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Banack HR, Cook CE, Grandi SM, Scime NV, Andary R, Follis S, Allison M, Manson JE, Jung SY, Wild RA, Farland LV, Shadyab AH, Bea JW, Odegaard AO. The association between reproductive history and abdominal adipose tissue among postmenopausal women: results from the Women's Health Initiative. Hum Reprod 2024:deae118. [PMID: 38890130 DOI: 10.1093/humrep/deae118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 04/05/2024] [Indexed: 06/20/2024] Open
Abstract
STUDY QUESTION What is the association between reproductive health history (e.g. age at menarche, menopause, reproductive lifespan) with abdominal adiposity in postmenopausal women? SUMMARY ANSWER Higher visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) tissue levels were observed among women with earlier menarche, earlier menopause, and greater parity. WHAT IS KNOWN ALREADY Postmenopausal women are predisposed to accumulation of VAT and SAT. Reproductive health variables are known predictors of overall obesity status in women, defined by BMI. STUDY DESIGN, SIZE, DURATION This study is a secondary analysis of data collected from the baseline visit of the Women's Health Initiative (WHI). The WHI is a large prospective study of postmenopausal women, including both a randomized trial and observational study. There were 10 184 women included in this analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS Data were collected from a reproductive health history questionnaire, dual-energy x-ray absorptiometry scans, and anthropometric measures at WHI baseline. Reproductive history was measured via self-report, and included age at menarche, variables related to pregnancy, and age at menopause. Reproductive lifespan was calculated as age at menopause minus age at menarche. Statistical analyses included descriptive analyses and multivariable linear regression models to examine the association between reproductive history with VAT, SAT, total body fat, and BMI. MAIN RESULTS AND THE ROLE OF CHANCE Women who reported early menarche (<10 years) or early menopause (<40 years) had the highest levels of VAT. Adjusted multivariable linear regression results demonstrate women who experienced menarche >15 years had 23 cm2 less VAT (95% CI: -31.4, -14.4) and 47 cm2 less SAT (95% CI: -61.8, -33.4) than women who experienced menarche at age 10 years or earlier. A similar pattern was observed for age at menopause: compared to women who experienced menopause <40 years, menopause at 50-55 years was associated with 19.3 cm2 (95% CI: -25.4, -13.3) less VAT and 27.4 cm2 (-29.6, 10.3) less SAT. High parity (>3 pregnancies) was also associated with VAT and SAT. For example, adjusted beta coefficients for VAT were 8.36 (4.33, 12.4) and 17.9 (12.6, 23.2) comparing three to four pregnancies with the referent, one to two pregnancies. LIMITATIONS, REASONS FOR CAUTION The WHI reproductive health history questionnaire may be subject to poor recall owing to a long look-back window. Residual confounding may be present given lack of data on early life characteristics, such as maternal and pre-menarche characteristics. WIDER IMPLICATIONS OF THE FINDINGS This study contributes to our understanding of reproductive lifespan, including menarche and menopause, as an important predictor of late-life adiposity in women. Reproductive health has also been recognized as a sentinel marker for chronic disease in late life. Given established links between adiposity and cardiometabolic outcomes, this research has implications for future research, clinical practice, and public health policy that makes use of reproductive health history as an opportunity for chronic disease prevention. STUDY FUNDING/COMPETING INTEREST(S) HRB and AOO are supported by the National Institute of Health National Institute of Aging (R01AG055018-04). JWB reports royalties from 'ACSM'S Body Composition Assessment Book' and consulting fees from the WHI. The remaining authors have no competing interests to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Hailey R Banack
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Claire E Cook
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sonia M Grandi
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Natalie V Scime
- Department of Health & Society, University of Toronto Scarborough, Scarborough, Canada
| | - Rana Andary
- School of Medicine, University of California, Irvine, CA, USA
| | - Shawna Follis
- Stanford Prevention Research Center, School of Medicine , Stanford University, Stanford, CA, USA
| | - Matthew Allison
- Division of Preventive Medicine, Department of Family Medicine, UC San Diego, San Diego, CA, USA
| | - JoAnn E Manson
- Division of Preventive Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Su Yong Jung
- Department of Epidemiology, Fielding School of Public Health, School of Nursing, UCLA, Los Angeles, CA, USA
| | - Robert A Wild
- Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA
| | - Leslie V Farland
- Epidemiology and Biostatistics Department, University of Arizona, Tucson, AZ, USA
| | - Aladdin H Shadyab
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, Herbert Wertheim School of Public Health & Human Longevity Science, UC San Diego, San Diego, CA, USA
| | - Jennifer W Bea
- Department of Health Promotion Science, University of Arizona, Tucson, AZ, USA
| | - Andrew O Odegaard
- Division of Preventive Medicine, Department of Family Medicine, UC San Diego, San Diego, CA, USA
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Reiband HK, Klemmensen RT, Rosthøj S, Sørensen TIA, Heitmann BL. Body weight in childhood, adolescence, and young adulthood in relation to later risk of disabilities and early retirement among Danish female nurses. Int J Obes (Lond) 2024; 48:859-866. [PMID: 38356024 DOI: 10.1038/s41366-024-01487-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 12/01/2023] [Accepted: 01/26/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Obesity is now the most common health problem in the younger population in Western societies and obesity rates are higher in lower socioeconomic status (SES) groups. We investigated whether overweight in childhood, independently of overweight in adulthood, influenced adult employment status and later risk of having disabilities. Using data from the Danish Female Nurse Cohort study, we examined associations between overweight in childhood/adolescence, and young adulthood and disabilities and early retirement in later adulthood (>44 years) and whether it was influenced by menopausal age ( RESULTS Our results showed that overweight in childhood, adolescence and young adulthood was associated with an increased risk of disabilities and early retirement. Especially childhood overweight that did not persist into adulthood was associated with an increased risk of disabilities (OR = 1.82, 95% CI = 1.26-2.63) and early retirement (OR = 2.05, 95% CI = 1.38-3.03) in the postmenopausal group. A similar increased risk for disabilities (OR = 1.76, 95% CI = 1.26-2.47) was seen for adolescent overweight that did not persist into adulthood. CONCLUSION The results show that in a well-educated population of women, overweight in childhood and/or adolescence had adverse socioeconomic consequences for later risk of disabilities and early retirement irrespective of weight status in adulthood.
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Affiliation(s)
- Hanna Kruse Reiband
- The Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark.
| | - Rikke Tannenberg Klemmensen
- The Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Susanne Rosthøj
- The Danish Cancer Institute, Research Centre, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thorkild I A Sørensen
- Center for Childhood Health, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- NNF Centre for Basic Metabolic Health, University of Copenhagen, Copenhagen, Denmark
| | - Berit Lilienthal Heitmann
- The Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
- Department of Public Health, Section for general Practise, Faculty of Health and Medical Sciences University of Copenhagen, Copenhagen, Denmark
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Del Bianco T, Lockwood Estrin G, Tillmann J, Oakley BF, Crawley D, San José Cáceres A, Hayward H, Potter M, Mackay W, Smit P, du Plessis C, Brink L, Springer P, Odendaal H, Charman T, Banaschewski T, Baron-Cohen S, Bölte S, Johnson M, Murphy D, Buitelaar J, Loth E, Jones EJ. Mapping the link between socio-economic factors, autistic traits and mental health across different settings. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1280-1296. [PMID: 37822256 DOI: 10.1177/13623613231200297] [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: 10/13/2023]
Abstract
LAY ABSTRACT Autistic individuals are more likely than non-autistic individuals to experience a mental health condition in their lifetime, and this includes externalising and internalising symptoms. We know very little about how different environments and family conditions impact these symptoms for autistic individuals. Improving our understanding of these relationships is important so that we can identify individuals who may be in greater need of support. In this article, we seek to improve our understanding of how environmental and family conditions impact externalising and internalising symptoms in autistic and non-autistic people. To do this, we conducted analyses with two cohorts in very different settings - in Europe and South Africa - to ensure our findings are globally representative. We used advanced statistical methods to establish environmental and family conditions that were similar to each other, and which could be combined into specific 'factors'. We found that four similar 'factors' could be identified in the two cohorts. These were distinguished by personal characteristics and environmental conditions of individuals, and were named Person Characteristics, Family System, Parental and Material Resources. Interestingly, just 'Family System' was associated with internalising and externalising symptoms, and this was the same in both cohorts. We also found that having high traits of autism impacted this relationship between Family System and mental health conditions with opposite directions in the two settings. These results show that characteristics in the Family System are associated with internalising and externalising symptoms, and autistic persons are particularly impacted, reinforcing the notion that family stressors are important to consider when implementing policy and practice related to improving the mental health of autistic people.
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Affiliation(s)
| | | | - Julian Tillmann
- King's College London, UK
- F. Hoffmann-La Roche AG, Switzerland
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Taastrøm K, Kjeldsen AC, Hjorth S, Gommesen D, Axelsen SM, Nohr EA. Urinary Incontinence in Midlife According to Weight Changes Across and After Childbearing Years. Int Urogynecol J 2024; 35:579-588. [PMID: 38214717 PMCID: PMC11024002 DOI: 10.1007/s00192-023-05713-z] [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: 08/29/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to investigate how weight change across and after the childbearing years was associated with urinary incontinence (UI) in midlife. METHODS Data were obtained from 35,645 women responding to the Maternal Follow-up questionnaire in the Danish National Birth Cohort in 2013-2014. Outcome was self-reported UI and its subtypes. Exposures were changes in body mass index (BMI) across and after the childbearing years. Adjusted odds ratios were estimated using logistic regression. RESULTS At follow-up, the mean age was 44 years and 32% experienced UI. Compared with stable weight, weight gain across the childbearing years of > 1 to 3, > 3 to 5 or > 5 BMI units increased the odds of any UI by 15%, 27%, and 41% respectively. For mixed UI, the odds increased by 23%, 41%, and 68% in these groups. Weight gain after childbearing showed the same pattern, but with a higher increase in the odds of mixed UI (25%, 60%, and 95% in the respective groups). Women with any weight loss during this period had 9% lower odds of any UI than women with a stable weight. CONCLUSIONS Weight gain across and after childbearing increased the risk of UI in midlife, especially the subtype mixed UI. Weight loss after childbearing decreased the risk.
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Affiliation(s)
- Katja Taastrøm
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Anne Cathrine Kjeldsen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sarah Hjorth
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ditte Gommesen
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Susanne M Axelsen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Ellen A Nohr
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Urbute A, Frederiksen K, Thomsen LT, Kesmodel US, Kjaer SK. Overweight and obesity as risk factors for cervical cancer and detection of precancers among screened women: A nationwide, population-based cohort study. Gynecol Oncol 2024; 181:20-27. [PMID: 38103421 DOI: 10.1016/j.ygyno.2023.12.002] [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: 06/01/2023] [Revised: 11/22/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE Obesity is a known risk factor for many types of cancer. However, there is no clear evidence whether overweight and obesity increases the risk of cervical cancer. We investigated the association between body mass index (BMI) and detection of squamous and glandular cervical cancer and precancer. METHODS Based on the Medical Birth Registry, we conducted a nationwide cohort study in Denmark of 384,559 women with BMI ≥18.5 kg/m2 (pre-pregnancy BMI reported at the start of the pregnancy) having a cervical cytology screening at age 23-49 years within 5 years following the date of childbirth. The cohort was followed for 10 years from the first cervical cytology screening after the childbirth. We assessed absolute risks of cervical lesions according to BMI with the Aalen-Johansen estimator. We conducted Cox proportional hazards regression analyses to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). Analyses were adjusted for age, calendar year, parity, oral contraception use, HPV vaccination, smoking, country of origin, and education. RESULTS Overweight and obesity were associated with higher rates of cervical cancer (HR = 1.24, 95% CI 1.04-1.49 and HR = 1.14, 95% CI 0.91-1.43, respectively) and lower rates of cervical precancer detection (HR = 0.88, 95% CI 0.84-0.92 and HR = 0.67, 95% CI 0.63-0.71, respectively). CONCLUSIONS Higher than normal BMI was associated with higher incidence rates of cervical cancer and lower rates of precancer detection, emphasizing the importance of further research in possible mechanisms behind this association.
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Affiliation(s)
- Aivara Urbute
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Strandboulevarden 49, Copenhagen, Denmark
| | - Kirsten Frederiksen
- Statistics and Data analysis, Danish Cancer Institute, Strandboulevarden 49, Copenhagen, Denmark
| | - Louise T Thomsen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Strandboulevarden 49, Copenhagen, Denmark
| | - Ulrik Schiøler Kesmodel
- Department of Obstetrics and Gynecology, Aalborg University Hospital, and Department of Clinical Medicine, Aalborg University, Reberbansgade 9, Aalborg, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Strandboulevarden 49, Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark.
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Drzymalla E, Crider KS, Wang A, Marta G, Khoury MJ, Rasooly D. Epigenome-wide association studies of prenatal maternal mental health and infant epigenetic profiles: a systematic review. Transl Psychiatry 2023; 13:377. [PMID: 38062042 PMCID: PMC10703876 DOI: 10.1038/s41398-023-02620-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 10/01/2023] [Accepted: 10/06/2023] [Indexed: 12/18/2023] Open
Abstract
Prenatal stress and poor maternal mental health are associated with adverse offspring outcomes; however, the biological mechanisms are unknown. Epigenetic modification has linked maternal health with offspring development. Epigenome-wide association studies (EWAS) have examined offspring DNA methylation profiles for association with prenatal maternal mental health to elucidate mechanisms of these complex relationships. The objective of this study is to provide a comprehensive, systematic review of EWASs of infant epigenetic profiles and prenatal maternal anxiety, depression, or depression treatment. We conducted a systematic literature search following PRISMA guidelines for EWAS studies between prenatal maternal mental health and infant epigenetics through May 22, 2023. Of 645 identified articles, 20 fulfilled inclusion criteria. We assessed replication of CpG sites among studies, conducted gene enrichment analysis, and evaluated the articles for quality and risk of bias. We found one repeated CpG site among the maternal depression studies; however, nine pairs of overlapping differentially methylatd regions were reported in at least two maternal depression studies. Gene enrichment analysis found significant pathways for maternal depression but not for any other maternal mental health category. We found evidence that these EWAS present a medium to high risk of bias. Exposure to prenatal maternal depression and anxiety or treatment for such was not consistently associated with epigenetic changes in infants in this systematic review and meta-analysis. Small sample size, potential bias due to exposure misclassification and statistical challenges are critical to address in future efforts to explore epigenetic modification as a potential mechanism by which prenatal exposure to maternal mental health disorders leads to adverse infant outcomes.
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Affiliation(s)
- Emily Drzymalla
- Division of Blood Disorders and Public Health Genomics, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Krista S Crider
- Infant Outcomes Research and Prevention Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Arick Wang
- Infant Outcomes Research and Prevention Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Muin J Khoury
- Division of Blood Disorders and Public Health Genomics, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Danielle Rasooly
- Division of Blood Disorders and Public Health Genomics, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Clapp MA. Examining long-term health impacts of multiparity. Menopause 2023; 30:690-691. [PMID: 37253214 DOI: 10.1097/gme.0000000000002205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Mark A Clapp
- From the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA
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Tatah L, Bain LE, Kongnyuy E, Assah F, Mbanya JC. Shared correlates of maternal and childhood overweight in Cameroon: a cross-sectional analysis of demographic and health survey data. BMC Public Health 2023; 23:1265. [PMID: 37386386 PMCID: PMC10311895 DOI: 10.1186/s12889-023-16164-y] [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: 10/03/2022] [Accepted: 06/21/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Overweight parents are likelier to bear overweight babies, who are likelier to grow into overweight adults. Understanding the shared risks of being overweight between the mother-child dyad is essential for targeted life course interventions. In this study, we aimed to identify such risk factors in Cameroon. METHODS We conducted secondary data analysis using Cameroon's 2018 Demographic and Health Surveys. We used weighted multilevel binary logistic regressions to examine individual, household, and community correlates of maternal (15-49 years) and child (under five years) overweight. RESULTS We retained 4511 complete records for childhood and 4644 for maternal analysis. We found that 37% [95%CI:36-38%] of mothers and 12% [95%CI:11-13%] of children were overweight or obese. Many environmental and sociodemographic factors were positively associated with maternal overweight, namely urban residence, wealthier households, higher education, parity and being a Christian. Childhood overweight was positively associated with a child being older and a mother being overweight, a worker, or a Christian. Therefore, only religion affected both mothers overweight (aOR: 0.71[95%CI:0.56-0.91]) and childhood overweight (aOR 0.67[95%CI: 0.5-0.91]). Most of the potentially shared factors only indirectly affected childhood overweight through maternal overweight. CONCLUSION Besides religion, which affects both mothers and childhood overweight (with the Muslim faith being protective), much of childhood overweight is not directly explained by many of the observed determinants of maternal overweight. These determinants are likely to influence childhood overweight indirectly through maternal overweight. Extending this analysis to include unobserved correlates such as physical activity, dietary, and genetic characteristics would produce a more comprehensive picture of shared mother-child overweight correlates.
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Affiliation(s)
- Lambed Tatah
- Health of Populations in Transition Research Group (HoPiT), University of Yaoundé I, 8046, Yaoundé, Cameroon
- Medical Research Council Epidemiology Unit, University of Cambridge, CB2 0QQ, Cambridge, UK
| | - Luchuo Engelbert Bain
- Department of Psychology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
- International Development Research Centre, IDRC, Ottawa, ON, Canada
| | | | - Felix Assah
- Health of Populations in Transition Research Group (HoPiT), University of Yaoundé I, 8046, Yaoundé, Cameroon
| | - Jean Claude Mbanya
- Health of Populations in Transition Research Group (HoPiT), University of Yaoundé I, 8046, Yaoundé, Cameroon
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Skajaa GØ, Kampmann U, Ovesen PG, Fuglsang J. Breastfeeding and insulin requirements in women with Type 1 diabetes mellitus in the first year postpartum. Acta Diabetol 2023; 60:899-906. [PMID: 36991223 DOI: 10.1007/s00592-023-02068-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/28/2023] [Indexed: 03/31/2023]
Abstract
AIMS To explore whether breastfeeding affects postpartum insulin requirements, HbA1c levels, and pregnancy weight retention in women with Type 1 Diabetes Mellitus (T1DM). METHODS This prospective study included 66 women with T1DM. The women were divided into two groups based on whether they were breastfeeding (BF) at 6 months postpartum (BFyes, n = 32) or not (BFno, n = 34). Mean daily insulin requirement (MDIR), HbA1c levels, and pregnancy weight retention at 5 time-points from discharge to 12 months postpartum were compared. RESULTS MDIR increased by 35% from 35.7 IU at discharge to 48.1 IU at 12 months postpartum (p < 0.001). MDIR in BFyes and BFno were comparable, however in BFyes, MDIR were continuously lower compared to BFno. Postpartum HbA1c increased rapidly from 6.8% at 1 month to 7.4% at 3 months postpartum and settled at 7.5% at 12 months postpartum. The increase in HbA1c during the first 3 months postpartum was most pronounced in BFno (p < 0.001). Although neither were statistically significant, from 3 months postpartum HbA1c levels were highest in the BFno and BFno had a higher pregnancy weight retention compared to BFyes (p = 0.31). CONCLUSION In women with T1DM, breastfeeding did not significantly affect postpartum insulin requirements, HbA1c levels or pregnancy weight retention in the first year after delivery.
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Affiliation(s)
- Gitte Øskov Skajaa
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8210, Aarhus, Denmark.
| | - Ulla Kampmann
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Per Glud Ovesen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8210, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Fuglsang
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8210, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
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Sørensen SM, Urbute A, Frederiksen K, Kjaer SK. Prepregnancy Body Mass Index and Risk of Differentiated Thyroid Cancer: A Prospective Cohort Study of More than 440,000 Danish Women. Thyroid 2023; 33:365-372. [PMID: 36173097 DOI: 10.1089/thy.2022.0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: High body mass index (BMI) has previously been associated with increased risk of differentiated thyroid cancer (DTC); however, only few studies have investigated the association with BMI in a large cohort assessed at a young age and with sufficient data on confounding factors. We assessed the association between excess body weight and the risk of DTC and papillary thyroid cancer (PTC) in a large cohort of young Danish women with substantial confounder control. Methods: We included all parous Danish women registered with a prepregnancy BMI ≥18.5 kg/m2 during 2004-2016 in the Danish Medical Birth Registry in the study population. Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) with confidence intervals (CIs) of DTC according to BMI. In subanalyses, we investigated PTC as a separate group. Analyses were adjusted for calendar time, education, smoking status, benign thyroid disease (BTD), type II diabetes, parity, and oral contraceptive use. In addition, we examined the association with increasing BMI stratified for previous BTD. Results: A total of 443,403 women were included in the study population, and the median age at baseline was 30.0 years. Altogether, 463 women were diagnosed with DTC during follow-up. Excess body weight was associated with a higher rate of DTC (overweight, BMI 25-29.9 kg/m2: HR = 1.54; CI 1.25-1.90. Obese, BMI ≥30 kg/m2: HR = 1.32; CI 1.00-1.75) compared with normal weight. Results were similar in PTC. In addition, we found an increased rate of DTC with increasing BMI, when investigating BMI as a continuous variable per 5 kg/m2 increase (HR = 1.17; CI 1.07-1.27). The results were similar in women without previous BTD. Conclusions: Our study confirms that excess body weight is associated with an increased incidence of DTC and PTC in women.
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Affiliation(s)
- Sarah M Sørensen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Aivara Urbute
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kirsten Frederiksen
- Unit of Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Scheuer CM, Andersen MH, Mathiesen ER, Ringholm L, Müller CL, Truong JM, Lie-Olesen MM, Overgaard M, McIntyre HD, Jensen DM, Damm P, Clausen TD. Regional divergence and time trends in the prevalence of gestational diabetes mellitus: a national Danish cohort study. Acta Diabetol 2023; 60:379-386. [PMID: 36539623 PMCID: PMC9931790 DOI: 10.1007/s00592-022-02013-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
AIMS To evaluate the prevalence and time trends of gestational diabetes mellitus (GDM) across the five regions of Denmark with uniform national guidelines for screening and diagnosing GDM. METHODS This register-based national cohort study included 287,684 births from 2013 to 2017. Trends in GDM prevalence over time and differences between the five regions were evaluated. Crude and adjusted odd ratios (ORs) for GDM were calculated including potential confounding clinical risk factors as age, BMI, educational level, marital status, parity, country of origin and assisted reproduction. RESULTS From 2013 to 2017, GDM prevalence in Denmark increased by 7% per year (OR 1.07, 95% CI 1.06-1.09, P < 0.001). GDM prevalence varied considerably between regions and ranged from 3.0 to 5.9% in 2017, corresponding to a maximal regional difference of 97%. In crude analyses, the risk of GDM in 2017 was significantly different in four of five regions compared to the remaining regions (OR ranging from 0.60 to 1.55), and these differences persisted after adjusting for confounding clinical risk factors (adjusted OR: 0.59-1.45). CONCLUSION The prevalence of GDM increased over time in all Danish regions with substantial regional divergence. Up to a 97%, difference in GDM prevalence was observed between Danish regions, which was not explained by available clinical risk factors. This occurred despite national guidelines and raises the question of whether regional variations in screening efficacy, diagnostic procedures or inequality in clinical health care access may explain the observed differences.
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Affiliation(s)
- Cathrine M Scheuer
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark.
| | - Maria H Andersen
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | - Elisabeth R Mathiesen
- Department of Endocrinology and Metabolism, Center for Pregnant Women with Diabetes, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Ringholm
- Department of Endocrinology and Metabolism, Center for Pregnant Women with Diabetes, Copenhagen, Denmark
| | - Clara L Müller
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | - Jun-Mei Truong
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | | | - Martin Overgaard
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - H David McIntyre
- Mater Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Dorte M Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Peter Damm
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
| | - Tine D Clausen
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Taha Z, El Ktaibi F, Al Dhaheri AI, Papandreou D, Ali Hassan A. Prevalence and Sociodemographic Profiles of Grand Multipara in Abu Dhabi, United Arab Emirates. Nutrients 2022; 14:4686. [PMID: 36364947 PMCID: PMC9654687 DOI: 10.3390/nu14214686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 09/29/2023] Open
Abstract
The literature shows that grand multipara mothers are major contributors to poor maternal and perinatal health compared to multipara mothers. Data regarding parity profiles are essential, especially in rapidly transforming countries such as the United Arab Emirates (UAE). This study aimed to investigate the prevalence and factors associated with multipara mothers compared to multipara mothers in Abu Dhabi, UAE. The data were collected from seven health care centers located in Abu Dhabi.From1818 enrolled mothers, the prevalence of grand multipara was 135(7.4%, 95% Confidence Interval (CI) = 7.2, 7.6). In logistic regression analysis, factors associated positively with grand multipara were a higher maternal age (Adjusted Odd Ratio (AOR) = 1.28, 95% CI = 1.21, 1.34), Arab mothers (AOR = 5.66, 95% CI 2.81, 11.40), overweight pre-pregnancy (AOR = 2.01, 95% CI = 1.26, 3.21), and limited family support for breastfeeding (AOR = 2.05, 95% CI = 1.21, 3.50). The prevalence of grand multipara was low compared to previous researching the UAE. Sociodemographic factors were more prominent and associated with grand multipara mothers compared to obstetrical ones. Therefore, more programs (nutritional, physical activities, and psychosocial) are needed to improve maternal and perinatal health to support grand multipara mothers. Further, research is required to explore the difference in parity based on nationalities, especially from a sociocultural point of view.
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Affiliation(s)
- Zainab Taha
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi P.O. Box 144534, United Arab Emirates
| | - Farid El Ktaibi
- Department of Mathematics and Statistics, College of Natural and Health Sciences, Zayed University, Abu Dhabi P.O. Box 144534, United Arab Emirates
| | - Aysha Ibrahim Al Dhaheri
- Institute of Public Health, College of Medicine & Health Science, Abu Dhabi P.O. Box 15551, United Arab Emirates
| | - Dimitrios Papandreou
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi P.O. Box 144534, United Arab Emirates
| | - Ahmed Ali Hassan
- Department of Research, Taami for Agricultural and Animal Production, Khartoum, Sudan
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Women with obesity participate less in cervical cancer screening and are more likely to have unsatisfactory smears: Results from a nationwide Danish cohort study. Prev Med 2022; 159:107072. [PMID: 35460722 DOI: 10.1016/j.ypmed.2022.107072] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/22/2022] [Accepted: 04/18/2022] [Indexed: 11/21/2022]
Abstract
Some studies found an association between obesity and increased cervical cancer risk, but potential mechanisms are unknown. In this nationwide register-based cohort study, we investigated the association between overweight/obesity and cervical cancer screening participation and risk of unsatisfactory smears. The study population was identified in the Danish Medical Birth Registry. We included 342,526 women aged 23-49 years with pre-pregnancy body mass index (BMI) registered during 2004-2013. Screening participation and unsatisfactory smears during up to four years after child birth were identified in a nationwide pathology register. We used absolute risk regression to estimate the relative absolute risk (RAR) with 95% confidence intervals (CIs) of screening participation according to BMI, adjusted for age, calendar year, sociodemographic characteristics, parity and previous high-grade cervical intraepithelial neoplasia. Among those who were screened (n = 295,482), we used log-binomial regression to investigate the relative risk (RR) of an unsatisfactory smear according to BMI, adjusted for age, year, parity, oral contraceptive use and pathology department. A lower proportion of obese women (79.3%) than women of normal weight (85.8%) were screened, and obese women had lower adjusted probability of being screened than women of normal weight (RARadjusted = 0.94, 95% CI, 0.93-0.95). A higher proportion of obese women (2.4%) than women of normal weight (1.7%) had an unsatisfactory smear, and this association remained after adjustments (RRadjusted = 1.28, 95% CI, 1.19-1.38). In conclusion, women with obesity were less likely to participate in cervical cancer screening and more likely to have an unsatisfactory smear than women of normal weight.
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Simmons SS, Hagan JE, Schack T. Then and Now: Investigating Anthropometrics and Child Mortality among Females in Malawi. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106171. [PMID: 35627708 PMCID: PMC9140720 DOI: 10.3390/ijerph19106171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Abstract
Information on the concentration of body mass index and child death among females in Malawi, where the epidemics of weight gain have been disconcerting and preventable deaths among children linger, is limited. Therefore, the study examined the polarity of body mass index and the death of children among females. Using data from the Malawian Demographic and Health Survey from 2000 to 2015–2016, the study applied for the first time the index of concentration at the extremes and indirect demographic techniques to estimate the polarity of body mass index and child mortality among 65,499 females aged 15 to 49 years. The preponderance of obesity more than doubled from 2000 to 2015–2016 and was highest among females who were older (35–49 years), urban dwellers, rich, and located in districts within the central and southern regions. In addition, child survival was low among underweight, overweight, and obese females. While national-, regional-, and individual-level statistics are in development, these findings provide helpful information for health experts and other stakeholders to initiate appropriate age-region specific programs and interventions in Malawi, including targeting females in the high socio-economic bracket.
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Affiliation(s)
- Sally Sonia Simmons
- Department of Social Policy, London School of Economics and Political Science, London WC2A 2AE, UK;
- Institute of Demography, National Research University-Higher School of Economics, 101000 Moscow, Russia
| | - John Elvis Hagan
- Department of Health, Physical Education & Recreation, College of Education Studies, University of Cape Coast, Cape Coast PMB TF0494, Ghana
- Neurocognition and Action Research Group—Biomechanics, Faculty of Psychology & Sport Sciences/CITEC, Bielefeld University, Postfach 10 01 31, 33501 Bielefeld, Germany;
- Correspondence:
| | - Thomas Schack
- Neurocognition and Action Research Group—Biomechanics, Faculty of Psychology & Sport Sciences/CITEC, Bielefeld University, Postfach 10 01 31, 33501 Bielefeld, Germany;
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Human Milk Oligosaccharides and Bacterial Profile Modulate Infant Body Composition during Exclusive Breastfeeding. Int J Mol Sci 2022; 23:ijms23052865. [PMID: 35270006 PMCID: PMC8911220 DOI: 10.3390/ijms23052865] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 02/06/2023] Open
Abstract
Human milk is a complex and variable ecosystem fundamental to the development of newborns. This study aimed to investigate relationships between human milk oligosaccharides (HMO) and human milk bacterial profiles and infant body composition. Human milk samples (n = 60) were collected at two months postpartum. Infant and maternal body composition was measured with bioimpedance spectroscopy. Human milk bacterial profiles were assessed using full-length 16S rRNA gene sequencing and 19 HMOs were quantitated using high-performance liquid chromatography. Relative abundance of human milk bacterial taxa were significantly associated with concentrations of several fucosylated and sialylated HMOs. Individual human milk bacteria and HMO intakes and concentrations were also significantly associated with infant anthropometry, fat-free mass, and adiposity. Furthermore, when data were stratified based on maternal secretor status, some of these relationships differed significantly among infants born to secretor vs non-secretor mothers. In conclusion, in this pilot study the human milk bacterial profile and HMO intakes and concentrations were significantly associated with infant body composition, with associations modified by secretor status. Future research designed to increase the understanding of the mechanisms by which HMO and human milk bacteria modulate infant body composition should include intakes in addition to concentrations.
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16
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Ziauddeen N, Huang JY, Taylor E, Roderick PJ, Godfrey KM, Alwan NA. Interpregnancy weight gain and childhood obesity: analysis of a UK population-based cohort. Int J Obes (Lond) 2022; 46:211-219. [PMID: 34645936 PMCID: PMC8748200 DOI: 10.1038/s41366-021-00979-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 09/20/2021] [Accepted: 09/29/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Maternal obesity increases the risk of adverse long-term health outcomes in mother and child including childhood obesity. We aimed to investigate the association between interpregnancy weight gain between first and second pregnancies and risk of overweight and obesity in the second child. METHODS We analysed the healthcare records of 4789 women in Hampshire, UK with their first two singleton live births within a population-based anonymised linked cohort of routine antenatal records (August 2004 and August 2014) with birth/early life data for their children. Measured maternal weight and reported height were recorded at the first antenatal appointment of each pregnancy. Measured child height and weight at 4-5 years were converted to age- and sex-adjusted body mass index (BMI z-score). Log-binomial regression was used to examine the association between maternal interpregnancy weight gain and risk of childhood overweight and obesity in the second child. This was analysed first in the whole sample and then stratified by baseline maternal BMI category. RESULTS The prevalence of overweight/obesity in the second child was 19.1% in women who remained weight stable, compared with 28.3% in women with ≥3 kg/m2 weight gain. Interpregnancy gain of ≥3 kg/m2 was associated with increased risk of childhood overweight/obesity (adjusted relative risk (95% CI) 1.17 (1.02-1.34)), with attenuation on adjusting for birthweight of the second child (1.08 (0.94-1.24)). In women within the normal weight range at first pregnancy, the risks of childhood obesity (≥95th centile) were increased with gains of 1-3 kg/m2 (1.74 (1.07-2.83)) and ≥3 kg/m2 (1.87 (1.18-3.01)). CONCLUSION Children of mothers within the normal weight range in their first pregnancy who started their second pregnancy with a considerably higher weight were more likely to have obesity at 4-5 years. Supporting return to pre-pregnancy weight and limiting weight gain between pregnancies may achieve better long-term maternal and offspring outcomes.
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Affiliation(s)
- Nida Ziauddeen
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK.
- NIHR Applied Research Collaboration Wessex, Southampton, UK.
| | - Jonathan Y Huang
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Elizabeth Taylor
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul J Roderick
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Keith M Godfrey
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Nisreen A Alwan
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK.
- NIHR Applied Research Collaboration Wessex, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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Vázquez-Osorio IM, Vega-Sánchez R, Maas-Mendoza E, Heller Rouassant S, Flores-Quijano ME. Exclusive Breastfeeding and Factors Influencing Its Abandonment During the 1st Month Postpartum Among Women From Semi-rural Communities in Southeast Mexico. Front Pediatr 2022; 10:826295. [PMID: 35252066 PMCID: PMC8894443 DOI: 10.3389/fped.2022.826295] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/24/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION In this study we describe breastfeeding practices among women from semi-rural communities in southeast Mexico, and explore which factors, modifiable or not, are associated with such practices. MATERIALS AND METHODS This was a formative cross-sectional study that included 143 mothers with infants 4-6 months old, from semi-rural communities in Tabasco, Mexico. We collected data on two categories of factors: (1) women's sociodemographic characteristics, and (2) maternal / infant factors. We first analyzed the frequency of various breastfeeding practices. Then, we classified participants into the up to 1 month of exclusive breastfeeding group ( ≤ 1 m-EBF) and the beyond 1 month EBF group (>1 m-EBF), if they practiced EBF for less or more than 1 month, respectively. We compared the two categories of factors between groups and then, using logistic regression models, explored which factors were associated with practicing >1 m-EBF. RESULTS By the end of the 1st month postpartum, 51.7% of participants had abandoned EBF, introduced milk formula (35%), other food (9.1%), non-nutritive liquids (7.7%), or had stopped breastfeeding completely. In the next months, EBF practice fell sharply and mixed feeding grew importantly.Logistic regression models showed that women were more likely to be in the >1 m-EBF group if they lived with the baby's father, had complications during pregnancy, delivered vaginally and attended a health center at least three times postpartum. To the contrary, women were less likely to be practice >1 m-EBF if they gave infants other liquids during their hospital stay; experienced pain or discomfort in breasts/nipples, or used a pacifier after hospitalization; had larger bodies (i.e., higher BMI); and believed that you should give the infant powdered milk or some other food when the baby is not full. CONCLUSION Many factors associated with abandoning EBF, particularly in the early postpartum period, are modifiable and can be altered through timely interventions that include giving correct information and ensuring its comprehension; assertive personal counseling and accompaniment must be provided to mothers; and reinforcement during the early postpartum at health facilities and other settings.
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Affiliation(s)
- Inocente Manuel Vázquez-Osorio
- Licenciatura de Nutrición, División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Mexico.,Jurisdicción Sanitaria 4 del Municipio de Centro, Secretaría de Salud, Villahermosa, Mexico
| | - Rodrigo Vega-Sánchez
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Eric Maas-Mendoza
- Licenciatura de Nutrición, División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Mexico
| | - Solange Heller Rouassant
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Mexico City, Mexico.,Private Practitioner, Naucalpan, Estado de México, Mexico, Mexico
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18
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Wu B, Luo S, Xu C, Yang T, Chen Y. Influence factors for upper respiratory tract infection in Chinese rural children: A cross-sectional study. Front Pediatr 2022; 10:954363. [PMID: 36568418 PMCID: PMC9768359 DOI: 10.3389/fped.2022.954363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022] Open
Abstract
AIM The prevalence rate of upper respiratory tract infection (URTI) is high in children. Influencing factors for URTI have been reported in Chinese urban children, but those have not been explored in rural children. In China, children in the rural areas are a disadvantaged group. Therefore, this study aims to explore influencing factors for URTI in Chinese rural children. METHODS This is a cross-sectional study based on the 1991-2015 China Health and Nutrition Survey (CHNS). In total, 5,289 children were eligible for the analysis, including 3,684 rural children and 1,605 urban children. The generalized estimating equation was used to determine the influencing factors, and results were expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs). RESULTS The results showed that rural children aged 7-12 and 13-17 years had lower odds of URTI than those aged 0-1 year, with OR value of 0.17 (95% CI, 0.11-0.27) and 0.12 (95% CI, 0.08-0.19), respectively. Compared with uneducated mothers, those with education level of primary school (OR: 0.59, 95% CI, 0.42-0.84), lower middle school (OR: 0.53, 95% CI, 0.38-0.73), and upper middle school and technical school (OR: 0.62, 95% CI, 0.40-0.95) were associated with the lower odds of URTI in rural children. Children, whose mothers were office workers, had 46% lower odds of URTI than those with farmer mothers (OR: 0.54, 95% CI, 0.34-0.84). CONCLUSIONS This study found that mother's education level, children's age, and mother's occupation were significant influencing factors for URTI, which suggested the importance to improve mother's health-related knowledge and working conditions in Chinese rural areas.
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Affiliation(s)
- Bichen Wu
- Respiratory Department, Hunan Children's Hospital, Changsha, China
| | - Shujuan Luo
- Respiratory Department, Hunan Children's Hospital, Changsha, China
| | - Chang Xu
- Respiratory Department, Hunan Children's Hospital, Changsha, China
| | - Ting Yang
- Respiratory Department, Hunan Children's Hospital, Changsha, China
| | - Yanping Chen
- Respiratory Department, Hunan Children's Hospital, Changsha, China
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Association of ADIPOQ-rs2241766 and FTO-rs9939609 genetic variants with body mass index trajectory in women of reproductive age over 6 years of follow-up: the PREDI study. Eur J Clin Nutr 2022; 76:159-172. [PMID: 33850313 DOI: 10.1038/s41430-021-00911-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/12/2021] [Accepted: 03/26/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Interindividual variations in body mass index (BMI) can be partially explained by genetic differences. We aimed to examine the association of the ADIPOQ-rs2241766, LEP-rs7799039 and FTO-rs9939609 genetic variants with BMI trajectory in women of reproductive age over 6 years of follow-up. METHODS This was a prospective study that used data from 435 women of the PREDI Study conducted in Brazil. Socioeconomic, biological and anthropometric data were collected at four time points: 2012 (baseline) in the maternity hospital, and 2013-14, 2016-17 and 2018 (1st, 2nd and 3rd follow-ups) at the participant's home. Genotyping was performed by PCR-RFLP. Linear mixed-effect and Poisson regression models were used to address the association of ADIPOQ, LEP and FTO genotypes with BMI and overweight/obesity status. RESULTS Women carrying the risk allele (TA or AA) of the FTO-rs9939609 genetic variant had a 1.16 kg/m2 higher BMI over the follow-up period than those carrying the wild-type genotype (TT), even when adjusted for potential confounders (95% CI: 0.23-2.10, p = 0.015). The risk of obesity associated with the FTO-TA or AA genotype decreased over the years, demonstrating an influence of time on its trajectory (IRR = 0.99, 95% CI: 0.98-0.99, p = 0.016). There was no variation in BMI trajectories for the ADIPOQ-rs2241766, LEP-rs7799039 or FTO-rs9939609 genetic variant. CONCLUSIONS The results of this study suggest that monitoring women of reproductive age with ADIPOQ-rs2241766 TG/GG or FTO-rs9939609 TA/AA genotypes may be an important strategy to reduce maternal excess body weight and, consequently, the long-term public health burden of obesity.
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Jensen SD, Andreassen P, Knorr S, Rasmussen L, Ovesen P, Kampmann U, Bruun JM. Ambivalence and moral dilemmas in women's lived experiences of obesity and pregnancy: Qualitative insights for maternal lifestyle interventions. Scand J Caring Sci 2021; 36:416-425. [PMID: 34877704 DOI: 10.1111/scs.13052] [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: 07/01/2021] [Revised: 11/12/2021] [Accepted: 11/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Maternal obesity is a global health concern that is associated with significant effects on both short- and long-term health of both mother and child. However, maternal lifestyle interventions tend to focus solely on diet and physical activity in ways that disembody and disengage the social context in which women live their lives. AIMS The aim of this study was to explore the lived experiences of maternal obesity and delve into how experiences of the body and motherhood affect women's motivation for participating in a postpartum lifestyle intervention. METHOD A qualitative study using in-depth semi-structured interviews based on participant-generated photographs was used to allow the women to openly express their lived experiences of maternal obesity. The study emanated from a gynaecological department of a major Danish hospital, and five pregnant or postpartum women living with obesity participated. Interviews were audio recorded, transcribed and analysed using an Interpretive Phenomenological Approach. RESULTS The analysis identified an overall theme of ambivalence and four subthemes among the participating women. The themes reflected contrasting feelings where the obese body was simultaneously an arena for aesthetic failure, functional success and moral dilemmas. Experiences of weight stigma and moral accusations in healthcare settings further increased the women's sense of ambivalence and challenged their strong desire to lose weight. CONCLUSION This study highlights an ambivalent and vulnerable situation of maternal obesity which makes moral sensitivity towards weight and body concerns crucial to consider in future maternal health interventions. Our data suggest that an emphasis on functionality and capability rather than aesthetics and measured ideals would be useful in providing care and support in postpartum lifestyle interventions for women living with obesity.
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Affiliation(s)
- Sissel D Jensen
- Danish National Centre for Obesity, Aarhus, Denmark.,Steno Diabetes Centre Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sine Knorr
- Steno Diabetes Centre Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Louise Rasmussen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Per Ovesen
- Steno Diabetes Centre Aarhus, Aarhus University Hospital, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Ulla Kampmann
- Steno Diabetes Centre Aarhus, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Jens M Bruun
- Danish National Centre for Obesity, Aarhus, Denmark.,Steno Diabetes Centre Aarhus, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
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21
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Brodowski L, Rochow N, Yousuf EI, Kohls F, von Kaisenberg CS, Schild RL, Berlage S, Hagenah HP, Voigt M. The cumulative impact of parity on the body mass index (BMI) in a non-selected Lower Saxony population. J Perinat Med 2021; 49:460-467. [PMID: 33554575 DOI: 10.1515/jpm-2020-0261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/23/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES During the last decade obesity has been continuously rising in adults in industrial countries. The increased occurrence of perinatal complications caused by maternal obesity poses a major challenge for obstetricians during pregnancy and childbirth. This study aims to examine the association between parity, pregnancy, birth risks, and body mass index (BMI) of women from Lower Saxony, Germany. METHODS This retrospective cohort study examined pseudonymized data of a non-selected singleton cohort from Lower Saxony's statewide quality assurance initiative. Mothers were categorized according to BMI as normal weight (18.5 to <25 kg/m2) or obese (≥30 kg/m2). RESULTS Most of the mothers in this study population were either in their first (33.9%) or second pregnancy (43.4%). The mean age of women giving birth for the first time was 28.3 years. Maternal age increased with increasing parity. The proportion of pregnant women with a BMI over 30 was 11% in primiparous women, 14.3% in second para, 17.3% in third para and 24.1% in fourth para or more women. Increasing parity was positively correlated with the incidence of classical diseases related to obesity, namely diabetes mellitus, gestational diabetes, hypertension, pregnancy-related hypertension and urinary protein excretion. An increased risk of primary or secondary cesarean section was observed in the obese women, particularly during the first deliveries. CONCLUSIONS There is a positive and significant correlation between parity and increased maternal BMI. The highest weight gain happens during the first pregnancy. The rate of operative deliveries and complications during delivery is increased in obese pregnant women.
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Affiliation(s)
- Lars Brodowski
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany
| | - Niels Rochow
- Department of Pediatrics, Paracelsus Medical University, Nuremberg, Germany.,Department of Pediatrics, Univesity Hospital Rostock, Rostock, Germany.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Efrah I Yousuf
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, Canada
| | - Fabian Kohls
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany
| | | | - Ralf L Schild
- Obstetrics and Gynecology, Diakovere Hospital Hannover, Hannover, Germany
| | - Silvia Berlage
- Center for Quality and Management in Health Care, Ärztekammer Niedersachsen, Hannover, Germany
| | - Hans Peter Hagenah
- Department of Obstetrics, Agaplesion Diakonieklinikum Rotenburg, Rotenburg, Germany
| | - Manfred Voigt
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany.,Biological Anthropology, Medical Faculty, University of Freiburg, Freiburg, Germany
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22
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Abstract
OBJECTIVE This study aimed to examine the relationship between age at first childbirth and oral health. The mediation effect of body mass index (BMI) on this relationship was also determined. METHODS This study analyzed data of 2,506 parous postmenopausal women aged 50 or older from the Korea National Health and Nutrition Examination Survey 2013-2015. Chewing inconvenience was investigated by an oral interview. Periodontitis and dental caries were determined through dental examinations. Multivariable logistic regression analysis was performed to examine the relationship between age at first childbirth and oral health, and mediation analysis was performed to examine the contribution of BMI on the relationship between age at first childbirth and oral health. RESULTS Women who underwent their first delivery between the age of 26 and 46 years had significantly decreased odds of chewing inconvenience (odds ratio [OR] = 0.72, 95% confidence interval [95% CI] = 0.56-0.93, P = 0.010) compared with the odds of those women whose first delivery was between at the age of 15 and 22 years. We also found a significant linear relationships between age at first childbirth and odds of chewing inconvenience (OR = 0.83, 95% CI = 0.74-0.95, P = 0.017) and dental caries (OR = 0.84, 95% CI = 0.74-0.96, P = 0.025). BMI accounted for 12.9% of the relationship between age at first childbirth and dental caries. Age at first childbirth was only indirectly associated with periodontitis through BMI (OR = 0.98, 95% CI = 0.96-0.99, P = 0.003). CONCLUSIONS Women whose first delivery occurred at a young age had significantly increased odds of chewing inconvenience and dental caries. BMI mediated the relationships between age at first childbirth and periodontitis and dental caries.
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23
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Halkjær SI, de Knegt VE, Lo B, Nilas L, Cortes D, Pedersen AE, Mirsepasi-Lauridsen HC, Andersen LO, Nielsen HV, Stensvold CR, Johannesen TB, Kallemose T, Krogfelt KA, Petersen AM. Multistrain Probiotic Increases the Gut Microbiota Diversity in Obese Pregnant Women: Results from a Randomized, Double-Blind Placebo-Controlled Study. Curr Dev Nutr 2020; 4:nzaa095. [PMID: 32617453 PMCID: PMC7319727 DOI: 10.1093/cdn/nzaa095] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/21/2020] [Accepted: 05/21/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Maternal obesity is associated with adverse pregnancy outcomes. Probiotic supplementation during pregnancy may have positive effects on blood glucose, gestational weight gain (GWG), and the risk of gestational diabetes mellitus [GDM and glycated hemoglobin (HbA1c)]. OBJECTIVES This feasibility study involved a daily probiotic intervention in obese pregnant women from the early second trimester until delivery. The primary aim was to investigate the effect on GWG and maternal glucose homeostasis (GDM and HbA1c). Secondary aims were the effect on infant birth weight, maternal gut microbiota, and other pregnancy outcomes. METHODS We carried out a randomized double-blinded placebo-controlled study in 50 obese pregnant women. Participants were randomly allocated (1:1) to multistrain probiotic (4 capsules of Vivomixx®; total of 450 billion CFU/d) or placebo at 14-20 weeks of gestation until delivery. Participants were followed with 2 predelivery visits at gestational week 27-30 and 36-37 and with 1 postdelivery visit. All visits included blood and fecal sampling. An oral-glucose-tolerance test was performed at inclusion and gestational week 27-30. RESULTS Forty-nine participants completed the study. Thirty-eight participants took >80% of the capsules (n = 21), placebo (n = 17). There was no significant difference in GWG, GDM, HbA1c concentrations, and infant birth weight between groups. Fecal microbiota analyses showed an overall increase in α-diversity over time in the probiotic group only (P = 0.016). CONCLUSIONS Administration of probiotics during pregnancy is feasible in obese women and the women were willing to participate in additional study visits and collection of fecal samples during pregnancy. Multistrain probiotic can modulate the gut microbiota in obese women during pregnancy. A larger study population is needed to uncover pregnancy effects after probiotic supplementation. This trial was registered at clincaltrials.gov as NCT02508844.
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Affiliation(s)
- Sofie Ingdam Halkjær
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | - Bobby Lo
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Lisbeth Nilas
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Dina Cortes
- Department of Pediatrics, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anders Elm Pedersen
- Department of Dentistry, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Lee O'Brien Andersen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Henrik Vedel Nielsen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | | | - Thor Bech Johannesen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Thomas Kallemose
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Karen Angeliki Krogfelt
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Andreas Munk Petersen
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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24
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Prendergast C, Wray S. Human myometrial artery function and endothelial cell calcium signalling are reduced by obesity: Can this contribute to poor labour outcomes? Acta Physiol (Oxf) 2019; 227:e13341. [PMID: 31299139 DOI: 10.1111/apha.13341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 06/17/2019] [Accepted: 07/07/2019] [Indexed: 12/15/2022]
Abstract
AIMS Determining how obesity affects function in human myometrial arteries, to help understand why childbirth has poor outcomes in obese women. METHODS Myometrial arteries were studied from 84 biopsies. Contraction (vasopressin and U-46619) and relaxation (carbachol, bradykinin, SNAP) was assessed using wire myography. eNOS activity was assessed using L-NAME. Cholesterol was reduced using methyl-β-cyclodextrin to determine whether it altered responses. Differences in endothelial cell intracellular Ca2+ signalling were assessed using confocal microscopy. RESULTS The effects of BMI on relaxation were agonist specific and very marked; all vessels, irrespective of BMI, relaxed to bradykinin but 0% of vessels (0/13) from obese women relaxed to carbachol, compared to 59% (10/17) from normal weight women. Cholesterol-lowering drugs did not restore carbachol responses (n = 6). All vessels, irrespective of BMI, relaxed when NO was directly released by SNAP (n = 19). Inhibition of eNOS with L-NAME had a significant effect in normal but not overweight/obese vessels. Compared to bradykinin, a lower proportion of endothelial cells responded to carbachol and the amplitude of the calcium response was significantly less, in all vessels. Furthermore, a significantly lower proportion of endothelial cells responded to carbachol in the overweight/obese group compared to control. In contrast to relaxation, the effect of contractile agonists was unchanged with increasing BMI. CONCLUSIONS The ability of human myometrial arteries to relax is significantly impaired with obesity, and our data suggest this is due to a deficit in endothelial calcium signalling. This inability to recover following compression during contractions, might contribute to poor labours in obese women.
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Affiliation(s)
- Clodagh Prendergast
- Department of Molecular and Cellular Physiology, Institute of Translational Medicine University of Liverpool Liverpool UK
| | - Susan Wray
- Department of Molecular and Cellular Physiology, Institute of Translational Medicine University of Liverpool Liverpool UK
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Martínez-Hortelano JA, Berlanga-Macías C, Pozuelo-Carrascosa DP, Sanabria-Martínez G, Poyatos-León R, Martínez-Vizcaíno V. Interpregnancy weight change and perinatal outcomes: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e15470. [PMID: 31096442 PMCID: PMC6531238 DOI: 10.1097/md.0000000000015470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/08/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Growing evidence suggests that interpregnancy weight change (IPWC) is a risk factor for perinatal outcomes, since it may increase the probability of gestational complications including gestational diabetes or cesarean delivery. Additionally, IPWC may affect neonatal outcomes increasing the prevalence of newborns small for gestational age or preterm birth. However, the association between IPWC and perinatal outcomes has not systematically synthesized thus far. This study protocol aims to provide a clear, transparent and standardized procedure for systematically reviewing the association between IPWC and perinatal outcomes. METHODS AND ANALYSIS This systematic review and meta-analyses protocol is based on the preferred reporting items for systematic review and meta-analysis protocols and the Cochrane Collaboration Handbook. MEDLINE, EMBASE, the Cochrane Library, and Web of Science will be systematically searched from their inception. No limits will be defined by study design, as such different tools to assess risk of bias will be used:Odd ratios and their corresponding 95% confidence intervals will be reported to evaluate associations between IPWC and perinatal outcomes. RESULTS The results of this study will be published in a peer-reviewed journal. CONCLUSION This systematic review and meta-analysis will systematically synthesize the evidence regarding the association between IPWC and perinatal outcomes. Data will be extracted from published articles and findings will be published in peer-reviewed journals. Ethical approval and informed consent will not be required due to the nature of the study. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018100449.
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Affiliation(s)
| | | | | | | | | | - Vicente Martínez-Vizcaíno
- Universidad de Castilla- La Mancha, Health and Social Care Research Center
- Universidad Autónoma de Chile, Faculty of Health Sciences. Talca, Chile
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