SS
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50
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Mukerjee S, Zhu Y, Zsombok A, Mauvais-Jarvis F, Zhao J, Lazartigues E. Perinatal Exposure to Western Diet Programs Autonomic Dysfunction in the Male Offspring. Cell Mol Neurobiol 2017; 38:233-242. [PMID: 28478572 DOI: 10.1007/s10571-017-0502-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/03/2017] [Indexed: 12/15/2022]
Abstract
Although the deleterious influence of protein deficiency on fetal programming is well documented, the impact of a Western diet on epigenetic mechanisms is less clear. We hypothesized that high-fat high-sucrose diet (HFHSD) consumption during pregnancy leads to epigenetic modifications within the progeny's compensatory renin-angiotensin system (RAS), affecting autonomic and metabolic functions. Dams were fed HFHSD (45% fat and 30% sucrose) or regular chow (RD) from mating until weaning of the pups (~7 weeks). Offspring from both groups were then maintained on chow and studied in adulthood (3-7 months). Offspring from HFHSD-exposed dams (OH) exhibited no difference in body weight or fasting blood glucose compared to controls (OR). In 3-month-old offspring, DNA methylation was significantly lower for the ACE2 gene (P < 0.05) in the brainstem, kidney and cecum. Moreover, ACE2 activity in the hypothalamus was increased at 7 months (OH: 91 ± 1 vs. OR: 74 ± 4 AFU/mg/min, P < 0.05). Although baseline blood pressure was not different between groups, vagal tone in OH was significantly impaired compared to OR. At the same time, OH offspring had a 1.7-fold increase in AT1a receptor expression and a 1.3-fold increase in ADAM17 mRNA. DOCA-salt treatment further revealed and exacerbated hypertensive response in the OH progeny (OH: 130 ± 6 vs. OR: 108 ± 3 mmHg, P < 0.05). Taken together, our data suggest that perinatal exposure to HFHSD resulted in epigenetic modifications of the compensatory brain RAS, potentially affecting plasticity of neuronal networks leading to autonomic dysfunction in the male offspring.
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Affiliation(s)
- Snigdha Mukerjee
- Department of Pharmacology and Experimental Therapeutics and Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Yun Zhu
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Andrea Zsombok
- Department of Physiology, Tulane University, New Orleans, LA, USA
| | | | - Jinying Zhao
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Eric Lazartigues
- Department of Pharmacology and Experimental Therapeutics and Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA, USA. .,Department of Pharmacology and Experimental Therapeutics, School of Medicine, Louisiana State University Health Sciences Center, 1901 Perdido Street, Room 5218, New Orleans, LA, 70112, USA.
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