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Liu X, Zhou J, Chen J, Li L, Yuan L, Li S, Sun X, Zhou X. Risk of Asthma and Allergies in Children Delivered by Cesarean Section: A Comprehensive Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00645-7. [PMID: 38908434 DOI: 10.1016/j.jaip.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/24/2024] [Accepted: 06/10/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND It is unclear whether cesarean delivery increases the risk of allergic diseases in offspring. OBJECTIVE To investigate the association between cesarean delivery and the risk of allergic diseases in offspring. METHODS We searched PubMed, Embase, and the Cochrane Library for relevant studies up to October 12, 2023. Observational studies comparing the risk of allergic diseases in offspring delivered by cesarean section versus those delivered vaginally were included. Most-adjusted estimates from individual studies were synthesized by meta-analysis. RESULTS A total of 113 studies were included, 70 of which had a low risk of bias. Compared with offspring delivered vaginally, offspring delivered by cesarean section had significantly greater risks of asthma (odds ratio [OR] = 1.20; 95% CI, 1.16-1.25), allergic rhinitis or conjunctivitis (OR = 1.15' CI 1.09-1.22), atopic dermatitis or eczema (OR = 1.08; CI, 1.04-1.13), food allergies (OR = 1.35; CI, 1.18-1.54), and allergic sensitization (OR = 1.19; CI, 1.10-1.28). Cesarean delivery did not significantly increase urticaria risk. Sensitivity analyses including only studies with a low risk of bias, adjusted estimates, prospective data collection, large sample sizes, or outcomes from medical records generally supported these findings. Offspring age, study region latitude, economy type, and cesarean delivery rate accounted for some of the clinical heterogeneity. We found no data on allergic purpura. CONCLUSIONS Most-adjusted estimates suggest that cesarean delivery is associated with increased risks of asthma, allergic rhinitis or conjunctivitis, atopic dermatitis or eczema, food allergies, and allergic sensitization in offspring. The impact of cesarean delivery on urticaria and purpura remains uncertain.
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Affiliation(s)
- Xiaowu Liu
- Evidence-Based Medicine Research Center, Jiangxi University of Chinese Medicine, Jiangxi, China; Outcome Assessment Research Team in Chinese Medicine, Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangdong, China
| | - Jieyi Zhou
- Evidence-Based Medicine Research Center, Jiangxi University of Chinese Medicine, Jiangxi, China
| | - Jianrong Chen
- Department of Endocrinology and Metabolism, First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, China
| | - Ling Li
- Chinese Evidence-Based Medicine Center and Chinese Cochrane Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lixia Yuan
- Evidence-Based Medicine Research Center, Jiangxi University of Chinese Medicine, Jiangxi, China
| | - Shuqing Li
- Evidence-Based Medicine Research Center, Jiangxi University of Chinese Medicine, Jiangxi, China
| | - Xin Sun
- Evidence-Based Medicine Research Center, Jiangxi University of Chinese Medicine, Jiangxi, China; Chinese Evidence-Based Medicine Center and Chinese Cochrane Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Xu Zhou
- Evidence-Based Medicine Research Center, Jiangxi University of Chinese Medicine, Jiangxi, China.
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Cao C, Wang S, Liu Y, Yue S, Wang M, Yu X, Ding Y, Lv M, Fang K, Chu M, Liao Z. Factors influencing C-reactive protein status on admission in neonates after birth. BMC Pediatr 2024; 24:89. [PMID: 38302903 PMCID: PMC10832075 DOI: 10.1186/s12887-024-04583-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/21/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVE To explore the factors influencing C-reactive protein (CRP) status in neonates on admission after birth. METHODS 820 newborns born and hospitalized at Xiangya Hospital of Central South University from Jan. 2020 to Dec. 2020 were retrospectively analyzed. Maternal medical history and medication use during pregnancy, neonatal demographic information and status at birth were collected through the electronic medical record system. Statistical software was used to analyze the possible relationship between perinatal factors and CRP on admission after birth. RESULTS A total of 820 neonates were analyzed, including 463 males and 357 females with a mean gestational age (GA) of 36.07 ± 3.30 weeks. (1) Multifactor Logistic regression analysis: larger GA (OR: 1.13, 95%CI: 1.00-1.28, P = 0.042), premature rupture of membranes (PROM) ≥ 18 h (OR: 2.39, 95%CI: 1.35-4.23, P = 0.003) and maternal autoimmune diseases (OR: 5.30, 95%CI: 2.15-13.07, P < 0.001) were independent risk factors for CRP ≥ 8 mg/L. Cesarean delivery (OR 0.40, 95%CI: 0.26-0.60, P < 0.001) was independent protective factor for CRP ≥ 8 mg/L. (2) Threshold effect analysis: A non-linear relationship was found between GA and CRP. When GA is less than 33.9 weeks, the risk of CRP ≥ 8 mg/L was reduced by 28% with one week increased (P < 0.001), and when GA is more than 33.9 weeks, the risk of CRP ≥ 8 mg/L was increased by 61% with one week increased (P < 0.001). CONCLUSIONS GA, PROM, maternal autoimmune diseases and cesarean delivery were all independent influences neonatal CRP ≥ 8 mg/L on admission, and there was a nonlinear relationship between GA and neonatal CRP ≥ 8 mg/L on admission.
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Affiliation(s)
- Chuanding Cao
- Department of Neonatology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Shuo Wang
- Department of Neonatology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Yang Liu
- Department of Neonatology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Shaojie Yue
- Department of Neonatology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Mingjie Wang
- Department of Neonatology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Xiaohe Yu
- Department of Neonatology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Ying Ding
- Department of Neonatology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Mei Lv
- Department of Neonatology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Keren Fang
- Department of Neonatology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Meiyan Chu
- Department of Neonatology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Zhengchang Liao
- Department of Neonatology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan, 410008, China.
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de Carvalho VM, Chung-Filho AA, Braga FHP, Chagas-Neto P, Soares-Lima SC, Pombo-de-Oliveira MS. Interaction between birth characteristics and CRHR1, MC2R, NR3C1, GLCCI1 variants in the childhood lymphoblastic leukemia risk. Front Oncol 2024; 13:1274131. [PMID: 38348123 PMCID: PMC10859751 DOI: 10.3389/fonc.2023.1274131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/31/2023] [Indexed: 02/15/2024] Open
Abstract
Background The incidence rate of childhood acute lymphoblastic leukemia (ALL) differs worldwide, and the interplay between hemostasis actors and the maladaptive responses to environmental exposures has been explored. It has been proposed that endogenous cortisol, induced by different triggers, would eliminate pre-leukemic clones originated in utero. Herein, we tested if the interaction between CRHR1rs242941 C>A, MC2Rrs1893219 A>G, NR3C1rs41423247 G>C, and GLCCI1rs37972 C>T (players in glucocorticoid secretion) and birth characteristics would be associated with ALL risk. Methods Children aged <10 years were enrolled within the EMiLI project (period: 2012 to 2020). The study had three steps: (1) observational analysis of birth characteristics (n = 533 cases and 1,603 controls); (2) genotyping to identify single-nucleotide variants (n = 756 cases and 431 controls); and (3) case-only to test gene-environment interactions (n = 402 cases). Genetic syndromes were exclusion criteria. The controls were healthy children. The distribution of the variables was assessed through Pearson's chi-square test. Logistic regression (LR) tests were run fitted and adjusted for selected covariate models to estimate the association risk. Formal interaction analysis was also performed. Genotyping was tested by qPCR with TaqMan probes (NR3C1) or by high-resolution melting (MC2R and GLCCI1). Hardy-Weinberg equilibrium (HWE) was accessed by the chi-square test. The genotype-risk association was tested in co-dominant, dominant, and recessive models. The gene-environment interaction odds ratio (iOR) was assessed in case-only. Results Low birthweight, C-section, and low maternal schooling were associated with increased risk for ALL, adjOR 2.11, 95% CI, 1.02-4.33; adjOR 1.59, 95% CI, 1.16-2.17; and adjOR 3.78, 95% CI, 2.47-5.83, respectively, in a multiple logistic regression model. MC2R rs1893219 A>G was negatively associated with ALL (AG: OR = 0.68; 95% CI = 0.50-0.94 and GG: OR = 0.60; 95% CI = 0.42-0.85), while for GLCCI1 rs37972 C>T, TT was positively associated with ALL (OR = 1.91; 95% CI = 1.21-3.00). The combination of genotypes for MC2R (AA) and GLCCI1 (TT) increased ALL risk (OR = 2.61; 95% CI = 1.16-5.87). In a multiplicative interaction, MC2R rs1893219 A>G was associated with children whose mothers had less than 9 years of schooling (iOR = 1.99; 95% CI = 1.11-1.55). Conclusion Our study has demonstrated a significant association between MC2R rs1893219 A>G (reduced risk) and GLCCI1 rs37972 C>T variants (increased risk) and childhood ALL susceptibility. Based on this evidence, genes controlling the HPA axis activity may play a role in leukemogenesis, and further investigation is needed to substantiate our findings.
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Affiliation(s)
- Vitoria Müller de Carvalho
- Research Center, Molecular Carcinogenesis Program, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Alython Araujo Chung-Filho
- Research Center, Molecular Carcinogenesis Program, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Flávio Henrique Paraguassu Braga
- National Placental and Umbilical Cord Blood Bank, Instituto Nacional de Câncer (INCA), Ministério da Saúde (MS), Rio de Janeiro, Brazil
| | - Paulo Chagas-Neto
- Research Center, Molecular Carcinogenesis Program, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Sheila Coelho Soares-Lima
- Research Center, Molecular Carcinogenesis Program, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Maria S. Pombo-de-Oliveira
- Research Center, Molecular Carcinogenesis Program, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
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Khajehei M. Endorphins, Sexuality, and Reproduction. ADVANCES IN NEUROBIOLOGY 2024; 35:397-433. [PMID: 38874734 DOI: 10.1007/978-3-031-45493-6_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Beta-endorphin is secreted from the hypothalamus and pituitary in both mother and newborn. The placenta produces numerous pituitary hormones from the third month of pregnancy, one of which is βE. It has been suggested that βE has a role in the appetitive and precopulatory phase of sexual behavior in animals. An increase in endorphin levels during sexual activity in humans may contribute to attachment and bonding between partners, but contradictory reports in the literature question the association between sexuality and βE levels. The level of βE also increases during pregnancy, rises in early labor, peaks in late labor, and drops in the postpartum period. This fluctuation provides natural analgesia, raises the pain threshold, decreases the sensation of pain, or suppresses pain, and decreases fear levels during labor and birth. Beta-endorphin also protects the fetus from hypoxia during labor and birth and potential neural damage by aiding blood flow to the brain under hypoxic conditions. It has been suggested that a variety of pharmacologic and nonpharmacologic complementary therapies, when used in pregnancy, labor, and birth, activate the opioid receptors in the CNS and alter the sensation of pain during labor and birth, affect the mother-child attachment and affect sexual function. These studies report contradictory results that will be discussed in this chapter.
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Schleier M, Lubig J, Kehl S, Hébert S, Woelfle J, van der Donk A, Bär A, Reutter H, Hepp T, Morhart P. Diagnostic Utility of Interleukin-6 in Early-Onset Sepsis among Term Newborns: Impact of Maternal Risk Factors and CRP Evaluation. CHILDREN (BASEL, SWITZERLAND) 2023; 11:53. [PMID: 38255366 PMCID: PMC10813840 DOI: 10.3390/children11010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
(1) Background: Interleukin-6 (IL-6) levels act as an early infection marker preceding C-reactive protein (CRP) elevation. This study seeks to analyze IL-6 behavior in suspected early-onset sepsis (EOS) cases among term newborns, comparing it to that of CRP and evaluating IL-6's diagnostic utility. We also aim to assess the impact of maternal risk factors on EOS in term newborns, quantifying their influence for informed decision making. (2) Methods: The retrospective data analysis included 533 term newborns who were admitted to our hospital because of suspected EOS. IL-6, CRP, and the impact of maternal risk factors were analyzed in the context of EOS using binomial test, Chi-squared test, logistic and linear regression. (3) Results: In the cases of EOS, both IL-6 and CRP were elevated. The increase in CRP can be predicted by the initial increase in IL-6 levels. Among the assessed risk factors, intrapartum maternal fever (adjusted odds ratio 18.1; 95% CI (1.7-4.1)) was identified as the only risk factor significantly associated with EOS. (4) Conclusions: Employing IL-6 as an early infection marker enhanced EOS diagnostic precision due to its detectable early rise. However, caution is required, as elevations in IL-6 and CRP levels do not exclusively indicate EOS. Increased CRP levels in healthy newborns with maternal risk factors may be attributed to dynamics of vaginal labor.
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Affiliation(s)
- Maria Schleier
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Intensive Care, Friedrich-Alexander-University of Erlangen-Nürnberg, Loschgestraße 15, 91054 Erlangen, Germany; (M.S.); (J.L.); (S.H.); (J.W.); (A.v.d.D.); (A.B.); (H.R.)
| | - Julia Lubig
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Intensive Care, Friedrich-Alexander-University of Erlangen-Nürnberg, Loschgestraße 15, 91054 Erlangen, Germany; (M.S.); (J.L.); (S.H.); (J.W.); (A.v.d.D.); (A.B.); (H.R.)
| | - Sven Kehl
- Department of Gynecology and Obstetrics Medicine, Division of Obstetrics, Friedrich-Alexander-University of Erlangen-Nürnberg, Universitätsstraße 21/23, 91054 Erlangen, Germany;
| | - Steven Hébert
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Intensive Care, Friedrich-Alexander-University of Erlangen-Nürnberg, Loschgestraße 15, 91054 Erlangen, Germany; (M.S.); (J.L.); (S.H.); (J.W.); (A.v.d.D.); (A.B.); (H.R.)
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Intensive Care, Friedrich-Alexander-University of Erlangen-Nürnberg, Loschgestraße 15, 91054 Erlangen, Germany; (M.S.); (J.L.); (S.H.); (J.W.); (A.v.d.D.); (A.B.); (H.R.)
| | - Adriana van der Donk
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Intensive Care, Friedrich-Alexander-University of Erlangen-Nürnberg, Loschgestraße 15, 91054 Erlangen, Germany; (M.S.); (J.L.); (S.H.); (J.W.); (A.v.d.D.); (A.B.); (H.R.)
| | - Alisa Bär
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Intensive Care, Friedrich-Alexander-University of Erlangen-Nürnberg, Loschgestraße 15, 91054 Erlangen, Germany; (M.S.); (J.L.); (S.H.); (J.W.); (A.v.d.D.); (A.B.); (H.R.)
| | - Heiko Reutter
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Intensive Care, Friedrich-Alexander-University of Erlangen-Nürnberg, Loschgestraße 15, 91054 Erlangen, Germany; (M.S.); (J.L.); (S.H.); (J.W.); (A.v.d.D.); (A.B.); (H.R.)
- Institute of Human Genetics, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Tobias Hepp
- Institute for Medical Informatics, Biometry and Epidemiology (IMBE), Friedrich-Alexander-University Erlangen-Nürnberg, Waldstraße 6, 91054 Erlangen, Germany;
| | - Patrick Morhart
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Intensive Care, Friedrich-Alexander-University of Erlangen-Nürnberg, Loschgestraße 15, 91054 Erlangen, Germany; (M.S.); (J.L.); (S.H.); (J.W.); (A.v.d.D.); (A.B.); (H.R.)
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de Los Reyes S, Dude A, Doll J, Plunkett BA. The association between a single abnormal glucose and fetal c-peptide. Acta Diabetol 2023; 60:1359-1363. [PMID: 37347447 DOI: 10.1007/s00592-023-02123-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/28/2023] [Indexed: 06/23/2023]
Abstract
AIM We aimed to evaluated if fetuses of subjects with one elevated value on the 3-h GTT had a measurable physiologic difference in fetal C-peptide levels as compared to those with no elevated values on the GTT. METHODS We performed a prospective cohort study to evaluate insulin levels in singleton non-anomalous fetuses of subjects with one elevated value on the GTT as compared to subjects with no elevated values on their GTT. Fetal insulin levels were measured by fetal C-peptide in cord blood. Distribution of data was assessed and outliers representing values > the 99th and < the 1st percentiles were excluded. Data were log transformed to achieve normal distribution and univariable analyses were performed to compare fetal C-peptide levels, baseline maternal characteristics and perinatal outcomes in subjects with one elevated value as compared those with no elevated values. RESULTS Our analysis included 99 subjects, with 49 subjects in the one elevated value group and 50 subjects in the no elevated values group. Fetal C-peptide levels (picomoles per liters, pmol/L), were significantly higher in the elevated value group as compared to the no elevated value group (mean ± SD; 4.6 ± 0.8 vs. 4.3 ± 0.7, P = 0.046, respectively). In univariable analysis, there was no significant difference in maternal characteristics or adverse composite perinatal outcomes. CONCLUSION Fetuses of subjects who had one elevated value on their GTT had a measurable physiologic difference in C-peptide levels as compared to fetuses of subjects with no elevated values on the GTT.
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Affiliation(s)
- Samantha de Los Reyes
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NorthShore University HealthSystem/University of Chicago, 2650 Ridge Ave., Walgreen Building, Evanston, IL, 60201, USA.
| | - Annie Dude
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina - Chapel Hill, 3010 Old Clinic Building, CB 7570, Chapel Hill, NC, 27599, USA
| | - Jennifer Doll
- Department of Biomedical Sciences, University of Wisconsin Milwaukee, Enderis Hall 417, Milwaukee, USA
| | - Beth A Plunkett
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NorthShore University HealthSystem, 2650 Ridge Ave, Walgreen Building, Evanston, IL, 60201, USA
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Hung KC, Chen JY, Hsing CH, Hsu CW, Liu PH, Chang YJ, Chen JY, Chiu SF, Sun CK. Association of labor epidural analgesia exposure with long-term risk of autism spectrum disorder in offspring: A meta-analysis of observational studies. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:1177-1189. [PMID: 36448720 DOI: 10.1177/13623613221138690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
LAY ABSTRACT A previous meta-analysis has demonstrated a superior analgesic efficacy of epidural analgesia (e.g. labor epidural analgesia) in comparison with non-epidural approaches. The widely accepted safety of labor epidural analgesia also endorses its current popularity in obstetric practice. However, the results of a recent large-scale longitudinal study that demonstrated a significant increase in risk of autism spectrum disorder in offspring from mothers with labor epidural analgesia exposure have raised some concerns over the safety of its use. The current meta-analysis aimed at examining the strength of evidence regarding this issue based on updated clinical data. Through systematically reviewing seven eligible observational studies involving 4,021,406 children from electronic databases, our results showed a slight but statistically significant increase in risk of autism spectrum disorder in children with exposure to labor epidural analgesia compared with those without. The finding was consistent in subgroup analysis focusing on siblings and children delivered vaginally. Nevertheless, despite the tendency of an increased risk of autism spectrum disorder in children exposed to labor epidural analgesia <4 h, this effect was not observed in those exposed to labor epidural analgesia >8 h (data from two studies). In conclusion, the level of evidence linking labor epidural analgesia to autism spectrum disorder development in offspring was very low based on the latest data because of the small effect size and the finding of a lack of cumulative dose-response effect in the current analysis. Further studies are warranted to provide an insight into this issue.
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Affiliation(s)
- Kuo-Chuan Hung
- Chi Mei Medical Center, Taiwan
- Chia Nan University of Pharmacy and Science, Taiwan
| | | | | | - Chih-Wei Hsu
- Kaohsiung Chang Gung Memorial Hospital, Taiwan
- Chang Gung University, Taiwan
| | | | - Ying-Jen Chang
- Chi Mei Medical Center, Taiwan
- Chia Nan University of Pharmacy and Science, Taiwan
| | - Jui-Yi Chen
- Chi Mei Medical Center, Taiwan
- Chia Nan University of Pharmacy and Science, Taiwan
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Noda M, Yoshida S, Kawakami C, Takeuchi M, Kawakami K, Ito S. Association between combined spinal-epidural analgesia and neurodevelopment at 3 years old: The Japan Environment and Children's Study. J Obstet Gynaecol Res 2023. [PMID: 37005004 DOI: 10.1111/jog.15642] [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: 10/28/2022] [Accepted: 03/15/2023] [Indexed: 04/04/2023]
Abstract
AIM To investigate the association between maternal combined spinal-epidural analgesia during vaginal delivery and neurodevelopment in 3-year-old children. METHODS Using data from the Japan Environment and Children's Study, a birth cohort study on pregnant women and their offspring, we described the background, perinatal outcomes, and neurodevelopmental outcomes of participants with a singleton pregnancy who received combined spinal-epidural analgesia during vaginal delivery and those who did not. The association between maternal combined spinal-epidural analgesia and abnormalities in five domains of the Ages and Stages Questionnaire, Third Edition, was analyzed using univariable and multivariable logistic regression analyses. Crude and adjusted odds ratios with 95% confidence intervals (95% CI) were calculated. RESULTS Among 59 379 participants, 82 (0.1%) children (exposed group) were born to mothers who received combined spinal-epidural analgesia during vaginal delivery. In the exposed versus control groups, 1.2% versus 3.7% had communication abnormalities (adjusted odds ratio [95% CI]: 0.30 [0.04-2.19]), 6.1% versus 4.1% exhibited gross-motor abnormalities (1.36 [95% CI: 0.55-3.36]), 10.9% vs. 7.1% had fine-motor abnormalities (1.46 [95% CI: 0.72-2.96]), 6.1% vs. 6.9% showed difficulties with problem-solving (0.81 [95% CI: 0.33-2.01]), and 2.4% vs. 3.0% had personal-social problems (0.70 [95% CI: 0.17-2.85]). CONCLUSIONS Exposure to combined spinal-epidural analgesia during vaginal delivery was not associated with the risk of neurodevelopmental abnormalities; however, the sample size of our study might not be appropriate for the study design.
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Affiliation(s)
- Masahiro Noda
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Satomi Yoshida
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Chihiro Kawakami
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Kenkel WM, Kingsbury MA, Reinhart JM, Cetinbas M, Sadreyev RI, Carter CS, Perkeybile AM. Lasting consequences on physiology and social behavior following cesarean delivery in prairie voles. Horm Behav 2023; 150:105314. [PMID: 36731301 PMCID: PMC10023354 DOI: 10.1016/j.yhbeh.2023.105314] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 02/04/2023]
Abstract
Cesarean delivery is associated with diminished plasma levels of several 'birth-signaling' hormones, such as oxytocin and vasopressin. These same hormones have been previously shown to exert organizational effects when acting in early life. For example, our previous work found a broadly gregarious phenotype in prairie voles exposed to oxytocin at birth. Meanwhile, cesarean delivery has been previously associated with changes in social behavior and metabolic processes related to oxytocin and vasopressin. In the present study, we investigated the long-term neurodevelopmental consequences of cesarean delivery in prairie voles. After cross-fostering, vole pups delivered either via cesarean or vaginal delivery were studied throughout development. Cesarean-delivered pups responded to isolation differently in terms of their vocalizations (albeit in opposite directions in the two experiments), huddled in less cohesive groups under warmed conditions, and shed less heat. As young adults, we observed no differences in anxiety-like or alloparental behavior. However, in adulthood, cesarean-delivered voles of both sexes failed to form partner preferences with opposite sex conspecifics. In a follow-up study, we replicated this deficit in partner-preference formation among cesarean-delivered voles and were able to normalize pair-bonding behavior by treating cesarean-delivered vole pups with oxytocin (0.25 mg/kg) at delivery. Finally, we detected minor differences in regional oxytocin receptor expression within the brains of cesarean-delivered voles, as well as microbial composition of the gut. Gene expression changes in the gut epithelium indicated that cesarean-delivered male voles have altered gut development. These results speak to the possibility of unintended developmental consequences of cesarean delivery, which currently accounts for 32.9 % of deliveries in the U.S. and suggest that further research should be directed at whether hormone replacement at delivery influences behavioral outcomes in later life.
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Affiliation(s)
- William M Kenkel
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States of America.
| | - Marcy A Kingsbury
- Department of Pediatrics, Massachusetts General Hospital, Cambridge, MA, United States of America
| | - John M Reinhart
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States of America
| | - Murat Cetinbas
- Department of Molecular Biology, Massachusetts General Hospital, Boston, MA, United States of America; Department of Genetics, Massachusetts General Hospital, Boston, MA, United States of America
| | - Ruslan I Sadreyev
- Department of Molecular Biology, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Department of Pathology, Massachusetts General Hospital, Boston, MA, United States of America
| | - C Sue Carter
- Department of Psychology, University of Virginia, Charlottesville, VA, United States of America
| | - Allison M Perkeybile
- Department of Psychology, University of Virginia, Charlottesville, VA, United States of America
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10
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Pombo-de-Oliveira MS, Petridou ET, Karalexi MA, Junqueira MER, Braga FHP, Bouzas LF, Murra GRC, Lopes LF, Ntzani E, Greaves M. The Interplay of Cesarean-Section Delivery and First-Birth Order as Risk Factors in Acute Lymphoblastic Leukemia. Cancer Epidemiol Biomarkers Prev 2023; 32:371-379. [PMID: 36525650 DOI: 10.1158/1055-9965.epi-22-0664] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/24/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Childhood B-cell precursor acute lymphoblastic leukemia (BCP-ALL) has been associated with early-life exposures, including birth by cesarean section (C-section), and a deficit of social exposure (first child). These exposures as proxies for microbiome acquisition in infancy are essential to prime the immune system and restrain later dysregulated immune responses that can trigger ALL in susceptible individuals. We tested risk factors pertaining to immune stimulation that may impact BCP-ALL development. METHODS Cases comprised 1,126 children (0-12 years) with ALL (BCP-ALL: 78.5%) from the EMiLI study group in Brazil (2002-2020). Age- and sex-matched controls (n = 2,252) were randomly selected from healthy children whose mothers participated in the National Placental and Umbilical Cord Blood Bank donation. Multiple logistic regression was run fitted and adjusted for selected covariates models. RESULTS C-section delivery was associated with increased risk for ALL [odds ratio (OR) ALL: 1.10; 95% confidence intervals (CI), 1.04-1.15; ORBCP-ALL: 1.09; 95% CI, 1.03-1.14], as well as being the firstborn child. Interaction analysis showed a significant effect of first birth on the observed C-section associations (P < 0.0001). Indeed, high-risk children, namely, firstborn children delivered via C-section were at increased risk for ALL (OR: 2.33; 95% CI, 2.40-4.84) compared with non-first, vaginally born children. An increased risk was found for firstborn children delivered by C-section and non-breastfed with ALL (ORALL: 2.32; 95% CI, 1.27-4.24; ORBCP-ALL: 2.37; 95% CI, 1.18-4.76). CONCLUSIONS Our observations are in accord with the prediction that exposures determining microbiome composition and adrenal pathway in infancy contribute to the risk of BCP-ALL. IMPACT These findings encourage the exploration of potential preventive interventions. See related commentary by Wiemels and Gallant, p. 292.
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Affiliation(s)
| | - Eleni Th Petridou
- Hellenic Society for Social Pediatrics and Health Promotion, Athens, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria A Karalexi
- Hellenic Society for Social Pediatrics and Health Promotion, Athens, Greece
| | | | | | - Luis Fernando Bouzas
- National Placental and Umbilical Cord Blood Bank, INCA, MS, Rio de Janeiro, Brazil
| | | | - Luiz Fernando Lopes
- Children's Cancer Hospital, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Evangelia Ntzani
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island
| | - Mel Greaves
- Center for Evolution and Cancer, Institute of Cancer Research, Sutton, United Kingdom
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11
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Obaid YY, Toubasi AA, Albustanji FH, Al-Qawasmeh AR. Perinatal risk factors for infantile hypertrophic pyloric stenosis: A systematic review and meta-analysis. J Pediatr Surg 2023; 58:458-466. [PMID: 36137827 DOI: 10.1016/j.jpedsurg.2022.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/15/2022] [Accepted: 08/19/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Infantile hypertrophic pyloric stenosis (IHPS) is one of the most common diseases that require surgical intervention amongst the paediatric population. Although the treatment and the diagnosis of pyloric stenosis are well established, the perinatal risk factors associated with it still need further investigation. METHODS We searched the following databases: Cochrane, Google Scholar, PubMed, and Scopus. Studies were included if they were case-control or cohort in design and studied the perinatal risk factors associated with IHPS. The quality of the included studies was assessed using the Newcastle-Ottawa scale (NOS). RESULTS Twenty-one articles were included in this meta-analysis, including 18,104,753 participants. Our analysis showed a significant association between IHPS and male sex (RR=2.71, 95% CI:1.93-3.78), maternal smoking (RR=1.75, 95% CI: 1.54 - 2.00), bottle-feeding (RR=1.68, 95% CI: 1.42 - 1.98), being first born (RR=1.23, 95% CI:1.07-1.40), African ethnicity (RR=0.51, 95% CI: 0.35-0.75), and cesarean section (RR=1.57, 95% CI: 1.49-1.66). On the contrary, there was no significant association between IHPS and multiple gestations, preterm labour, being born in summer, and small for gestational age (SGA). CONCLUSION In conclusion, our analysis showed that male sex, bottle feeding, maternal smoking and African ethnicity were significantly associated with the risk of IHPS. However, most of the included articles were retrospective in design which necessitates conducting future prospective well-designed studies to further investigate the risk factors of IHPS.
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Affiliation(s)
- Yazan Y Obaid
- Faculty of Medicine, University of Jordan, Amman, Jordan, 11962.
| | - Ahmad A Toubasi
- Faculty of Medicine, University of Jordan, Amman, Jordan, 11962
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12
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Imai K, Hara H, Sawada T, Wada M. Comparison of the Clinical Characteristics of Infants with Punctate White Matter Lesions and/or Cystic Lesions. Neuropediatrics 2023; 54:6-13. [PMID: 36543181 DOI: 10.1055/s-0042-1759789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND We aimed to investigate the differences in the clinical characteristics of preterm infants with punctate white matter lesions (PWMLs) and those with cystic periventricular leukomalacia (cPVL) using term-equivalent age magnetic resonance imaging. METHODS We conducted a retrospective case-control study to explore the clinical characteristics of infants (< 35 weeks gestation, born between 2007 and 2017 in a single Level III perinatal center) with PWML, cPVL or with PWML plus cPVL and compared them with those of gestational-age-matched controls. RESULTS Among 602 infants, 29, 5, and 4 were assigned to the PWML group, cPVL group, and PWML plus cPVL group (PWML-cPVL group), respectively. Compared to the control group (n = 87), the PWML group had higher birth weights (p = 0.04), rates of histological chorioamnionitis (p = 0.04), vaginal delivery (p = 0.008), and early heart contraction failure (within 72 hours after birth) (p = 0.003). The cPVL group had lower umbilical blood gas base excess (p = 0.01), higher rate of late-onset circulatory collapse (p = 0.008), and higher hydrocortisone requirements (p = 0.03) than the control group (n = 15). The PWML-cPVL group had a higher rate of intraventricular hemorrhage (p = 0.03) than the control group (n = 12). In the multivariate logistic regression analysis, vaginal delivery (odds ratio [OR] = 3.5; 95% confidence interval [CI] = 1.37-9.40; p = 0.009), higher birth weight (per 1 g) (OR = 1.001; 95% CI = 1.0001-1.002; p = 0.03), and early heart contraction failure (OR = 5.4; 95% CI = 1.84-16.8; p = 0.002), were independent risk factors for PWML. CONCLUSION Clinical characteristics of infants with PWML compared with gestational-age-matched controls differed from those with cPVL or PWML plus cPVL, as PWML were not related to severe disruption of hemodynamics.
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Affiliation(s)
- Ken Imai
- Neonatal Division, Maternal and Perinatal Center, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.,Division of Neuropediatrics, Nagano-Children's Hospital, Azumino, Nagano, Japan
| | - Hiroko Hara
- Department of Diagnostic Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Tatsuo Sawada
- Department of Pathology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Masaki Wada
- Neonatal Division, Maternal and Perinatal Center, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
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13
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Nielsen ST, Lytsen RM, Strandkjær N, Hansen MK, Sillesen AS, Vøgg ROB, Raja AA, Rasmussen IJ, Kamstrup PR, Benn M, Iversen K, Bundgaard H, Frikke-Schmidt R. Red blood cell parameters in early childhood: a prospective cohort study. Clin Chem Lab Med 2023; 61:275-284. [PMID: 36377310 DOI: 10.1515/cclm-2022-0826] [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: 08/24/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Red blood cell parameters are frequently used biomarkers when assessing clinical status in newborns and in early childhood. Cell counts, amounts, and concentrations of these parameters change through gestation and after birth. Robust age-specific reference intervals are needed to optimize clinical decision making. METHODS The Copenhagen Baby Heart Study (CBHS) and the COMPARE study are prospective cohort studies including red blood cell parameters from 7,938 umbilical cord blood samples and 295 parallel venous blood samples from newborns with follow-up at two and at 14-16 months after birth. RESULTS For venous blood at birth, reference intervals for hemoglobin, erythrocytes, and hematocrit were 145-224 g/L, 4.1-6.4 × 1012/L, and 0.44-0.64, respectively. Hemoglobin, erythrocytes, and hematocrit were lower at birth in children delivered by prelabor cesarean section compared to vaginal delivery. Conversion algorithms based on term newborns were: venous hemoglobin=(umbilical cord hemoglobin-86.4)/0.39; venous erythrocytes=(umbilical cord erythrocytes-2.20)/0.44; and venous hematocrit=(umbilical cord hematocrit-0.24)/0.45. CONCLUSIONS This study presents new reference intervals for red blood cell parameters in early childhood, describes the impact of delivery mode, and provide exact functions for converting umbilical cord to venous blood measurements for term newborns. These findings may improve clinical decision making within neonatology and infancy and enhance our clinical understanding of red blood cell parameters for health and diseases in early life.
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Affiliation(s)
- Sofie Taageby Nielsen
- Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Rikke Mohr Lytsen
- Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Nina Strandkjær
- Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - Malene Kongsgaard Hansen
- Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - Anne-Sophie Sillesen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - R Ottilia B Vøgg
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - Anna Axelsson Raja
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ida Juul Rasmussen
- Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Pia R Kamstrup
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - Marianne Benn
- Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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14
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Jiang T, Jiang S, Cui Y, Yang JP, Du YH, Li J, Pang B, Li B. Assessment of reporting quality in randomized controlled trials of acupuncture for labor pain. FRONTIERS IN PAIN RESEARCH 2022; 3:999162. [DOI: 10.3389/fpain.2022.999162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022] Open
Abstract
ObjectiveTo evaluate the reporting quality of randomized controlled trials (RCTs) of acupuncture for labor pain, and to explore relevant factors for facilitating reporting transparency and integrity for future RCTs.MethodEight Chinese and English databases were systematically searched from their inception until August 31, 2021. General characteristics and methodological quality of the included reports were evaluated based on the CONSORT statement and the STRICTA guidelines. Descriptive statistical analysis was performed. Cohen's κ-statistics were calculated to assess the agreement of all items between two reviewers.ResultsA total of 84 RCTs were included. Based on the CONSORT statement, a positive reporting rate (greater than 80%) was evident for the items “trial design” “participants” “intervention” “outcomes” “numbers analyzed” and “generalizability”. The quality of reporting for the items “randomized in the title or abstract” “sample size” “allocation concealment” “implementation” “blinding” “recruitment” “ancillary analyses” “harms” “interpretation” “registration” and “protocol” was poor with positive rates less than 10%. Based on the STRICTA guidelines, the items “extent to which treatment varied” “number of needle insertions per subject per session” and “control or comparator interventions” had poor reporting quality with positive rates of less than 10%. Substantial agreement was observed for most items and excellent agreement for some items.ConclusionThe reporting quality of RCTs of acupuncture for labor pain is suboptimal generally. Rigorous adherence to the CONSORT statement and the STRICTA guidelines should be emphasized in future studies to improve the quality of acupuncture RCT reports.
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15
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Asare-Bediako B, Adu-Agyeiwaah Y, Abad A, Li Calzi S, Floyd JL, Prasad R, DuPont M, Asare-Bediako R, Bustelo XR, Grant MB. Hematopoietic Cells Influence Vascular Development in the Retina. Cells 2022; 11:3207. [PMID: 36291075 PMCID: PMC9601270 DOI: 10.3390/cells11203207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 11/16/2022] Open
Abstract
Hematopoietic cells play a crucial role in the adult retina in health and disease. Monocytes, macrophages, microglia and myeloid angiogenic cells (MACs) have all been implicated in retinal pathology. However, the role that hematopoietic cells play in retinal development is understudied. The temporal changes in recruitment of hematopoietic cells into the developing retina and the phenotype of the recruited cells are not well understood. In this study, we used the hematopoietic cell-specific protein Vav1 to track and investigate hematopoietic cells in the developing retina. By flow cytometry and immunohistochemistry, we show that hematopoietic cells are present in the retina as early as P0, and include microglia, monocytes and MACs. Even before the formation of retinal blood vessels, hematopoietic cells localize to the inner retina where they eventually form networks that intimately associate with the developing vasculature. Loss of Vav1 lead to a reduction in the density of medium-sized vessels and an increased inflammatory response in retinal astrocytes. When pups were subjected to oxygen-induced retinopathy, hematopoietic cells maintained a close association with the vasculature and occasionally formed 'frameworks' for the generation of new vessels. Our study provides further evidence for the underappreciated role of hematopoietic cells in retinal vasculogenesis and the formation of a healthy retina.
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Affiliation(s)
- Bright Asare-Bediako
- Vision Science Graduate Program, School of Optometry, University of Alabama at Birmingham, Birmingham, AL 35233, USA
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama, Birmingham, AL 35294, USA
| | - Yvonne Adu-Agyeiwaah
- Vision Science Graduate Program, School of Optometry, University of Alabama at Birmingham, Birmingham, AL 35233, USA
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama, Birmingham, AL 35294, USA
| | - Antonio Abad
- Centro de Investigación del Cáncer de Salamanca, CSIC and University of Salamanca, 37007 Salamanca, Spain
- Instituto de Biología Molecular y Celular del Cáncer, CSIC and University of Salamanca, 37007 Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBER), CSIC and University of Salamanca, 37007 Salamanca, Spain
| | - Sergio Li Calzi
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama, Birmingham, AL 35294, USA
| | - Jason L. Floyd
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama, Birmingham, AL 35294, USA
| | - Ram Prasad
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama, Birmingham, AL 35294, USA
| | - Mariana DuPont
- Vision Science Graduate Program, School of Optometry, University of Alabama at Birmingham, Birmingham, AL 35233, USA
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama, Birmingham, AL 35294, USA
| | - Richmond Asare-Bediako
- Thomas H. Gosnell School of Life Sciences, Rochester Institute of Technology, Rochester, NY 14623, USA
| | - Xose R. Bustelo
- Centro de Investigación del Cáncer de Salamanca, CSIC and University of Salamanca, 37007 Salamanca, Spain
| | - Maria B. Grant
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama, Birmingham, AL 35294, USA
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16
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Samuel TM, Thielecke F, Lavalle L, Chen C, Fogel P, Giuffrida F, Dubascoux S, Martínez-Costa C, Haaland K, Marchini G, Agosti M, Rakza T, Costeira MJ, Picaud JC, Billeaud C, Thakkar SK. Mode of Neonatal Delivery Influences the Nutrient Composition of Human Milk: Results From a Multicenter European Cohort of Lactating Women. Front Nutr 2022; 9:834394. [PMID: 35464009 PMCID: PMC9033294 DOI: 10.3389/fnut.2022.834394] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/18/2022] [Indexed: 12/03/2022] Open
Abstract
Background The effect of the mode of neonatal delivery (cesarean or vaginal) on the nutrient composition of human milk (HM) has rarely been studied. Given the increasing prevalence of cesarean section (C-section) globally, understanding the impact of C-section vs. vaginal delivery on the nutrient composition of HM is fundamental when HM is the preferred source of infant food during the first 4 postnatal months. Objective This study aimed to evaluate the association between mode of delivery and nutrient composition of HM in the first 4 months of life. Design Milk samples were obtained from 317 healthy lactating mothers as part of an exploratory analyses within a multicenter European longitudinal cohort (ATLAS cohort) to study the HM composition, and its potential association with the mode of delivery. We employed traditional mixed models to study individual nutrient associations adjusted for mother’s country, infant birth weight, parity, and gestational age, and complemented it, for the first time, with a multidimensional data analyses approach (non-negative tensor factorization, NTF) to examine holistically how patterns of multiple nutrients and changes over time are associated with the delivery mode. Results Over the first 4 months, nutrient profiles in the milk of mothers who delivered vaginally (n = 237) showed significantly higher levels of palmitoleic acid (16:1n-7), stearic acid (18:0), oleic acid (18:1n-9), arachidic acid (20:0), alpha-linolenic acid (18:3n-3), eicosapentaenoic acid (20:5n-3), docosahexenoic acid (22:6n-3), erucic acid (22:1n-9), monounsaturated fatty acids (MUFA)%, calcium, and phosphorus, whereas the ratios of arachidonic acid/docosahexaenoic acid (ARA/DHA) and n-6/n-3, as well as polyunsaturated fatty acids (PUFA)% were higher in milk from women who had C-sections, in the unadjusted analyses (p < 0.05 for all), but did not retain significance when adjusted for confounders in the mixed models. Using a complementary multidimension data analyses approach (NTF), we show few similar patterns wherein a group of mothers with a high density of C-sections showed increased values for PUFA%, n-6/n-3, and ARA/DHA ratios, but decreased values of MUFA%, 20:1n-9, iodine, and fucosyl-sialyl-lacto-N-tetraose 2 during the first 4 months of lactation. Conclusion Our data provide preliminary insights on differences in concentrations of several HM nutrients (predominantly fatty acids) among women who delivered via C-section. Although these effects tend to disappear after adjustment for confounders, given the similar patterns observed using two different data analytical approaches, these preliminary findings warrant further confirmation and additional insight on the biological and clinical effects related to such differences early in life.
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Affiliation(s)
- Tinu M. Samuel
- Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Frank Thielecke
- Department of Health Promotion, Swiss Distance University of Applied Sciences, Regensdorf, Brig, Switzerland
| | - Luca Lavalle
- Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Cheng Chen
- Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | | | | | - Stephane Dubascoux
- Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | | | | | | | | | - Thameur Rakza
- Centre d’Investigation Clinique de Lille, Hôpital Jeanne de Flandre, Lille, France
| | | | | | | | - Sagar K. Thakkar
- Nestlé Research, Société des Produits Nestlé S.A., Singapore, Singapore
- *Correspondence: Sagar K. Thakkar,
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17
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Tulmac OB, Sayan CD, Dag ZO, Oguz Y, Gencosmanoglu G, Caglar T, Kisa U. Serum Copeptin Levels in Threatened Preterm Labor. Fetal Pediatr Pathol 2021; 40:414-422. [PMID: 32050829 DOI: 10.1080/15513815.2020.1721626] [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] [Indexed: 10/25/2022]
Abstract
We investigated maternal copeptin level's usefulness in prediction of preterm birth. Materials and methods: The study was comprised of 97 pregnant women hospitalized for threatened preterm labor and 35 healthy pregnant women without preterm labor. Serum copeptin were compared with likelihood of threatened preterm labor timing of delivery and time interval to delivery. Result: Copeptin level of threatened preterm labor group was higher than of control group [7.76(0.39-35.62) ng/mL, 6.23(1.64-36.88) ng/mL, respectively, p = .04]. Copeptin levels of women did not differ according to preterm or term birth [7.76(0.69-35.62) ng/mL, 6.73(0.39-36.88) ng/mL, respectively, p = .22). Quartiles of copeptin levels were not associated with risk status or preterm birth. Conclusions: Serum copeptin is higher in threatened preterm labor. It does not differentiate those with threatened preterm labor verses preterm birth.
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Affiliation(s)
| | | | | | - Yuksel Oguz
- Ministry of Health Ankara City Hospital, Obstetrics and Gynecology Department, Ankara, Turkey
| | | | - Turhan Caglar
- Zekai Tahir Burak Women's Health Training and Research Hospital, Ankara, Turkey
| | - Ucler Kisa
- Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
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18
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Approach to inherited arrhythmias in pregnancy. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Dwyer KE, Wang R, Cozen W, Cartmel B, Wiemels JL, Morimoto LM, Metayer C, Ma X. Mode of Delivery, Birth Characteristics, and Early-Onset Non-Hodgkin Lymphoma in a Population-Based Case-Control Study. Cancer Epidemiol Biomarkers Prev 2021; 30:2286-2293. [PMID: 34548330 DOI: 10.1158/1055-9965.epi-21-0535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/09/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The etiology of non-Hodgkin lymphoma (NHL) in children and in adolescents and young adults (AYA) is not well understood. METHODS We evaluated potential associations between mode of delivery, birth characteristics, and NHL risk in a population-based case-control study, which included 3,064 cases of NHL [490 with Burkitt lymphoma, 981 with diffuse large B-cell lymphoma (DLBCL), and 978 with T-cell NHL) diagnosed at the age of 0 to 37 years in California during 1988 to 2015 and 153,200 controls frequency matched on year of birth. Odds ratios (OR) and 95% confidence intervals (CI) were estimated from an unconditional multivariable logistic regression model that included year of birth and birth characteristics. RESULTS Individuals born via cesarean section had a decreased risk of pediatric Burkitt lymphoma (age 0-14 years; OR = 0.71, 95% CI: 0.51-0.99) and pediatric T-cell NHL (OR = 0.73, 95% CI: 0.55-0.97) compared with those born vaginally. Having a birth order of second (OR = 0.73, 95% CI: 0.57-0.93) or third or higher (OR = 0.76, 95% CI: 0.58-0.99) was associated with a lower risk of pediatric T-cell NHL compared with first-borns. AYA (age 15-37 years) with a heavier birthweight had an elevated risk of DLBCL (OR for each kg = 1.16, 95% CI: 1.00-1.35). Associations between other birth characteristics, including plurality, maternal age, maternal education, and NHL risk, also exhibited variations across subgroups based on age of diagnosis and histologic subtype. CONCLUSIONS These findings support a role of mode of delivery and birth characteristics in the etiology of early-onset NHL. IMPACT This study underscores the etiologic heterogeneity of early-onset NHL.
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Affiliation(s)
- Kayla E Dwyer
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Rong Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Wendy Cozen
- Division of Hematology/Oncology, Department of Medicine, School of Medicine, University of California, Irvine, California
| | - Brenda Cartmel
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Joseph L Wiemels
- Center for Genetic Epidemiology, USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Libby M Morimoto
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California
| | - Catherine Metayer
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California
| | - Xiaomei Ma
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.
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Vidarsdottir H, Halldorsson TI, Geirsson RT, Bjarnason R, Franzson L, Valdimarsdottir UA, Thorkelsson T. Mode of delivery was associated with transient changes in the metabolomic profile of neonates. Acta Paediatr 2021; 110:2110-2118. [PMID: 33636029 DOI: 10.1111/apa.15822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 11/28/2022]
Abstract
AIMS To estimate potential differences in neonatal metabolomic profiles at birth and at the time of newborn screening by delivery mode. METHODS A prospective study at Women's Clinic at Landspitali-The National University Hospital of Iceland. Women having normal vaginal birth or elective caesarean section from November 2013 to April 2014 were offered participation. Blood samples from mothers before birth and umbilical cord at birth were collected and amino acids and acylcarnitines measured by tandem mass spectrometry. Results from the Newborn screening programme in Iceland were collected. Amino acids and acylcarnitines from different samples were compared by delivery mode. RESULTS Eighty three normal vaginal births and 32 elective caesarean sections were included. Mean differences at birth were higher for numerous amino acids, and some acylcarnitines in neonates born vaginally compared to elective caesarean section. Maternal blood samples and newborn screening results showed small differences that lost significance after correction for multiple testing. Many amino acids and some acylcarnitines were numerically higher in cord blood compared to maternal. Many amino acids and most acylcarnitines were numerically higher in newborn screening results compared to cord blood. CONCLUSION We observed transient yet distinct differences in metabolomic profiles between neonates by delivery mode.
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Affiliation(s)
- Harpa Vidarsdottir
- Faculty of Medicine School of Health Sciences University of Iceland Reykjavik Iceland
- Department of Neonatology Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden
| | | | - Reynir Tomas Geirsson
- Faculty of Medicine School of Health Sciences University of Iceland Reykjavik Iceland
- Women's Clinic Landspitali – The National University Hospital of Iceland Reykjavik Iceland
| | - Ragnar Bjarnason
- Faculty of Medicine School of Health Sciences University of Iceland Reykjavik Iceland
- Children's Hospital Iceland Landspitali – The National University Hospital of Iceland Reykjavik Iceland
| | - Leifur Franzson
- Faculty of Pharmaceutical Sciences School of Health Science University of Iceland Reykjavik Iceland
- Department of Genetics and Molecular Medicine Landspitali – The National University Hospital of Iceland Reykjavik Iceland
| | - Unnur Anna Valdimarsdottir
- Center for Public Health Science School of Health Science University of Iceland Reykjavik Iceland
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden
- Department of Epidemiology Harvard T H Chan School of Public Health Boston MA USA
| | - Thordur Thorkelsson
- Faculty of Medicine School of Health Sciences University of Iceland Reykjavik Iceland
- Children's Hospital Iceland Landspitali – The National University Hospital of Iceland Reykjavik Iceland
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21
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Eugster NS, Corminboeuf F, Koch G, Vogt JE, Sutter T, van Donge T, Pfister M, Gerull R. Vaginal Delivery and Low Gestational Age are Key Risk Factors for Hypernatremia in Neonates<32 Weeks. KLINISCHE PADIATRIE 2021; 234:20-25. [PMID: 34102699 DOI: 10.1055/a-1443-6208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abstract
Background Preterm neonates frequently experience hypernatremia (plasma sodium concentrations >145 mmol/l), which is associated with clinical complications, such as intraventricular hemorrhage.
Study design In this single center retrospective observational study, the following 7 risk factors for hypernatremia were analyzed in very low gestational age (VLGA, below 32 weeks) neonates: gestational age (GA), delivery mode (DM; vaginal or caesarian section), sex, birth weight, small for GA, multiple birth, and antenatal corticosteroids. Machine learning (ML) approaches were applied to obtain probabilities for hypernatremia.
Results 824 VLGA neonates were included (median GA 29.4 weeks, median birth weight 1170 g, caesarean section 83%). 38% of neonates experienced hypernatremia. Maximal sodium concentration of 144 mmol/l (interquartile range 142–147) was observed 52 hours (41–65) after birth. ML identified vaginal delivery and GA as key risk factors for hypernatremia. The risk of hypernatremia increased with lower GA from 22% for GA ≥ 31–32 weeks to 46% for GA < 31 weeks and 60% for GA < 27 weeks. A linear relationship between maximal sodium concentrations and GA was found, showing decreases of 0.29 mmol/l per increasing week GA in neonates with vaginal delivery and 0.49 mmol/l/week after cesarean section. Sex, multiple birth and antenatal corticosteroids were not associated hypernatremia.
Conclusion VLGA neonates with vaginal delivery and low GA have the highest risk for hypernatremia. Early identification of neonates at risk and early intervention may prevent extreme sodium excursions and associated clinical complications.
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Affiliation(s)
- Nadia S Eugster
- Division of Neonatology Inselspital Bern, University Children's Hospital, University of Bern, Bern, Switzerland
| | - Florence Corminboeuf
- Division of Neonatology Inselspital Bern, University Children's Hospital, University of Bern, Bern, Switzerland
| | - Gilbert Koch
- Department of Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Julia E Vogt
- Department of Computer Science, ETH Zürich, Zurich, Switzerland
| | - Thomas Sutter
- Department of Computer Science, ETH Zürich, Zurich, Switzerland
| | - Tamara van Donge
- Department of Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Marc Pfister
- Department of Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Roland Gerull
- Division of Neonatology Inselspital Bern, University Children's Hospital, University of Bern, Bern, Switzerland.,Neonatology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
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22
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Han SM, Derraik JGB, Binia A, Sprenger N, Vickers MH, Cutfield WS. Maternal and Infant Factors Influencing Human Milk Oligosaccharide Composition: Beyond Maternal Genetics. J Nutr 2021; 151:1383-1393. [PMID: 33768224 DOI: 10.1093/jn/nxab028] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/06/2021] [Accepted: 01/26/2021] [Indexed: 02/06/2023] Open
Abstract
Maternal genetics is a key determinant of human milk oligosaccharide (HMO) composition in human milk. Beyond genetic status, other factors influencing the HMO profile are poorly defined. Thus, we aimed to review the existing evidence on the associations between nongenetic maternal and infant factors and HMO composition. A systematic search was performed on PubMed and Web of Science (without a time restriction) to identify any relevant studies published. In total, 1056 results were obtained, of which 29 articles were selected to be included in this review. The range of factors investigated include lactation stage, maternal pre-pregnancy BMI (ppBMI), maternal age, parity, maternal diet, mode of delivery, infant gestational age, and infant sex. The data suggest that, beyond maternal genetics, HMO composition seems to be influenced by all these factors, but the underlining mechanisms remain speculative. The published evidence is discussed in this review, along with potential implications for infant growth and development. For example, 2'-fucosyllactose, which was reportedly increased in mothers with higher ppBMIs, was also associated with increased infant weight and height. In addition, greater levels of sialylated HMOs after preterm birth may support brain development in these infants.
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Affiliation(s)
- Soo Min Han
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, The University of Auckland, Auckland, New Zealand.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Aristea Binia
- Nestlé Research, Société des Produits Nestlé SA, Lausanne, Switzerland
| | - Norbert Sprenger
- Nestlé Research, Société des Produits Nestlé SA, Lausanne, Switzerland
| | - Mark H Vickers
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, The University of Auckland, Auckland, New Zealand.,A Better Start-National Science Challenge, The University of Auckland, Auckland, New Zealand
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23
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Hacioglu C, Sahin IE, Uyuk C. Correlation of perilipin 2 and lipid metabolism in elective cesarean section and vaginal delivery: a prospective study with oxidative and apoptotic pathways. Mol Biol Rep 2021; 48:3991-3998. [PMID: 34009567 DOI: 10.1007/s11033-021-06399-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/03/2021] [Indexed: 11/24/2022]
Abstract
Vaginal delivery (VD) and elective cesarean (CS) delivery modes may cause significant differences in maternal and fetal metabolism. In this study, we aimed to investigate changes in lipid metabolism, oxidative and apoptotic signaling pathways during VD and CS in maternal and cord blood and placenta tissue. The study included two groups of participants delivered via 90 CS and 90 VD. Maternal and cord blood samples were collected from the participants. In addition, placenta samples were also taken after delivery. Total oxidant (TOS), malondialdehyde (MDA), total antioxidant (TAS), glutathione (GSH), cleaved caspase 3 (CASP3) and perilipin 2 (PLIN2) levels were measured to determine oxidative stress, antioxidant levels and apoptosis status in the VD and CS groups. Besides, PLIN2 mRNA expressions in placental specimens were analyzed. We found no statistically significant difference in maternal age, body mass index, gestational age, birth weight and Apgar scores in both groups (P > 0.05). The increase in MDA, TOS, GSH and TAS levels was higher in the VD group compared to the CS group (P < 0.05). Similarly, PLIN2 levels and lipid profiles showed an increase in the VD group (P < 0.05 vs CS group). Likewise, PLIN2 expression enhanced in the VD group (P < 0.05 vs CS group). However, CASP3 activity reduced in maternal and cord blood in the VD group compared to the CS group. Our results support that the delivery mode may cause differences in lipid profile, oxidative and apoptotic status by affecting PLIN2 levels in both maternal and cord blood and placenta tissue.
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Affiliation(s)
- Ceyhan Hacioglu
- Department of Medical Biochemistry, Faculty of Medicine, Düzce University, Duzce, Turkey.
| | - Ibrahim Ethem Sahin
- Department of Medical Biochemistry, Faculty of Medicine, Düzce University, Duzce, Turkey
| | - Can Uyuk
- Department of Obstetrics and Gynecology, Faculty of Medicine, Düzce University, Duzce, Turkey
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24
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Schenone CV, Argoti P, Goedecke P, Mari G. Neonatal blood pressure before and after delayed umbilical cord clamping. J Matern Fetal Neonatal Med 2021; 35:5260-5264. [PMID: 33478292 DOI: 10.1080/14767058.2021.1876656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe values of blood pressure (BP) before and after delayed cord clamping (DCC) in healthy term neonates born to low risk pregnancies, examine differences in the temporal patterns of BP during this transition, and assess potential correlation of these parameters with maternal and perinatal clinical and demographic variables. METHODS Prospective observational study of term infants eligible for DCC born vaginally from uncomplicated pregnancies. Neonatal BP was estimated noninvasively before DCC, at 30 min and 24 h of life. Median, minimum, maximum, mean and standard deviation, as well as percentiles for BP values were calculated. Pearson correlation assessed the correlation between demographic and clinical variables and BP measurements. Spearman correlation studied the association between BP parameters prior to DCC and Apgar scores. Repeated measures ANOVA and Tukey post hoc analyses were used to compare BP measurements over time. A p-value of <.05 was considered significant. RESULTS A total of 54 patients were included. Mean neonatal birthweight was 3185 g and gestational age 39/3 weeks. The mean values for the systolic, diastolic, and mean BP prior to DCC were 97 ± 24.9 mmHg, 58 ± 21.9 mmHg and 67 ± 27.7 mmHg respectively. A statistically significant difference was detected when comparing BP values obtained before DCC with those measured afterwards (Figure 1). A positive correlation was found between SBP and MAP prior to DCC and Apgar scores at 1 min. [Figure: see text]. CONCLUSION We describe novel values of BP before DCC in healthy term infants following vaginal delivery. Data suggest that neonates whose cord is clamped in a delayed fashion experience an increase blood pressures immediately after birth, followed by a significant drop within 30 min to levels that remain unchanged at 24 h of life. BP values obtained after DCC in our study are similar to those found by previous authors. Further studies are needed to determine the clinical significance of these findings and assess the potential of BP prior to DCC to evaluate immediate postnatal adaptation. LIMITATIONS Results generalizability may have been limited by varying degrees of neonatal resuscitation, inability to perform more than one measurement before cord clamping ensued, as well as an unequal distribution of self-reported race in our cohort. Also, noninvasive BP estimates have proven less accurate that invasive methods. Finally, our cohort was comprised by a relatively small sample and larger studies will be required to corroborate our findings.
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Affiliation(s)
- Claudio V Schenone
- Department of Obstetrics & Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Pedro Argoti
- Department of Obstetrics & Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Patricia Goedecke
- Department of Biostatistics, Epidemiology and Research Design, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Giancarlo Mari
- Department of Obstetrics & Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Obstetrics and Gynecology, Cleveland Clinic, Women's Health Institute, Cleveland, OH, USA
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25
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Kenkel W. Birth signalling hormones and the developmental consequences of caesarean delivery. J Neuroendocrinol 2021; 33:e12912. [PMID: 33145818 PMCID: PMC10590550 DOI: 10.1111/jne.12912] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/12/2022]
Abstract
Rates of delivery by caesarean section (CS) are increasing around the globe and, although several epidemiological associations have already been observed between CS and health outcomes in later life, more are sure to be discovered as this practice continues to gain popularity. The components of vaginal delivery that protect offspring from the negative consequences of CS delivery in later life are currently unknown, although much attention to date has focused on differences in microbial colonisation. Here, we present the case that differing hormonal experiences at birth may also contribute to the neurodevelopmental consequences of CS delivery. Levels of each of the 'birth signalling hormones' (oxytocin, arginine vasopressin, epinephrine, norepinephrine and the glucocorticoids) are lower following CS compared to vaginal delivery, and there is substantial evidence for each that manipulations in early life results in long-term neurodevelopmental consequences. We draw from the research traditions of neuroendocrinology and developmental psychobiology to suggest that the perinatal period is a sensitive period, during which hormones achieve organisational effects. Furthermore, there is much to be learned from research on developmental programming by early-life stress that may inform research on CS, as a result of shared neuroendocrine mechanisms at work. We compare and contrast the effects of early-life stress with those of CS delivery and propose new avenues of research based on the links between the two bodies of literature. The research conducted to date suggests that the differences in hormone signalling seen in CS neonates may produce long-term neurodevelopmental consequences.
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Affiliation(s)
- William Kenkel
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
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26
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Lúcio CF, Silva LCG, Vannucchi CI. Perinatal cortisol and blood glucose concentrations in bitches and neonatal puppies: effects of mode of whelping. Domest Anim Endocrinol 2021; 74:106483. [PMID: 32615505 DOI: 10.1016/j.domaniend.2020.106483] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 03/29/2020] [Accepted: 04/12/2020] [Indexed: 01/11/2023]
Abstract
The decision on how and when to assist whelping is crucial for the survival rate of puppies and health status of the dam. However, medical or surgical therapy in dystocia can impact both maternal and neonatal stress and glucose response differently. This study aims to compare perinatal cortisol and glucose among different modes of delivery in bitches and neonates. We analyzed 50 puppies derived from 27 healthy bitches. According to the condition at birth, bitches and their puppies were allocated into either a Eutocia Group (vaginal birth with no whelping assistance), Fetal Dystocia Group (whelping assistance with fetal manipulation), Maternal Dystocia Group (whelping assistance because of partial uterine inertia corrected by oxytocin administration), or Cesarean Section Group (fetal or maternal dystocia bitches subjected to C-section). Maternal blood cortisol and glucose concentrations were analyzed during the perinatal period (prepartum, intrapartum, postpartum, and 1 h after postpartum). Neonatal blood samples were collected within 5 min and 1 h after birth for assessment of cortisol and glucose. Maternal dystocia bitches had higher cortisol concentrations at postpartum than the Fetal Dystocia Group. At 1 h postpartum, the Cesarean Section Group had higher cortisol concentrations compared with fetal dystocia bitches. The Eutocia Group presented increased cortisol concentrations at intrapartum and postpartum, whereas fetal dystocia bitches had higher intrapartum cortisol concentrations than at 1 h postpartum. The Maternal Dystocia Group presented higher postpartum cortisol concentrations than at prepartum and 1 h postpartum. Maternal glucose had a progressive increase throughout peripartum and was higher during postpartum and at 1 h postpartum. C-section bitches had the highest blood glucose concentration. Neonatal cortisol concentrations at birth were higher than 1 h after birth. Fetal dystocia puppies had higher cortisol concentrations, whereas caesarian section puppies had lower cortisol levels. Fetal dystocia and C-section puppies had higher glucose concentrations than the Eutocia Group. In conclusion, maternal dystocia leads to high cortisol concentrations in bitches immediately postpartum, whereas only fetal dystocia causes increased neonatal cortisol concentrations. Moreover, fetal dystocia and C-section are hyperglycemic obstetrical conditions for neonatal puppies; on the other hand, only C-section causes hyperglycemia in bitches.
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Affiliation(s)
- C F Lúcio
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, Rua Prof. Orlando Marques de Paiva, 87 - Cidade Universitária, São Paulo 05508-270, Brazil
| | - L C G Silva
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, Rua Prof. Orlando Marques de Paiva, 87 - Cidade Universitária, São Paulo 05508-270, Brazil
| | - C I Vannucchi
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, Rua Prof. Orlando Marques de Paiva, 87 - Cidade Universitária, São Paulo 05508-270, Brazil.
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27
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Martinez LD, Glynn LM, Sandman CA, Wing DA, Davis EP. Cesarean delivery and infant cortisol regulation. Psychoneuroendocrinology 2020; 122:104862. [PMID: 33080520 PMCID: PMC7818649 DOI: 10.1016/j.psyneuen.2020.104862] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cesarean delivery reduces the risk of infant and maternal morbidity and mortality when medically indicated, however, the cesarean delivery rate is estimated to be two to three times higher than medically necessary. The World Health Organization and American College of Obstetricians and Gynecologists have expressed concern over the high rates of cesarean delivery, citing evidence that cesarean delivery has negative short- and long-term consequences for the health of the infant, mother, and for future pregnancies. Infants delivered by cesarean are at an increased risk of metabolic disease and immune dysfunction throughout the lifespan. Preliminary research suggests that the hypothalamic pituitary adrenal (HPA) axis is a plausible pathway linking cesarean delivery to poor health later in life. The present study examines the relation between mode of delivery and HPA axis function in six-month-old infants. We also examine whether the cesarean delivery was elective or indicated altered to the relation between mode of delivery and infant cortisol profiles. METHODS The sample included 136 mother/infant pairs. Thirty-nine women delivered by cesarean and 97 delivered vaginally. Maternal and infant medical records were reviewed for prenatal medical history and birth outcomes. Infant saliva was collected for cortisol analysis at a 6-month well-baby checkup. Samples were collected upon arrival to the appointment (baseline) and 20 min after exposure to a painful stressor, the inoculation procedure (response). A mixed model ANCOVA was conducted to determine whether salivary cortisol concentrations differed between the two delivery groups. To examine whether complications related to having an indicated cesarean delivery contributed to any association between mode of delivery and cortisol production, cortisol concentrations were compared between the subgroup of infants whose cesarean deliveries were elective (e.g. maternal request or previous cesarean delivery) to infants delivered vaginally. RESULTS Infants delivered by cesarean had lower cortisol concentrations at baseline and after the inoculation procedure compared to those delivered vaginally. Further, the relation between mode of delivery and cortisol levels persisted even when the analyses were restricted to compare only the elective cesarean deliveries (e.g. maternal request or previous cesarean delivery) to those delivered vaginally. DISCUSSION This study provides evidence for an association between cesarean delivery and infant HPA axis function in infancy. Findings are consistent with the hypothesis that the HPA axis is a plausible pathway that links cesarean delivery with long-term health outcomes.
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Affiliation(s)
- Leticia D Martinez
- Department of Psychology, University of Denver, Denver, CO, USA; Department of Educational, School, and Counseling Psychology, University of Missouri, Columbia, MO, USA
| | - Laura M Glynn
- Department of Psychology, Chapman University, Orange, CA, USA
| | - Curt A Sandman
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, USA
| | - Deborah A Wing
- Department of Obstetrics and Gynecology, University of California, Irvine, Irvine, CA United States
| | - Elysia Poggi Davis
- Department of Psychology, University of Denver, Denver, CO, USA; Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, USA.
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28
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Słabuszewska-Jóźwiak A, Szymański JK, Ciebiera M, Sarecka-Hujar B, Jakiel G. Pediatrics Consequences of Caesarean Section-A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8031. [PMID: 33142727 PMCID: PMC7662709 DOI: 10.3390/ijerph17218031] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cesarean section is a surgical procedure, which is the most frequently performed in gynecology and obstetrics. It is commonly believed that an operative delivery is a less painful and safer mode of delivery, which translates into an increasing number of the procedures performed without medical indications. The maternal sequelae of cesarean sections are well elucidated and widely discussed in the literature, while long-term neonatal consequences still remain the issue of research and scientific dispute. The aim of the present paper was to perform a systematic review of current literature regarding pediatrics consequences of cesarean section. METHODS We reviewed available data from PubMed, Science Direct as well as Google Scholar bases concerning early and long-term neonatal sequelae of operative deliveries. The following key words were used: "cesarean section", "caesarean section", "neonatal outcomes", "respiratory disorders", "asthma", "obesity", "overweight", and "neurological disorders". A total of 1636 papers were retrieved out of which 27 were selected for the final systematic review whereas 16 articles provided data for meta-analysis. Statistical analyses were performed using RevMan 5.4. To determine the strength of association between the caesarean section and respiratory tract infections, asthma, diabetes type 1 as well as obesity the pooled odds ratios (OR) with the 95% confidence intervals (CI) were calculated. RESULTS Conducted meta-analyses revealed that caesarean section is a risk factor for respiratory tract infections (pooled OR = 1.30 95%CI 1.06-1.60, p = 0.001), asthma (pooled OR = 1.23 95%CI 1.14-1.33, p < 0.00001) as well as obesity (pooled OR = 1.35 95%CI 1.29-1.41, p < 0.00001) in offspring. CONCLUSIONS The results of the studies included indicated that children delivered by cesarean section more commonly developed respiratory tract infections, obesity and the manifestations of asthma than children delivered vaginally. The risk of developing diabetes mellitus type 1 or neurological disorders in offspring after caesarean section is still under discussion.
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Affiliation(s)
- Aneta Słabuszewska-Jóźwiak
- First Department of Obstetrics and Gynaecology, Centre of Postgraduate Medical Education, Żelazna 90 Street, 01-004 Warsaw, Poland; (J.K.S.); (G.J.)
| | - Jacek Krzysztof Szymański
- First Department of Obstetrics and Gynaecology, Centre of Postgraduate Medical Education, Żelazna 90 Street, 01-004 Warsaw, Poland; (J.K.S.); (G.J.)
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynaecology, Centre of Postgraduate Medical Education, Cegłowska 80 Street, 01-809 Warsaw, Poland;
| | - Beata Sarecka-Hujar
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Kasztanowa 3 Street, 41-200 Sosnowiec, Poland;
| | - Grzegorz Jakiel
- First Department of Obstetrics and Gynaecology, Centre of Postgraduate Medical Education, Żelazna 90 Street, 01-004 Warsaw, Poland; (J.K.S.); (G.J.)
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29
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Does the Caesarean Section Impact on 11β HSD2 and Fetal Cortisol? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155566. [PMID: 32752242 PMCID: PMC7432821 DOI: 10.3390/ijerph17155566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 01/09/2023]
Abstract
Purpose: Comparison of the activity of 11beta-hydroxysteroid dehydrogenase type 2 in the placenta and the umbilical cord blood cortisol level between caesarean sections with or without uterine contraction and vaginal delivery groups. Cortisol is the main stress hormone responsible for the normal adaptation of the neonate to extrauterine life. The disorders resulting from a dysfunction of the 11β-HSD 2–cortisol system can explain the higher risk of developing diseases in children born by caesarean section. Methods: 111 healthy, pregnant women in singular pregnancy at term of delivery were included into the study. The study comprised 11β-HSD 2 in placental tissue from 49 pregnant women delivering by elective caesarean section and 46 pregnant women delivering by vagina. In 16 cases of the elective caesarean section, regular uterine contractions were declared. Cortisol level was estimated in umbilical cord blood directly after delivery. Results: We found no statistically significant differences in the activity of 11β-HSD 2 in placentas delivered via caesarean sections (29.61 on average in elective caesarean sections and 26.65 on average in intrapartum caesarean sections) compared to vaginal deliveries (31.94 on average, p = 0.381), while umbilical cord blood cortisol in the elective caesarean sections group was significantly lower (29.86 on average) compared to the vaginal deliveries (55.50 on average, p < 0.001) and intrapartum caesarean sections (52.27 on average, p < 0.001). Conclusions: The model of placental 11β-HSD 2 activity and umbilical cord blood cortisol concentration seems to be significant in conditions of stress associated with natural uterine contractions in labour.
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Abstract
The main inherited cardiac arrhythmias are long QT syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia and Brugada syndrome. These rare diseases are often the underlying cause of sudden cardiac death in young individuals and result from mutations in several genes encoding ion channels or proteins involved in their regulation. The genetic defects lead to alterations in the ionic currents that determine the morphology and duration of the cardiac action potential, and individuals with these disorders often present with syncope or a life-threatening arrhythmic episode. The diagnosis is based on clinical presentation and history, the characteristics of the electrocardiographic recording at rest and during exercise and genetic analyses. Management relies on pharmacological therapy, mostly β-adrenergic receptor blockers (specifically, propranolol and nadolol) and sodium and transient outward current blockers (such as quinidine), or surgical interventions, including left cardiac sympathetic denervation and implantation of a cardioverter-defibrillator. All these arrhythmias are potentially life-threatening and have substantial negative effects on the quality of life of patients. Future research should focus on the identification of genes associated with the diseases and other risk factors, improved risk stratification and, in particular for Brugada syndrome, effective therapies.
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Mohamadi-Jorjafki E, Abbasnejad M, Kooshki R, Esmaeili-Mahani S, Raoof M. Mode of delivery alters dental pulp nociception and pain-induced changes in cognitive performance in adults male rats. Can J Physiol Pharmacol 2020; 98:717-724. [PMID: 32516558 DOI: 10.1139/cjpp-2019-0370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This study examined the effects of delivery mode on the response to inflammatory pulpal pain and pain-induced changes in cognitive performance in adult rats. Experiments were done on rats born by vaginal or caesarean section (C-section) delivery. Dental pulp was irritated by intradental capsaicin (100 μg) application and then nociceptive scores were recorded for 40 min. Spatial and passive avoidance learning and memory were assessed using the Morris water maze (MWM) and shuttle box tools, respectively. Additionally, in vivo recording of field excitatory postsynaptic potential (fEPSP) in the CA1 of the hippocampus was used to verify synaptic plasticity. Capsaicin produced more significant nociceptive behavior in vaginally delivered rats compared to C-section rats (P < 0.01). C-section-delivered rats show better performance in both MWM and shuttle box tests. Likewise, C-section rats had greater fEPSP slopes compared to the vaginally delivered group (P < 0.05). Capsaicin impairs cognitive performance in rats born by each delivery route. However, capsaicin effects were more significant in rats delivered vaginally than by C-section. Overall, C-section-delivered rats show lower sensitivity to capsaicin-evoked pulpal nociception and better cognitive performance than vaginally delivered rats. These effects are in part mediated by reduced neuroinflammation and enhanced neuronal synaptic plasticity following C-section delivery.
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Affiliation(s)
- Elham Mohamadi-Jorjafki
- Department of Biology, Faculty of Sciences, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Mehdi Abbasnejad
- Department of Biology, Faculty of Sciences, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Razieh Kooshki
- Department of Biology, Faculty of Sciences, Lorestan University, Khorramabad, Iran
| | - Saeed Esmaeili-Mahani
- Department of Biology, Faculty of Sciences, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Maryam Raoof
- Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran.,Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universities Amsterdam, Amsterdam, the Netherlands
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La Camera G, La Via L, Murabito P, Pitino S, Dezio V, Interlandi A, Minardi C, Astuto M. Epidural analgesia during labour and stress markers in the newborn. J OBSTET GYNAECOL 2020; 41:690-692. [PMID: 32496840 DOI: 10.1080/01443615.2020.1755621] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Labour and modes of delivery can influence the plasma levels of stress hormones and cytokines involved in pathophysiologic cascade, potentially damaging brain development of the newborn. This prospective observational, single-centre, case-control, non-profit study aimed to detect potential differences in foetal well-being such as stress neuroendocrine responses. Quantitative determinations of the stress markers interleukin (IL)-1β, IL-8, and β-endorphin were compared between the control group and the epidural analgesia group. We found higher IL1-β levels but lower IL-8 and β-endorphin levels in the epidural analgesia group than in the control group. No significant inter-group differences were observed for any parameters. Our findings demonstrate that epidural analgesia for pain relief during labour does not result in significant differences in blood stress response markers.IMPACT STATEMENTWhat is already known on this subject? We already know that plasma levels of stress hormones and cytokines are influenced by labour and delivery modes. This has a deep impact on the newborn in terms of brain damage, immune system deficits, and altered hypothalamic-pituitary axis responses. We also know that epidural analgesia is a widespread practice that offers pain relief to the woman in labour, but there are few studies on the potentially negative effects of epidural labour analgesia on the unborn child.What do the results of this study add? This study found no significative differences in blood stress response markers between the epidural analgesia group and the control group. Under this study circumstances we found out that epidural analgesia does not significantly influence the newborn's well-being during labour and delivery.What are the implications of these findings for clinical practice and/or further research? These findings must be confirmed by further studies to verify whether epidural analgesia is safe for the newborn's development.
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Affiliation(s)
- Giuseppa La Camera
- Department of Surgery and Medical and Surgical Specialties - Section of Anaesthesiology and Intensive Care, University of Catania (Italy), Catania, Italy
| | - Luigi La Via
- School of Specialization in Anaesthesia, Resuscitation, Intensive Care and Pain Medicine, University of Catania, Catania, Italy
| | - Paolo Murabito
- Department of Surgery and Medical and Surgical Specialties - Section of Anaesthesiology and Intensive Care, University of Catania (Italy), Catania, Italy
| | - Sofia Pitino
- Department of Anaesthesia and Intensive Care, University Hospital "G. Rodolico" of Catania, Catania, Italy
| | - Veronica Dezio
- School of Specialization in Anaesthesia, Resuscitation, Intensive Care and Pain Medicine, University of Catania, Catania, Italy
| | - Alessandra Interlandi
- School of Specialization in Anaesthesia, Resuscitation, Intensive Care and Pain Medicine, University of Catania, Catania, Italy
| | - Carmelo Minardi
- Department of Anaesthesia and Intensive Care, University Hospital "G. Rodolico" of Catania, Catania, Italy
| | - Marinella Astuto
- Department of Surgery and Medical and Surgical Specialties - Section of Anaesthesiology and Intensive Care, University of Catania (Italy), Catania, Italy
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Huang Y, Tzeng JY, Maguire R, Hoyo C, Allen T. The association between neuraxial anesthesia and the development of childhood asthma - a secondary analysis of the newborn epigenetics study cohort. Curr Med Res Opin 2020; 36:1025-1032. [PMID: 32212939 PMCID: PMC7269869 DOI: 10.1080/03007995.2020.1747417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objectives: Childhood asthma is a common chronic illness that has been associated with mode of delivery. However, the effect of cesarean delivery alone does not fully account for the increased prevalence of childhood asthma. We tested the hypothesis that neuraxial anesthesia used for labor analgesia and cesarean delivery alters the risk of developing childhood asthma.Methods: Within the Newborn Epigenetics Study birth cohort, 196 mother and child pairs with entries in the electronic anesthesia records were included. From these records, data on maternal anesthesia type, duration of exposure, and drugs administered peripartum were abstracted and combined with questionnaire-derived prenatal risk factors and medical records and questionnaire-derived asthma diagnosis data in children. Logistic regression models were used to evaluate associations between type of anesthesia, duration of anesthesia, and the development of asthma in males and females.Results: We found that longer duration of epidural anesthesia was associated with a lower risk of asthma in male children (OR = 0.80; 95% CI = 0.66-0.95) for each hour of epidural exposure. Additionally, a unit increase in the composite dose of local anesthetics and opioid analgesics administered via the spinal route was associated with a lower risk of asthma in both male (OR = 0.59, 95% CI = 0.36-0.96) and female children (OR 0.26, 95% CI 0.09-0.82).Conclusion: Our data suggest that peripartum exposure to neuraxial anesthesia may reduce the risk of childhood asthma primarily in males. Larger human studies and model systems with longer follow-up are required to elucidate these findings.
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Affiliation(s)
- Yueyang Huang
- Bioinformatics Research Center, North Carolina State University, Raleigh, NC, USA
| | - Jung-Ying Tzeng
- Bioinformatics Research Center, North Carolina State University, Raleigh, NC, USA
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
- Department of Statistics, North Carolina State University, Raleigh, NC, USA
| | - Rachel Maguire
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Cathrine Hoyo
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Terrence Allen
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
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Werner A, Wu C, Zachariae R, Nohr EA, Uldbjerg N, Hansen ÅM. Effects of antenatal hypnosis on maternal salivary cortisol during childbirth and six weeks postpartum-A randomized controlled trial. PLoS One 2020; 15:e0230704. [PMID: 32357152 PMCID: PMC7194394 DOI: 10.1371/journal.pone.0230704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/05/2020] [Indexed: 11/29/2022] Open
Abstract
Background Cortisol has been used to capture psychophysiological stress during childbirth and postpartum wellbeing. We explored the effect of a brief antenatal training course in self-hypnosis on salivary cortisol during childbirth and 6 weeks postpartum. Methods In a randomized, controlled trial conducted at Aarhus University Hospital Skejby Denmark during the period January 2010 until October 2010, a total of 349 healthy nulliparous women were included. They were randomly allocated to a hypnosis group (n = 136) receiving three one-hour lessons in self-hypnosis with additional audio-recordings, a relaxation group (n = 134) receiving three one-hour lessons in various relaxation methods with audio-recordings for additional training, and a usual care group (n = 79) receiving ordinary antenatal care only. Salivary cortisol samples were collected during childbirth (at the beginning of the pushing state, 30 minutes, and 2 hours after childbirth), and 6 weeks postpartum (at wake up, 30 minutes after wake up, and evening). Cortisol concentrations were compared using a linear mixed-effects model. Correlations between cortisol concentrations and length of birth, experienced pain and calmness during birth were examined by a Spearman rank correlation test. Findings During childbirth, week correlations were found between cortisol concentrations 30 minutes after childbirth and length of birth. In the beginning of the pushing state and 2 hours after childbirth, we found a tendency towards higher cortisol concentrations in the hypnosis group compared to the other two groups (hypnosis versus relaxation p = 0.02 and 0.03, hypnosis versus usual care p = 0.08 and 0.05). No differences were observed in cortisol concentrations between the groups 30 minutes after childbirth (hypnosis versus relaxation p = 0.08, hypnosis versus usual care 0.10) or 6 weeks postpartum (hypnosis versus relaxation: p = 0.85, 0.51, and 0.68, hypnosis versus usual care: p = 0.85, 0.93, and 0.96). Conclusion Antenatal hypnosis training may increase the release of cortisol during childbirth with no long-term consequences. Further research is needed to help interpret these findings.
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Affiliation(s)
- Anette Werner
- Institute of Clinical Research, Research Unit of Gynecology and Obstetrics, University of Southern Denmark, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- * E-mail:
| | - Chunsen Wu
- Institute of Clinical Research, Research Unit of Gynecology and Obstetrics, University of Southern Denmark, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Robert Zachariae
- Department of Oncology, Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus, Denmark
- Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Ellen A. Nohr
- Institute of Clinical Research, Research Unit of Gynecology and Obstetrics, University of Southern Denmark, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Niels Uldbjerg
- Department of Gynecology and Obstetrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- National Research Centre for the Working Environment, Copenhagen, Denmark
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Salivary cortisol levels as a biomarker for severity of withdrawal in opioid-exposed newborns. Pediatr Res 2020; 87:1033-1038. [PMID: 31578040 DOI: 10.1038/s41390-019-0601-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/19/2019] [Accepted: 09/03/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Scoring tools used to quantify withdrawal in infants with neonatal abstinence syndrome (NAS) are often confounded by subjective measurements. This study assessed salivary cortisol as an objective biomarker of withdrawal severity in opioid-exposed newborns. METHODS A prospective study was conducted in 25 full-term opioid-exposed newborns monitored for NAS. Morning and evening salivary cortisol levels were collected starting within 48 h post birth until initiation of pharmacologic treatment for withdrawal (Pre-Treatment) or when the infant was discharged without pharmacotherapy (No Treatment). RESULTS Cortisol levels in the Pre-Treatment group (n = 11) were significantly higher within the first week of life (median 1.74 µg/dl) than in the No Treatment group (n = 11; median 0.72 µg/dl; P = 0.003); three infants had inadequate saliva volume for cortisol assay. Cortisol significantly decreased after 72 h post birth among infants discharged without pharmacotherapy (≤72 h median 1.25 µg/dl; ≥72 h median 0.58 µg/dl; P = 0.022), whereas cortisol remained elevated for infants subsequently treated for severity of withdrawal. No cortisol circadian rhythm was observed for either group. CONCLUSIONS Salivary cortisol in opioid-exposed newborns may provide an index of stress and help identify infants who will have more severe clinical presentation of NAS. Such a biomarker would allow risk stratification for early treatment and discharge decisions.
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Tao K, Hara Y, Ishihara Y, Ohshima Y. Cesarean section predominantly affects right ventricular diastolic function during the early transitional period. Pediatr Neonatol 2019; 60:523-529. [PMID: 30713044 DOI: 10.1016/j.pedneo.2019.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/10/2018] [Accepted: 01/15/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although the mode of delivery is well known to affect pulmonary function, the effects of a cesarean delivery on postnatal changes in cardiac mechanics have not been clearly defined. METHODS To evaluate whether delivery mode influences cardiac function in the early transitional period, 42 infants delivered by cesarean section (CS) and 110 by vaginal delivery (VD) were enrolled, and they underwent serial echocardiography at 0, 1, 2, and 5 days of age. Longitudinal changes in ejection fraction (EF), fractional area change (FAC), mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), Tei index, ratio of peak early diastolic flow velocity (E) to peak early diastolic annular velocity (e') (E/e'), and deceleration time (DcT) were compared between the two groups. RESULTS FAC and DcT of both ventricles increased during the first week, whereas Tei index of each chamber decreased irrespective of delivery mode. E/e's of both ventricles were significantly higher and MAPSE was significantly lower in the CS than VD group throughout the observation period. After adjustment for the effects of birth weight, gestational age, and oxygen administration by multivariate analysis, right ventricular E/e', which reflects diastolic function of the right ventricle, was most affected by delivery mode. CONCLUSION CS affected diastolic function of the right ventricle in the 2nd day after giving birth and did not persist. Delayed adaptation of the neonatal myocardium and/or persistence of pulmonary hypertension might explain the hemodynamic changes in neonates born by CS.
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Affiliation(s)
- Katsuo Tao
- Department of Pediatrics, Fukui Aiiku Hospital, Fukui, Japan; Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
| | - Yoshikazu Hara
- Department of Pediatrics, Sugita Genpaku Memorial Obama Municipal Hospital, Fukui, Japan.
| | | | - Yusei Ohshima
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
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Samuel TM, Binia A, de Castro CA, Thakkar SK, Billeaud C, Agosti M, Al-Jashi I, Costeira MJ, Marchini G, Martínez-Costa C, Picaud JC, Stiris T, Stoicescu SM, Vanpeé M, Domellöf M, Austin S, Sprenger N. Impact of maternal characteristics on human milk oligosaccharide composition over the first 4 months of lactation in a cohort of healthy European mothers. Sci Rep 2019; 9:11767. [PMID: 31409852 PMCID: PMC6692355 DOI: 10.1038/s41598-019-48337-4] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 08/01/2019] [Indexed: 12/14/2022] Open
Abstract
Human milk oligosaccharide (HMO) composition varies among lactating mothers and changes during the course of lactation period. Interindividual variation is largely driven by fucosyltransferase (FUT2 and FUT3) polymorphisms resulting in 4 distinct milk groups. Little is known regarding whether maternal physiological status contributes to HMO variability. We characterized the trajectories of 20 major HMOs and explored whether maternal pre-pregnancy body mass index (ppBMI), mode of delivery, or parity may affect milk HMO composition. Using longitudinal breastmilk samples from healthy mothers (n = 290) across 7 European countries, we characterized HMO composion and employed mixed linear models to explore associations of maternal characteristics with individual HMOs. We observed HMO-specific temporal trajectories and milk group dependencies. We observed relatively small but significant differences in HMO concentrations based on maternal ppBMI, mode of delivery and parity. Our findings suggest that HMO composition to be regulated time-dependently by an enzyme as well as substrate availability and that ppBMI, mode of delivery, and parity may influence maternal physiology to affect glycosylation marginally within the initital period of lactation. Our observational study is the largest European standardized and longitudinal (up to 4 months) milk collection study assessing HMO concentrations and basic maternal characteristics. Time of lactation and milk groups had the biggest impact on HMO variation. Future studies need to elucidate these observations and assess the physiological significance for the breastfed infant.
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Affiliation(s)
- Tinu Mary Samuel
- Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Aristea Binia
- Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | | | - Sagar K Thakkar
- Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | | | | | - Isam Al-Jashi
- Al Jashi Isam Private Med. Practice, Bucharest, Romania
| | | | | | | | | | | | | | | | | | - Sean Austin
- Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Norbert Sprenger
- Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland.
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Pundir S, Mäkelä J, Nuora A, Junttila N, Wall CR, Linderborg K, Cameron-Smith D, Lagström H. Maternal influences on the glucocorticoid concentrations of human milk: The STEPS study. Clin Nutr 2019; 38:1913-1920. [DOI: 10.1016/j.clnu.2018.06.980] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 06/05/2018] [Accepted: 06/24/2018] [Indexed: 11/24/2022]
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Investigating Stress Response during Vaginal Delivery and Elective Cesarean Section through Assessment of Levels of Cortisol, Interleukin 6 (IL-6), Growth Hormone (GH) and Insulin-Like Growth Factor 1 (IGF-1). J Clin Med 2019; 8:jcm8081112. [PMID: 31357604 PMCID: PMC6723771 DOI: 10.3390/jcm8081112] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 12/24/2022] Open
Abstract
Background: How do stress related phenomena during labor differ between vaginal delivery (VD) and elective cesarean section (CS), remains of heightened interest. The purpose of this study is to investigate discrepancies regarding the stress response during VD and CS. Methods: Cortisol, interleukin 6 (IL-6), growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels from parturients’ peripheral blood were evaluated on three time-points, namely during the first stage of labor (TP1), two hours post labor (TP2) and 48 h post labor (TP3). Levels were also evaluated from the umbilical cord blood. A total of 50 women were enrolled in this prospective cohort study, with 24 and 26 subjected to CS and VD, respectively. Results: No statistically significant differences were observed between the two groups at TP1. Only GH levels presented the same pattern during the three time-points among both groups. In the umbilical cord blood, the CS group presented statistically significant higher IGF-1 and GH levels. In the umbilical cord blood, IGF-1 and GH levels were positively correlated, while GH and cortisol levels were negatively correlated. Conclusion: CS is a less stressful procedure than VD and is further associated with less intense inflammation, albeit with a longer inflammatory response period. Labor physiology during CS differs considerably regarding respective observations during VD. This merits extensive investigation in order to decipher these data for optimal clinical practice and guidelines.
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Plasma cortisol and ACTH levels in 416 VLBW preterm infants during the first month of life: distribution in the AGA/SGA population. J Perinatol 2019; 39:934-940. [PMID: 31068663 DOI: 10.1038/s41372-019-0381-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study is to establish the serum level distribution of cortisol and ACTH in VLBW preterm newborns and determine which neonates are ideal candidates for the stimulation test for adrenal insufficiency. METHODS Plasma cortisol and ACTH levels were evaluated in 416 VLBW newborns on days 1, 7, and 30 of life. Gender, gestational age, weight, type of delivery, RDS prophylaxis, and perinatal morbidities were considered as potential variability factors. RESULTS Cortisol and ACTH levels significantly decreased between 1, 7, and 30 days. Significantly higher cortisol levels were found at lower gestational ages and in infants born by vaginal delivery, whereas lower levels were observed in those born after maternal corticosteroid treatment. The distribution of cortisol and ACTH levels in healthy infants born by cesarian section is presented. CONCLUSION Even if high or low levels were not frequently linked to illness, the presented distribution data may indicate that the newborns are ideal candidates for the stimulation test.
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Mjelle AB, Guthe HJT, Reigstad H, Bjørke‐Monsen AL, Markestad T. Serum concentrations of C-reactive protein in healthy term-born Norwegian infants 48-72 hours after birth. Acta Paediatr 2019; 108:849-854. [PMID: 30222898 DOI: 10.1111/apa.14578] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 09/03/2018] [Accepted: 09/12/2018] [Indexed: 11/28/2022]
Abstract
AIM To determine serum C-reactive protein (CRP) concentrations in healthy term-born infants shortly after birth. METHODS We sampled blood from 182 infants along with the routine neonatal screening programme at 48-72 hours of age from consecutively recruited healthy infants without signs of infection and a gestational age (GA) of at least 37 weeks. The blood was stored at minus 20°C until analysis in one assay after the end of the study. RESULTS The CRP levels were positively skewed. The median concentration was 5.0 mg/L, 48.9% of the neonates had values <5.0 mg/L, 19.8% ≥10.0 mg/L, 7.1% ≥20.0 mg/L and 1.1% (2 neonates) >30 mg/L. The CRP level was positively related to GA and duration of labour, slightly higher in boys than girls and after vaginal compared to Caesarean delivery. CONCLUSION In healthy neonates born at term, the CRP concentrations did not vary substantially with various common perinatal clinical conditions, and levels above 30 mg/L were uncommon at two to three days of age.
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Affiliation(s)
- Anders Batman Mjelle
- Department of Clinical Medicine University of Bergen Bergen Norway
- Department of Pediatric and Adolescent Medicine Haukeland University Hospital Bergen Norway
| | - Hans Jørgen Timm Guthe
- Department of Pediatric and Adolescent Medicine Haukeland University Hospital Bergen Norway
| | - Hallvard Reigstad
- Department of Pediatric and Adolescent Medicine Haukeland University Hospital Bergen Norway
| | - Anne Lise Bjørke‐Monsen
- Laboratory of Clinical Biochemistry Haukeland University Hospital Bergen Norway
- Department of Clinical Science University of Bergen Bergen Norway
| | - Trond Markestad
- Department of Clinical Science University of Bergen Bergen Norway
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Chen L, Guilmette J, Luo ZC, Cloutier A, Wang WJ, Yang MN, Fraser WD, Dubois J, Nuyt AM. Placental 11β-HSD2 and Cardiometabolic Health Indicators in Infancy. Diabetes Care 2019; 42:964-971. [PMID: 30833369 DOI: 10.2337/dc18-2041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/05/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Fetal excessive exposure to glucocorticoids may program cardiometabolic risk. Placental 11 β-hydroxysteroid dehydrogenase 2 (11β-HSD2) serves as a barrier to prevent fetal overexposure to maternal glucocorticoids. It has not been explored whether placental 11β-HSD2 levels are associated with cardiometabolic health in postnatal life. RESEARCH DESIGN AND METHODS In a prospective birth cohort study of 246 mother-infant pairs, we measured placental 11β-HSD2 expression and maternal (32-35 weeks of gestation) and cord plasma cortisol concentrations. The primary outcomes were HOMA of insulin resistance (IR) and blood pressure (BP) in infants at age 1 year. Other outcomes included fasting insulin, HOMA β-cell function, carotid intima-media thickness, weight z score, and skinfold thickness (triceps and subscapular) at age 1 year. RESULTS Placental 11β-HSD2 expression was negatively correlated with HOMA-IR (r = -0.17, P = 0.021) and fasting insulin (r = -0.18, P = 0.017) and marginally negatively correlated with systolic BP (r = -0.16, P = 0.057) but was not correlated with HOMA of β-cell function, diastolic BP, carotid intima-media thickness, and skinfold thickness (all P > 0.1) in infants at age 1 year. Cord plasma cortisol was negatively correlated to skinfold thickness (r = -0.20, P = 0007) but was not correlated with other outcomes at age 1 year. Maternal plasma cortisol was positively correlated with maximal carotid intima-media thickness (r = 0.20, P = 0.03) but was not correlated with other outcomes. Adjusting for maternal and infant characteristics, the associations were similar. CONCLUSIONS The study is the first to show that higher placental 11β-HSD2 expression is associated with lower IR in infancy. Independent cohort studies are required to confirm this novel finding.
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Affiliation(s)
- Lu Chen
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Prosserman Center for Population Health Research, Mount Sinai Hospital, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Sainte-Justine University Hospital and Research Center, University of Montreal, Montreal, Quebec, Canada.,Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Julie Guilmette
- Sainte-Justine University Hospital and Research Center, University of Montreal, Montreal, Quebec, Canada.,Department of Pathology, Charles-Lemoyne Hospital, Longueuil, Quebec, Canada
| | - Zhong-Cheng Luo
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Prosserman Center for Population Health Research, Mount Sinai Hospital, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada .,Sainte-Justine University Hospital and Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Anik Cloutier
- Sainte-Justine University Hospital and Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Wen-Juan Wang
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Prosserman Center for Population Health Research, Mount Sinai Hospital, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Meng-Nan Yang
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Prosserman Center for Population Health Research, Mount Sinai Hospital, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - William D Fraser
- Sainte-Justine University Hospital and Research Center, University of Montreal, Montreal, Quebec, Canada.,Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Josée Dubois
- Sainte-Justine University Hospital and Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Anne Monique Nuyt
- Sainte-Justine University Hospital and Research Center, University of Montreal, Montreal, Quebec, Canada
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Ng SM, Ogundiya A, Didi M, Turner MA. Adrenal function of extremely premature infants in the first 5 days after birth. J Pediatr Endocrinol Metab 2019; 32:363-367. [PMID: 30849046 DOI: 10.1515/jpem-2018-0417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/08/2019] [Indexed: 11/15/2022]
Abstract
Background There is limited data on adrenal function in the early days after birth in extremely premature infants. The relationship between plasma adrenocorticotrophic (ACTH) and cortisol hormone is central to the integrity of the hypothalamic-pituitary-adrenal (HPA) axis yet there are no studies examining this relationship in prematurity. Methods The aim of this study was to examine the relationship between early morning plasma cortisol and ACTH concentrations during the first 5 days after birth in infants born at less than 28 weeks' gestation and to identify any independent factors that determine plasma cortisol levels in these infants during extreme prematurity. We prospectively studied early morning plasma ACTH and cortisol concentrations in infants born below 28 weeks' gestation during the first 5 days of birth. Plasma cortisol was measured without extraction, using DPC Immulite® 2000 using a solid phase 2 site chemiluminescent immunometric assay. ACTH was measured using a radioimmunoassay. Spearman's correlation was used to examine the relationship between cortisol and ACTH. Multiple regression analysis was used to examine the relationship between plasma cortisol and clinical risk index for babies (CRIB) score, antenatal dexamethasone, mode of delivery and gestation. Results There were 95 infants (53 males) of mean gestation 25.3 ± 1.3 standard deviation (SD) (range 23-27 + 6) weeks. The mean birth weight was 809 ± 17.0 g. The mean plasma cortisol was 400.5 ± 42.6 nmol/L and the mean plasma ACTH was 4.5 ± 0.9 pmol/L. Early morning plasma cortisol correlated significantly with gestation (R = 0.4, p = 0.005). Early morning plasma ACTH did not correlate with early morning plasma cortisol (R = -0.12, p = 0.7). Multiple regression analysis showed that gestation was the only independent determinant of early morning plasma cortisol concentration (beta coefficient = -0.4, p = 0.04). Conclusions The relationship between early morning plasma ACTH and plasma cortisol is either not established or is impaired in infants of less than 28 weeks' gestation in the first 5 days after birth. The plasma cortisol level is mainly determined by gestation and is not directly related to illness severity, antenatal steroids or plasma ACTH in these infants in the first 5 days after birth.
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Affiliation(s)
- Sze M Ng
- Department of Paediatrics, Southport and Ormskirk NHS Trust, Ormskirk, Lancashire, UK.,Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Akinsola Ogundiya
- Department of Paediatrics, Southport and Ormskirk NHS Trust, Ormskirk, Lancashire, UK
| | - Mohammed Didi
- Department of Endocrinology, Alder Hey Children's Hospital, Liverpool, UK
| | - Mark A Turner
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Birth experience in newborn infants is associated with changes in nociceptive sensitivity. Sci Rep 2019; 9:4117. [PMID: 30858561 PMCID: PMC6412011 DOI: 10.1038/s41598-019-40650-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 02/12/2019] [Indexed: 01/25/2023] Open
Abstract
Vaginal birth prepares the fetus for postnatal life. It confers respiratory, cardiovascular and homeostatic advantages to the newborn infant compared with elective cesarean section, and is reported to provide neonatal analgesia. We hypothesize that infants born by vaginal delivery will show lower noxious-evoked brain activity a few hours after birth compared to those born by elective cesarean section. In the first few hours of neonatal life, we record electrophysiological measures of noxious-evoked brain activity following the application of a mildly noxious experimental stimulus in 41 infants born by either vaginal delivery or by elective cesarean section. We demonstrate that noxious-evoked brain activity is related to the mode of delivery and significantly lower in infants born by vaginal delivery compared with those born by elective cesarean section. Furthermore, we found that the magnitude of noxious-evoked brain activity is inversely correlated with fetal copeptin production, a surrogate marker of vasopressin, and dependent on the experience of birth-related distress. This suggests that nociceptive sensitivity in the first few hours of postnatal life is influenced by birth experience and endogenous hormonal production.
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Macallister K, Smith-Collins A, Gillet H, Hamilton L, Davis J. Serial C-Reactive Protein Measurements in Newborn Infants without Evidence of Early-Onset Infection. Neonatology 2019; 116:85-91. [PMID: 31112949 DOI: 10.1159/000497237] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/25/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND C-reactive protein (CRP) is used to assist the diagnosis and monitoring of newborn infection. Little is known about CRP activity after birth in the absence of infection. OBJECTIVE The aim of this work was to describe postnatal CRP responses in the first days of life in asymptomatic infants with a negative blood culture. METHODS Data were collected from infants who had a blood culture taken at <72 h of age in a UK maternity hospital. All CRP values and their time from birth were recorded. Infants with signs of infection, positive blood culture, or major congenital anomalies were excluded. Infants were analysed by gestation (greater or less than 37 weeks). Normalised CRP curves were generated by linear interpolation and centile curves were derived. Comparisons of median CRP values between groups were made by Mann-Whitney U test at 24, 36, and 48 h. RESULTS During the study period a total of 219 babies were screened. After exclusions, 73 infants (58 term, 15 preterm) were analysed. In asymptomatic term neonates the CRP (mg/L) peaked at 9.4 after 34.6 h. In preterm babies the CRP peak was 1.75 at 43 h. The median (IQR) values were higher in the term group at 24 and 36 h: 2.5 (1-10.5) versus 0 (0-2.2; p = 0.02) and 3 (0-8.6) versus 0 (0-2.8; p = 0.031). CONCLUSIONS A CRP rise was demonstrated in term and preterm infants without evidence of infection. This rise was greatest in term infants. CRP values must be interpreted in the context of an infant's clinical condition and not used alone to guide clinical decision making.
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Affiliation(s)
- Kathryn Macallister
- Neonatal Directorate, King Edward Memorial and Perth Children's Hospitals, Women and Newborn Health Service, Perth, Washington, Australia.,Neonatal Department, Gloucestershire Royal Hospital NHS Foundation Trust, Gloucester, United Kingdom
| | - Adam Smith-Collins
- Regional Neonatal intensive Care Unit, St. Michael's Hospital, University Hospital Bristol, NHS Foundation Trust, Bristol, United Kingdom.,Department of Neonatal Neuroscience, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Helen Gillet
- Regional Neonatal intensive Care Unit, St. Michael's Hospital, University Hospital Bristol, NHS Foundation Trust, Bristol, United Kingdom
| | - Linze Hamilton
- Regional Neonatal intensive Care Unit, St. Michael's Hospital, University Hospital Bristol, NHS Foundation Trust, Bristol, United Kingdom
| | - Jonathan Davis
- Neonatal Directorate, King Edward Memorial and Perth Children's Hospitals, Women and Newborn Health Service, Perth, Washington, Australia, .,Centre for Newborn Research and Education, School of Child and Paediatric Health, University of Western Australia, Perth, Washington, Australia,
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46
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Tribe RM, Taylor PD, Kelly NM, Rees D, Sandall J, Kennedy HP. Parturition and the perinatal period: can mode of delivery impact on the future health of the neonate? J Physiol 2018; 596:5709-5722. [PMID: 29533463 PMCID: PMC6265543 DOI: 10.1113/jp275429] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/25/2018] [Indexed: 12/21/2022] Open
Abstract
Caesarean section and instrumental delivery rates are increasing in many parts of the world for a range of cultural and medical reasons, with limited consideration as to how 'mode of delivery' may impact on childhood and long-term health. However, babies born particularly by pre-labour caesarean section appear to have a subtly different physiology from those born by normal vaginal delivery, with both acute and chronic complications such as respiratory and cardio-metabolic morbidities being apparent. It has been hypothesized that inherent mechanisms within the process of labour and vaginal delivery, far from being a passive mechanical process by which the fetus and placenta are expelled from the birth canal, may trigger certain protective developmental processes permissive for normal immunological and physiological development of the fetus postnatally. Traditionally the primary candidate mechanism has been the hormonal surges or stress response associated with labour and vaginal delivery, but there is increasing awareness that transfer of the maternal microbiome to the infant during parturition. Transgenerational transmission of disease traits through epigenetics are also likely to be important. Interventions such as probiotics, neonatal gut seeding and different approaches to clinical care have potential to influence parturition physiology and improve outcomes for infants.
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Affiliation(s)
- R. M. Tribe
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas’ Hospital CampusKing's College LondonLondon SE1 7EHUK
| | - P. D. Taylor
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas’ Hospital CampusKing's College LondonLondon SE1 7EHUK
| | - N. M. Kelly
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas’ Hospital CampusKing's College LondonLondon SE1 7EHUK
| | - D. Rees
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas’ Hospital CampusKing's College LondonLondon SE1 7EHUK
| | - J. Sandall
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas’ Hospital CampusKing's College LondonLondon SE1 7EHUK
| | - H. P. Kennedy
- Yale School of Nursing400 West Campus DriveWest HavenCT 06516USA
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Sun X, Li J, Jin S, Li Y, Liu W, Zhao H, Zhou Y, Jiang Y, Liu H, Xia W, Cai Z, Xu S, Shen X. Associations between repeated measures of maternal urinary phthalate metabolites during pregnancy and cord blood glucocorticoids. ENVIRONMENT INTERNATIONAL 2018; 121:471-479. [PMID: 30278310 DOI: 10.1016/j.envint.2018.09.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/04/2018] [Accepted: 09/22/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Previous studies have suggested that phthalates might disrupt fetal steroidogenesis. However, the evidence of the effects of prenatal phthalate exposure across pregnancy on fetal glucocorticoids was insufficient. OBJECTIVE We investigated the associations between urinary phthalate metabolites across pregnancy and cord blood glucocorticoids in a prospective birth cohort. METHODS Our study included 553 mother-infant pairs from a prospective birth cohort conducted in Wuhan, China. Maternal urine samples were collected at 14, 24 and 36 weeks of gestation (mean). Urinary phthalate metabolites and cord blood glucocorticoids (cortisol and cortisone) were measured. Generalized estimating equation models were conducted to explore the relationships of phthalate metabolite concentrations at each trimester and glucocorticoid levels. RESULTS Among the participants, mono‑benzyl phthalate (MBzP) in the first trimester was associated with higher cortisol/cortisone ratio concentrations, and mono‑(2‑ethyl‑5‑carboxypentyl) phthalate (MECPP) and mono‑(2‑ethyl‑5‑oxohexyl) phthalate (MEOHP) measured in the third trimester were associated with decreased cortisone. Moreover, the associations between phthalates and glucocorticoids varied by sex. Among the female infants, each 10-fold increase in several maternal urinary phthalate metabolite concentrations in 1st and 3rd trimester was associated with the increased glucocorticoid levels with percent changes ranged from 16.2%-55.9%. However, among male infants, each 10-fold increase in maternal urinary MECPP, mono‑(2‑ethyl‑5‑hydroxyhexyl) phthalate (MEHHP) and MEOHP in 3rd trimester was associated with 20.8%-36.3% decreased cortisol and cortisone levels, respectively. CONCLUSION We have shown that prenatal phthalate exposure during early and late trimester disrupted the infant steroidogenesis and these associations might be modified by infant sex. To the best of our knowledge, this is the first study to evaluate phthalate exposure at three trimesters during pregnancy in relation to infant glucocorticoids.
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Affiliation(s)
- Xiaojie Sun
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan 430030, Hubei, China
| | - Jiufeng Li
- State Key Laboratory of Environmental and Biological Analysis, Department of Chemistry, Hong Kong Baptist University, Hong Kong, China
| | - Shuna Jin
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan 430030, Hubei, China
| | - Yuanyuan Li
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan 430030, Hubei, China
| | - Wenyu Liu
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan 430030, Hubei, China
| | - Hongzhi Zhao
- State Key Laboratory of Environmental and Biological Analysis, Department of Chemistry, Hong Kong Baptist University, Hong Kong, China
| | - Yanqiu Zhou
- State Key Laboratory of Environmental and Biological Analysis, Department of Chemistry, Hong Kong Baptist University, Hong Kong, China
| | - Yangqian Jiang
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan 430030, Hubei, China
| | - Hongxiu Liu
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan 430030, Hubei, China
| | - Wei Xia
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan 430030, Hubei, China
| | - Zongwei Cai
- State Key Laboratory of Environmental and Biological Analysis, Department of Chemistry, Hong Kong Baptist University, Hong Kong, China
| | - Shunqing Xu
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan 430030, Hubei, China.
| | - Xiantao Shen
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan 430030, Hubei, China.
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Smajlagić D, Kvarme Jacobsen K, Myrum C, Haavik J, Johansson S, Zayats T. Moderating effect of mode of delivery on the genetics of intelligence: Explorative genome-wide analyses in ALSPAC. Brain Behav 2018; 8:e01144. [PMID: 30378284 PMCID: PMC6305932 DOI: 10.1002/brb3.1144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/27/2018] [Accepted: 09/30/2018] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Intelligence is a core construct of individual differences in cognitive abilities and a strong predictor of important life outcomes. Within recent years, rates of cesarean section have substantially increased globally, though little is known about its effect on neurodevelopmental trajectories. Thus, we aimed to investigate the influence of delivery by cesarean section on the genetics of intelligence in children. METHODS Participants were recruited through the Avon Longitudinal Study of Parents and Children (ALSPAC). Intelligence was measured by the Wechsler Intelligence Scale for Children (WISC). Genotyping was performed using the Illumina Human Hap 550 quad genome-wide SNP genotyping platform and was followed by imputation using MACH software. Genome-wide interaction analyses were conducted using linear regression. RESULTS A total of 2,421 children and 2,141,747 SNPs were subjected to the genome-wide interaction analyses. No variant reached genome-wide significance. The strongest interaction was observed at rs17800861 in the GRIN2A gene (β = -3.43, 95% CI = -4.74 to -2.12, p = 2.98E-07). This variant is predicted to be located within active chromatin compartments in the hippocampus and may influence binding of the NF-kappaB transcription factor. CONCLUSIONS Our results may indicate that mode of delivery might have a moderating effect on genetic disposition of intelligence in children. Studies of considerable sizes (>10,000) are likely required to more robustly detect variants governing such interaction. In summary, the presented findings prompt the need for further studies aimed at increasing our understanding of effects various modes of delivery may have on health outcomes in children.
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Affiliation(s)
- Dinka Smajlagić
- Department of Clinical Science, KG Jebsen Center for Neuropsychiatric DisordersUniversity of BergenBergenNorway
- Center for Medical Genetics and Molecular MedicineHaukeland University HospitalBergenNorway
| | - Kaya Kvarme Jacobsen
- Department of Biomedicine, KG Jebsen Center for Neuropsychiatric DisordersUniversity of BergenBergenNorway
| | - Craig Myrum
- Department of Biomedicine, KG Jebsen Center for Neuropsychiatric DisordersUniversity of BergenBergenNorway
| | - Jan Haavik
- Department of Biomedicine, KG Jebsen Center for Neuropsychiatric DisordersUniversity of BergenBergenNorway
| | - Stefan Johansson
- Department of Clinical Science, KG Jebsen Center for Neuropsychiatric DisordersUniversity of BergenBergenNorway
- Center for Medical Genetics and Molecular MedicineHaukeland University HospitalBergenNorway
| | - Tetyana Zayats
- Department of Biomedicine, KG Jebsen Center for Neuropsychiatric DisordersUniversity of BergenBergenNorway
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Antonucci R, Antonucci L, Locci C, Porcella A, Cuzzolin L. Current Challenges in Neonatal Resuscitation: What is the Role of Adrenaline? Paediatr Drugs 2018; 20:417-428. [PMID: 29923109 DOI: 10.1007/s40272-018-0300-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Adrenaline, also known as epinephrine, is a hormone, neurotransmitter, and medication. It is the best established drug in neonatal resuscitation, but only weak evidence supports current recommendations for its use. Furthermore, the available evidence is partly based on extrapolations from adult studies, and this introduces further uncertainty, especially when considering the unique physiological characteristics of newly born infants. The timing, dose, and route of administration of adrenaline are still debated, even though this medication has been used in neonatal resuscitation for a long time. According to the most recent Neonatal Resuscitation Guidelines from the American Heart Association, adrenaline use is indicated when the heart rate remains < 60 beats per minute despite the establishment of adequate ventilation with 100% oxygen and chest compressions. The aforementioned guidelines recommend intravenous administration (via an umbilical venous catheter) of adrenaline at a dose of 0.01-0.03 mg/kg (1:10,000 concentration). Endotracheal administration of a higher dose (0.05-0.1 mg/kg) may be considered while venous access is being obtained, even if supportive data for endotracheal adrenaline are lacking. The safety and efficacy of intraosseous administration of adrenaline remain to be investigated. This article reviews the evidence on the circulatory effects and tolerability of adrenaline in the newborn, discusses literature data on adrenaline use in neonatal cardiopulmonary resuscitation, and describes international recommendations and outcome data regarding the use of this medication during neonatal resuscitation.
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Affiliation(s)
- Roberto Antonucci
- Pediatric Clinic, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.
| | - Luca Antonucci
- Academic Department of Pediatrics, Children's Hospital Bambino Gesù, University of Rome "Tor Vergata", Rome, Italy
| | - Cristian Locci
- Pediatric Clinic, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Annalisa Porcella
- Division of Neonatology and Pediatrics, "Nostra Signora di Bonaria" Hospital, San Gavino Monreale, Italy
| | - Laura Cuzzolin
- Department of Diagnostics and Public Health, Section of Pharmacology, University of Verona, Verona, Italy
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50
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Greenbaum S, Sheiner E, Wainstock T, Segal I, Ben-Harush M, Sergienko R, Walfisch A. Cesarean Delivery and Childhood Malignancies: A Single-Center, Population-Based Cohort Study. J Pediatr 2018; 197:292-296.e3. [PMID: 29398059 DOI: 10.1016/j.jpeds.2017.12.049] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 10/30/2017] [Accepted: 12/18/2017] [Indexed: 12/12/2022]
Abstract
Rising rates of cesarean deliveries worldwide prompt the evaluation of long-term morbidity to the offspring. In this retrospective cohort study, we evaluated whether cesarean delivery influences the development of childhood malignancies. We identified an association of cesarean delivery with acute lymphoblastic leukemia in children, suggesting prudence in the recommendation of cesarean delivery for nonmedically indicated cases.
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Affiliation(s)
- Shirley Greenbaum
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Miriam Ben-Harush
- Department of Pediatric Hemato-Oncology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruslan Sergienko
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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