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Huang X, Fan D, Li W, Chen G, Li P, Rao J, Lan S, Wang L, Lin D. Optimal gestational weight change associated with improved perinatal outcomes in women with gestational diabetes mellitus: a population-based study in the United States. Am J Clin Nutr 2024; 120:737-745. [PMID: 39009137 DOI: 10.1016/j.ajcnut.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/04/2024] [Accepted: 07/10/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Optimal gestational weight change (GWC) is little known among pregnant women with gestational diabetes mellitus (GDM). OBJECTIVES This study aimed to explore the optimal GWC ranges for women with GDM and validate these ranges compared with the Institute of Medicine (IOM) guidelines. METHODS A population-based cohort study using natality data from the National Center for Health Statistics in the United States included 1,338,460 mother-infant pairs with GDM from 2014 to 2020. Poisson regression models were performed to identify GWC ranges (GDM targets) associated with acceptable risks (<10% increase) for a severity-weighted composite outcome including preterm birth (PTB) <37 wk, large for gestational age (LGA, birthweight >90th percentile) and small for gestational age (SGA, birthweight <10th percentile). These targets were validated in individual outcomes including PTB, LGA, SGA, hypertensive disorders of pregnancy, neonatal intensive care unit admission, and neonatal respiratory morbidity, and compared with the IOM guidelines using logistic regression models with population-attributable fractions (PAFs) calculated. RESULTS The severity-weighted composite outcome had a U-shaped or a J-shaped relationship with GWC across body mass index categories. The GDM targets were 14.1 to 20.3 kg, 9.0 to 17.0 kg, 4.8 to 13.8 kg, -0.8 to 10.8 kg, -2.4 to 8.2 kg, and -8.3 to 6.0 kg for underweight, normal weight, overweight, class 1 obesity, class 2 obesity, and class 3 obesity, respectively. GWC outside the GDM or the IOM targets was associated with increased adverse perinatal outcomes in validation analyses. PAFs indicated that the IOM guidelines reduced a similar or higher proportion of adverse perinatal outcomes compared with the GDM targets for women with GDM, except for those with class 2 and 3 obesity. CONCLUSIONS The IOM guidelines are generally applicable for women with GDM, except for women with moderate and severe obesity. The optimal GWC ranges for women with GDM and moderate to severe obesity may be lower than the IOM guidelines.
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Affiliation(s)
- Xuqiong Huang
- Medical Administration Division, Huadu District People's Hospital of Guangzhou, Guangdong, China
| | - Dazhi Fan
- Foshan Institute of Fetal Medicine, Maternal & Child Health Hospital of Foshan, Guangdong, China; Department of Obstetrics, Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
| | - Weijiang Li
- Medical Administration Division, Huadu District People's Hospital of Guangzhou, Guangdong, China
| | - Gengdong Chen
- Foshan Institute of Fetal Medicine, Maternal & Child Health Hospital of Foshan, Guangdong, China; Department of Obstetrics, Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
| | - Pengsheng Li
- Foshan Institute of Fetal Medicine, Maternal & Child Health Hospital of Foshan, Guangdong, China; Department of Obstetrics, Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
| | - Jiaming Rao
- Foshan Institute of Fetal Medicine, Maternal & Child Health Hospital of Foshan, Guangdong, China; Department of Obstetrics, Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
| | - Shiyan Lan
- Department of Obstetrics, Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
| | - Lijuan Wang
- Department of Obstetrics, Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
| | - Dongxin Lin
- Foshan Institute of Fetal Medicine, Maternal & Child Health Hospital of Foshan, Guangdong, China; Department of Obstetrics, Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China.
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Cameron NA, Yee LM, Dolan BM, O'Brien MJ, Greenland P, Khan SS. Trends in Cardiovascular Health Counseling Among Postpartum Individuals. JAMA 2023; 330:359-367. [PMID: 37490084 PMCID: PMC10369213 DOI: 10.1001/jama.2023.11210] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/06/2023] [Indexed: 07/26/2023]
Abstract
Importance Poor prepregnancy cardiovascular health (CVH) and adverse pregnancy outcomes (APOs) are key risk factors for subsequent cardiovascular disease (CVD) in birthing adults. The postpartum visit offers an opportunity to promote CVH among at-risk individuals. Objective To determine prevalence, predictors, and trends in self-reported CVH counseling during the postpartum visit. Design, Setting, and Participants Serial, cross-sectional analysis of data from 2016-2020 from the Pregnancy Risk Assessment Monitoring System (PRAMS), a nationally representative, population-based survey. The primary analysis included individuals who attended a postpartum visit 4 to 6 weeks after delivery with available data on receipt of CVH counseling, self-reported prepregnancy CVD risk factors (obesity, diabetes, and hypertension), and APOs (gestational diabetes, hypertensive disorders of pregnancy, and preterm birth) (N = 167 705 [weighted N = 8 714 459]). Exposures Total number of CVD risk factors (0, 1, or ≥2 prepregnancy risk factors or APOs). Main Outcomes and Measures Annual, age-adjusted prevalence of self-reported postpartum CVH counseling per 100 individuals, defined as receipt of counseling for healthy eating, exercise, and losing weight gained during pregnancy, was calculated overall and by number of CVD risk factors. Average annual percent change (APC) assessed trends in CVH counseling from 2016 through 2020. Data were pooled to calculate rate ratios (RRs) for counseling that compared individuals with and without CVD risk factors after adjustment for age, education, postpartum insurance, and delivery year. Results From 2016 through 2020, prevalence of self-reported postpartum CVH counseling declined from 56.2 to 52.8 per 100 individuals among those with no CVD risk factors (APC, -1.4% [95% CI, -1.8% to -1.0%/y]), from 58.5 to 57.3 per 100 individuals among those with 1 risk factor (APC, -0.7% [95% CI, -1.3% to -0.1%/y]), and from 61.9 to 59.8 per 100 individuals among those with 2 or more risk factors (APC, -0.8% [95% CI, -1.3% to -0.3%/y]). Reporting receipt of counseling was modestly higher among individuals with 1 risk factor (RR, 1.05 [95% CI, 1.04 to 1.07]) and with 2 or more risk factors (RR, 1.11 [95% CI, 1.09 to 1.13]) compared with those who had no risk factors. Conclusions and Relevance Approximately 60% of individuals with CVD risk factors or APOs reported receiving CVH counseling at their postpartum visit. Prevalence of reporting CVH counseling decreased modestly over 5 years.
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Affiliation(s)
- Natalie A Cameron
- Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, Illinois
| | - Lynn M Yee
- Feinberg School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University, Chicago, Illinois
| | - Brigid M Dolan
- Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, Illinois
| | - Matthew J O'Brien
- Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, Illinois
| | - Philip Greenland
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Sadiya S Khan
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, Illinois
- Feinberg School of Medicine, Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
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Marley AR, Ryder JR, Turcotte LM, Spector LG. Maternal obesity and acute lymphoblastic leukemia risk in offspring: A summary of trends, epidemiological evidence, and possible biological mechanisms. Leuk Res 2022; 121:106924. [PMID: 35939888 DOI: 10.1016/j.leukres.2022.106924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/13/2022] [Accepted: 08/01/2022] [Indexed: 10/16/2022]
Abstract
Acute lymphoblastic leukemia, a heterogenous malignancy characterized by uncontrolled proliferation of lymphoid progenitors and generally initiated in utero, is the most common pediatric cancer. Although incidence of ALL has been steadily increasing in recent decades, no clear reason for this trend has been identified. Rising concurrently with ALL incidence, increasing maternal obesity rates may be partially contributing to increasing ALL prevelance. Epidemiological studies, including a recent meta-analysis, have found an association between maternal obesity and leukemogenesis in offspring, although mechanisms underlying this association remain unknown. Therefore, the purpose of this review is to propose possible mechanisms connecting maternal obesity to ALL risk in offspring, including changes to fetal/neonatal epigenetics, altered insulin-like growth factor profiles and insulin resistance, modified adipokine production and secretion, changes to immune cell populations, and impacts on birthweight and childhood obesity/adiposity. We describe how each proposed mechanism is biologically plausible due to their connection with maternal obesity, presence in neonatal and/or fetal tissue, observation in pediatric ALL patients at diagnosis, and association with leukemogenesis, A description of ALL and maternal obesity trends, a summary of epidemiological evidence, a discussion of the pathway from intrauterine environment to subsequent malignancy, and propositions for future directions are also presented.
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Affiliation(s)
- Andrew R Marley
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, 420 Delaware St SE MMC 715, Minneapolis, MN 55455, USA.
| | - Justin R Ryder
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, 420 Delaware St SE MMC 715, Minneapolis, MN 55455, USA; Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Ave S AO-102, Minneapolis, MN 55454, USA
| | - Lucie M Turcotte
- Division of Hematology/Oncology, Department of Pediatrics, University of Minnesota, 420 Delaware St SE MMC 484, Minneapolis, MN 55455, USA; Masonic Cancer Center, University of Minnesota, 425 East River Parkway, Minneapolis, MN 55455, USA
| | - Logan G Spector
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, 420 Delaware St SE MMC 715, Minneapolis, MN 55455, USA; Masonic Cancer Center, University of Minnesota, 425 East River Parkway, Minneapolis, MN 55455, USA
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Frey HA, Ashmead R, Farmer A, Kim YH, Shellhaas C, Oza-Frank R, Jackson RD, Costantine MM, Lynch CD. Association of Prepregnancy Body Mass Index With Risk of Severe Maternal Morbidity and Mortality Among Medicaid Beneficiaries. JAMA Netw Open 2022; 5:e2218986. [PMID: 35763297 PMCID: PMC9240907 DOI: 10.1001/jamanetworkopen.2022.18986] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
IMPORTANCE The association between body mass index (BMI, which is calculated as weight in kilograms divided by height in meters squared) and severe maternal morbidity (SMM) and/or mortality is uncertain, judging from the current evidence. OBJECTIVE To examine the association between prepregnancy BMI and SMM and/or mortality through 1 year post partum and to identify both the direct and indirect implications of maternal obesity for SMM and/or mortality by examining hypertensive disorders and pregestational diabetes as potential mediators. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study was conducted from March to October 2021 using the vital records and linked Medicaid claims data in the state of Ohio from January 1, 2012, through December 31, 2017. The cohort comprised pregnant Medicaid beneficiaries who delivered at 20 weeks' gestation or later and had prepregnancy BMI information. EXPOSURES The primary exposure was maternal prepregnancy BMI, which was categorized as follows: underweight (<18.5), healthy weight (18.5-24.9), overweight (25.0-29.9), class 1 obesity (30.0-34.9), class 2 obesity (35.0-39.9), and class 3 obesity (≥40.0). MAIN OUTCOMES AND MEASURES The primary outcome was a composite of SMM (defined using Centers for Disease Control and Prevention criteria) and/or maternal mortality between 20 weeks' gestation and 1 year post partum. Additional periods were assessed, including 20 weeks' gestation through delivery hospitalization and 20 weeks' gestation through 42 days post partum. Generalized estimating equation models were used to estimate adjusted relative risks (aRRs) for the primary outcome according to BMI category. Maternal hypertensive diseases and pregestational diabetes were assessed as potential meditators. RESULTS In a cohort of 347 497 pregnancies among 276 691 Medicaid beneficiaries (median [IQR] maternal age at delivery, 25 [21-29] years; 210 470 non-Hispanic White individuals [60.6%]), the prevalence of maternal obesity was 30.5% (n = 106 031). Composite SMM and/or mortality outcome occurred in 5.3% of pregnancies (n = 18 398). Overweight (aRR, 1.07; 95% CI, 1.03-1.11) and obesity (class 1: aRR, 1.19 [95% CI, 1.14-1.24]; class 2: aRR, 1.37 [95% CI, 1.30-1.44]; class 3: aRR, 1.71 [95% CI, 1.63-1.80]) were associated with an elevated risk of SMM and/or mortality during pregnancy to 1 year post partum compared with healthy BMI. Similar findings were observed when the follow-up period was shortened to 42 days post partum or the delivery hospitalization. Hypertension mediated 65.1% (95% CI, 64.6%-65.6%) of the association between obesity and the primary outcome. CONCLUSIONS AND RELEVANCE Results of this study showed that maternal prepregnancy obesity was associated with an elevated risk of SMM and/or mortality. Hypertensive disorders appeared to mediate this association, suggesting that improved prevention and management of hypertensive disorders in pregnancy may reduce morbidity and mortality in individuals with obesity.
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Affiliation(s)
- Heather A. Frey
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Robert Ashmead
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University, Columbus
| | - Alyssa Farmer
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University, Columbus
| | - Yoshie H. Kim
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University, Columbus
| | - Cynthia Shellhaas
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
- Bureau of Maternal, Child and Family Health, Ohio Department of Health, Columbus
| | - Reena Oza-Frank
- Bureau of Maternal, Child and Family Health, Ohio Department of Health, Columbus
| | - Rebecca D. Jackson
- Department of Internal Medicine/Endocrinology, and Diabetes and Metabolism, The Ohio State University, Columbus
| | - Maged M. Costantine
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Courtney D. Lynch
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
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Wang L, Zhang X, Chen T, Tao J, Gao Y, Cai L, Chen H, Yu C. Association of Gestational Weight Gain With Infant Morbidity and Mortality in the United States. JAMA Netw Open 2021; 4:e2141498. [PMID: 34967878 PMCID: PMC8719246 DOI: 10.1001/jamanetworkopen.2021.41498] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE The associations of gestational weight gain (GWG) with infant morbidity and mortality are unclear, and the existing recommendations for GWG have not been stratified by the severity of obesity. OBJECTIVES To identify optimal GWG ranges associated with reduced risks of infant morbidity and mortality across maternal body mass index (BMI) categories. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used US nationwide, linked birth and infant death data between 2011 and 2015 to assess the associations of GWG in 2.0-kg groups with infant morbidity and mortality and identified optimal GWG ranges associated with reduced risks of both outcomes, using multivariable logistic regression models. Statistical analysis was performed from February 11 to October 14, 2021. EXPOSURE Gestational weight gain equivalent to 40 weeks. MAIN OUTCOMES AND MEASURES The 2 main outcomes were (1) significant morbidity of the newborn infant, defined as any presence of assisted ventilation, admission to the neonatal intensive care unit, surfactant therapy, antibiotic therapy, or seizures; and (2) infant mortality younger than 1 year of age (<1 hour, 1-23 hours, 1-6 days, 7-27 days, or 28-365 days after birth). RESULTS In this study of 15 759 945 mother-infant dyads, the mean (SD) age of the women was 28.1 (5.9) years. Women gained a mean (SD) of 14.1 (7.3) kg during pregnancy, and the mean (SD) GWG decreased with BMI categories (underweight, 15.7 [6.4] kg; normal weight, 15.4 [6.2] kg; overweight, 14.2 [7.4] kg; obesity class 1, 12.2 [8.0] kg; obesity class 2, 10.3 [8.4] kg; obesity class 3, 8.2 [9.2] kg; P < .001). A total of 8.8% of the newborns experienced significant morbidity, with the lowest prevalence among infants delivered by women in the normal weight BMI class (8.0%) and the highest among infants delivered by women with class 3 obesity (12.4%); 0.34% of infants died within 1 year of birth, with the lowest prevalence among infants delivered by women in the normal weight BMI class (0.28%) and the highest among infants delivered by women with class 3 obesity (0.58%). Optimal GWG ranges were 12.0 to less than 24.0 kg for underweight and normal weight women, 10.0 to less than 20.0 kg for overweight women, 8.0 to less than 16.0 kg for women with class 1 obesity, 6.0 to less than 16.0 kg for class 2 obesity, and 6.0 to less than 10.0 kg for class 3 obesity. The lower bounds of the optimal GWG ranges appeared to be higher than the existing recommendations for overweight women (10.0 vs 7.0 kg) and for those with class 1 (8.0 vs 5.0 kg), class 2 (6.0 vs 5.0 kg), and class 3 (6.0 vs 5.0 kg) obesity. CONCLUSIONS AND RELEVANCE This study analyzed the associations of GWG with infant morbidity and mortality across BMI categories and found that inadequate GWG was associated with increased risks of adverse infant outcomes even for women with obesity. The results suggested that weight maintenance or weight loss should not be used as routine guidelines.
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Affiliation(s)
- Lijun Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, Nanning, China
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Xiaoyu Zhang
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Tingting Chen
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Jun Tao
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Yanduo Gao
- Ultrasound Diagnosis Department, Hubei Maternal and Child Health Hospital, Wuhan, China
| | - Li Cai
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Huijun Chen
- Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Health Sciences , Wuhan University, Wuhan, China
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Contribution of Prepregnancy Obesity to Racial and Ethnic Disparities in Severe Maternal Morbidity. Obstet Gynecol 2021; 137:864-872. [PMID: 33831920 DOI: 10.1097/aog.0000000000004356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/04/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the role of prepregnancy obesity as a mediator in the association between race-ethnicity and severe maternal morbidity. METHODS We conducted an analysis on a population-based retrospective cohort study using 2010-2014 birth records linked with hospital discharge data in New York City. A multivariable logistic regression mediation model on a subgroup of the sample consisting of normal-weight and obese women (n=409,021) calculated the mediation effect of obesity in the association between maternal race-ethnicity and severe maternal morbidity, and the residual effect not mediated by obesity. A sensitivity analysis was conducted excluding the severe maternal morbidity cases due to blood transfusion. RESULTS Among 591,455 live births, we identified 15,158 cases of severe maternal morbidity (256.3/10,000 deliveries). The severe maternal morbidity rate among obese women was higher than that of normal-weight women (342 vs 216/10,000 deliveries). Black women had a severe maternal morbidity rate nearly three times higher than White women (420 vs 146/10,000 deliveries) and the severe maternal morbidity rate among Latinas was nearly twice that of White women (285/10,000 deliveries). Among women with normal or obese body mass index (BMI) only (n=409,021), Black race was strongly associated with severe maternal morbidity (adjusted odds ratio [aOR] 3.02, 95% CI 2.88-3.17) but the obesity-mediated effect represented only 3.2% of the total association (aOR 1.03, 95% CI 1.02-1.05). Latina ethnicity was also associated with severe maternal morbidity (aOR 2.01, 95% CI 1.90-2.12) and the obesity-mediated effect was similarly small: 3.4% of the total association (aOR 1.02, 95% CI 1.01-1.03). In a sensitivity analysis excluding blood transfusion, severe maternal morbidity cases found a higher mediation effect of obesity in the association with Black race and Latina ethnicity (15.3% and 15.2% of the total association, respectively). CONCLUSION Our findings indicate that prepregnancy obesity, a modifiable factor, is a limited driver of racial-ethnic disparities in overall severe maternal morbidity.
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Wang L, Chen J, Leung LT, Mai ZM, Ho SY, Lam TH, Wang MP. Characterization of Respiratory Symptoms Among Youth Using Heated Tobacco Products in Hong Kong. JAMA Netw Open 2021; 4:e2117055. [PMID: 34259848 PMCID: PMC8280960 DOI: 10.1001/jamanetworkopen.2021.17055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
IMPORTANCE Heated tobacco products (HTPs) are promoted as less harmful than combustible cigarettes but epidemiological evidence is scarce, especially in youth. OBJECTIVE To investigate the associations of persistent respiratory symptoms with HTP use, cigarette use, and dual use among Hong Kong youth. DESIGN, SETTING, AND PARTICIPANTS This was a territorywide cross-sectional school-based survey conducted from October 2018 to July 2019 using an anonymous questionnaire. Schools were randomly invited from a proportionate stratified sample in all 18 districts of Hong Kong. Poisson regression models using generalized estimating equations yielded adjusted prevalence ratios (APRs) of respiratory symptoms in (1) former and current HTP (vs never) users in the whole sample and stratified by cigarette use status and (2) exclusive HTP and dual users vs exclusive cigarette users. Statistical analysis was performed from October 2020 to March 2021. EXPOSURES Former and current use of cigarettes, HTPs, e-cigarettes, and other tobacco products. MAIN OUTCOMES AND MEASURES Respiratory symptoms for 3 consecutive months in the past 12 months. RESULTS The study included 33 627 students with a mean (SD) age of 14.8 (1.9) years; 51.3% (18 171) were boys. Respiratory symptoms were reported by 16.3% (n = 5549) of all students, 29.3% (n = 226) of current users of e-cigarettes, 31.2% (n = 314) of current users of cigarettes, and 33.5% (n = 179) of current users of HTPs. Respiratory symptoms were associated with former (APR, 1.30; 95% CI, 1.06-1.59) and current (APR, 1.59; 95% CI, 1.23-2.06) vs never HTP use and current vs never cigarette use (APR, 1.50; 95% CI, 1.30-1.74) after adjusting for various tobacco use. Associations between respiratory symptoms and current vs never HTP use were observed in never (APR, 1.88; 95% CI, 1.36-2.59) and former (APR, 2.15; 95% CI, 1.12-4.12) cigarette users, but not in current cigarette users (APR, 1.24; 95% CI, 0.97-1.59). Respiratory symptoms were associated with exclusive ever HTP use (APR, 1.46, 95% CI, 1.15-1.86) and ever dual use (APR, 1.29; 95% CI, 1.08-1.54) vs exclusive ever cigarette use. There was no association between exclusive current HTP (vs cigarette) use and respiratory symptoms (1.40; 95% CI, 0.93-2.11). CONCLUSIONS AND RELEVANCE This cross-sectional study found that former and current HTP use were associated with persistent respiratory symptoms among youth, especially among never and former cigarette users. Respiratory symptoms were more prevalent in ever exclusive HTP users and ever dual users than ever exclusive cigarette users. These findings suggest that using HTPs instead of cigarettes may not reduce health risks.
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Affiliation(s)
- Lijun Wang
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Jianjiu Chen
- School of Public Health, University of Hong Kong, Hong Kong, China
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Lok Tung Leung
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Zhi-Ming Mai
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Sai Yin Ho
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong, China
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Wende ME, Liu J, Mclain AC, Wilcox S. Gestational weight gain disparities in South Carolina: Temporal trends, 2004-2015. Paediatr Perinat Epidemiol 2021; 35:37-46. [PMID: 33196107 DOI: 10.1111/ppe.12706] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Few studies have examined secular trends in gestational weight gain (GWG) and findings are inconsistent. Parallel to increasing trends in pre-pregnancy obesity, we hypothesised similar increasing GWG trends. OBJECTIVES The study examined trends in GWG in South Carolina (SC), using methods to reduce bias. We also examined whether the 12-year trends in GWG varied according to race/ethnicity and pre-pregnancy weight. METHODS Data came from SC birth certificates, 2004 to 2015. We calculated standardised GWG z-scores (GWGZ), using smoothed reference values to account for gestational age and pre-pregnancy body mass index. Quantile regression was used to examine trends in GWGZ, adjusting for pre-pregnancy weight status, race/ethnicity, parity, WIC participation, smoking during pregnancy, residence, age, and birth cohort. RESULTS Among 615 093 women, the mean GWGZ was -0.4 (SD = 1.3), which increased from -0.4 in 2004-2005 to -0.2 in 2014-2015. GWGZ increased at the 5th, 10th, 25th, 50th, and 75th percentiles (ranging 0.04 to 0.73 units), with differential trends observed in sub-groups by pre-pregnancy weight and racial/ethnic group. Notably, non-Hispanic White women showed larger increasing trends (0.89 units) compared to non-Hispanic Black (0.55 units) and Hispanic (0.76 units) women in the 5th percentile. Decreasing trends were seen overall for the 90th (-0.02) and 95th percentile (-0.06 units) but positive trends were not seen among women experiencing obese class 1 (no change in 90th and 95th), and 2 (0.01 units in 90th, -0.02 units in 95th). CONCLUSIONS This study shows increasing GWGZ trends from the 5th to the 75th percentiles and decreasing trends in 90th and 95th percentiles in SC for the last decade. Racial/ethnic and pre-pregnancy weight disparities did not improve over the study period. Future research is needed to confirm these findings in other states and to develop strategies to narrow racial and pre-pregnancy weight disparities at the highest and lowest percentiles.
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Affiliation(s)
- Marilyn E Wende
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Jihong Liu
- Department of Epidemiology and Biostatistiscs, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Alexander C Mclain
- Department of Epidemiology and Biostatistiscs, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Sara Wilcox
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Dunton M, Inglett S, Marin T. Influences of Maternal Prepregnancy Obesity and Gestational Diabetes Mellitus on the Infant Gut Microbiome in Full-Term Infants. J Perinat Neonatal Nurs 2020; 34:251-256. [PMID: 32697545 DOI: 10.1097/jpn.0000000000000504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This review examines the current evidence of how prepregnancy obesity (PPO) and gestational diabetes mellitus (GDM) influence the newborn gut microbiome. Scientific gaps in the literature are described to guide future research in this area. The prevalence of PPO and GDM increased to 64% in the United States over the past decade. Prepregnancy obesity and GDM influence newborn gut microbiome and contribute to adverse short- and long-term outcomes in full-term infants. This review aims to discuss current research findings related to the associations between PPO and GDM, separately, and together, on infant gut microbiome outcomes, provide an overview of short-term and long-term outcomes, describe clinical relevance, and identify avenues for future scientific inquiry. This review found that PPO and GDM influence infant gut microbiomes. Infants born to women with PPO and GDM were found to have lower levels of diversity in gut microbiota than infants born to normal prepregnancy weight women and those born to women without GDM.
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Affiliation(s)
- Montana Dunton
- Departments of Biobehavioral Nursing (Ms Dunton and Dr Inglett) and Physiological and Technological Nursing (Dr Marin), Augusta University College of Nursing, Augusta, Georgia
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Rockhill KM, England LJ, Tong VT, Sharma AJ. Biochemically confirmed smoking cessation and gestational weight gain. Birth 2019; 46:326-334. [PMID: 30633363 PMCID: PMC11268955 DOI: 10.1111/birt.12414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prenatal smoking cessation has substantial health benefits for mothers and offspring, but concerns about weight gain may be a barrier to quitting. We quantified gestational weight gain associated with biochemically confirmed smoking cessation. METHODS Data originated from a randomized controlled cessation trial: Smoking Cessation in Pregnancy project (1987-1991). We calculated gestational weight gain using self-reported prepregnancy weight and measured weight at 30-34 weeks of gestation. We used linear regression to estimate adjusted mean differences in gain for quitters versus continuing smokers by the last trimester. The effects of quitting earlier (by 2nd trimester) versus later (by 3rd trimester) were calculated. We assessed the percentages who gained weight according to Institute of Medicine (IOM) recommendations within 2 weeks of a full-term delivery. RESULTS At 30-34 weeks, nulliparous and multiparous quitters gained an average of 3.0 pounds (95% CI 0.9-5.1 pounds) (1.4 kg [0.4-2.3 kg]) and 6.6 pounds (95% CI 4.3-8.9 pounds) (3.0 kg [1.9-4.0 kg]) more, respectively, than continuing smokers. Weight gain in early quitters did not differ significantly from that in late quitters. Quitters were more likely than continuing smokers to gain above current guidelines (60.3% vs 46.3%) and were less likely to gain below guidelines (11.5% vs 21.6%) (P = 0.002). CONCLUSIONS Although quitters had modest additional weight gain by 30-34 weeks compared to continuing smokers, a high proportion in both groups gained in excess of IOM recommendations. Both quitters and continuing smokers may need support to achieve optimal gestational weight gain.
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Affiliation(s)
- Karilynn M. Rockhill
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Lucinda J. England
- Division of Congenital and Developmental Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia
- U.S. Public Health Service Commissioned Corps, Atlanta, Georgia
| | - Van T. Tong
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea J. Sharma
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
- U.S. Public Health Service Commissioned Corps, Atlanta, Georgia
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