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Haapanen M, Kuitunen I, Vaajala M. Influence of smoking and socioeconomic status on labor analgesia: a nationwide register-based study in Finland. Arch Gynecol Obstet 2024; 310:1989-1996. [PMID: 39028434 PMCID: PMC11393191 DOI: 10.1007/s00404-024-07647-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 07/09/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE Labor pain can be treated by medical and non-medical analgesia. Smoking during pregnancy has been shown to increase the incidence of several complications and may influence analgesic effectiveness. Previous studies have linked socioeconomic status to the use of epidurals for labor analgesia. We aimed to determine whether smoking and socioeconomic status influence the use of labor analgesia in Finland. METHODS From January 1, 2004 to December 31, 2018, we collected data from the national Finnish Medical Birth Register on smoking status, labor analgesia, and socioeconomic status during pregnancy. These categorized variables were presented as absolute numbers and percentages. We included data on singleton pregnancies and excluded any data on pregnancies that missed smoking or socioeconomic status. RESULTS 71,603 women smoked during the first trimester, 42,079 women continued to smoke after the first trimester, and 641,449 were non-smokers. The four most used labor analgesia were nitrous oxide, epidural, other medical analgesia, and non-medical analgesia. The most frequently used analgesia was nitrous oxide, which was used by 60.8% of the group of smokers after the first trimester, 58.8% of smokers during the first trimester, and 54.5% of non-smokers. There were no substantial differences between socioeconomic status classes and labor analgesia used. CONCLUSION Women who continued smoking after the first trimester used labor analgesia more often than non-smokers. There were no clear differences between socioeconomic status classes and labor analgesia used. These findings highlight the need to reduce maternal smoking during pregnancy, and universal social healthcare systems should promote equality in labor analgesia.
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Affiliation(s)
- M Haapanen
- Department of Gynecology and Obstetrics, Mikkeli Central Hospital, Porrassalmenkatu 35-37, 50100, Mikkeli, Finland.
- Kuopio Pediatric Research Unit (KUPRU), Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - I Kuitunen
- Kuopio Pediatric Research Unit (KUPRU), Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Pediatrics and Neonatology, Kuopio University Hospital, Kuopio, Finland
| | - M Vaajala
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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2
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Benedetto C, Borella F, Divakar H, O'Riordan SL, Mazzoli M, Hanson M, O'Reilly S, Jacobsson B, Conry JA, McAuliffe FM. FIGO Preconception Checklist: Preconception care for mother and baby. Int J Gynaecol Obstet 2024; 165:1-8. [PMID: 38426290 DOI: 10.1002/ijgo.15446] [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] [Indexed: 03/02/2024]
Abstract
The preconception period is a unique and opportunistic time in a woman's life when she is motivated to adopt healthy behaviors that will benefit her and her child, making this time period a critical "window of opportunity" to improve short- and long-term health. Improving preconception health can ultimately improve both fetal and maternal outcomes. Promoting health before conception has several beneficial effects, including an increase in seeking antenatal care and a reduction in neonatal mortality. Preconception health is a broad concept that encompasses the management of chronic diseases, including optimal nutrition, adequate consumption of folic acid, control of body weight, adoption of healthy lifestyles, and receipt of appropriate vaccinations. Use of the FIGO Preconception Checklist, which includes the key elements of optimal preconception care, will empower women and their healthcare providers to better prepare women and their families for pregnancy.
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Affiliation(s)
- Chiara Benedetto
- Department of Obstetrics and Gynecology, Sant'Anna University Hospital, Torino, Italy
- FIGO Committee on Well Woman Health Care, London, UK
| | - Fulvio Borella
- Department of Obstetrics and Gynecology, Sant'Anna University Hospital, Torino, Italy
| | - Hema Divakar
- FIGO Committee on Well Woman Health Care, London, UK
| | - Sarah L O'Riordan
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin, Dublin, Ireland
- FIGO Committee on the Impact of Pregnancy on Long-Term Health, London, UK
| | - Martina Mazzoli
- Department of Obstetrics and Gynecology, Sant'Anna University Hospital, Torino, Italy
| | - Mark Hanson
- Institute of Developmental Sciences, University of Southampton, Southampton, UK
| | - Sharleen O'Reilly
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - Bo Jacobsson
- FIGO Division of Maternal and Newborn Health, London, UK
- Department of Genes and Environment, Norwegian Institute of Public Health, Oslo, Norway
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Jeanne A Conry
- The Environmental Health Leadership Foundation, California, USA
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin, Dublin, Ireland
- FIGO Committee on the Impact of Pregnancy on Long-Term Health, London, UK
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3
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Bulletti FM, Sciorio R, Palagiano A, Bulletti C. The artificial uterus: on the way to ectogenesis. ZYGOTE 2023; 31:457-467. [PMID: 37357356 DOI: 10.1017/s0967199423000175] [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] [Indexed: 06/27/2023]
Abstract
The inability to support the growth and development of a mature fetus up to delivery results in significant human suffering. Current available solutions include adoption, surrogacy, and uterus transplantation. However, these options are subject to several ethical, religious, economic, social, and medical concerns. Ectogenesis is the process in which an embryo develops in an artificial uterus from implantation through to the delivery of a live infant. This current narrative review summarizes the state of recent research focused on human ectogenesis. First, a literature search was performed to identify published reports of previous experiments and devices used for embryo implantation in an extracorporeally perfused human uterus. Furthermore, studies fitting that aim were selected and critically evaluated. Results were synthesized, interpreted, and used to design a prospective strategy for future research. Therefore, this study suggests that full ectogenesis might be obtained using a computer-controlled system with extracorporeal blood perfusion provided by a digitally controlled heart-lung-kidney system. From a clinical perspective, patients who will derive significant benefits from this technology are mainly those women diagnosed with anatomical abnormalities of the uterus and those who have undergone previous hysterectomies, numerous abortions, and experienced premature birth. Ectogenesis is the complete development of an embryo in an artificial uterus. It represents the solutions for millions of women suffering from premature deliveries, and the inability to supply growth and development of embryos/fetuses in the womb. In the future, ectogenesis might replace uterine transplantation and surrogacy.
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Affiliation(s)
| | - Romualdo Sciorio
- Edinburgh Assisted Conception Programme, Royal Infirmary of Edinburgh, EdinburghEH16 4SA, UK
| | - Antonio Palagiano
- Reproductive Science Pioneer, Assisted Fertilization Center (CFA), Naples, Italy
| | - Carlo Bulletti
- Extra Omnes, Assisted Reproductive Technology (ART), Center in Cattolica, Italy, and Associate Adjunct Professor, Department of Obstetrics, Gynecology, and Reproductive Science, Yale University, New Haven, Connecticut, USA
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Caffarelli C, Gracci S, Giannì G, Bernardini R. Are Babies Born Preterm High-Risk Asthma Candidates? J Clin Med 2023; 12:5400. [PMID: 37629440 PMCID: PMC10455600 DOI: 10.3390/jcm12165400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Among preterm infants, the risk of developing asthma is a matter of debate. This review discusses the state of the art of poorly understood prematurity-associated asthma. Impaired pulmonary function is common in children born prematurely. Preterm infants are prone to developing viral respiratory tract infections, bronchiolitis in the first year of life, and recurrent viral wheezing in preschool age. All of these conditions may precede asthma development. We also discuss the role of both atopic sensitization and intestinal microbiome and, consequently, immune maturation. Diet and pollution have been considered to better understand how prematurity could be associated with asthma. Understanding the effect of factors involved in asthma onset may pave the way to improve the prediction of this asthma phenotype.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Azienda Ospedaliero-Universitaria, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Serena Gracci
- Pediatric Unit, San Giuseppe Hospital, 50053 Empoli, Italy
| | - Giuliana Giannì
- Clinica Pediatrica, Azienda Ospedaliero-Universitaria, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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Abdulkadir M, Tischfield JA, Heiman GA, Hoekstra PJ, Dietrich A. Polygenic and environmental determinants of tics in the Avon Longitudinal Study of Parents and Children. Am J Med Genet B Neuropsychiatr Genet 2023; 192:73-84. [PMID: 36479979 PMCID: PMC10247895 DOI: 10.1002/ajmg.b.32924] [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: 05/08/2022] [Revised: 11/14/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022]
Abstract
Tourette syndrome (TS) is caused by multiple genetic and environmental factors. Yet, little is known about the interplay of these factors in the occurrence of tics. We investigated whether polygenic risk score (PRS) of TS and pregnancy-related factors together enhance the explained variance of tic occurrence in the Avon Longitudinal Study of Parents and Children (Ncases = 612; Ncontrols = 4,201; 50% male; mean age 13.8 years). We included a cumulative adverse pregnancy risk score, maternal anxiety and depression, and maternal smoking and alcohol use during pregnancy. We investigated possible joint effects of genetic and pregnancy-related risk factors using a multivariable approach, and explored mediation effects between the pregnancy-related risk factors in explaining tic presence. The PRS and the cumulative adverse pregnancy risk score, maternal anxiety, or maternal depression explained significantly more variance of tic presence compared to models including only the PRS. Furthermore, we found that the cumulative adverse pregnancy risk score mediated the association between several pregnancy-related factors (maternal anxiety, depression, and smoking) and tics. The combination of a PRS and pregnancy-related risk factors explained more variance of tics in a general population cohort compared to studying these factors in isolation.
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Affiliation(s)
- Mohamed Abdulkadir
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, The Netherlands
- Rutgers, the State University of New Jersey, Department of Genetics and the Human Genetics Institute of New Jersey, Piscataway, NJ, USA
| | - Jay A. Tischfield
- Rutgers, the State University of New Jersey, Department of Genetics and the Human Genetics Institute of New Jersey, Piscataway, NJ, USA
| | - Gary A. Heiman
- Rutgers, the State University of New Jersey, Department of Genetics and the Human Genetics Institute of New Jersey, Piscataway, NJ, USA
| | - Pieter J. Hoekstra
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, The Netherlands
| | - Andrea Dietrich
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, The Netherlands
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Kurihara C, Kuniyoshi KM, Rehan VK. Preterm Birth, Developmental Smoke/Nicotine Exposure, and Life-Long Pulmonary Sequelae. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040608. [PMID: 37189857 DOI: 10.3390/children10040608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 05/17/2023]
Abstract
This review delineates the main pulmonary issues related to preterm birth, perinatal tobacco/nicotine exposure, and its effects on offspring, focusing on respiratory health and its possible transmission to subsequent generations. We review the extent of the problem of preterm birth, prematurity-related pulmonary effects, and the associated increased risk of asthma later in life. We then review the impact of developmental tobacco/nicotine exposure on offspring asthma and the significance of transgenerational pulmonary effects following perinatal tobacco/nicotine exposure, possibly via its effects on germline epigenetics.
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Affiliation(s)
- Chie Kurihara
- Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Katherine M Kuniyoshi
- Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Virender K Rehan
- Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
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Racial differences in the impact of maternal smoking on sudden unexpected infant death. J Perinatol 2023; 43:345-349. [PMID: 36271297 PMCID: PMC9589613 DOI: 10.1038/s41372-022-01516-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prenatal smoking increases the risk of Sudden Unexpected Infant Death (SUID). Whether exposure patterns and associations differ by race requires further study. OBJECTIVES Determine if patterns of exposure and associations between SUID and maternal smoking before and during pregnancy differ by race. METHODS Using U.S. National Center for Health Statistics linked birth/infant death files 2012-2013, we documented SUID by smoking duration and race. Maternal smoking history: never, pre-pregnancy only, and pre-pregnancy plus first, first, second, or all trimesters. RESULTS Smoking was more common in non-Hispanic White (NHW) than non-Hispanic Black (NHB) mothers and more evident for both in SUID cases. The most common exposure duration is from before and throughout pregnancy (SUID: 78.3% NHW, 66.9% NHB; Survivors: 60.22% and 53.96%, respectively). NHB vs. NHW SUID rates per 1000 live births were 1.07 vs. 0.34 for non-smokers and 3.06 and 1.79 for smokers, ORs trended upward for both with increasing smoking duration. CONCLUSION Fewer NHB mothers smoked, but both NHB and NHW groups exhibited a dose-response relationship between smoking duration and SUID. The most common duration was from before to the end of pregnancy, suggesting difficulty in quitting and a need for effective interventions.
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Johnson MG, Suchting R, Scheid LM, Holzapfel L, Chalise A, Stotts AL, Chapman JC, Khan AM, Northrup TF. Evaluating the relationship of in utero nicotine exposure with hypoglycemia after delivery: An observational study. J Neonatal Perinatal Med 2023; 16:445-452. [PMID: 37742665 PMCID: PMC10865725 DOI: 10.3233/npm-230124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND Hypoglycemia in neonates is common and contributes to 4.0-5.8% of neonatal intensive care unit (NICU) admissions. In utero nicotine exposure is underexplored as a potential contributor to neonatal hypoglycemia. Rat models have shown that in utero nicotine exposure can be associated with a reduction in pancreatic beta cell mass, leading to glucose dysregulation. The primary aim of this work is to study the risk of developing hypoglycemia after birth in a population of in utero nicotine-exposed neonates. METHODS We conducted a retrospective matched cohort study that augmented an existing dataset of neonates admitted to a level IV NICU with household-based in utero nicotine exposure (N = 335). Neonates in the control group parents denied household smoking (N = 325), were born within a 6-month timeframe, and were within a birthweight of 50 grams of a nicotine-exposed neonate. Data reviewed included gestational age, growth parameters, maternal history of diabetes, and glucose levels within the first three hours of life per unit protocol. RESULTS 660 neonates were included in the analysis. In utero nicotine exposure demonstrated a 94.3% posterior probability (PP) for greater hypoglycemia risk (RR = 1.185, 95% CrI = [0.953, 1.445]). A 94.6% PP was demonstrated when neonates who were small for gestational age, intrauterine growth-restricted, and born to diabetic mothers were excluded (n = 482; RR = 1.271, 95% CrI = [0.946, 1.669]). CONCLUSION Nicotine exposure in utero was found to be a potential risk factor for developing hypoglycemia after birth. Mechanisms of action should be explored, and additional research on in utero nicotine exposure risks should follow.
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Affiliation(s)
- Mary G. Johnson
- Department of Pediatrics, Division of Neonatology, McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA
- Department of Pediatrics, Division of Neonatology, Louisiana State University Health Science Center, New Orleans, LA, USA
| | - Robert Suchting
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA
| | - Lisa M. Scheid
- Department of Pediatrics, Division of Neonatology, McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - L.N. Holzapfel
- Department of Pediatrics, Division of Neonatology, McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA
| | - Aditi Chalise
- McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA
| | - Angela L. Stotts
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA
- Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA
| | - John C. Chapman
- Department of Pediatrics, Division of Neonatology, McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA
| | - Amir M. Khan
- Department of Pediatrics, Division of Neonatology, McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA
| | - Thomas F. Northrup
- Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA
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Smoking cessation in pregnant women using financial incentives: a feasibility study. BMC Pregnancy Childbirth 2022; 22:963. [PMID: 36564748 PMCID: PMC9789602 DOI: 10.1186/s12884-022-05292-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 12/07/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The high prevalence of smoking pregnant women in Dutch areas with lower socioeconomic status and the consecutively harmful exposure to tobacco to both mother and child, depicted a high need for a novel intervention. According to other studies, the utilisation of financial incentives appeared to be a promising method for smoking cessation in pregnant women. Therefore, the aim of this study was to investigate the feasibility of implementing contingent financial incentives as smoking cessation support for pregnant women in the Netherlands. METHODS Feasibility study consisting of four developmental phases: (1) acceptability of Dutch population regarding financial-incentive-intervention by conducting an online questionnaire, (2) composing a pilot study utilising the financial-incentive-intervention in clinical practice, (3) execution of the composed pilot study and (4) evaluation of the executed pilot study utilising a mixed-methods approach. A financial-incentive-intervention, given in a contingent financial scheme (during five consequential appointments, respectively €25/€50/€100/€150/€250), if smoking abstinence was proven by the amount of cotinine in the urine of the pregnant women measured utilising a urine dipstick test. The public acceptability for the financial-incentive-intervention was assessed using 5-Likert scales. The number of pregnant women able to abstain from smoking during the pilot study and utilising the financial-incentive-intervention in clinical practice were used to assess the prosperity and practicality of the pilot study respectively. The pilot study was evaluated using a mixed-methods approach. RESULTS In total, 55.1% of the Dutch population sample (n = 328) found a financial incentive inappropriate for smoking cessation in pregnant women, while the healthcare professionals and pilot study participants thought the financial-incentive-intervention to be a helpful approach. Eleven vouchers were given during the pilot study, and one woman completed all test points and tested negative for cotinine at the end of the pilot study. CONCLUSION Although the financial-incentive-intervention appeared to be a promising approach for smoking cessation in pregnant women, the acceptability of the Dutch population and the number of pregnant women able to abstain smoking during this pilot study was low. Despite the limited study population, this study proved the concept of this financial-incentive-intervention to be feasible for implementation in the Netherlands. TRIAL REGISTRATION Not applicable since this is a feasibility study prior to a trial.
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Cui Y, Chen D, Lin H, Tao Y. The association between low birth weight and/or preterm birth and dental caries -A systematic review and meta-analysis. Int J Dent Hyg 2022. [PMID: 36524312 DOI: 10.1111/idh.12651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/01/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Studies on the association between adverse birth outcomes and dental caries in children have shown conflicting results, so the aim of this systematic review and meta-analysis was to investigate the association between adverse birth outcomes and dental caries in children. METHODS We systematically searched articles in four electronic databases (Web of Science, PubMed, Cochrane Library and Embase) published prior to August 2021. The odds ratio (OR) (or converted OR) and the corresponding 95% confidence intervals (95% CI) were processed. The certainty of evidence was assessed using GRADE's risk bias assessment tool. Random effects model was used for this meta-analysis. RESULTS A total of thirty-one observational studies met the inclusion criteria. The pooled estimates indicated that children exposed to low birth weight (LBW)/preterm birth (PTB) did not experience higher dental caries in primary teeth. Subgroup analyses showed that children with LBW (OR: 1.30, 95% CI: 1.03-1.63) were prone to have dental caries in primary teeth for cross-sectional studies, but no significant differences for prospective studies. PTB children experienced more primary caries in high-income countries (OR: 1.31, 95% CI: 1.00-1.70) than in low- and middle-income countries. CONCLUSIONS The current evidence did not suggest a significant association between LBW and dental caries in children for primary teeth. Children with PTB in high-income countries had a higher prevalence of primary dental caries. Further prospective studies should adjust for confounding factors (age, oral health and family finances) to determine the definitive association between LBW/PTB and dental caries.
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Affiliation(s)
- Yuqi Cui
- Department of Preventive Dentistry, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Dongru Chen
- Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Department of Orthodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Huancai Lin
- Department of Preventive Dentistry, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Ye Tao
- Department of Preventive Dentistry, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, China
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Muacevic A, Adler JR, Punshi H, Dengani M, Agrawal S, Jain K, Verma N, Naik S. The Outcome of Pregnancy Among Tobacco Users in Tertiary Care Hospital of Chhattisgarh Province of India. Cureus 2022; 14:e32877. [PMID: 36699785 PMCID: PMC9870601 DOI: 10.7759/cureus.32877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Tobacco use is responsible for numerous adverse pregnancy outcomes for females and their infants. The aim of this study was to explore the adverse outcome of tobacco use among pregnant females. METHOD A cross-sectional study was conducted on 1250 females in the third trimester of pregnancy from April to June 2022, which were exposed to tobacco use in the form of gudaku, tobacco chewing, gutka, or smoking. Complications and outcomes during and after pregnancy were recorded based on self-administered questionnaires. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY) software version 20.0 for categorical data, frequencies (n) and percentages (%) were calculated, and the chi-square test was used for determining intergroup differences. RESULTS Out of 1250 females, tobacco exposure was present among 429 (34.3%), and 821 (65.7%) had no tobacco exposure. Of 429, 36.10% of females complained about complications such as abortion (1.60%), antepartum hemorrhage (0.90%), congenital anomaly (0.20%), infertility (1.20%), intrauterine fetal death (IUFD) (0.50%), intrauterine growth restriction (IUGR) (0.90%), oligohydramnios (OLIGO) (3.30%), preterm labor (18.40%), premature rupture of membrane (6.30%), and anemia (2.80%), which were slightly higher than the females with no tobacco exposure. In tobacco users, obstructive complications were found to be significant with a p value of 0.0036. CONCLUSION Our study concluded that tobacco use could have an adverse effect on their fetus and infants, as well as the pregnant females themselves. Policymakers need to ensure effective strategies that pregnant females, their partners, and close relatives need to have enough knowledge to avoid potential risks.
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12
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Gunes HY, Caliskan DK, Sakar HA, Yuzkat N. Does smoking affect the onset time of sensory blocks or the duration of motor blocks in parturient women? A randomized controlled trial. Niger J Clin Pract 2022; 25:2039-2045. [PMID: 36537463 DOI: 10.4103/njcp.njcp_527_22] [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] [Indexed: 06/17/2023]
Abstract
BACKGROUND In general, smoking or exposure to secondhand smoke is still common worldwide, and the rate of smoking in women of childbearing age is gradually increasing. Cesarean section rates have been increasing in recent years, and anesthesia guidelines recommend regional anesthesia for cesarean sections. Since nicotine and local anesthetics have different effects on ligand-gated ion channels, smoking may affect spinal anesthesia in pregnant women. Aim: The aim of this study was to investigate the effects of smoking on spinal anesthesia, which is applied for cesarean sections in pregnant women. Patients and. METHODS After approval from the institution's ethics committee, 100 pregnant women were divided into two groups: current smokers (Group S, smoker) (n = 50) and lifelong nonsmokers (Group NS, nonsmoker) (n = 50). The dose of local anesthetic was adjusted according to the height of each patient. After free cerebrospinal fluid flow was observed, all patients were given 20 μμg of fentanyl in 0.05 mg/cm hyperbaric 0.5% bupivacaine within 10 seconds. The onset of sensory and motor block, the duration of sensory and motor block, and the visual analogue scale (VAS) score were monitored. RESULTS Data from 100 parturient women were investigated. Even though the median time required for the onset of sensory block to occur was significantly higher in Group S (P = 0.019), the duration of motor block was found to be shorter (P = 0.003); however, the duration of sensory block was similar in both groups (P = 0.771). VAS scores were significantly higher in Group S (P = 0.001). CONCLUSIONS In conclusion, the pregnant women who smoked had longer motor block onset times, shorter motor block durations, higher VAS scores, and lower patient satisfaction levels.
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Affiliation(s)
- H Y Gunes
- Department of Anesthesiology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - D K Caliskan
- Department of Anesthesiology, Van Research and Training Hospital, University of Health Sciences, Van, Turkey
| | - H A Sakar
- Department of Anesthesiology, Van Research and Training Hospital, University of Health Sciences, Van, Turkey
| | - N Yuzkat
- Department of Anesthesiology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
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Liu XC, Strodl E, Wu CA, Huang LH, Yin XN, Wen GM, Sun DL, Xian DX, Chen WQ. Critical window for the association between prenatal environmental tobacco smoke exposure and preterm birth. ENVIRONMENTAL RESEARCH 2022; 212:113427. [PMID: 35561826 DOI: 10.1016/j.envres.2022.113427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/30/2022] [Accepted: 05/02/2022] [Indexed: 06/15/2023]
Abstract
Although environmental tobacco smoke (ETS) exposure is considered to be a severe public health problem and a modifiable risk factor for preterm birth (PTB), we still lack a comprehensive understanding of the PTB risk associated with trimester-specific prenatal ETS exposure. This study aimed to examine the accumulation of risk across trimester ETS exposure and the critical window of the association between maternal ETS exposure during pregnancy and PTB. A total of 63,038 mother-child pairs were involved in the analysis of the 2017 survey of Longhua Child Cohort Study. Information about socio-demographic characteristics, prenatal ETS exposure, and birth outcomes were collected using a self-report questionnaire. A series of logistic regression models were employed to assess the associations between prenatal ETS exposure and PTB. We found that maternal ETS exposure during pregnancy significantly increased the risk of PTB and this association increased with both the average level of daily ETS exposure and the number of trimesters of ETS exposure. Moreover, mothers who were initially exposed to ETS in the 1st trimester of pregnancy had significant higher risk of PTB (OR = 1.34, 95% CI: 1.25-1.44). Furthermore, mothers exposed to ETS in the 1st trimester only (OR = 1.26, 95%CI: 1.04-1.50), in both 1st and 2nd trimester (OR = 1.35, 95%CI: 1.08-1.67) and throughout pregnancy (OR = 1.35, 95%CI: 1.24-1.46) experienced a significantly high risk of PTB. Prenatal maternal ETS exposure during only the 2nd trimester also resulted in a high risk of PTB with marginal significance (OR = 1.33, 95% CI:0.78-2.13). To conclude, the 1st and early 2nd trimester might be the critical window for prenatal ETS exposure causing PTB.
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Affiliation(s)
- Xin-Chen Liu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Esben Strodl
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Chuan-An Wu
- Women's and Children's Hospital of Longhua District of Shenzhen, Shenzhen, China
| | - Li-Hua Huang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Na Yin
- Women's and Children's Hospital of Longhua District of Shenzhen, Shenzhen, China
| | - Guo-Min Wen
- Women's and Children's Hospital of Longhua District of Shenzhen, Shenzhen, China
| | - Deng-Li Sun
- Women's and Children's Hospital of Longhua District of Shenzhen, Shenzhen, China
| | - Dan-Xia Xian
- Women's and Children's Hospital of Longhua District of Shenzhen, Shenzhen, China
| | - Wei-Qing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; School of Health, Xinhua College of Guangzhou, China.
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Verbeke E, Bogaerts A, Nuyts T, Crombag N, Luyten J. Cost-effectiveness of mental health interventions during and after pregnancy: A systematic review. Birth 2022; 49:364-402. [PMID: 35322898 DOI: 10.1111/birt.12623] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/29/2021] [Accepted: 02/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mental health problems during and after pregnancy such as depression, anxiety, post-traumatic stress disorder (PTSD), or addiction are common and can have lifelong implications for both parents and offspring. This review investigates the cost-effectiveness of interventions tackling these problems, assesses the methodological quality of included studies, and indicates suggestions for further research. METHODS Thirteen databases were searched for economic evaluations of interventions related to antenatal, perinatal, and postnatal mental health conditions, published between 2000 and September 2021, in high-income countries. RESULTS Thirty-nine studies met all inclusion criteria. Interventions considered were screening programs, pharmacological treatments, and various forms of psychosocial and psychological support. Six studies reported that the intervention was cost-saving. Eighteen were cost-effective and seven likely to be cost-effective. Only six studies included health outcomes for the child; one study considered paternal health. The time horizon for which costs and consequences were considered was for most evaluations limited to 1 year (n = 18) or 2 years (n = 11) postpartum. CONCLUSIONS Given the importance of the subject, a relatively low number of studies have investigated the cost-effectiveness of interventions tackling mental health problems during and after pregnancy. The scant evidence available suggests good overall value for money. Likely, cost-effectiveness is underestimated as costly long-term consequences on offspring are systematically excluded. No evidence was found for several frequently occurring conditions. Further research is required to obtain reliable, long-term effectiveness data and to address the methodological challenges related to measuring all relevant health outcomes for all parties affected.
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Affiliation(s)
- Evelyn Verbeke
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Annick Bogaerts
- Department of Development & Regeneration, Women & Child, REALIFE research group, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium.,Faculty of Health, University of Plymouth, Devon PL4 8AA, UK
| | - Tinne Nuyts
- Department of Development & Regeneration, Women & Child, REALIFE research group, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Neeltje Crombag
- Department of Development and Regeneration, Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium
| | - Jeroen Luyten
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
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Fernandez-Rodriguez B, Gomez AR, Jimenez Moreno BS, de Alba C, Galindo A, Villalain C, Pallás C, Herraiz I. Smoking influence on early and late fetal growth. J Perinat Med 2022; 50:200-206. [PMID: 34929071 DOI: 10.1515/jpm-2021-0226] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 12/06/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Smoking during pregnancy is a leading and modifiable risk factor for fetal growth restriction (FGR) and low birthweight (<10th centile). We studied the effects of smoking in the development of early and late FGR or low birthweight, as well as in uteroplacental and fetoplacental hemodynamics of growth-restricted fetuses. METHODS Retrospective cohort study of 5,537 consecutive singleton pregnancies delivered at ≤34 + 0 ("early delivery" group, n=95) and >34 + 0 ("late delivery" group, n=5,442) weeks of gestation. Each group was divided into smokers and non-smokers. Prenatal diagnosis of FGR was based on customized fetal growth standards and fetal Doppler, and postnatal birthweight was assessed using the Olsen newborn chart. RESULTS There were 15/95 (15.8%) and 602/5,442 (11.1%) smokers in the early and late delivery groups, respectively. In early deliveries, FGR was diagnosed in 3/15 (20%) of smokers and in 20/80 (25%) of non-smokers (p=0.68). We also found no differences in birthweights and hemodynamics. In late deliveres, FGR was detected in 30/602 (5%) smokers and 64/4,840 (1.3%) non-smokers (p<0.001). Birthweights <3rd centile and <10th centile were more common in smokers vs. non-smokers: 38/602 (6.3%) vs. 87/4,840 (1.8%) and 89/602 (14.8%) vs. 288/4,840 (6%), respectively (all p<0.01). Fetal Doppler of late FGR showed slightly higher umbilical artery resistances in smokers. CONCLUSIONS Smoking in pregnancy is associated with FGR, low birthweight and higher umbilical artery Doppler resistances after 34 weeks of gestation, but we could not confirm this association in earlier deliveries.
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Affiliation(s)
| | - Ana Roche Gomez
- Department of Neonatology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Blanca Sofia Jimenez Moreno
- Department of Neonatology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Concepción de Alba
- Department of Neonatology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Alberto Galindo
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Cecilia Villalain
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Carmen Pallás
- Department of Neonatology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Ignacio Herraiz
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
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Xavier J, Singh S, Kumari P, Ravichandiran V. Neurological repercussions of neonatal nicotine exposure: A review. Int J Dev Neurosci 2021; 82:3-18. [PMID: 34913189 DOI: 10.1002/jdn.10163] [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] [Received: 08/10/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 12/25/2022] Open
Abstract
Smoking during pregnancy is hazardous to both the mother and the foetus, according to a substantial amount of recorded data. Exposure to nicotine and other compounds in cigarette smoke increases the risk of sudden infant death syndrome (SIDS) by two to five times during pregnancy. Serotonergic abnormalities have been discovered in SIDS infants in the zone of the medulla oblongata, which is known to control cardio-respiratory function. SIDS establishes a connection between depression, learning difficulties and behavioural disorders. Prenatal nicotine intake during the second trimester affects the dopaminergic neurological system, making the foetal brain more susceptible to nicotine and developing ADHD symptoms not just in a foetus but in adolescents also. Prenatal nicotine exposure alters the neurological route of neurotransmitters, acetylcholine and dopamine. Nicotine enhances neuronal activity in adults but desensitizes these processes in babies and young children exposed prenatally. The impact of a neurotoxin like nicotine is determined by the amount and duration of exposure. Continued exposure throughout pregnancy will influence a wide range of activities in the neurodevelopment, whereas exposure confined to a single stage of pregnancy may only affect the processes that are forming at that stage. To decrease the effect of nicotine on neonates due to maternal smoking strategies like nicotine replacement therapy (NRT), folic acid treatment and other behavioural treatments have been studied. Hence, this review focuses on the impact of exposure to nicotine on neonates, which results in various neurological consequences and smoking cessation therapies.
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Affiliation(s)
- Joyal Xavier
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Export Promotion Industrial Park (EPIP), Hajipur, India
| | - Sanjiv Singh
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Export Promotion Industrial Park (EPIP), Hajipur, India
| | - Priyanka Kumari
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Export Promotion Industrial Park (EPIP), Hajipur, India
| | - V Ravichandiran
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Export Promotion Industrial Park (EPIP), Hajipur, India
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Arita Y, Kirk M, Gupta N, Antony R, Park HJ, Stecker MM, Peltier MR. Effect of 2,6-xylidine (DMA) on secretion of biomarkers for inflammation and neurodevelopment by the placenta. J Reprod Immunol 2021; 149:103458. [PMID: 34952372 DOI: 10.1016/j.jri.2021.103458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/17/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
Cigarette smoke enhances placental inflammation and interferes with steroidogenesis. However, the chemicals in the smoke responsible for these biological activities are unclear. 2,6 xylidine (also called 2,6 Dimethylaniline, DMA) is a component of cigarette smoke that has carcinogenic properties but its effects on the placenta are unknown. Therefore, we hypothesized that DMA may interfere with placental steroidogenesis or enhance placental inflammation. Placental explant cultures were treated with 0-50,000 nM DMA and concentrations of progesterone (P4), estradiol (E2), testosterone (T), IL-1β, TNF-α, IL-6, sgp130, HO-1, IL-10, 8-Isoprostane (8-IsoP), and BDNF in the conditioned medium were quantified. Since many environmental toxins enhance the proinflammatory host response to infection, we also performed experiments on placental cultures co-stimulated with 107 heat-killed E. coli. DMA alone significantly reduced P4 and T secretion but enhanced E2 secretion. The toxin also reduced placental secretion of IL-6, sgp130, and BDNF. For bacteria-stimulated cultures, DMA increased secretion of P4 and T, and proinflammatory cytokines (IL-1β, TNF-α) but had mixed effects on anti-inflammatory markers, increasing some (sgp130, IL-10) and reducing others (HO-1). However, DMA enhanced 8-IsoP levels by bacteria-stimulated placental cultures, suggesting that it increases oxidative stress by the tissues. These studies suggest that DMA affects secretion of biomarkers by the placenta and may promote inflammation. Further studies are needed to determine if these observed changes occur in vivo and the extent to which DMA exposure increases the risk of adverse pregnancy outcomes associated with smoking in pregnancy.
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Affiliation(s)
- Yuko Arita
- Department of Foundations of Medicine, NYU-Long Island School of Medicine, NY, 11501, United States
| | - Michael Kirk
- Department of Foundations of Medicine, NYU-Long Island School of Medicine, NY, 11501, United States
| | - Neha Gupta
- Department of Foundations of Medicine, NYU-Long Island School of Medicine, NY, 11501, United States
| | - Ronny Antony
- Department of Foundations of Medicine, NYU-Long Island School of Medicine, NY, 11501, United States
| | - Hyeon-Jeong Park
- Department of Foundations of Medicine, NYU-Long Island School of Medicine, NY, 11501, United States
| | - Mark M Stecker
- Fresno Institute of Neuroscience, Fresno, CA, United States
| | - Morgan R Peltier
- Department of Foundations of Medicine, NYU-Long Island School of Medicine, NY, 11501, United States; Department of Psychiatry, Jersey Shore University Medical Center, Neptune, NJ, 07753, United States.
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18
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Kumar P, Srivastava S, Maurya C, Dhillon P. An assessment of the role of socio-economic, maternal and service utilization factors in increasing self-reported maternal complications in India. BMC Pregnancy Childbirth 2021; 21:519. [PMID: 34289804 PMCID: PMC8296634 DOI: 10.1186/s12884-021-03997-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Self-reported maternal complications are associated with maternal morbidity, deliveries by C-section, postpartum depression, and maternal death. Thus, it is necessary to examine the contribution of socio-demographic and maternal characteristics, as well as service utilization in the rising self-reporting of maternal complications (difficulty with daylight vision, convulsions, swelling of the legs, body or face, heavy vaginal bleeding or high fever) in India. The study aimed at examining the factors that have influenced the increasing prevalence of maternal complications between 2005–06 and 2015–16 in India. Methods Data from the two most recent rounds of the National Family Health Survey, which covered a sample of 36,850 and 190,898 women respectively who delivered in the last five years preceding the survey has been used. Logistic regression analysis was performed to carve out the factors which significantly contributed to maternal complications among women aged 15 – 49 years in India. With the help of the Fairlie decomposition technique, the study quantified the contribution of factors which influenced the changes in maternal complications in the period from 2005–06 to 2015–16. Results A significant increase was seen in the prevalence of maternal complications — from 43.6% to 53.7% between the years 2005–06 and 2015–16. About 21% of the increase could be explained by certain maternal, households level factors, service utilization and birth outcomes. For example, service utilization, in which 13% was attributed to the place of delivery and 6% to postnatal care, was the major contributor to the increase in maternal complications from 2005–06 to 2015–16). This was followed by individual-level factors like education (2%), body mass index (4%) and tobacco use,. It was also found that household-level factors like standard of living (-3.7%) and region (-1.4%), and birth weight contributed to the reduction of complications during the period. Conclusion The increase in the prevalence of maternal complications in India could be attributed mainly attributed to increase in reporting behavior, an outcome of increased utilization of maternal healthcare services, and increase in BMI. However, reduced prevalence of maternal complications can be attributed to the decrease in the prevalence of low-birth-weight babies and tobacco use among women in India. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03997-x.
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Affiliation(s)
- Pradeep Kumar
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Shobhit Srivastava
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Chanda Maurya
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Preeti Dhillon
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, Maharashtra, India.
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Passively inhaled tobacco smoke - pregnancy and neonatal outcomes in correlation with placental histopathology. Placenta 2021; 112:23-27. [PMID: 34243117 DOI: 10.1016/j.placenta.2021.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/03/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION We aimed to investigate the effect of maternal passive smoking (MPS) during pregnancy-on placental pathology and pregnancy outcomes. METHODS A prospective case-control study. We recruited low-risk laboring women at 37+0-41 + 0 weeks between 9/2019-7/2020. MPS was defined as exposure to in-house spouse tobacco smoking of >20 cigarettes/day in the absence of maternal active-smoking. In attempt to "purify" the effect of MPS on placental pathology-we excluded cases with preeclampsia, diabetes, suspected fetal growth restriction (FGR), preterm labor, and illicit drug use. Maternal characteristics, pregnancy outcomes, and placental pathology were compared between the MPS group and a control group matched for gestational age, maternal age, and delivery date. Placental lesions were classified according to the "Amsterdam" criteria. The study was powered to detect a 33% difference in placental malperfusion lesions. Multivariable regression was performed to identify independent associations with placental malperfusion lesions. RESULTS In labor, the MPS group (n = 115) had higher rates of meconium stained amniotic fluid (MSAF, p < 0.001) and non-reassuring fetal heart-rate (NRFHR,p = 0.006), compared to controls (n = 115). Neonates in the MPS group had higher rates of undiagnosed FGR (p = 0.01) and NICU admissions (p = 0.004). The MPS group had higher rates of placental-hypoplasia (p = 0.02) and fetal vascular malperfusion (FVM) lesions (p = 0.04). In regression analysis MPS was associated with FVM lesions independent of background confounders (aOR = 1.24 95% CI 1.10-2.65). DISCUSSION In otherwise low-risk pregnancies, MPS was associated with higher rates of MSAF, NRFHR, undiagnosed FGR, and NICU admissions, probably mediated via placental FVM. These worrisome findings mandate patient counseling and further investigation in larger population-based studies.
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Bermudez LG, Madariaga I, Zuñiga MI, Olaya M, Cañas A, Rodriguez LS, Moreno OM, Rojas A. RUNX1 gene expression changes in the placentas of women smokers. Exp Ther Med 2021; 22:902. [PMID: 34257715 PMCID: PMC8243315 DOI: 10.3892/etm.2021.10334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/21/2021] [Indexed: 11/28/2022] Open
Abstract
The placenta can be affected by environmental factors, such as exposure to cigarette smoke. This exposure in the fetal context is considered a risk factor for the development of short-term postnatal diseases, such as asthma. Asthma is an inflammatory disease characterized by predominant acquisition of CD4 T lymphocytes (TLs) of the Th2 type. Transcription factors such as GATA binding protein 3 (GATA3) and STAT6 actively participate in the differentiation of virgin TLs towards the Th2 profile, while transcription factors such as STAT1, T-Box transcription factor 21 (T-BET), RUNX1 and RUNX3 participate in their differentiation towards the Th1 profile. The objective of the current study was to evaluate the impact of exposure to cigarette smoke on the gene expression of STAT1, T-BET, GATA3, IL-4, RUNX1 and RUNX3 during the gestation period, and to determine whether the expression levels of these genes are associated with changes in global methylation. STAT1, GATA3, RUNX1 and RUNX3 protein and mRNA expression levels in the placental tissue of women smokers and non-smoking women were determined via immunohistochemistry and quantitative PCR (qPCR) respectively. Additionally, T-BET and IL-4 mRNA expression levels were determined by qPCR. On the other hand, global methylation was determined via ELISA. In the present study, significant increases were observed in RUNX1 transcription factor expression in placentas from women smokers when compared with placentas of non-smoking women. Similarly, significant increases in the expression of GATA3, IL-4 and RUNX3 mRNA were observed. The changes in gene expression were not associated with changes in the global methylation levels. Finally, a higher frequency of low-birth-weight infants were identified in cases of exposure to cigarette smoke during pregnancy when compared with infants not exposed to cigarette smoke during pregnancy. Thus, the data of the present study contributed to the understanding of the genetic and clinical impacts of exposure to cigarette smoke during pregnancy and its importance in maternal and fetal health.
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Affiliation(s)
- Litzy Gisella Bermudez
- Institute of Human Genetics, School of Medicine, Pontificia Universidad Javeriana, Bogotá 110231, Colombia
| | - Ithzayana Madariaga
- Institute of Human Genetics, School of Medicine, Pontificia Universidad Javeriana, Bogotá 110231, Colombia
| | - Maria Isabel Zuñiga
- Department of Pathology, School of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá 110231, Colombia
| | - Mercedes Olaya
- Department of Pathology, School of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá 110231, Colombia
| | - Alejandra Cañas
- Department of Internal Medicine, School of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá 110231, Colombia
| | - Luz-Stella Rodriguez
- Institute of Human Genetics, School of Medicine, Pontificia Universidad Javeriana, Bogotá 110231, Colombia
| | - Olga Maria Moreno
- Institute of Human Genetics, School of Medicine, Pontificia Universidad Javeriana, Bogotá 110231, Colombia
| | - Adriana Rojas
- Institute of Human Genetics, School of Medicine, Pontificia Universidad Javeriana, Bogotá 110231, Colombia
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Tavoli Z, Tajdar A, Kheiltash A, Rabie M. Determination of risk factors and cumulative effects of the maternal and neonatal risk factors in relation to preterm labor. J Family Med Prim Care 2021; 10:1747-1753. [PMID: 34123923 PMCID: PMC8144790 DOI: 10.4103/jfmpc.jfmpc_1118_20] [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: 06/08/2020] [Revised: 09/09/2020] [Accepted: 12/20/2020] [Indexed: 11/04/2022] Open
Abstract
Background Preterm labor is the leading cause of neonatal morbidity and mortality this study aimed to determine single and combined effects of all risk factors in relation to preterm labor. Methods This was a case-control study that included patients from a teaching hospital affiliated to Tehran University of Medical Sciences. Women who came to this hospital for delivery were divided into two groups: 200 in preterm delivery (before 37 weeks) and 195 in term delivery (after 37 weeks). Results In all 409 pregnant women were delivered. 217 were preterm (group A) and 192 were term (group B). The mean age of mothers in group A was 30.04 ± 5.74 and the mean age of mothers in group B was 27.28 ± 5.90 (P < 0.001). The risk of preterm labor was 4.22 higher in mother with any risk factor before or during pregnancy (P < 0.001), it was 3.67 higher in mother with complication of pregnancy (P < 0.001) and it was 3.40 higher in neonate with any complication (P = 0.002) compared to mother without any risk factors. For each mother, we calculated risk score for preterm labor by counting the number of risk factors. The risk of preterm labor was significantly higher in mother with risk factors compared to those without any risk factors (P for trend = 0. 002). Mother with two risk factors had a 5.60 (P = 0.01) and mother with three or more risk factors had a 23.48 (P = 0. 001) times higher risk for preterm labor than those who did not have any risk factors. Conclusion The screening and identification of mothers with risk factors for preterm delivery can increasing mother's attention and participation to better manage of these condition to have more safe pregnancy period.
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Affiliation(s)
- Zahra Tavoli
- Department of Obstetrics and Gynecology, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Tajdar
- Department of Family Medicine, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Azita Kheiltash
- Department of Community Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Rabie
- Department of Obstetrics and Gynecology, Arash Women Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Opondo C, Harrison S, Alderdice F, Carson C, Quigley MA. Electronic cigarette use (vaping) and patterns of tobacco cigarette smoking in pregnancy-evidence from a population-based maternity survey in England. PLoS One 2021; 16:e0252817. [PMID: 34086809 PMCID: PMC8177470 DOI: 10.1371/journal.pone.0252817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/21/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Exposure to tobacco products during pregnancy presents a potential harm to both mother and baby. This study sought to estimate the prevalence of vaping during pregnancy and to explore the factors and outcomes associated with vaping in pregnancy. SETTING England. PARTICIPANTS Women who gave birth between 15th and 28th October 2017. METHODS A cross-sectional population-based postal survey of maternal and infant health, the National Maternity Survey (NMS) 2018. The prevalence of vaping and patterns of cigarette smoking were estimated, and regression analysis was used to explore associations between maternal characteristics and vaping, and between vaping and birth outcomes. OUTCOME MEASURES Unweighted and weighted prevalence of vaping with 95% confidence intervals, and unadjusted and adjusted relative risks or difference in means for the association of participant characteristics and secondary outcomes with vaping. Secondary outcome measures were: preterm birth, gestational age at birth, birthweight, and initiation and duration of breastfeeding. RESULTS A total of 4,509 women responded to the survey. The prevalence of vaping in pregnancy was 2.8% (95%CI 2.4% to 3.4%). This varied according to the pattern of cigarette smoking in pregnancy: 0.3% in never-smokers; 3.3% in ex-smokers; 7.7% in pregnancy-inspired quitters; 9.5% in temporary quitters; and 17.7% in persistent smokers. Younger women, unmarried women, women with fewer years of formal education, women living with a smoker, and persistent smokers were more likely to vape, although after adjusting for pattern of cigarette smoking and maternal characteristics, persistent smoking was the only risk factor. We did not find any association between vaping and preterm birth, birthweight, or breastfeeding. CONCLUSIONS The prevalence of vaping during pregnancy in the NMS 2018 was low overall but much higher in smokers. Smoking was the factor most strongly associated with vaping. Co-occurrence of vaping with persistent smoking has the potential to increase the harms of tobacco exposure in pregnant women and their infants.
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Affiliation(s)
- Charles Opondo
- Nuffield Department of Population Health, NIHR Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Siân Harrison
- Nuffield Department of Population Health, NIHR Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Fiona Alderdice
- Nuffield Department of Population Health, NIHR Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Claire Carson
- Nuffield Department of Population Health, NIHR Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Maria A. Quigley
- Nuffield Department of Population Health, NIHR Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
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23
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Prenatal Exposure to Cigarette Smoke and Anogenital Distance at 4 Years in the INMA-Asturias Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094774. [PMID: 33947132 PMCID: PMC8124891 DOI: 10.3390/ijerph18094774] [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: 04/12/2021] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 11/17/2022]
Abstract
Smoking by women is associated with adverse pregnancy outcomes such as spontaneous abortion, preterm delivery, low birth weight, infertility, and prolonged time to pregnancy. Anogenital distance (AGD) is a sensitive biomarker of prenatal androgen and antiandrogen exposure. We investigated the effect of smoking and passive smoke exposure during pregnancy on anogenital distance in offspring at 4 years in the INMA-Asturias cohort (Spain). Women were interviewed during pregnancy to collect information on tobacco consumption, and anogenital distance was measured in 381 children: Anoscrotal distance in boys and anofourchetal distance in girls. We also measured maternal urinary cotinine levels at 32 weeks of pregnancy. We constructed linear regression models to analyze the association between prenatal smoke exposure and anogenital distance and adjusted the models by relevant covariates. Reported prenatal smoke exposure was associated with statistically significant increased anogenital index (AGI), both at week 12 of pregnancy (β = 0.31, 95% confidence interval: 0.00, 0.63) and at week 32 of pregnancy (β = 0.31, 95% confidence interval: 0.00, 0.63) in male children, suggesting altered androgenic signaling.
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24
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Schiliro M, Vogel ER, Paolini L, Pabelick CM. Cigarette Smoke Exposure, Pediatric Lung Disease, and COVID-19. Front Physiol 2021; 12:652198. [PMID: 33986692 PMCID: PMC8110920 DOI: 10.3389/fphys.2021.652198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/06/2021] [Indexed: 12/29/2022] Open
Abstract
The detrimental effects of tobacco exposure on children's health are well known. Nonetheless, the prevalence of secondhand or direct cigarette smoke exposure (CSE) in the pediatric population has not significantly decreased over time. On the contrary, the rapid incline in use of e-cigarettes among adolescents has evoked public health concerns since increasing cases of vaping-induced acute lung injury have highlighted the potential harm of these new "smoking" devices. Two pediatric populations are especially vulnerable to the detrimental effects of cigarette smoke. The first group is former premature infants whose risk is elevated both due to their prematurity as well as other risk factors such as oxygen and mechanical ventilation to which they are disproportionately exposed. The second group is children and adolescents with chronic respiratory diseases, in particular asthma and other wheezing disorders. Coronavirus disease 2019 (COVID-19) is a spectrum of diseases caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has spread worldwide over the last year. Here, respiratory symptoms ranging from mild to acute respiratory distress syndrome (ARDS) are at the forefront of COVID-19 cases among adults, and cigarette smoking is associated with worse outcomes in this population, and cigarette smoking is associated with worse outcomes in this population. Interestingly, SARS-CoV-2 infection affects children differently in regard to infection susceptibility, disease manifestations, and complications. Although children carry and transmit the virus, the likelihood of symptomatic infection is low, and the rates of hospitalization and death are even lower when compared to the adult population. However, multisystem inflammatory syndrome is recognized as a serious consequence of SARS-CoV-2 infection in the pediatric population. In addition, recent data demonstrate specific clinical patterns in children infected with SARS-CoV-2 who develop multisystem inflammatory syndrome vs. severe COVID-19. In this review, we highlight the pulmonary effects of CSE in vulnerable pediatric populations in the context of the ongoing SARS-CoV-2 pandemic.
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Affiliation(s)
- Marta Schiliro
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Elizabeth R. Vogel
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Lucia Paolini
- Department of Pediatric, San Gerardo Hospital, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy
| | - Christina M. Pabelick
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
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25
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Musanejad E, Haghpanah T, Mirzaie V, Ezzatabadipour M. Effects of ethanol and nicotine co-administration on follicular atresia and placental histo-morphology in the first-generation mice pups during intrauterine development and lactation periods. Toxicol Rep 2021; 8:793-803. [PMID: 33850734 PMCID: PMC8038947 DOI: 10.1016/j.toxrep.2021.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/28/2021] [Accepted: 03/31/2021] [Indexed: 11/21/2022] Open
Abstract
This study is evaluating the effects of ethanol and nicotine exposure during pregnancy and lactation on placenta histology and follicular atresia in the first-generation (f1) mice pups. The experimental groups were 5 groups of NMRI pregnant mice, including: control, vehicle (received normal saline) ethanol (3 g/kg/day, 20 % v/v intraperitoneally), nicotine (1 mg/kg/day, subcutaneously), and ethanol plus nicotine which received both. Pregnant animals in each group were then divided into two groups, one group for examining the placenta that was treated for 18 days and the other group for the ovary of one-day-old (PND1) and fifty-six-day-old (PND56) female offspring who were treated for 42 days (during intrauterine development and lactation). After the autopsy procedure, histopathological and morphometrical observations were done. Data revealed that the exposed mice had a significant change in the placenta morphometry and histology as well as a marked increase in the number of ovarian TUNEL positive cells on postnatal days 1 and 56. Therefore, maternal exposure to alcohol and nicotine during developmental and lactation periods could lead to changes in the placenta properties as well as an increase in the apoptotic ovarian follicles in f1 mice pups.
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Key Words
- AMH, Anti-Müllerian hormone
- ANOVA, analysis of variance
- BAX, BCL2 Associated X
- BMP, Bone morphogenetic protein
- Bcl-2, B-cell lymphoma 2
- CTL, control
- Ca2+, calcium
- DAPI, 4′,6-diamidino-2-phenylindole
- DNA, Deoxyribonucleic acid
- E2, Estradiol
- ELISA, enzyme-linked immunosorbent assay
- EtOH, ethanol
- Ethanol
- FSH, Follicle-stimulating hormone
- First-generation mice
- Follicular atresia
- GD, gestation day
- H&E, Hematoxylin and Eosin
- HCL, Hydrogen Chloride
- IUGR, intrauterine growth restriction
- NMRI, Naval Medical Research Institute
- Ni, nicotine
- Nicotine
- OFR, ovarian follicular reservoir
- OS, oxidative stress
- PBS, Phosphate-buffered saline
- PND, Postnatal day
- Placenta
- ROS, reactive-oxygen-species
- SEM, standard error of the mean
- SPSS, statistical package for the social sciences
- TUNEL, Terminal deoxynucleotidyl transferase dUTP nick end labeling
- Veh, vehicle
- WHO, World Health Organization
- cat.no, catalogue number
- i.p., intraperitoneally
- nAChRs, nicotinic acetylcholine receptors
- s.c., subcutaneously
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Affiliation(s)
- Elahe Musanejad
- Anatomical Sciences Department, School of Medicine, Kerman University of Medical Sciences, 76169-14115, Kerman, Iran
| | - Tahereh Haghpanah
- Anatomical Sciences Department, School of Medicine, Kerman University of Medical Sciences, 76169-14115, Kerman, Iran
| | - Vida Mirzaie
- Anatomical Sciences Department, School of Medicine, Kerman University of Medical Sciences, 76169-14115, Kerman, Iran
| | - Massood Ezzatabadipour
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
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Schilling L, Spallek J, Maul H, Tallarek M, Schneider S. Active and Passive Exposure to Tobacco and e-Cigarettes During Pregnancy. Matern Child Health J 2021; 25:656-665. [PMID: 33211261 PMCID: PMC8032614 DOI: 10.1007/s10995-020-03037-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Active and passive exposure to tobacco cigarettes during pregnancy is associated with multiple negative health outcomes for the fetus. In addition, exposure to e-cigarettes has been progressively discussed as a new threat to fetal health. Until now, there has been a lack of studies examining active and passive exposure to tobacco and e-cigarettes among pregnant women. The objective of our current STudy on E-cigarettes and Pregnancy (STEP) was to advance and complement the current knowledge regarding active and passive exposure to tobacco and e-cigarettes before pregnancy and during early and late pregnancy. METHODS One element of the STEP study was a quantitative cross-sectional design: A sample of 540 pregnant women recruited at an obstetrician clinic in Hamburg from April 2018 to January 2019 were surveyed once via a standardized questionnaire and provided complete information regarding their consumption of tobacco and e-cigarettes. We performed a descriptive analysis of tobacco and e-cigarette use before pregnancy and during early and late pregnancy, as well as bivariate analysis of these variables with sociodemographic determinants. Passive exposure was assessed by asking the participating pregnant women about the consumption of tobacco and e-cigarettes by their partners, in general, and in their homes. RESULTS Before pregnancy, 20.0% of the participants used tobacco cigarettes exclusively, 1.3% used e-cigarettes exclusively, and 6.5% were dual users. Educational level was significantly associated with tobacco cigarette use (p < 0.001) and dual use (p = 0.047) before pregnancy. During early (late) pregnancy, 8.7% (2.8%) used tobacco cigarettes and 0.4% (0.0%) used e-cigarettes exclusively. Twenty-point nine percent of women's partners consumed tobacco cigarettes exclusively, 2.7% consumed e-cigarettes exclusively, and 2.7% consumed both. A total of 8.5% (16.7%) of the partners who consumed tobacco cigarettes exclusively (e-cigarettes exclusively) did so in the women's homes. CONCLUSIONS FOR PRACTICE Among pregnant women, the use of tobacco cigarettes remains prominent before and during pregnancy, while e-cigarette use predominately occurs before pregnancy. Our study shows that pregnant women are frequently exposed to their partners' tobacco and e-cigarette use within their homes. Strategies to reduce such exposure should be further intensified.
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Affiliation(s)
- Laura Schilling
- Department of Public Health, Brandenburg University of Technology, Universitätsplatz 1, 01968 Senftenberg, Germany
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | | | - Marie Tallarek
- Department of Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | - Sven Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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27
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Avşar TS, McLeod H, Jackson L. Health outcomes of smoking during pregnancy and the postpartum period: an umbrella review. BMC Pregnancy Childbirth 2021; 21:254. [PMID: 33771100 PMCID: PMC7995767 DOI: 10.1186/s12884-021-03729-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Smoking during pregnancy (SDP) and the postpartum period has serious health outcomes for the mother and infant. Although some systematic reviews have shown the impact of maternal SDP on particular conditions, a systematic review examining the overall health outcomes has not been published. Hence, this paper aimed to conduct an umbrella review on this issue. METHODS A systematic review of systematic reviews (umbrella review) was conducted according to a protocol submitted to PROSPERO ( CRD42018086350 ). CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science, CRD Database and HMIC databases were searched to include all studies published in English by 31 December 2017, except those focusing exclusively on low-income countries. Two researchers conducted the study selection and quality assessment independently. RESULTS The review included 64 studies analysing the relationship between maternal SDP and 46 health conditions. The highest increase in risks was found for sudden infant death syndrome, asthma, stillbirth, low birth weight and obesity amongst infants. The impact of SDP was associated with the number of cigarettes consumed. According to the causal link analysis, five mother-related and ten infant-related conditions had a causal link with SDP. In addition, some studies reported protective impacts of SDP on pre-eclampsia, hyperemesis gravidarum and skin defects on infants. The review identified important gaps in the literature regarding the dose-response association, exposure window, postnatal smoking. CONCLUSIONS The review shows that maternal SDP is not only associated with short-term health conditions (e.g. preterm birth, oral clefts) but also some which can have life-long detrimental impacts (e.g. obesity, intellectual impairment). IMPLICATIONS This umbrella review provides a comprehensive analysis of the overall health impacts of SDP. The study findings indicate that while estimating health and cost outcomes of SDP, long-term health impacts should be considered as well as short-term effects since studies not including the long-term outcomes would underestimate the magnitude of the issue. Also, interventions for pregnant women who smoke should consider the impact of reducing smoking due to health benefits on mothers and infants, and not solely cessation.
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Affiliation(s)
- Tuba Saygın Avşar
- Health Economics Unit, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Hugh McLeod
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 2NT, UK
- National Institute for Health Research Applied Research Collaboration (NIHR ARC) West at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Louise Jackson
- Health Economics Unit, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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28
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Melamed N, Baschat A, Yinon Y, Athanasiadis A, Mecacci F, Figueras F, Berghella V, Nazareth A, Tahlak M, McIntyre HD, Da Silva Costa F, Kihara AB, Hadar E, McAuliffe F, Hanson M, Ma RC, Gooden R, Sheiner E, Kapur A, Divakar H, Ayres‐de‐Campos D, Hiersch L, Poon LC, Kingdom J, Romero R, Hod M. FIGO (international Federation of Gynecology and obstetrics) initiative on fetal growth: best practice advice for screening, diagnosis, and management of fetal growth restriction. Int J Gynaecol Obstet 2021; 152 Suppl 1:3-57. [PMID: 33740264 PMCID: PMC8252743 DOI: 10.1002/ijgo.13522] [Citation(s) in RCA: 195] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fetal growth restriction (FGR) is defined as the failure of the fetus to meet its growth potential due to a pathological factor, most commonly placental dysfunction. Worldwide, FGR is a leading cause of stillbirth, neonatal mortality, and short- and long-term morbidity. Ongoing advances in clinical care, especially in definitions, diagnosis, and management of FGR, require efforts to effectively translate these changes to the wide range of obstetric care providers. This article highlights agreements based on current research in the diagnosis and management of FGR, and the areas that need more research to provide further clarification of recommendations. The purpose of this article is to provide a comprehensive summary of available evidence along with practical recommendations concerning the care of pregnancies at risk of or complicated by FGR, with the overall goal to decrease the risk of stillbirth and neonatal mortality and morbidity associated with this condition. To achieve these goals, FIGO (the International Federation of Gynecology and Obstetrics) brought together international experts to review and summarize current knowledge of FGR. This summary is directed at multiple stakeholders, including healthcare providers, healthcare delivery organizations and providers, FIGO member societies, and professional organizations. Recognizing the variation in the resources and expertise available for the management of FGR in different countries or regions, this article attempts to take into consideration the unique aspects of antenatal care in low-resource settings (labelled “LRS” in the recommendations). This was achieved by collaboration with authors and FIGO member societies from low-resource settings such as India, Sub-Saharan Africa, the Middle East, and Latin America.
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Affiliation(s)
- Nir Melamed
- Division of Maternal Fetal MedicineDepartment of Obstetrics and GynecologySunnybrook Health Sciences CentreUniversity of TorontoTorontoONCanada
| | - Ahmet Baschat
- Center for Fetal TherapyDepartment of Gynecology and ObstetricsJohns Hopkins UniversityBaltimoreMDUSA
| | - Yoav Yinon
- Fetal Medicine UnitDepartment of Obstetrics and GynecologySheba Medical CenterTel‐HashomerSackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and GynecologyAristotle University of ThessalonikiThessalonikiGreece
| | - Federico Mecacci
- Maternal Fetal Medicine UnitDivision of Obstetrics and GynecologyDepartment of Biomedical, Experimental and Clinical SciencesUniversity of FlorenceFlorenceItaly
| | - Francesc Figueras
- Maternal‐Fetal Medicine DepartmentBarcelona Clinic HospitalUniversity of BarcelonaBarcelonaSpain
| | - Vincenzo Berghella
- Division of Maternal‐Fetal MedicineDepartment of Obstetrics and GynecologyThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Amala Nazareth
- Jumeira Prime Healthcare GroupEmirates Medical AssociationDubaiUnited Arab Emirates
| | - Muna Tahlak
- Latifa Hospital for Women and ChildrenDubai Health AuthorityEmirates Medical AssociationMohammad Bin Rashid University for Medical Sciences, Dubai, United Arab Emirates
| | | | - Fabrício Da Silva Costa
- Department of Gynecology and ObstetricsRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoSão PauloBrazil
| | - Anne B. Kihara
- African Federation of Obstetricians and GynaecologistsKhartoumSudan
| | - Eran Hadar
- Helen Schneider Hospital for WomenRabin Medical CenterPetach TikvaIsrael
- Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - Fionnuala McAuliffe
- UCD Perinatal Research CentreSchool of MedicineNational Maternity HospitalUniversity College DublinDublinIreland
| | - Mark Hanson
- Institute of Developmental SciencesUniversity Hospital SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of SouthamptonSouthamptonUK
| | - Ronald C. Ma
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong SARChina
- Hong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongHong Kong SARChina
| | - Rachel Gooden
- FIGO (International Federation of Gynecology and Obstetrics)LondonUK
| | - Eyal Sheiner
- Soroka University Medical CenterBen‐Gurion University of the NegevBe’er‐ShevaIsrael
| | - Anil Kapur
- World Diabetes FoundationBagsværdDenmark
| | | | | | - Liran Hiersch
- Sourasky Medical Center and Sackler Faculty of MedicineLis Maternity HospitalTel Aviv UniversityTel AvivIsrael
| | - Liona C. Poon
- Department of Obstetrics and GynecologyPrince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong SAR, China
| | - John Kingdom
- Division of Maternal Fetal MedicineDepartment of Obstetrics and GynecologyMount Sinai HospitalUniversity of TorontoTorontoONCanada
| | - Roberto Romero
- Perinatology Research BranchEunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNational Institutes of HealthU.S. Department of Health and Human ServicesBethesdaMDUSA
| | - Moshe Hod
- Helen Schneider Hospital for WomenRabin Medical CenterPetach TikvaIsrael
- Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael
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29
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Wetherill RR, Spilka NH, Maron M, Keyser H, Jagannathan K, Ely AV, Franklin TR. Influence of the natural hormonal milieu on brain and behavior in women who smoke cigarettes: Rationale and methodology. Contemp Clin Trials Commun 2021; 21:100738. [PMID: 33718654 PMCID: PMC7932892 DOI: 10.1016/j.conctc.2021.100738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/19/2021] [Accepted: 02/05/2021] [Indexed: 12/19/2022] Open
Abstract
Women experience more severe health consequences from smoking, have greater difficulty quitting, and respond less favorably to nicotine replacement therapy than men. The influence of fluctuating ovarian hormones, specifically estradiol (E) and progesterone (P), on brain and behavioral responses during exposure to smoking reminders (i.e., cues) may be a contributing factor. Results from our laboratory suggest that women in the late follicular phase of their menstrual cycle (MC) have enhanced smoking cue (SC) vulnerabilities and reduced functional connectivity in neurocircuitry underlying cognitive control, potentially placing them at greater risk for continued smoking and relapse. The primary aim of this study is to examine and link hormonal status with brain and behavioral responses to SCs over the course of three monthly MCs in naturally cycling women who are chronic cigarette smokers. This longitudinal, counterbalanced study collects brain and behavioral responses to SCs at three time points during a woman's MC. Participants complete psychological and physical examinations, biochemical hormonal verification visits, and at least three laboratory/neuroimaging scan visits. The scan visits include a 10-min SC task during blood oxygen level-dependent (BOLD) data acquisition and are timed to occur during the early follicular phase (low E and P), late follicular phase (high E, unopposed by P), and mid-luteal phase (high P, high E). The primary outcomes include brain responses to SCs (compared to non-SCs), subjective craving, E and P hormone levels, and behavioral responses to SCs. This study addresses a critical gap in our knowledge: namely, the impact of the natural hormonal milieu on brain and behavioral responses to SCs, a powerful relapse trigger. Additionally, this study will provide a roadmap for human sex differences researchers who are obliged to consider the often confounding cyclic hormonal fluctuations of women.
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Affiliation(s)
| | | | - Melanie Maron
- Perelman School of Medicine, The University of Pennsylvania, The Department of Psychiatry, 3535 Market Street Suite 500, Philadelphia, PA, 19104, USA
| | - Heather Keyser
- Perelman School of Medicine, The University of Pennsylvania, The Department of Psychiatry, 3535 Market Street Suite 500, Philadelphia, PA, 19104, USA
| | - Kanchana Jagannathan
- Perelman School of Medicine, The University of Pennsylvania, The Department of Psychiatry, 3535 Market Street Suite 500, Philadelphia, PA, 19104, USA
| | - Alice V. Ely
- Perelman School of Medicine, The University of Pennsylvania, The Department of Psychiatry, 3535 Market Street Suite 500, Philadelphia, PA, 19104, USA
| | - Teresa R. Franklin
- Perelman School of Medicine, The University of Pennsylvania, The Department of Psychiatry, 3535 Market Street Suite 500, Philadelphia, PA, 19104, USA
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30
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Tarran R, Barr RG, Benowitz NL, Bhatnagar A, Chu HW, Dalton P, Doerschuk CM, Drummond MB, Gold DR, Goniewicz ML, Gross ER, Hansel NN, Hopke PK, Kloner RA, Mikheev VB, Neczypor EW, Pinkerton KE, Postow L, Rahman I, Samet JM, Salathe M, Stoney CM, Tsao PS, Widome R, Xia T, Xiao D, Wold LE. E-Cigarettes and Cardiopulmonary Health. FUNCTION 2021; 2:zqab004. [PMID: 33748758 PMCID: PMC7948134 DOI: 10.1093/function/zqab004] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 01/06/2023] Open
Abstract
E-cigarettes have surged in popularity over the last few years, particularly among youth and young adults. These battery-powered devices aerosolize e-liquids, comprised of propylene glycol and vegetable glycerin, typically with nicotine, flavors, and stabilizers/humectants. Although the use of combustible cigarettes is associated with several adverse health effects including multiple pulmonary and cardiovascular diseases, the effects of e-cigarettes on both short- and long-term health have only begun to be investigated. Given the recent increase in the popularity of e-cigarettes, there is an urgent need for studies to address their potential adverse health effects, particularly as many researchers have suggested that e-cigarettes may pose less of a health risk than traditional combustible cigarettes and should be used as nicotine replacements. This report is prepared for clinicians, researchers, and other health care providers to provide the current state of knowledge on how e-cigarette use might affect cardiopulmonary health, along with research gaps to be addressed in future studies.
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Affiliation(s)
- Robert Tarran
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, NC, USA
| | - R Graham Barr
- Department of Medicine, Columbia University, New York, NY, USA
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Neal L Benowitz
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Aruni Bhatnagar
- Department of Medicine, American Heart Association Tobacco Regulation Center University of Louisville, Louisville, KY, USA
| | - Hong W Chu
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Pamela Dalton
- Monell Chemical Senses Center, Philadelphia, PA, USA
| | - Claire M Doerschuk
- Department of Medicine, Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, USA
| | - M Bradley Drummond
- Department of Medicine, Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Diane R Gold
- Department of Environmental Health, Harvard T.H. Chan School of Public Health and the Channing Division of Network Medicine, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Eric R Gross
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Nadia N Hansel
- Division of Pulmonary & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Philip K Hopke
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Robert A Kloner
- Huntington Medical Research Institutes, Pasadena, CA, USA
- Department of Medicine, Cardiovascular Division, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Vladimir B Mikheev
- Individual and Population Health, Battelle Memorial Institute, Columbus, OH, USA
| | - Evan W Neczypor
- Biomedical Science Program, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Kent E Pinkerton
- Center for Health and the Environment, University of California, Davis, CA, USA
| | - Lisa Postow
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Matthias Salathe
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Catherine M Stoney
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Philip S Tsao
- Division of Cardiovascular Medicine, VA Palo Alto Health Care System, Stanford University School of Medicine, Stanford, CA, USA
| | - Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Tian Xia
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - DaLiao Xiao
- Department of Basic Sciences, Lawrence D Longo, MD Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Loren E Wold
- Dorothy M. Davis Heart and Lung Research Institute, Colleges of Medicine and Nursing, The Ohio State University, Columbus, OH, USA
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31
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Kızılay DÖ, Aydın C, Aygün AP, Tuhan HÜ, Olukman Ö. Prenatal smoke exposure is associated with increased anogenital distance in female infants: a prospective case-control study. J Pediatr Endocrinol Metab 2021; 34:79-88. [PMID: 33035191 DOI: 10.1515/jpem-2020-0363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/06/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To investigate the effects of maternal smoking during pregnancy on newborn infants' anogenital distance (AGD). METHODS Fifty-six female and sixty-four male newborn infants from mothers who smoked during pregnancy were included in this study. A control group for each sex was selected from infants whose mothers had no active or passive (in either the household or the workplace) smoke exposure before or during pregnancy. Questionnaire data on maternal demographic characteristics and information about cigarette use were collected. We assessed genital anthropometry which included AGD for both male and female neonates, and stretched penile length (SPL), penile girth for males within the first 48 h after birth. AGD measurements were also normalized according to birth weight (AGD/weight in grams), length (AGD/height in millimeters), and ponderal index [AGD/(weight in grams/height in cubic centimeters)]. Anogenital index (AGI) was calculated by dividing the AGD by cube root of birth weight. RESULTS In female infants, prenatal smoke exposure was associated with significantly increased weight-adjusted AGD (p=0.03). There was also a significant correlation between mothers' daily smoking rates and weight-adjusted AGD (r=0.27/p=0.03). In male infants, fetal smoke exposure was not associated with any AGD measurements, SPL and penile girth. CONCLUSIONS A significant increase in weight-adjusted AGD in female infants exposed to maternal smoking may be an indicator of antenatal androgen exposure and may pose a risk for short and long-term endocrine, metabolic and behavioral problems.
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Affiliation(s)
- Deniz Özalp Kızılay
- Bakırçay University Çiğli Training and Research Hospital, Department of Pediatrics, Division of Pediatric Endocrinology, Izmir, Turkey
| | - Cansever Aydın
- Bakırçay University Çiğli Training and Research Hospital, Department of Pediatrics, Izmir, Turkey
| | - Ayşe Pakel Aygün
- Bakırçay University Çiğli Training and Research Hospital, Department of Pediatrics, Izmir, Turkey
| | - Hale Ünver Tuhan
- Bakırçay University Çiğli Training and Research Hospital, Department of Pediatrics, Division of Pediatric Endocrinology, Izmir, Turkey
| | - Özgür Olukman
- Bakırçay University Çiğli Training and Research Hospital, Department of Pediatrics, Division of Neonatology, Izmir, Turkey
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Ratnasiri AWG, Gordon L, Dieckmann RA, Lee HC, Parry SS, Arief VN, DeLacy IH, Lakshminrusimha S, DiLibero RJ, Basford KE. Smoking during Pregnancy and Adverse Birth and Maternal Outcomes in California, 2007 to 2016. Am J Perinatol 2020; 37:1364-1376. [PMID: 31365931 DOI: 10.1055/s-0039-1693689] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to determine associations between maternal cigarette smoking and adverse birth and maternal outcomes. STUDY DESIGN This is a 10-year population-based retrospective cohort study including 4,971,896 resident births in California. Pregnancy outcomes of maternal smokers were compared with those of nonsmokers. The outcomes of women who stopped smoking before or during various stages of pregnancy were also investigated. RESULTS Infants of women who smoked during pregnancy were twice as likely to have low birth weight (LBW) and be small for gestational age (SGA), 57% more likely to have very LBW (VLBW) or be a preterm birth (PTB), and 59% more likely to have a very PTB compared with infants of nonsmokers. During the study period, a significant widening of gaps developed in both rates of LBW and PTB and the percentage of SGA between infants of maternal smokers and nonsmokers. CONCLUSION Smoking during pregnancy is associated with a significantly increased risk of adverse birth and maternal outcomes, and differences in rates of LBW, PTB, and SGA between infants of maternal smokers and nonsmokers increased during this period. Stopping smoking before pregnancy or even during the first trimester significantly decreased the infant risks of LBW, PTB, SGA, and the maternal risk for cesarean delivery.
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Affiliation(s)
- Anura W G Ratnasiri
- Benefits Division, California Department of Health Care Services, Sacramento, California.,Faculty of Science, School of Agriculture and Food Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Lauren Gordon
- Benefits Division, California Department of Health Care Services, Sacramento, California
| | - Ronald A Dieckmann
- Pediatrics and Emergency Medicine, University of California San Francisco, San Francisco, California
| | - Henry C Lee
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Steven S Parry
- Benefits Division, California Department of Health Care Services, Sacramento, California
| | - Vivi N Arief
- Faculty of Science, School of Agriculture and Food Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Ian H DeLacy
- Faculty of Science, School of Agriculture and Food Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Ralph J DiLibero
- Benefits Division, California Department of Health Care Services, Sacramento, California
| | - Kaye E Basford
- Faculty of Science, School of Agriculture and Food Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine, School of Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia
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De Queiroz Andrade E, Da Silva Sena CR, Collison A, Murphy VE, Gould GS, Bonevski B, Mattes J. Association between active tobacco use during pregnancy and infant respiratory health: a systematic review and meta-analysis. BMJ Open 2020; 10:e037819. [PMID: 32998922 PMCID: PMC7528360 DOI: 10.1136/bmjopen-2020-037819] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/27/2020] [Accepted: 08/14/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate what is known about active tobacco use during pregnancy and the association with infant respiratory health. DESIGN Systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES MEDLINE, EMBASE, Cochrane, CINAHL, and Maternity and Infant Care were searched thoroughly until June 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included case-control and cohort studies estimating the association between active tobacco use during pregnancy and infant respiratory health (wheezing and apnoea) and lung function parameters in the first 12 months of life. DATA EXTRACTION AND SYNTHESIS Extraction and risk of bias assessment were conducted by two independent reviewers. The odds ratio, relative risk and mean differences were pooled with a 95% CI using the generic inverse variance method. Heterogeneity was assessed and expressed by percentage using I2. RESULTS We identified 4423 abstracts, and 21 publications met the eligibility criteria. Pooled OR showed an increase in wheezing episodes in infants born to mothers who were active tobacco users during pregnancy (OR 1.50, 95% CI 1.27 to 1.77, p<0.01). Mixed results were found on lung function parameters, and a meta-analysis including two studies with comparable methodology showed a trend towards reduced maximum flow rate at functional residual capacity of -34.59 mL/s (95% CI -72.81 to 3.63, p=0.08) in 1-month-old infants born to women who smoked during pregnancy. A higher risk of apnoea was described for infants born to mothers who used smokeless tobacco during pregnancy, while the results in infants born to women who actively smoked tobacco during pregnancy were non-conclusive. CONCLUSION Infants born to mothers who actively smoked during pregnancy are at higher odds of having wheeze and may have lower lung function. Smokeless tobacco use in pregnancy may increase the risk of apnoea in infancy. PROSPERO REGISTRATION NUMBER CRD42018083936.
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Affiliation(s)
- Ediane De Queiroz Andrade
- GrowUpWell Priority Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Carla Rebeca Da Silva Sena
- GrowUpWell Priority Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Adam Collison
- GrowUpWell Priority Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Vanessa E Murphy
- GrowUpWell Priority Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Gillian Sandra Gould
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Joerg Mattes
- GrowUpWell Priority Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Department of Paediatric Respiratory & Sleep Medicine, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
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Leszko M, Keenan-Devlin L, Adam EK, Buss C, Grobman W, Simhan H, Wadhwa P, Mroczek DK, Borders A. Are personality traits associated with smoking and alcohol use prior to and during pregnancy? PLoS One 2020; 15:e0232668. [PMID: 32421742 PMCID: PMC7233577 DOI: 10.1371/journal.pone.0232668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/20/2020] [Indexed: 11/23/2022] Open
Abstract
Cigarette smoking and alcohol consumption during pregnancy can have detrimental effects on the developing fetus, including fetal alcohol syndrome and low birth weight. Surprisingly little is known about the association of personality traits with smoking and alcohol consumption in the specific subpopulation of pregnant women. This study analyzed data from a geographically diverse sample of 603 pregnant women, aged 18 years and older, who provided information regarding their smoking and drinking habits before and during pregnancy. We compared women who consumed alcohol or smoked cigarettes before pregnancy with women who quit or continued smoking or drinking during pregnancy. Associations between personality and maladaptive behaviors prior to and during pregnancy were modeled using logistic regression. The study revealed that women who scored high on openness to experience were significantly more likely to continue alcohol consumption during pregnancy (OR = 1.07, 95% CI 1.01, 1.14, p = .02). This association was maintained after adjusting for potential confounds. This study demonstrated a significant relationship between personality traits and women's likelihood of continued alcohol consumption prior to and during pregnancy. Understanding personality-based determinants of health-detrimental behavior is important in order to design interventions that aim at decreasing rates of maladaptive health behaviors among pregnant women.
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Affiliation(s)
- Magdalena Leszko
- Department of Psychology, University of Szczecin, Szczecin, Poland
| | - Lauren Keenan-Devlin
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston, IL, United States of America
| | - Emma K. Adam
- Institute for Policy Research, Evanston, IL, United States of America
- School of Education and Social Policy, Northwestern University, Evanston, IL, United States of America
| | - Claudia Buss
- Health and Disease Research Program, University of California Irvine, Irvine, CA, United States of America
- Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - William Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Evanston, IL, United States of America
- Center for Healthcare Studies, Institute for Public Health and Medicine, Chicago, IL, United States of America
| | - Hyagriv Simhan
- Division of Maternal-Fetal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa, United States of America
- Division of Obstetrical Services, Magee Women’s Hospital, Pittsburgh, Pa, United States of America
| | - Pathik Wadhwa
- Health and Disease Research Program, University of California Irvine, Irvine, CA, United States of America
| | - Daniel K. Mroczek
- Department of Psychology, Northwestern University, Weinberg College of Arts & Sciences, Evanston, IL, United States of America
| | - Ann Borders
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston, IL, United States of America
- Center for Healthcare Studies, Institute for Public Health and Medicine, Chicago, IL, United States of America
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Investigation of factors associated with spontaneous preterm birth in pregnant women living with HIV. AIDS 2020; 34:719-727. [PMID: 31895145 DOI: 10.1097/qad.0000000000002464] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate factors contributing to preterm birth (PTB), including cART use and clinical and social determinants of health, in women living with HIV (WLWH) from British Columbia, Canada. DESIGN Retrospective observational cohort. METHODS We investigated the effect of cART use and other clinical and demographic factors on spontaneous PTB (sPTB) rates (<37 weeks gestational age) among 631 singleton pregnancies between 1997 and 2018. Exposure to cART was modelled in comparison to no exposure, exposure in the first trimester, and between regimens. Differences in sPTB risk were estimated using time-dependent Cox's proportional hazards models. RESULTS Overall, the sPTB rate was 16%. Cumulative cART use was associated with lower risk of PTB (Wald test P = 0.02; hazard ratio = 0.98, 95% CI = 0.96-0.99) and specific cART regimens were not associated with increased risk of sPTB. Exposure in the first trimester was not associated with sPTB and for each week of cART exposure, the risk of sPTB decreased by 2%. In a multivariable model, HIV viral load and substance use remained associated with risk of sPTB, but not cART exposure. CONCLUSION The sPTB rate among pregnant WLWH was more than three times higher than in the general population. However, sPTB was not related specifically to use of cART; in fact, cART appeared to reduce the risk of sPTB. Uncontrolled HIV replication and substance use were associated with increased risk of sPTB among pregnant WLWH. This emphasizes the important role of prenatal care, access to cART, and smoking cessation and harm reduction to reduce the risk of sPTB in WLWH.
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Bista B, Dhungana RR, Chalise B, Pandey AR. Prevalence and determinants of non-communicable diseases risk factors among reproductive aged women of Nepal: Results from Nepal Demographic Health Survey 2016. PLoS One 2020; 15:e0218840. [PMID: 32176883 PMCID: PMC7075700 DOI: 10.1371/journal.pone.0218840] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 02/22/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Non-Communicable Diseases (NCDs) are the major killer diseases globally. They share the common risk factors such as smoking, harmful use of alcohol, physical inactivity, and low fruits/vegetable consumption. The clustering of these risk factors multiplies the risk of developing NCDs. NCDs affect women inequitably causing significant threats to the health of women and future generations. But, the distribution and clustering of NCDs risk factors among Nepalese women are not adequately explored yet. This study aimed to assess the clustering and socio-demographic distribution of major NCD risk factors in Nepalese women. METHODS We used the data of 6,396 women age 15 to 49 years from the recent Nepal Demographic and Health Survey (NDHS). The survey applied a stratified multi-stage cluster sampling method to select the eligible women participants from across Nepal. We analyzed data using the multiple Poisson regression and reported the adjusted prevalence ratio (APR). RESULTS A total of 8.9% of participants were current smokers, 22.2% were overweight and obesity and 11.5% of the participants were hypertensive. Around 6% of participants had co-occurrence of two NCDs risk factors. Smoking, overweight and obesity and hypertension were significantly associated with age, education, province, wealth index, and ethnicity. Risk factors were more likely to cluster in women of age40-49 years (ARR = 2.95, 95%CI: 2.58-3.38), widow/separated (ARR = 3.09; 95% CI:2.24-4.28) and among Dalit women (ARR = 1.34; 95% CI:1.17-1.55). CONCLUSION This study found that NCDs risk factors were disproportionately distributed by age, education, socio-economic status and ethnicity and clustered in more vulnerable groups such as widow/separated women and the Dalit women.
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Affiliation(s)
| | - Raja Ram Dhungana
- Institute of Health & Sports, Victoria University, Melbourne, Australia
| | - Binaya Chalise
- Graduate School for International Development and Cooperation, Hiroshima University, Higashihiroshima, Japan
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Prenatal tobacco smoking is associated with postpartum depression in Japanese pregnant women: The japan environment and children's study. J Affect Disord 2020; 264:76-81. [PMID: 31846904 DOI: 10.1016/j.jad.2019.11.145] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/16/2019] [Accepted: 11/30/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Previous studies in Western countries have examined the association between prenatal smoking and risk for Postpartum depression (PPD). However, evidence from Japan is lacking, despite the high prevalence of smoking among pregnant women. Therefore, we examined the association between prenatal smoking and PPD among pregnant Japanese women. METHODS We analyzed data for up to 1 month after childbirth from the Japan Environment and Children's Study (JECS), a nationwide birth cohort study. Among the 103,070 pregnant women recruited, 80,872 eligible participants were included in the analysis. PPD was defined as a score of ≥9 on the Edinburgh Postnatal Depression Scale (EPDS). Prenatal smoking and length of smoking cessation among ex-smokers were obtained using self-administered questionnaires at second/third trimester. RESULTS Among 80,872 pregnant women, 9.0% reported PPD. Multivariable-adjusted odds ratios (OR) (95% confidence intervals) for PPD (reference: never smoked) were 1.24 (1.12-1.37) for women who quit smoking after becoming pregnant, and 1.38 (1.21-1.56) for those who smoked during pregnancy. Compared with women who had never smoked, those who quit smoking ≤5 years before childbirth had a higher occurrence of PPD, with a multivariable-adjusted OR of 1.10 (1.00-1.22). LIMITATIONS Questionnaire data was self-reported by participants, thus smoking status might be under-reported. CONCLUSIONS Women who smoked during pregnancy, quit smoking after becoming pregnant, and quit smoking ≤5 years before childbirth are more likely to experience PPD than those who had never smoked.
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Effects of maternal smoking on human placental vascularization: A systematic review. Taiwan J Obstet Gynecol 2020; 58:454-459. [PMID: 31307732 DOI: 10.1016/j.tjog.2019.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2019] [Indexed: 12/11/2022] Open
Abstract
The abnormal development of placental vascularization leads to placental insufficiency, which further reduces the nutrient and trace exchange between maternal circulation and fetal circulation. These changes cause maternal and fetal complications. The objective of our systematic review was to explore the effects of maternal smoking on placental vascularization. The eligibility criteria were: articles with experimental, quasi-experimental or observational design, performed on human subjects, that study the association, correlation or causation between maternal smoking and changes in placental vascular network. A total of 33 full-text papers were assessed for eligibility, resulting in 12 original articles that were included in the systematic review. Doppler studies confirm reductions in blood flow velocity waveforms and increase in RI in the uterine, umbilical and fetal middle cerebral arteries. These findings are confirmed by morphometric measurements of fetal capillaries in villi that were shown to be smaller in smoke exposure groups.
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Lu Y, Ji B, Zhao G, Dai J, Sakurai R, Liu Y, Mou Q, Xie Y, Zhang Q, Xu S, Rehan VK. Comparison of Protective Effects of Electroacupuncture at ST 36 and LU 5 on Pulmonary and Hypothalamic Pituitary Adrenal Axis Changes in Perinatal Nicotine-Exposed Rats. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3901528. [PMID: 32090085 PMCID: PMC6996710 DOI: 10.1155/2020/3901528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/18/2019] [Indexed: 12/02/2022]
Abstract
BACKGROUND Maternal smoking and/or exposure to environmental tobacco smoke continue to be significant factors in fetal and childhood morbidity and are a serious public health issue worldwide. Nicotine passes through the placenta easily with minimal biotransformation, entering fetal circulation, where it results in many harmful effects on the developing offspring, especially on the developing respiratory system. OBJECTIVES Recently, in a rat model, electroacupuncture (EA) at maternal acupoints ST 36 has been shown to block perinatal nicotine-induced pulmonary damage; however, the underlying mechanism and the specificity of ST 36 acupoints for this effect are unknown. Here, we tested the hypothesis that compared with EA at ST 36, EA at LU 5 acupoints, which are on lung-specific meridian, will be equally or more effective in preventing perinatal nicotine-induced pulmonary changes. METHODS Twenty-four pregnant rat dams were randomly divided into 4 groups: saline ("S"), nicotine ("N"), nicotine + ST 36 (N + ST 36), and nicotine + LU 5 (N + LU 5) groups. Nicotine (1 mg/kg, subcutaneously) and EA (at ST 36 or LU 5 acupoints, bilaterally) were administered from embryonic day 6 to postnatal day 21 once daily. The "S" group was injected saline. As needed, using ELISA, western analysis, q-RT-PCR, lung histopathology, maternal and offspring hypothalamic pituitary adrenal axes, offspring key lung developmental markers, and lung morphometry were determined. RESULTS With nicotine exposure, alveolar count decreased, but mean linear intercept and septal thickness increased. It also led to a decrease in pulmonary function and PPARγ and an increase of β-catenin and glucocorticoid receptor expression in lung tissue and corticosterone in the serum of offspring rats. Electroacupuncture at ST 36 normalized all of these changes, whereas EA at LU 5 had no obvious effect. CONCLUSION Electroacupuncture applied to ST 36 acupoints provided effective protection against perinatal nicotine-induced lung changes, whereas EA applied at LU 5 acupoints was ineffective, suggesting mechanistic specificity and HPA axis' involvement in mediating EA at ST 36 acupoints' effects in mitigating perinatal nicotine-induced pulmonary phenotype. This opens the possibility that other acupoints, besides ST 36, can have similar or even more robust beneficial effects on the developing lung against the harmful effect of perinatal nicotine exposure. The approach proposed by us is simple, cheap, quick, easy to administer, and is devoid of any significant side effects.
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Affiliation(s)
- Yawen Lu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Bo Ji
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Guozhen Zhao
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Jian Dai
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Reiko Sakurai
- Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Yitian Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Qiujie Mou
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Yana Xie
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Qin Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Shuang Xu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Virender Kumar Rehan
- Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
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Ouh YT, Lee KM, Ahn KH, Hong SC, Oh MJ, Kim HJ, Han SW, Cho GJ. Predicting peripartum blood transfusion: focusing on pre-pregnancy characteristics. BMC Pregnancy Childbirth 2019; 19:477. [PMID: 31805880 PMCID: PMC6896253 DOI: 10.1186/s12884-019-2646-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/27/2019] [Indexed: 01/09/2023] Open
Abstract
Background Obstetric hemorrhage is one of the most common causes of obstetrical morbidity and mortality, and transfusion is the most important management for hemorrhage. The aim of our study was to investigate the pre-pregnancy and pregnancy risk factors for peripartum transfusion. Methods Women who delivered a baby from 2010 to 2014 in Korea and participated in the Korean National Health Screening Program for Infants and Children were included. To analyze pre-pregnant risk factors for peripartum transfusion, an additional analysis was done for women who underwent a National Health Screening Examination within 1 year before pregnancy, including maternal waist circumference, body mass index, blood pressure, laboratory tests and history of smoking. Multivariable logistic regression analysis was used to estimate the risk factors for peripartum transfusion. Results Of the total 1,980,126 women who met the inclusion criteria, 36,868 (1.86%) were transfused at peripartum. In a multivariable regression model, the pregnancy risk factors for peripartum transfusion included maternal age above 35 years [odds ratio (OR): 1.41; 95% confidence interval (CI): 1.32–1.50], preterm birth (OR: 2.39; 95% CI: 2.15–2.65), and maternal hypertension (OR: 2.49; 95% CI: 2.24–2.77). Pre-pregnancy risk factors including fasting glucose level of more than 126 mg/dL (OR: 1.11; 95% CI: 1.02–1.20), current-smoker status (OR: 1.20; 95% CI: 1.06–1.37), and waist-circumference less than 80 cm (OR: 1.18; 95% CI: 1.06–1.30) were independently associated with peripartum blood transfusion. Conclusions Several pre-pregnancy and pregnancy risk factors were associated with peripartum blood transfusion. Some identified factors are modifiable before conception, and our study validated peripartum blood transfusion as a form of triage.
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Affiliation(s)
- Yung-Taek Ouh
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Kyu-Min Lee
- School of Industrial Management Engineering, Korea University, 145 Anam-Ro, Seongbuk-Gu, Seoul, 02841, Republic of Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Hai-Joong Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Sung Won Han
- School of Industrial Management Engineering, Korea University, 145 Anam-Ro, Seongbuk-Gu, Seoul, 02841, Republic of Korea.
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea.
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Ae-Ngibise KA, Wylie BJ, Boamah-Kaali E, Jack DW, Oppong FB, Chillrud SN, Gyaase S, Kaali S, Agyei O, Kinney PL, Mujtaba M, Wright RJ, Asante KP, Lee AG. Prenatal maternal stress and birth outcomes in rural Ghana: sex-specific associations. BMC Pregnancy Childbirth 2019; 19:391. [PMID: 31664941 PMCID: PMC6819589 DOI: 10.1186/s12884-019-2535-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/24/2019] [Indexed: 01/08/2023] Open
Abstract
Background In developed countries, prenatal maternal stress has been associated with poor fetal growth, however this has not been evaluated in rural sub-Saharan Africa. We evaluated the effect of prenatal maternal stress on fetal growth and birth outcomes in rural Ghana. Methods Leveraging a prospective, rural Ghanaian birth cohort, we ascertained prenatal maternal negative life events, categorized scores as 0-2 (low stress; referent), 3-5 (moderate), and > 5 (high) among 353 pregnant women in the Kintampo North Municipality and Kintampo South District located within the middle belt of Ghana. We employed linear regression to determine associations between prenatal maternal stress and infant birth weight, head circumference, and length. We additionally examined associations between prenatal maternal stress and adverse birth outcome, including low birth weight, small for gestational age, or stillbirth. Effect modification by infant sex was examined. Results In all children, high prenatal maternal stress was associated with reduced birth length (β = − 0.91, p = 0.04; p-value for trend = 0.04). Among girls, moderate and high prenatal maternal stress was associated with reduced birth weight (β = − 0.16, p = 0.02; β = − 0.18, p = 0.04 respectively; p-value for trend = 0.04) and head circumference (β = − 0.66, p = 0.05; β = − 1.02, p = 0.01 respectively; p-value for trend = 0.01). In girls, high prenatal stress increased odds of any adverse birth outcome (OR 2.41, 95% CI 1.01-5.75; p for interaction = 0.04). Sex-specific analyses did not demonstrate significant effects in boys. Conclusions All infants, but especially girls, were vulnerable to effects of prenatal maternal stress on birth outcomes. Understanding risk factors for impaired fetal growth may help develop preventative public health strategies. Trial registration NCT01335490 (prospective registration). Date of Registration: April 14, 2011. Status of Registration: Completed.
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Affiliation(s)
- Kenneth Ayuurebobi Ae-Ngibise
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana.,School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Blair J Wylie
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ellen Boamah-Kaali
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana
| | - Darby W Jack
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Felix Boakye Oppong
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory at Columbia University, Palisades, NY, USA
| | - Stephaney Gyaase
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana
| | - Seyram Kaali
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana
| | - Oscar Agyei
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana
| | - Patrick L Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Mohammed Mujtaba
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana
| | - Rosalind J Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kwaku Poku Asante
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana
| | - Alison G Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA.
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Axfors C, Eckerdal P, Volgsten H, Wikström AK, Ekselius L, Ramklint M, Sundström Poromaa I, Skalkidou A. Investigating the association between neuroticism and adverse obstetric and neonatal outcomes. Sci Rep 2019; 9:15470. [PMID: 31664086 PMCID: PMC6820798 DOI: 10.1038/s41598-019-51861-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/04/2019] [Indexed: 11/13/2022] Open
Abstract
Neuroticism is not only associated with affective disorders but also with certain somatic health problems. However, studies assessing whether neuroticism is associated with adverse obstetric or neonatal outcomes are scarce. This observational study comprises first-time mothers (n = 1969) with singleton pregnancies from several cohorts based in Uppsala, Sweden. To assess neuroticism-related personality, the Swedish universities Scales of Personality was used. Swedish national health registers were used to extract outcomes and confounders. In logistic regression models, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for the outcomes by an increase of 63 units of neuroticism (equalling the interquartile range). Analyses were adjusted for maternal age, educational level, height, body mass index, year of delivery, smoking during pregnancy, involuntary childlessness, and psychiatric morbidity. Main outcomes were mode of delivery, gestational diabetes mellitus, gestational hypertension, preeclampsia, induction of delivery, prolonged delivery, severe lacerations, placental retention, postpartum haemorrhage, premature birth, infant born small or large for gestational age, and Apgar score. Neuroticism was not independently associated with adverse obstetric or neonatal outcomes besides gestational diabetes. For future studies, models examining sub-components of neuroticism or pregnancy-specific anxiety are encouraged.
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Affiliation(s)
- Cathrine Axfors
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Patricia Eckerdal
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Helena Volgsten
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna-Karin Wikström
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Lisa Ekselius
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Mia Ramklint
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | | | - Alkistis Skalkidou
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Kuniyoshi KM, Rehan VK. The impact of perinatal nicotine exposure on fetal lung development and subsequent respiratory morbidity. Birth Defects Res 2019; 111:1270-1283. [PMID: 31580538 DOI: 10.1002/bdr2.1595] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/13/2019] [Accepted: 09/05/2019] [Indexed: 01/18/2023]
Abstract
Maternal smoking during pregnancy remains as a significant public health crisis as it did decades ago. Although its prevalence is decreasing in high-income countries, it has worsened globally, along with a concerning emergence of electronic-cigarette usage within the last two decades. Extensive epidemiologic and experimental evidence exists from both human and animal studies, demonstrating the detrimental long-term pulmonary outcomes in the offspring of mothers who smoke during pregnancy. Even secondhand and thirdhand smoke exposure to the developing lung might be as or even more harmful than firsthand smoke exposure. Furthermore, these effects are not limited only to the exposed progeny, but can also be transmitted transgenerationally. There is compelling evidence to support that the majority of the effects of perinatal smoke exposure on the developing lung, including the transgenerational transmission of asthma, is mediated by nicotine. Nicotine exposure induces cell-specific molecular changes in lungs, which offers a unique opportunity to prevent, halt, and/or reverse the resultant damage through targeted molecular interventions. Experimentally, the proposed interventions, such as administration of peroxisome proliferator-activated receptor gamma (PPARγ) agonists can not only block but also potentially reverse the perinatal nicotine exposure-induced respiratory morbidity in the exposed offspring. However, the development of a safe and effective intervention is still many years away. In the meantime, electropuncture at specific acupoints appears to be emerging as a more practical and safe physiologic approach to block the harmful pulmonary consequences of perinatal nicotine exposure.
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Affiliation(s)
- Katherine M Kuniyoshi
- Department of Pediatrics, David Geffen School of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor, UCLA Medical Center, Torrance, California
| | - Virender K Rehan
- Department of Pediatrics, David Geffen School of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor, UCLA Medical Center, Torrance, California
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44
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Bertini G, Elia S, Lori S, Dani C. Abnormal neurological soft signs in babies born to smoking mothers were associated with lower breastfeeding for first three months. Acta Paediatr 2019; 108:1256-1261. [PMID: 30788864 DOI: 10.1111/apa.14762] [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: 06/30/2018] [Revised: 02/02/2019] [Accepted: 02/18/2019] [Indexed: 11/28/2022]
Abstract
AIM We examined associations between neurological alterations in infants born to smoking mothers and breastfeeding success at discharge and three months of age. METHODS This 2016 study compared 35 normal weight infants born to smoking mothers at 37-41 weeks and 35 matched controls born to non-smoking mothers at the Maternity Hospital of Careggi University, Florence, Italy. Neonatal behaviour was evaluated using the neurological soft signs (NSS) component of the Graham-Rosenblith Scale. Breastfeeding variables were measured using the LATCH score that covers: breast latching, audible swallowing, type of nipple, mother's comfort and help they needed to hold their baby to their breast. A questionnaire on excessive crying and feeding was distributed at discharge, and further data were collected during a three-month telephone interview. RESULTS At discharge, the infants born to smoking mothers had a significantly lower LATCH score and significantly poorer performance on several items of the NSS component than the controls. The LATCH score and number of NSS were inversely proportional. At the three-month follow-up only 57.1% of the smoking group infants were breastfeeding compared with 87.5% of the control infants (p < 0.01). CONCLUSION Infants with smoking mothers displayed altered neurobehavioural profiles and had a difficult start to breastfeeding.
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Affiliation(s)
- G Bertini
- Division of Neonatology Careggi University Hospital Florence Italy
| | - S Elia
- Division of Neonatology Careggi University Hospital Florence Italy
| | - S Lori
- Neurophysiology Unit Neuro‐Musculo‐Skeletal Department Careggi University Hospital Florence Italy
| | - C Dani
- Department of Neurosciences, Psychology, Drug Research and Child Health Careggi University Hospital of Florence Florence Italy
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Kamai EM, McElrath TF, Ferguson KK. Fetal growth in environmental epidemiology: mechanisms, limitations, and a review of associations with biomarkers of non-persistent chemical exposures during pregnancy. Environ Health 2019; 18:43. [PMID: 31068204 PMCID: PMC6505101 DOI: 10.1186/s12940-019-0480-8] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 04/16/2019] [Indexed: 05/18/2023]
Abstract
BACKGROUND Non-persistent chemicals, such as phthalates, environmental phenols, organophosphate pesticides, and others, are challenging to study because of their ubiquity in the environment, diverse exposure routes, and high temporal variability of biomarkers. Nonetheless, there is interest in understanding how gestational exposure to these chemicals may affect fetal growth, as perturbations to normal fetal growth are related to a plethora of adverse health outcomes in childhood and adulthood. METHODS The purpose of this review is to describe the state of the science on this topic. We searched PubMed for studies that included both 1) biomarkers of non-persistent chemicals collected during pregnancy and 2) fetal growth outcomes measured at birth (e.g., birth weight) or by ultrasound in utero (e.g., estimated fetal weight). RESULTS The bulk of the literature we found uses biomarkers measured at a single time point in pregnancy and birth weight as the primary measure of fetal growth. There is a small, but growing, body of research that uses ultrasound measures to assess fetal growth during pregnancy. In addition to summarizing the findings of the publications we identified, we describe inconsistencies in methodology, areas for improvement, and gaps in existing knowledge that can be targeted for improvement in future work. This literature is characterized by variability in methodology, likely contributing to the inconsistency of results reported. We further discuss maternal, placental, and fetal pathways by which these classes of chemicals may affect fetal growth. CONCLUSIONS To improve understanding of how everyday chemical exposures affect fetal growth, and ultimately lifelong health outcomes, mechanisms of toxicant action should be considered alongside improved study designs for future hypothesis-driven research.
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Affiliation(s)
- Elizabeth M. Kamai
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599 USA
| | - Thomas F. McElrath
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Kelly K. Ferguson
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, 111 TW Alexander Drive, Research Triangle Park, NC 27709 USA
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Ylijoki MK, Ekholm E, Ekblad M, Lehtonen L. Prenatal Risk Factors for Adverse Developmental Outcome in Preterm Infants-Systematic Review. Front Psychol 2019; 10:595. [PMID: 30971974 PMCID: PMC6445261 DOI: 10.3389/fpsyg.2019.00595] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/04/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Preterm infants are still at an increased risk for suboptimal neurodevelopmental outcomes when compared with term born infants. The development of a child born preterm can be jeopardized by suboptimal conditions during pregnancy, in addition to the suboptimal growth environment postnatally compared to the normal in utero environment. This review summarizes the literature on the role of chorioamnionitis, placental insufficiency, and maternal smoking on the developmental outcomes of preterm infants. Methods: A systematic database search was performed to identify all original articles published on or before September 12, 2018 that evaluated the impact of clinical or histological chorioamnionitis, abnormal prenatal fetal and placental blood flow, and prenatal smoking exposure on the neuropsychological and cognitive outcomes of preterm infants. We identified a total of 54 studies. Thirty five original articles evaluated the effects of clinical or histological chorioamnionitis; 15 studies evaluated the effects of abnormal blood flow patterns; and four studies evaluated the effects of maternal smoking during pregnancy. Results: The studies on prenatal risk factors showed conflicting results about the impact on the neurodevelopment of preterm infants. The majority of the studies did not show that chorioamnionitis poses a direct risk to the development of preterm infants. The role of abnormal prenatal placental and fetal blood flow on the development of preterm infants remained inconclusive because the sample sizes were often small and methodological problems complicated the interpretation of the data. Maternal smoking during pregnancy was assessed only in one cohort which showed that maternal smoking is a risk for suboptimal cognitive and neuropsychological development in preterm infants. Conclusions: This review summarizes the data on several prenatal risk factors which play a role in the developmental outcomes of preterm infants. To optimize the developmental outcomes, we need to first optimize the fetal wellbeing before birth. More research that extends from the fetal life to long-term developmental outcomes is needed.
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Affiliation(s)
- Milla K Ylijoki
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, Turku, Finland.,Department of Paediatric Neurology, Turku University Hospital, University of Turku, Turku, Finland
| | - Eeva Ekholm
- Department of Obstetrics and Gynaecology, Turku University Hospital, University of Turku, Turku, Finland
| | - Mikael Ekblad
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, United States.,Department of General Practice, Turku University Hospital, Turku University, Turku, Finland
| | - Liisa Lehtonen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, Turku, Finland
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47
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Factors associated with neonatal hypoxic ischemic encephalopathy in infants with an umbilical artery pH less than 7.00. Eur J Obstet Gynecol Reprod Biol 2019; 236:69-74. [PMID: 30884338 DOI: 10.1016/j.ejogrb.2019.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 02/01/2019] [Accepted: 02/06/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Our objective was to identify factors associated with hypoxic-ischemic encephalopathy (HIE) among newborns with an umbilical pH < 7.00. STUDY DESIGN Case-control study during a four-year study period in a single academic tertiary-center, including all neonates ≥35 weeks with an umbilical pH < 7.00. Cases were neonates with HIE, regardless of Sarnat classification, and controls were neonates without signs of HIE. We used univariate and multivariate analysis to compare the maternal, obstetric, and neonatal characteristics of cases and controls. RESULTS Among 21,211 births, 179 neonates≥35 weeks (0.84%) had an umbilical pH < 7.00. One hundred and forty-seven(82.1%) newborns had severe asphyxia without HIE, 32(17.9%) had HIE and 21(11.7%) needed therapeutic hypothermia. Neonates with HIE were significantly more likely to have 5-minute Apgar score<7(75% versus 15.7% P < 0.01), together with a lower mean umbilical arterial pH (6.84 versus 6.95, P < 0.01) and lower mean base deficits (-17.0 versus -12.7, P < 0.01). Factors significantly associated with HIE were the mother being overweight(28.1% for cases versus 14.3% for controls, adjusted OR=4.6[1.4-15.2]) or obese(25.0% versus 13.6%, aOR=15.5[1.1-12.5]), smoking(18.7% versus 5.4%, aOR=5.8[1.6-21.2]), a sentinel event as cord prolaps or placenta abruption (34.4% versus 13.6%, aOR=2.7[1.1-7.2]), and decreased fetal heart rate variability(68.7% versus 44.2%, aOR=2.8[1.1-6.9]). CONCLUSION Among neonates with an umbilical cord pH < 7.00, those with HIE had a more severe metabolic acidosis. Maternal factors associated with HIE among newborns with an umbilical pH < 7.00, were being overweight or obese, and smoking, and the associated obstetric factors were a sentinel event and decreased fetal heart rate variability.
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Rodriguez A, Wang Y, Ali Khan A, Cartwright R, Gissler M, Järvelin MR. Antenatal corticosteroid therapy (ACT) and size at birth: A population-based analysis using the Finnish Medical Birth Register. PLoS Med 2019; 16:e1002746. [PMID: 30807570 PMCID: PMC6390995 DOI: 10.1371/journal.pmed.1002746] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/18/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Antenatal corticosteroid therapy (ACT) is used clinically to prepare the fetal lung for impending preterm birth, but animal and human studies link corticosteroids to smaller birth size. Whether ACT is associated with birth size is debated; therefore, we assessed differences in birth size in treated versus untreated pregnancies. METHODS AND FINDINGS This observational register-based study used data from the Finnish Medical Birth Register (FMBR) covering all births in Finland (January 1, 2006-December 31, 2010). We used unadjusted and adjusted regression analyses as well as propensity score matching (PSM) to analyze whether birth size differed by ACT exposure. PSM provides a stringent comparison, as subsamples were created matched on baseline and medical characteristics between treated and untreated women. All analyses were stratified by timing of birth. The primary study outcome was birth size: birth weight (BWT), birth length (BL), ponderal index (PI), and head circumference (HC) measured immediately after birth and recorded in the FMBR. Additional analyses explored indicators of neonatal health in relation to ACT exposure and birth size. A total of 278,508 live-born singleton births with ≥24 gestational completed weeks were registered in the FMBR during the 5-year study period. Over 4% of infants were born preterm, and 4,887 women were treated with ACT (1.75%). More than 44% of the exposed infants (n = 2,173) were born at term. First, results of unadjusted regression analyses using the entire sample showed the greatest reductions in BWT as compared to the other analytic methods: very preterm -61.26 g (±SE 24.12, P < 0.01), preterm -232.90 g (±SE 17.24, P < .001), near term -171.50 g (±SE 17.52, P < .001), and at term -101.95 g (±SE 10.89, P < .001). Second, using the entire sample, regression analyses adjusted for baseline and medical conditions showed significant differences in BWT between exposed and unexposed infants: very preterm -61.54 g (±SE 28.62, P < .03), preterm -222.78 g (±SE 19.64, P < .001), near term -159.25 g (±SE 19.14, P < .001), and at term -91.62 g (±SE 11.86, P < .03). Third, using the stringent PSM analyses based on matched subsamples, infants exposed to ACT weighed less at birth: -220.18 g (±SE 21.43, P < .001), -140.68 g (±SE 23.09, P < .001), and -89.38 g (±SE 14.16, P < .001), born preterm, near term, and at term, respectively. Similarly, significant reductions in BL and HC were also observed using the three analytic methods. There were no differences among postterm infants regardless of analytic method. Likewise, we observed no differences with respect to PI. Additional analyses showed that exposed and unexposed infants had generally similar Apgar scores at birth, yet the ACT-treated infants received greater medical care during the first 7 days of life and beyond. Our study is mainly limited by lack of data in FMBR specifying the interval between treatment and birth as well as other potential confounders that could not be tested. CONCLUSIONS In this study, ACT was consistently associated with reduction in birth size for infants born preterm, near term, or at term. Further investigation is warranted alongside reevaluation of guidelines. Efforts need to be made to correctly identify and target patients who will deliver preterm. Reduced growth should be considered when deliberating early care decisions.
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Affiliation(s)
- Alina Rodriguez
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
- School of Psychology, University of Lincoln, Lincoln, United Kingdom
| | - Yingbo Wang
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Anohki Ali Khan
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Rufus Cartwright
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
- Department of Obstetrics and Gynaecology, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Mika Gissler
- THL National Institute for Health and Welfare, Information Services Department, Helsinki, Finland
- Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Stockholm, Sweden
| | - Marjo-Riitta Järvelin
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
- Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Department of Life Sciences, College of Health and Life Sciences, Brunel University London, London, United Kingdom
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Liu B, Hu X, Li Y, Ke J, Dasgupta C, Huang X, Walayat A, Zhang L, Xiao D. Epigenetic down-regulation of BK Ca channel by miR-181a contributes to the fetal and neonatal nicotine-mediated exaggerated coronary vascular tone in adult life. Int J Cardiol 2019; 281:82-89. [PMID: 30738609 DOI: 10.1016/j.ijcard.2019.01.099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/07/2019] [Accepted: 01/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fetal origin of adult cardiovascular disease is one of the most pressing public concerns and economic problem in modern life. Maternal cigarette smoking/nicotine abuse increases the risk of cardiovascular disease in offspring. However, the underlying mechanisms and theranostics remain unclear. We hypothesized that fetal and neonatal nicotine exposure enhances microRNA-181a (miR-181a) which targets large-conductance Ca2+-activated K+ (BKCa) channels, resulting in increased coronary vascular tone in adult offspring. METHODS Nicotine or saline was administered to pregnant rats via subcutaneous osmotic minipumps from gestational day 4 until postnatal day 10. Experiments were conducted in adult (~6 month old) male offspring. RESULTS Nicotine enhanced pressure-induced coronary vascular tone, which was abrogated by BKCa channel blocker. Nicotine selectively attenuated coronary BKCa β1 but not α subunit expression. Functionally, nicotine suppressed BKCa current density and inhibited BKCa activator NS1619-induced coronary relaxations. Furthermore, activation of BKCa increased coronary flow and improved heart ischemia/reperfusion-induced infarction. Nicotine selectively enhanced miR-181a expression. MiR-181a mimic inhibited BKCa β1 expression/channel current and decreased NS1619-induced coronary relaxation. Antioxidant eliminated the difference of BKCa current density between the saline and nicotine-treated groups and partially restored NS1619-induced relaxation in nicotine group. MiR-181a antisense decreased vascular tone and eliminated the differences between nicotine exposed and control groups. CONCLUSION Fetal and neonatal nicotine exposure-mediated miR-181a overexpression plays an important role in nicotine-enhanced coronary vascular tone via epigenetic down-regulation of BKca channel mechanism, which provides a potentially novel therapeutic molecular target of miR-181a/BKca channels for the treatment of coronary heart ischemic disease.
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Affiliation(s)
- Bailin Liu
- Lawrence D. Longo, MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Xiangqun Hu
- Lawrence D. Longo, MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Yong Li
- Lawrence D. Longo, MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Jun Ke
- Lawrence D. Longo, MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Chiranjib Dasgupta
- Lawrence D. Longo, MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Xiaohui Huang
- Lawrence D. Longo, MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Andrew Walayat
- Lawrence D. Longo, MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Lubo Zhang
- Lawrence D. Longo, MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Daliao Xiao
- Lawrence D. Longo, MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA.
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Allen AM, Jung AM, Lemieux AM, Alexander AC, Allen SS, Ward KD, al'Absi M. Stressful life events are associated with perinatal cigarette smoking. Prev Med 2019; 118:264-271. [PMID: 30468790 PMCID: PMC6322958 DOI: 10.1016/j.ypmed.2018.11.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/08/2018] [Accepted: 11/17/2018] [Indexed: 12/01/2022]
Abstract
Perinatal smoking, including smoking during pregnancy and postpartum smoking relapse, is a persistent public health problem. While childhood trauma has been linked to perinatal smoking, less is known about the association with more proximal stressful life events (SLEs). The objective of this study was to examine the association between SLEs that occurred during the year prior to childbirth with perinatal smoking. Using the Pregnancy Risk Assessment Monitoring System 2009-2011, perinatal smoking was assessed at three time points: (1) three months prior to pregnancy, (2) the last three months of pregnancy, and (3) two to six months postpartum. Survey respondents endorsed up to 13 SLEs (i.e., death of someone close). SLEs were analyzed individually, as well as using a cumulative score (range 0-13). Weighted analyses included unadjusted and adjusted logistic regression. Among those who smoked prior to pregnancy (n = 15,316), 48% (n = 7308) reported quitting smoking during pregnancy. Of those, 44% (n = 3126) reported postpartum smoking relapse. A total of 11 SLEs were associated with smoking during pregnancy and 2 SLEs were associated with postpartum smoking relapse. The odds of continued smoking during pregnancy was 12% higher for each SLE endorsed (adjusted odds ratio [aOR] = 1.12, 95% confidence interval [CI]: 1.09, 1.15) and this association was attenuated in relation to the odds of postpartum smoking relapse (aOR = 1.03, 95% CI: 0.99, 1.08). SLEs are associated with perinatal smoking. Additional research is needed to elucidate the mechanisms of action and to develop interventions specific to the needs of women who experience SLEs.
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Affiliation(s)
- Alicia M Allen
- Department of Family & Community Medicine, College of Medicine, University of Arizona, 3950 South Country Club Road, Suite 330, Tucson, AZ 85714-2238, United States of America.
| | - Alesia M Jung
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, PO Box 245211, Tucson, AZ 85724-5211, United States of America
| | - Andrine M Lemieux
- Department of Family Medicine & Biobehavioral Health, Medical School, University of Minnesota, Duluth, 1035 University Drive, 291 SMed, Duluth, MN 55812-3031, United States of America
| | - Adam C Alexander
- Department of Social and Behavioral Sciences, School of Public Health, University of Memphis, 3825 DeSoto Avenue, Room 207, Memphis, TN 38152, United States of America
| | - Sharon S Allen
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, 420 Delaware Street SE, Room A682, Minneapolis, MN 55455-0341, United States of America
| | - Kenneth D Ward
- School of Public Health, University of Memphis, 201 Robison Hall, Memphis, TN 38152-3420, United States of America
| | - Mustafa al'Absi
- Department of Family Medicine & Biobehavioral Health, Medical School, University of Minnesota, Duluth, 1035 University Drive, Duluth, MN, 55812-3031, United States of America
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