The fetal and infant origins of adult disease

Restoration of vascular dysfunction resulting from maternal high-fat diet via modulation of the NLRP3/IL-1β axis

This study investigated the impact of maternal high-fat diet on vascular function and endothelial homeostasis in offspring. We found that offspring exposed to maternal high-fat diet exhibited elevated blood pressure, impaired abdominal aortic vascular function, and endothelial homeostasis imbalance. These changes were accompanied by increased levels of reactive oxygen species (ROS) and upregulation of pro-inflammatory cytokines (including IL-1β, TNF-α, IL-6, and IL-10). Treatment with NLRP3 or IL-1β inhibitors prevented the deterioration in vascular function, reduced endothelial NO production, and inflammation induced by maternal high-fat diet exposure compared to the control group. The findings suggest that during pregnancy, mitigating the vascular impairments in offspring induced by maternal high-fat diet can be achieved by inhibiting the NLRP3/IL-1β pathway.

"Iron -free" CdSe/ZnS quantum dots disrupt neural differentiation of embryonic stem cells via the induction of ferroptosis

Exposure to Cadmium-based quantum dots (QDs) is becoming a growing threat to human health, necessitating a deeper understanding of their intracellular behavior and the associated toxic effects. Among the various domains of nanosafety assessment, the impact of these QDs on the nervous system is particularly critical; however, the potential effects on neurodevelopment and the underlying mechanisms remain largely unexplored. The current study explores the neural developmental toxicities associated with exposure to QDs made of cadmium selenide (CdSe) and encapsulated within a zinc sulfide (ZnS) shell using mouse embryonic stem cells (mESCs). Exposure to CdSe/ZnS QDs was found to impair the neural differentiation of mESCs via a novel mechanism of programmed cell death known as ferroptosis. Specifically, the CdSe/ZnS QDs were found to be internalized by cells, with a substantial fraction remaining within the cells even after a 24 h clearance period. Furthermore, nanoparticle internalization induced significant ROS/MDA elevation, mitochondrial depolarization and intracellular iron overload, collectively triggering ferroptosis and consequent tricarboxylic acid (TCA) cycle dysfunction. Importantly, the application of ferroptosis inhibitors was found to alleviate the disruption in the TCA cycle induced by CdSe/ZnS QDs and restore neural differentiation. Additionally, ferroptosis was established as a common form of cell death triggered by nanoparticles. These findings underscore the urgent need for further investigations into the safety profiles of CdSe/ZnS QDs in a neurological context, as an understanding of the underlying mechanisms can facilitate informed risk assessments and guide the development of safer nanomaterials for biomedical applications.

Placental Microvascular Architecture Imaging in Normal and Congenital Heart Disease Pregnancies

OBJECTIVES

To evaluate the placental vascular architecture using MV Flow™ imaging for analyzing vascular distribution per region of biological tissue in isolated congenital heart diseases (CHD), CHD associated with extracardiac malformations (EXM) and normal pregnancies, and to explore the relationship of fetal Doppler flow parameters and growth to placental perfusion in these conditions.

METHODS

Placental microvascular structure was assessed using MV-Flow™ in a total of 227 normal fetuses and 139 with CHD; fetuses with gestational age ranging from 11 to 41 weeks were included. Placental vascular indices (VIMV %) was acquired at three different segments of each placenta (upper, middle, and lower regions). Doppler pulsatility indices of fetal umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV), uterine artery (UtA), and cerebroplacental ratio were measured in both normal and CHD groups. The CHD group was divided into two subgroup based on whether it is associated with EXM.

RESULTS

Compared to the control group, the CHD with EXM group exhibited a significantly lower VIMV % for the upper, middle, and lower regions of the placenta (P = .005; P = .018; P = .039, respectively). In the total CHD group, VIMV % decreased in the middle segment of placenta in the 2nd trimester compared to the control group. But the VIMV % of upper and middle segments decreased in the 3rd trimester. Both subgroups, EXM and isolated CHD, showed similar distribution of gestational weeks. Doppler vascular indices were significantly different compared to normal in the total CHD group for UA-pulse index (PI), DV-PI, right UtA-PI, and left UtA-PI, with similar differences from normal for the CHD with EXM group. DV-PI was the only significantly different Doppler vascular parameter for the isolated CHD group compared to normal.

CONCLUSIONS

For the first time, MV-Flow™ imaging demonstrated reduced placental vascularity in fetuses with CHD and ECM and in fetuses with isolated CHD in the 3rd trimester of pregnancy. Application of MV-Flow™ as part of serial fetal echocardiographic surveillance in cases of CHD may allow for better understanding of the development of placental abnormalities.

Treatment of early-onset fetal growth restriction with low molecular weight heparin does not prolong gestation: a randomized clinical trial

BACKGROUND

Although there is a biological basis for it, there is scarce evidence on the effect of heparin in ameliorating placental insufficiency and maximizing gestational age at delivery among fetal growth restriction pregnancies.

OBJECTIVE

To explore the effectiveness of treatment using low molecular weight heparin at a prophylactic dose started at the time of diagnosis in prolonging gestation in pregnancies with early-onset fetal growth restriction.

STUDY DESIGN

This was a phase III, multicenter, triple-blind, parallel-arm randomized clinical trial conducted in 2 university hospitals in Spain. Singleton pregnancies qualifying for early-onset placental FGR according to the adapted Delphi consensus (20+0-31+6 weeks at diagnosis with umbilical artery Doppler with absent/reversed diastolic flow; or estimated fetal weight <10th percentile plus pulsatility index of umbilical artery Doppler >95th percentile; or estimated fetal weight <10th percentile plus mean pulsatility index of uterine artery Doppler >95th) were randomized to receive either subcutaneous treatment with bemiparin 3500 IU/0.2 mL/d or a placebo from inclusion at diagnosis to the time of delivery. The primary outcomes were prolongation of pregnancy from inclusion to live birth (days) and gestational age at live birth (days).

RESULTS

Forty-nine patients were included (23 in the low molecular weight heparin group and 26 in the placebo group). In the low molecular weight heparin group, the median prolongation of pregnancy was 42 days, while in the placebo group it was 41.5 days (median difference 0.5 days [95% confidence interval -22.7 to 6.3] (P=.667)) and in the low molecular weight heparin group, the median gestational age at delivery was 35.1 weeks, while in the placebo group, it was 34.6 weeks (median difference 0.5 weeks [95% confidence interval -3.4 to 1.2] (P=.639)).

CONCLUSION

The use of prophylactic dose low molecular weight heparin started at the time of diagnosis does not prolong pregnancy in individuals with early-onset fetal restriction.

Maternal Exposure to an Environmentally Relevant Phthalate Mixture Modulates the Steroidogenic Genes in the Adrenal Glands Throughout Postnatal Development of Male Rats

Phthalates are a group of chemicals used as plasticizers to enhance the malleability and flexibility of various products. The adrenal glands are responsible for producing hormones that maintain homeostasis, regulate blood pressure, and mediate stress responses. Early exposure of the adrenal glands to environmental toxicants can impair important responses, which can result in damage of adrenal development and functionality. This study aimed to investigate the effects of maternal exposure to a phthalate mixture on the development of the offspring's adrenal glands. Pregnant females (SD) were divided into three groups and treated daily, orally, from gestational day (GD) 10 to postnatal day (PND) 21 with corn oil (vehicle; Control: C) or a phthalate mixture containing 21% DEHP, 35% DEP, 15% DBP, 8% DiBP, 5% BBzP and 15% DiNP at doses of 20 μg/kg/day (T1) or 200 mg/kg/day (T2). The pups were weighed and euthanized at PND22, PND120, and PND540. Adrenal glands were collected and analyzed for steroidogenesis. Our results indicate that both doses of the mixture affected cholesterol metabolism and its mitochondrial internalization, altered the expression of StAR, Cyp11a1, and Cyp19a1, and created a microenvironment conducive to estrogenization. With aging, both doses modulated steroidogenic genes, leading to indications of hyposecretion. The higher dose (T2) also induced mitochondrial stress through the overexpression of Gpx1. In conclusion, our findings highlight the genic expression alterations in the adrenal glands of offspring exposed to phthalates during gestation and lactation, as well as their long-term consequences across different developmental stages, as potential impacts on adrenal homeostasis and metabolic functions.

Impact of endocrine disrupting chemicals (EDCs) on epigenetic regulation in the uterus: a narrative review

Endocrine disrupting chemicals (EDCs) are ubiquitous in the environment and have been shown to interfere with the endocrine system, leading to adverse effects on reproductive health. In females, EDC exposure has been linked to menstrual irregularities, infertility, and pregnancy complications. Epigenetic regulation, which involves modifications to DNA and histones that do not alter the underlying genetic code, plays a crucial role in female reproduction. EDCs have been shown to disrupt epigenetic mechanisms, leading to changes in gene expression that can have long-term effects on reproductive outcomes. Several EDCs, including bisphenol A (BPA) and phthalates, dioxins, and polychlorinated biphenyls (PCBs), have been shown to alter DNA methylation patterns and histone modifications in female reproductive tissues. These changes can lead to altered expression of genes involved in ovarian function, implantation, and placental development. Here, we integrate epidemiological and experimental evidence from the last 20 years to profile the types of diseases that EDCs trigger in the female reproductive system in relation to the uterus, and the corresponding molecular mechanisms that have been studied. In addition, this review will outline the state of knowledge of EDC epigenetic regulation in the uterus and how it impacts reproductive health, as well as identify areas for future research.

Impact of maternal microplastic exposure on offspring lung structure and function: Insights into transcriptional misregulation and the TGF-β/α-SMA pathway

The "Developmental Origins of Health and Disease" (DOHaD) theory suggests that prenatal exposure to harmful environmental factors may impair fetal tissue development, increasing the risk of diseases later in life. This study investigated the effects of prenatal exposure to polystyrene microplastics (PS-MPs) on offspring lung development. Pregnant Sprague-Dawley rats were randomly assigned to receive PS-MPs in drinking water until delivery, with a control group receiving standard water. Offspring were assessed at 7 and 120 d after birth without further PS-MPs exposure. Histopathological examination at 7 d revealed PS-MPs deposits, alveolar collapse, and inflammation in lung tissue. Gene expression analysis showed disruptions in tight junctions, transcriptional regulation, and transforming growth factor-beta (TGF-β) pathways. By day 120, lung dysfunction and structural changes, consistent with emphysema were observed. These findings demonstrate that prenatal PS-MPs exposure adversely affects lung development potentially increasing the risk of respiratory diseases. Public health measures should address the potential hazards of microplastics to fetal health.

Maternal malnutrition induces inflammatory pathways and oxidative stress in the dorsolateral prostate of male offspring rats

Maternal conditions during pregnancy can influence the long-term health of offspring. In particular, maternal malnutrition (MM), such as protein restriction, affects the development of several organs, including the male reproductive system. This study examined how a low-protein maternal diet impacts the structure and function of the dorsolateral prostate (DLP) in aging male rats. Male offspring were divided into two groups: A control group (CTR), whose mothers received a normal protein diet (17%) during pregnancy and lactation, and a low-protein group (GLLP), whose mothers received a low-protein diet (6%) during the same period. At 540 days of age, the offspring were euthanized, and the DLPs were collected for analysis. The GLLP group showed significant structural changes in the DLP, including increased epithelial and reduced stromal compartments. These rats also had lower levels of probasin (a prostate-specific protein), along with a higher number of mast cells, CD68 + macrophages, and IL-10 protein expression, indicating inflammation. Antioxidant balance was disrupted: Glutathione (GSH) levels increased, while catalase (CAT) and superoxide dismutase (SOD) decreased. The expression of SIRT1, a protein linked to aging and oxidative stress control, was reduced. In silico analysis using human prostate cancer data (PRAD-TCGA) revealed that biological pathways related to oxidative stress, immune response, and tissue remodeling were disrupted in both the rat model and human prostate cancer. In summary, maternal protein restriction leads to long-term changes in the dorsolateral prostate of aging male offspring, including inflammation, oxidative stress, and tissue remodeling. The reduced expression of SIRT1 may play a key role in these effects.

Early-life access to primary healthcare and educational attainment: Evidence from community health centers in China

This paper uses the rollout of community health centers (CHCs) from the 1950s to the 1970s in China to study the long-term effects of early-life access to primary healthcare on educational attainment. By leveraging the variation across birth cohorts and communities in the establishment of CHCs, we find that exposure to CHCs in early life significantly increases children's completed years of education in later life. Event study estimates confirm that the beneficial effects of CHC exposure are concentrated in early life. Mechanism analysis reveals that early-life exposure to CHCs improves birth health and childhood health. The results remain robust after considering a series of robustness checks, such as ruling out confounding factors and placebo tests. Our findings underscore the significance of early-life primary healthcare in building human capital and indicate that the returns on accessing primary healthcare may be significantly underestimated.

The molecular mechanisms of IUGR programmed adulthood cardiovascular disease

Intrauterine growth restriction (IUGR) is secondary to several maternal and fetal adverse conditions. Recently, there is a convincing association between the onset of IUGR and adulthood programmed complications. Among them, the disorders in the cardiovascular system have been revealed by a series of researches. Currently, the prevalence of IUGR is considered to be related to programmed hypertension, coronary artery lesions, pulmonary hypertension, metabolic dysfunction, and even heart failure. According to the emerging knowledge in this field, the experiences of IUGR would induce prolonged inflammation, oxidative injuries, aberrant metabolites and epigenetic regulation, which resulted in endothelial, smooth muscle cells and cardiomyocytes damages. In this review, we summarized the evidences and progress in establishing the association between IUGR and programmed cardiovascular diseases and involved molecular mechanisms. Furthermore, we also discussed the potential efficient therapeutic strategies. This comprehensive review demonstrated that IUGR manifested long-term consequences persisting into adulthood through multifaceted molecular pathways, notably oxidative stress mechanisms, mitochondrial dysfunction, and epigenetic alterations. These findings underscored the critical importance of implementing early preventive interventions and developing personalized therapeutic approaches in future clinical practice.

Low testosterone in primary infertile men is associated with a history of maternal obesity during pregnancy: Findings from a cross-sectional study

BACKGROUND

Maternal obesity increases offspring obesity risk, but limited data exist on its association with reproductive hormones in infertile males.

OBJECTIVES

To investigate the impact of maternal obesity during pregnancy on total testosterone levels in primary infertile men.

MATERIALS AND METHODS

Data from 418 men seeking medical help for primary infertility were analyzed. Demographics, clinical data, comorbidities, and history of maternal obesity during pregnancy were recorded. Testicular volume was assessed with Prader's orchidometer. Serum hormones, including calculated free testosterone, and semen parameters were collected. Low testosterone and low calculated free testosterone were defined as total testosterone <3 ng/mL and calculated free testosterone <120 pg/mL. Descriptive statistics and regression models evaluated associations between maternal obesity at pregnancy and both total testosterone and calculated free testosterone levels.

RESULTS

Median (interquartile range) age and body mass index were 36 (33‒40) years and 24.8 (23.1‒26.8) kg/m2. Men with low testosterone (n = 69) had higher body mass index, Charlson comorbidity index score, and follicle-stimulating hormone, but lower testicular volume, sex hormone-binding globulin, sperm concentration, motility, and normal morphology compared to men without low testosterone (all p < 0.04). Similarly, men with low calculated free testosterone (n = 226) showed higher sex hormone-binding globulin, lower estradiol, sperm concentration, and motility than those with normal calculated free testosterone values (all p < 0.02). Low testosterone (7.2% vs. 2.0%, p = 0.01) and low calculated free testosterone (4.4% vs. 1.0%, p = 0.03) were more frequently reported during maternal obesity. Multivariable logistic regression analysis showed that maternal obesity at pregnancy (odds ratio: 5.9), higher body mass index (odds ratio: 1.1), and lower testicular volume (odds ratio: 0.9) were independent predictors of low testosterone (all p < 0.01), adjusting for age. Multivariable linear regression analyses identified maternal obesity at pregnancy (β = ‒4.1) and lower testicular volume (β = 1.8) as independent predictors of calculated free testosterone (all p < 0.001), after accounting for age and body mass index.

CONCLUSIONS

Low testosterone is a frequent characteristic in primary infertile men. Although rare, maternal obesity at pregnancy is significantly associated with reduced total testosterone and calculated free testosterone levels. Further preventive strategies and close follow-up should be considered in this specific group.

Determining the interplay of prenatal parental BMI in shaping child BMI trajectories: the CHILD Cohort Study

BACKGROUND

Obesity is a major public health concern affecting millions of people globally. Early identification of individuals susceptible to obesity is crucial for reducing the burden of obesity. Obesity is often defined based on body-mass-index (BMI), and tracking BMI trajectories from early childhood offers a valuable tool for risk stratification. Although the role of mothers in shaping these trajectories is well-recognized, the paternal influence on childhood obesity development remains a knowledge gap. We hypothesize that children of fathers with obesity have higher odds of being in the rapid BMI growth trajectory with stronger estimates when the mother is also with overweight or obesity.

METHODS

We analyzed data from the Canadian CHILD Cohort Study, a pregnancy cohort in which both parents were enrolled in early pregnancy when BMI was assessed. The child's BMI was repeatedly collected from birth to age five. We used group-based trajectory modeling to identify offspring BMI z-score (BMIz) trajectory groups (age-and-sex standardized) and weighted multinomial logistic regression analysis to determine the associations between prenatal paternal BMI and offspring growth trajectories, stratified by maternal weight categories.

RESULTS

Among 2 238 participants, the mean prenatal paternal BMI was 27.44 (SD = 4.77), and 22.83% of fathers were with obesity. The four identified offspring BMIz trajectories were: low stable (n = 220, 9.83%), normative (n = 1 356, 60.59%), high stable (n = 572, 25.56%), and rapid BMIz growth trajectory (n = 90, 4.02%). Children of normal-weight mothers and fathers with obesity had 1.86 higher odds (OR: 1.86; 95%CI: 1.22-2.84) of being classified in the rapid growth BMIz trajectory, compared to children of normal-weight fathers. The odds of being in the rapid growth BMIz trajectory were higher when both mothers and fathers were with obesity (OR: 4.35; 95%CI: 2.65-7.14).

CONCLUSIONS

Children of fathers with obesity had higher odds of being in the rapid BMI growth trajectory, particularly when also the mother was with overweight or obesity. These results support the need for preconception advice and interventions for couples to optimize their offspring's health.

Urinary screening and nutritional health assessment in a community of indigenous school children from Totoró (Colombia)

A higher risk for kidney disease in aboriginal populations has been proposed but it has not been established in their children. Likewise, there is a lack of studies focused on early markers of kidney disease in South American indigenous children. A descriptive prevalence study with an exploratory analysis was conducted between November 2015 and April 2018 on 249 indigenous children aged 5-18 years from the "Institución Educativa Agropecuaria Pueblo Totoroés" in the Totoró indigenous reserve. Eighty-five percent of subjects received exclusive breastfeeding. Spontaneous proteinuria was found in nine subjects, and in one case the proteinuria persisted in a second sample. Isolated hematuria was seen in 1.6% of subjects and blood pressure measurement over the 95th percentile in 7.2%. Overweight and obesity was related to hematuria (P = .009) but weakly related to transient proteinuria (P = .06). Some urinalyses (3.6%) were suggestive of urinary infection, but urine culture was negative in all cases. Hematuria and proteinuria in indigenous children from Totoró are transient and related to overweight and obesity. Early markers of kidney disease can be applied to other indigenous communities. A lower prevalence of chronic underweight than the general Colombian indigenous population was found, which is proposed to be related to prolonged breastfeeding.

Effects of Peruvian mothers' experiences of violence, resilience, and posttraumatic stress on infant temperament: A longitudinal path model

Worldwide, research has demonstrated that maternal experiences of violence can adversely affect infant development, but moderating and mediating effects on this pathway are less understood, particularly within low- and middle-income countries. Using longitudinal structural equation modeling, the present study analyzed data from 251 Peruvian mothers during the prenatal and postpartum periods. We evaluated the relations between mothers' experiences of childhood violence (CV), prenatal intimate partner violence (IPV), posttraumatic stress symptoms (PTSS), and resilience, and how these factors influenced domains of their infants' temperament (i.e., surgency, negative affectivity, and regulatory capacity). Consistent with hypotheses, analyses revealed that mothers' CV exposure was associated with increased prenatal IPV and PTSS, and prenatal IPV was linked to increased prenatal PTSS and lower resilience. Prenatal PTSS was linked to lower infant regulatory capacity. Maternal prenatal resilience was negatively associated with prenatal PTSS. High postpartum maternal resilience mitigated the adverse effects of maternal CV on infant regulatory capacity. Inconsistent with hypotheses, postpartum PTSS was associated with higher infant regulatory capacity, though sensitivity testing suggested this finding may be spurious. Findings underscore the need for violence prevention and prenatal mental health interventions to reduce maternal PTSS and bolster resilience to support positive infant outcomes in Peru.

Synergistic impact of early-life stress and prenatal immune activation on spatial memory and oxidative metabolism in rat cortico-limbic networks

Early life exposure to immune activation and stress are critical factors involved in the development of mental and neurodevelopmental disorders in adulthood. This study explored the individual and combined effects of prenatal lipopolysaccharide-induced (LPS)-induced immune activation and postnatal maternal separation on cognitive performance and oxidative metabolism in male Wistar rats. Using a 2 × 2 factorial design, pregnant dams were exposed to LPS or saline on gestational day 15, and offspring underwent maternal separation from postnatal days 2-14. In adulthood, cognitive function was assessed using the Morris Water Maze, and regional brain energy metabolism was evaluated using quantitative histochemistry of cytochrome c oxidase (CCO) quantitative histochemistry in the prefrontal cortex, hippocampus, and retrosplenial cortex. Rats exposed to both stressors demonstrated significant impairments in spatial memory and cognitive flexibility, supporting the "two-hit" hypothesis of early adversity, which posits that early life exposure to an adverse environmental event (first hit) combined with subsequent exposure to stress during critical developmental periods (second hit) can significantly increase the risk of developing behavioral or neurodevelopmental disorders in adulthood. Accordingly, adult animals exposed to prenatal LPS and maternal separation showed prolonged escape latencies and decreased spatial memory retention during the behavioral tasks. Concurrently, CCO activity was markedly increased in all measured regions, reflecting heightened metabolic demands. These changes are consistent with impaired hippocampal-prefrontal-retrosplenial network integration and the underlying key processes involved in cognitive alterations such as memory or attention. This study underscores the synergistic effects of these environmental factors on cognitive and metabolic dysfunction, providing a translational model to better understand the etiology of neurodevelopmental disorders. The findings highlight the importance of addressing multiple interacting environmental factors in the context of early life adversity.

Proteomic analysis of chick embryonic heart in experimental hypoxia

Investigating prenatal hypoxia is difficult in mammals, as there are confounding factors stemming from maternal adaptations and compensatory mechanisms. We have thus established an avian model of hypoxic incubation (starting after 2 days of normoxia, 15% O2, normobaric, until the time of sampling at embryonic day 8) to study embryonic reactions to low oxygen concentration. Our previous studies have shown increased vascularization, oedema, and ventricular wall thinning preceding the lethality at mid-gestation. Analysis of the cardiac proteome after 6 days of hypoxic incubation showed strong upregulation of enzymes involved in anaerobic glycolysis as well as an increase in apoptosis-related proteins, cell adhesion proteins, and secretory activity.

Womb to wisdom: Early-life exposure to midwifery laws and later-life disability

Previous research documented that midwifery service quality improvements lead to improving maternal and infants' health outcomes. However, little is known about its influence for later-life outcomes including disability. This paper explores the potential effects of early-life exposure to the establishment of midwifery laws across US states on later-life disability outcomes. Midwifery laws were enacted during the late 19th and early 20th century and required midwives to gain formal education and training to obtain a license in order to legally practice. We use decennial census data over the years 1970-2000 and implement a difference-in-difference method and show that being born in a reform state is associated with significant reductions in various measures of disability, including work disability, cognitive difficulty, ambulatory difficulty, self-care difficulty, and a proxy for severe mental health. We also find significant increases in education, socioeconomic scores, housing wealth, and income. We further discuss the policy implications of the results.

Reversing the impact of an obesogenic diet on emotion regulation and brain metabolism: A rat model study

The global rise in obesity and poor dietary habits, particularly the consumption of high-fat, high-sucrose (HFS) diets, is a growing public health concern. These diets, especially when consumed during critical developmental periods, such as gestation and early life, are linked to long-term consequences on both physical and mental health. Early exposure to obesogenic diets has been shown to disrupts brain function and increases the risk of anxiety, depression, and additional emotional disorders. However, it has been suggested that dietary changes during early life may reverse these effects. This study investigated whether switching from an HFS diet to a standard diet (SD) after weaning could reverse abnormal emotional responses (o anxiety- and depression-like behavior) and brain energy metabolic capacity in rats. Male and female Wistar rats were divided into three groups: one on continuous SD, one on an HFS diet from gestation until adulthood, and one that shifted from HFS to SD after weaning. Emotional behavior was assessed using the saccharin preference test, forced swimming test, and elevated zero maze test. Brain metabolism was evaluated by measuring cytochrome c oxidase (CCO) activity in key regions involved in emotion regulation, such as the nucleus accumbens, ventral pallidum, dorsal striatum, and the bed nucleus of stria terminalis. Adult animals exposed to the HFS diet exhibited increased depression and anxiety-like behaviors, and elevated CCO activity. Notably, sex differences were observed, with males showing more pronounced anxiety- and depression-like behaviors, although both sexes improved after diet switching. These findings suggest that early dietary interventions can mitigate diet-induced emotional and metabolic disturbances, thereby underscoring the importance of nutrition during critical developmental periods.

Nutrition transition's latest stage: Are ultra-processed food increases in low- and middle-income countries dooming our preschoolers' diets and future health?

INTRODUCTION

Rapid shifts in dietary patterns, marked by increased consumption of ultra-processed foods (UPFs), are increasingly impacting the health and wellbeing of infants and toddlers in low- and middle-income countries.

METHODS

Utilizing data from the Demographic and Health Surveys, other national surveys, NCD-RisC data and Euromonitor sales data, we examine changes in stunting and overweight/obesity prevalence alongside the latest data on UPF consumption trends.

RESULTS

The prevalence of overweight/obesity among children and mothers is increasing rapidly while stunting rates decline slowly. Simultaneously, there is a significant increase in consumption of UPFs, especially among preschool-aged children. Increasingly, poorer households are experiencing faster rates of increase in overweight and obesity prevalence compared to wealthier households. Results highlight the early socialization of infants and toddlers to unhealthy discretionary foods including UPFs, potentially setting the stage for long-term dietary preferences that favour food with high sugar or excess sodium.

CONCLUSION

There is an urgent need to address the rapid increases in UPF consumption among infants and toddlers. Options include expanding the WHO Code on marketing to protect 0-3-year-olds; creating front-of-package warning labels focusing on products for children ages 0-3 years to remove all added sugar and limit sodium in foods and beverages they consume.

Barriers and strategies for recruitment of pregnant women in contemporary longitudinal birth cohort studies

BACKGROUND

Pregnancy and birth cohort studies are essential for studying the social and biological determinants of human health, yet racial and ethnic minority populations are underrepresented due to low recruitment and retention rates. Remote data collection has potential to improve recruitment of underrepresented populations. The aims of this descriptive qualitative study were to explore the perspectives of pregnant and postpartum women about the barriers and facilitators to enrolling themselves, their child, and their partner in a longitudinal birth cohort study, identify data collection strategies to address barriers, and generate recommendations for future cohort studies.

METHODS

Online focus groups and in-person interviews in English and Spanish were conducted between August and November 2022 with pregnant and postpartum women. Participants were recruited from Black and Hispanic serving obstetric clinics and community-based health and social organizations to ensure a racially and ethnically diverse sample. Analysis was conducted using an inductive thematic approach.

RESULTS

60 women participated in 10 focus groups and 11 interviews. Five themes emerged: challenges in committing time and resources to a research study; utility of compensation and resources; fears that research procedures would negatively impact child; concerns regarding data privacy and children's consent; and benefits for their family, community, and society. Black participants voiced concern about historical discrimination in science and mistrust of research, but also wanted to increase Black representation in research for future generations. Spanish-speaking participants expressed hesitancy related to fear of child injury and misuse of data. Women felt their partners would be reluctant to participate, but that incentives such as parental education would be motivating. Participants liked the flexibility of remote data collection in easing logistical challenges to participation but also expressed importance of personal study contact for facilitating access to resources, enhancing trust in the research process, and motivating retention. Participants also expressed the importance of transparency in data collection procedures and communication on study progress.

CONCLUSIONS

Leveraging technological advances in remote data collection may reduce some challenges to recruitment of women and families to birth cohort studies. However, building and maintaining trust among communities with engagement, transparency, and communication is critical for recruitment of underrepresented populations.

Maternal Nutritional Programming: Sex-Specific Cardiovascular and Immune Outcomes Following Perinatal High-Fat Diet Exposure

Background: The long-term effects of a perinatal high-fat diet on the cardiovascular function of offspring are not well elucidated. We hypothesize that perinatal exposure to a high-fat diet alters adult cardiovascular and immune responses in a sex-specific manner. Methods: Male and female offspring were born to perinatal high-fat (pHFD) or control diet (pCD)-fed C57BL/6 mothers and weaned to a control diet. Cardiovascular function (baseline and response to an acute isoproterenol stress test) was quantified at 8 weeks of age, and acute blood inflammatory response to a single low dose of lipopolysaccharide at 9 weeks of age. Results: Male pHFD offspring had identical baseline cardiovascular function compared to pCD mice but a blunted response to isoproterenol (20-45% reductions in cardiac output, stroke volume, and left ventricular fractional shortening). In contrast, baseline cardiovascular parameters were reduced in female pHFD compared to pCD offspring, but there was no effect of perinatal diet on response to isoproterenol. Concentrations of TNF-α and IL-6 in plasma two hours after a low-dose LPS administration were highest in female pCD mice. Conclusions: Perinatal high-fat diet exposure resulted in sex-specific adaptations in cardiovascular function and immune response. Female offspring displayed baseline impairments, whereas male offspring showed latent vulnerability under stress. These differences may reflect underlying hormonal or epigenetic mechanisms that diverge by sex. Future studies should examine the roles of sex hormones and gene regulation pathways to better understand these dimorphic outcomes. These findings emphasize the importance of maternal diet in shaping offspring cardiometabolic risks and highlight potential avenues for nutritional interventions during pregnancy.

Prospective Associations of Maternal Cardiometabolic Health With Children Cardiometabolic Health at Ages 3 to 6 Years

OBJECTIVE

Maternal cardiometabolic health (MCMH) may have critical effects on offspring lifetime cardiometabolic health (CMH), whereas evidence on the relationship between MCMH during pregnancy and children CMH (CCMH) at ages 3∼6 years remains unknown.

METHOD

The study included 1478 mother-child dyads from the Shanghai Maternal-Child Pairs Cohort study. MCMH was examined at a mean of 27.8 (24-36) weeks' gestation based on 8 metrics of the "Life Essential 8" framework involving prepregnancy body mass index, total cholesterol, glucose level, blood pressure, physical activity, sleep, diet quality, and nicotine exposure. CCMH was examined at the age of 3 to 6 based on 5 metrics including body mass index, physical activity, sleep health, diet quality, and nicotine exposure. To validate the robustness of the main analysis, 499 children were selected to reevaluate CCMH by 6 metrics (adding blood pressure) for sensitivity analysis.

RESULTS

Among 1478 mother-child dyads, the mean (SD) MCMH during pregnancy and CCMH scores were 67.07 (SD 8.82) and 73.80 (SD 10.75), respectively. After adjusting important confounders, each 10-point increase in (more favorable) MCMH score was significantly associated with a higher CCMH score [β: .85; 95% confidence interval (CI): .22, 1.47]. Subgroup analysis showed similar results in girls but not in boys. For cardiometabolic risk factors in children, the risk of overweight/obesity and hypertension in children decreased with increased MCMH score [overweight/obesity, relative risks (RRs): .98, 95% CI: .96, .99; hypertension, RRs: .66, 95% CI: .47, .92]. Sensitivity analysis showed similar results.

CONCLUSION

Better MCMH in pregnancy was associated with better CCMH at ages 3∼6 years.

The intergenerational legacy of early-life malnutrition during the great leap forward famine in China

BACKGROUND

Parents' early-age experiences may influence their life-course trajectories and potentially also affect the wellbeing of their offspring. There is an emerging body of literature on the intergenerational legacy of early childhood malnutrition. In this study, we examined whether and to what extent parental exposure to the 1959 China Famine associated with themselves and their children's outcomes. We differentiated exposures to famine at different stages (prenatal and childhood) of parents' life course.

METHOD

Using the 2010 China Family Panel Study (CFPS) data, this study applied the Difference-in-differences (DID) approach to examine the consequences of famine exposure.

RESULTS

Our analysis showed that mothers who experienced famine during their prenatal period were more likely to have lower socioeconomic outcomes and that their children were disadvantaged in terms of annual income and monthly salary. Fathers no matter born in pre-famine cohort or famine cohort are not associated with their socioeconomic outcomes, and the intergenerational consequences of famine on the economic outcomes of offspring do not appear to be conveyed along the paternal line. For health outcomes, however, the results showed that parental exposure to famine was not associated with children's health condition.

CONCLUSION

Our study extends the literature regarding Baker's hypothesis by providing the empirical evidence of the long-term intergenerational legacy of famine. Furthermore, the study enriches the empirical relevance of the intergenerational mobility research from the life-course perspective. Finally, the evidence of this study also offers policy implications for addressing the persistence of intergenerational inequality and poverty caused by early-life shocks.

The genetics of low and high birthweight and their relationship with cardiometabolic disease

AIMS/HYPOTHESIS

Low birthweight infants are at increased risk not only of mortality, but also of type 2 diabetes mellitus and CVD in later life. At the opposite end of the spectrum, high birthweight infants have increased risk of birth complications, such as shoulder dystocia, neonatal hypoglycaemia and obesity, and similarly increased risk of type 2 diabetes mellitus and CVD. However, previous genome-wide association studies (GWAS) of birthweight in the UK Biobank have primarily focused on individuals within the 'normal' range and have excluded individuals with high and low birthweight (<2.5 kg or >4.5 kg). The aim of this study was to investigate genetic variation associated within the tail ends of the birthweight distribution, to: (1) see whether the genetic factors operating in these regions were different from those that explained variation in birthweight within the normal range; (2) explore the genetic correlation between extremes of birthweight and cardiometabolic disease; and (3) investigate whether analysing the full distribution of birthweight values, including the extremes, improved the ability to detect genuine loci in GWAS.

METHODS

We performed case-control GWAS analysis of low (<2.5 kg) and high (>4.5 kg) birthweight in the UK Biobank using REGENIE software (Nlow=20,947; Nhigh=12,715; Ncontrols=207,506) and conducted three continuous GWAS of birthweight, one including the full range of birthweights, one involving a truncated GWAS including only individuals with birthweights between 2.5 and 4.5 kg and a third GWAS that winsorised birthweight values <2.5 kg and >4.5 kg. Additionally, we performed bivariate linkage disequilibrium (LD) score regression to estimate the genetic correlation between low/normal/high birthweight and cardiometabolic traits.

RESULTS

Bivariate LD score regression analyses suggested that high birthweight had a mostly similar genetic aetiology to birthweight within the normal range (genetic correlation coefficient [rG]=0.91, 95% CI 0.83, 0.99), whereas there was more evidence for a separate set of genes underlying low birthweight (rG=-0.74, 95% CI 0.66, 0.82). Low birthweight was also significantly positively genetically correlated with most cardiometabolic traits and diseases we examined, whereas high birthweight was mostly positively genetically correlated with adiposity and anthropometric-related traits. The winsorisation strategy performed best in terms of locus detection, with the number of independent genome-wide significant associations (p<5×10-8) increasing from 120 genetic variants at 94 loci in the truncated GWAS to 270 genetic variants at 178 loci, including 27 variants at 25 loci that had not been identified in previous birthweight GWAS. This included a novel low-frequency missense variant in the ABCC8 gene, a gene known to be involved in congenital hyperinsulinism, neonatal diabetes mellitus and MODY, that was estimated to be responsible for a 170 g increase in birthweight amongst carriers.

CONCLUSIONS/INTERPRETATION

Our results underscore the importance of genetic factors in the genesis of the phenotypic correlation between birthweight and cardiometabolic traits and diseases.

Non-linear association of low birthweight with risk factors including women's BMI: evidence from an international comparison

BACKGROUND

It is widely known that, in addition to physical characteristics such as parents' height and weight, social attributes such as parents' education, income level, and employment status have a significant impact on birthweight. However, these results were obtained using data from individual countries, and there were no country-level comparisons of the factors identified as influencing birthweight. A multi-country analysis is essential to determine whether these factors are consistently linked to low birthweight across different economic and healthcare systems.

METHODS

Using panel data on low-birthweight fertility rates for 143 countries over the period of 2000-2015, we used five factors (women's body mass index [BMI], real gross domestic product [GDP] per capita, women's employment status, healthcare level, and adolescent childbearing) in relation to countries' low-birthweight rates to determine how these factors relate to each country's low-birthweight rate and estimate a fixed-effects model. Considering the possibility that these five factors are non-linear rather than linear, we estimated quadratic and cubic functions. We conducted a detailed analysis of women's BMI and real GDP per capita. Furthermore, we considered the 2008 global financial crisis as an exogenous natural experiment for the low-birthweight rate and conducted a difference-in-differences (DID) analysis to confirm the possibility that the correlation between women's employment rate and low-birthweight rate is a causal relationship.

RESULTS

All five factors were identified as important risk factors. Of the five, all but adolescent childbearing were found to have a non-linear rather than a monotonous linear relationship with low birthweight. The low-birthweight rate improved sharply with improvement in women's average BMI below 28. Furthermore, the results of the DID analysis suggest that women's employment plays an important role in the relationship between low-birthweight rates and GDP.

CONCLUSIONS

These results provide a useful policy tool for achieving the goal of the 65th World Health Assembly to "reduce the incidence of low birthweight." In particular, improvements in women's average BMI, real GDP per capita, and women's employment rates in low-income countries may be linked to reductions in the incidence of low birthweight.

The long-term health effects of welfare reform

Childhood poverty is associated with poor health in adulthood, but social policies may buffer poverty's long-term harmful effects by providing cash and in-kind resources. This study assessed the long-term health effects of welfare reform, which added work requirements, sanctions for noncompliance, lifetime limits, and family caps to welfare programming in the US in the mid-1990s. Research has found mixed evidence on the short-term health effects of welfare reform, but fewer studies have documented its impacts on health across the life course. This study exploited temporal and state variation in the implementation of welfare reform to examine the association between exposure to welfare reform as a child on self-rated health, psychological distress, and chronic conditions in adulthood using data from the Panel Study of Income Dynamics. We found that welfare reform exposure in early childhood, from conception to age five, was associated with more psychological distress (b = 0.41, 95%CI 0.08, 0.74) and more chronic conditions (b = 0.21, 95%CI 0.10, 0.33) in adulthood. We also found that welfare reform exposure in later childhood, from ages six to 18, was associated with lower likelihood of reporting poor health (b = -0.03, 95%CI -0.05, -0.01), less psychological distress (b = -0.33, 95%CI -0.54, -0.11), and fewer chronic conditions (b = -0.18, 95%CI -0.25, -0.10), which was especially true for non-Hispanic Black and Hispanic individuals compared to non-Hispanic White individuals. Our findings suggest that the difference in outcomes based on age of exposure is related to the ease with which parents fulfill welfare requirements, though more research is needed on possible mechanisms.

Epigenetic biomarkers of socioeconomic status are associated with age-related chronic diseases and mortality in older adults

Later-life health is patterned by socioeconomic influences across the lifecourse. However, the pathways underlying the biological embedding of socioeconomic status (SES) and its consequences on downstream morbidity and mortality are not fully understood. Epigenetic markers like DNA methylation (DNAm) may be promising surrogates of underlying biological processes that can enhance our understanding of how SES shapes population health. Studies have shown that SES is associated with epigenetic aging measures, but few have examined relationships between early and later-life SES and DNAm sites across the epigenome. In this study, we trained and tested DNAm-based surrogates, or "biomarkers," of childhood and adult SES in two large, multiracial/ethnic samples of older adults-the Health and Retirement Study (n = 3,527) and the Multi-Ethnic Study of Atherosclerosis (n = 1,182). Both biomarkers were associated with downstream morbidity and mortality, and these associations persisted after controlling for measured SES, and in some cases, epigenetic aging clocks. Both childhood and adult SES biomarker CpG sites were enriched for genomic features that regulate gene expression (e.g. DNAse hypersensitivity sites and enhancers) and were implicated in prior epigenome-wide studies of inflammation, aging, and chronic disease. Distinct patterns also emerged between childhood CpGs and immune system dysregulation and adult CpGs and metabolic functioning, health behaviors, and cancer. Results suggest DNAm-based surrogate biomarkers of SES may be useful proxies for unmeasured social exposures that can augment our understanding of the biological mechanisms between social disadvantage and downstream health.

An assessment of organophosphate ester mixtures and the placental transcriptome

Prenatal exposure to organophosphate ester (OPE) chemicals, commonly used as flame retardants and plasticizers, has been associated with adverse birth outcomes. The placenta is a critical fetal organ and therefore may be involved in pathogenesis of birth outcomes. The goal of this study was to evaluate associations of 10 maternal urinary OPE metabolites, individually and as a mixture, with the placental transcriptome at birth in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study. Individual OPE metabolites were evaluated for associations with individual genes as well as co-expressed gene modules. Mixtures analysis was conducted using quantile g-computation. The analyses were performed with the entire data set (N = 737) as well as the sex-stratified subsets. Two genes (HAP1 and RAP1GAP) were associated with bis(1,3-dichloro-2-propyl) phosphate (BDCPP), and six genes were associated the mixture in the full data set. 3 genes were associated with diphenyl phosphate (DPHP) and 36 genes were associated with the mixture in a male stratified analysis. 2 genes were associated with DPHP, and 1 gene was associated with diethyl phosphate (DEP) in a female stratified analysis. Three gene modules were associated with BDCPP or diphenyl phosphate (DPHP) and one module was associated with the OPE mixture. 12 WGCNA modules were associated with individual OPE metabolites or the mixture in males, and 1 WGCNA module was associated with DEP in females. Five of the OPE-associated gene modules were enriched for a total of 17 KEGG pathways, and 11 modules were enriched with targets of 12 nuclear hormone receptor transcription factors. Overall, novel associations were identified between the placental transcriptome and OPE metabolites, individually and in mixture, including differences based on fetal sex. These findings highlight the need for additional research on mechanisms of OPE-associated gene expression changes in the placenta and associated health outcomes.

Longitudinal Placental Blood Volume Measurements in Zika-Infected Rhesus Macaques Using Ferumoxytol Enhanced MRI

Introduction

Measures of maternal fractional blood volume (mFBV) in the placenta holds potential to diagnose placental vasculature deficiencies. However, methods for quantitative mapping of blood volume are challenging to implement for clinical placenta evaluation. As a preliminary step towards human applications, this study assesses the feasibility of blood volume measurements using ferumoxytol enhanced variable flip angle (VFA) T1-mapping in Zika-infected rhesus macaques.

Methods

Seven pregnant rhesus macaques were imaged longitudinally at up to 3 timepoints across gestation (days 64.5±1.9, 100.8±3.9, and 145.3±1.8), corresponding to first, second, and third pregnancy trimester of the rhesus. Four animals received a Zika virus (ZIKV) injection into the amniotic fluid, while three control rhesus macaques received a saline injection. T1-weighted spoiled gradient echo sequences at four flip angles (2°, 6°, 10°, 14°) were used for quantitative mFBV assessment derived from pre- and post-contrast T1 mapping using ferumoxytol. Image quality assessment and segmentation assessment was performed on the full 3D coverage. Placental histopathology for all animals was analyzed by a professional pathologist with over 15 years of experience.

Results

All scans were successfully acquired and analyzed with no significant motion artifacts. 3D mFBV maps show regional heterogeneities within slices. FBV and total placental blood volume has an increasing trend with gestation.

Discussion

This study shows feasibilities to measure mFBV in non-human primates using ferumoxytol enhanced VFA T1-mapping.

Potentially causal associations between placental DNA methylation and schizophrenia and other neuropsychiatric disorders

Increasing evidence supports the role of the placenta in neurodevelopment and in the onset of neuropsychiatric disorders. Recently, mQTL and iQTL maps have proven useful in understanding relationships between SNPs and GWAS that are not captured by eQTL. In this context, we propose that part of the genetic predisposition to complex neuropsychiatric disorders acts through placental DNA methylation. We construct a public placental cis-mQTL database including 214,830 CpG sites calculated in 368 fetal placenta DNA samples from the INMA project, and run cell type-, gestational age- and sex-imQTL models. We combine these data with summary statistics of GWAS on ten neuropsychiatric disorders using summary-based Mendelian randomization and colocalization. We also evaluate the influence of identified DNA methylation sites on placental gene expression in the RICHS cohort. We find that placental cis-mQTLs are enriched in placenta-specific active chromatin regions, and establish that part of the genetic burden for schizophrenia, bipolar disorder, and major depressive disorder confers risk through placental DNA methylation. The potential causality of several of the observed associations is reinforced by secondary association signals identified in conditional analyses, the involvement of cell type-imQTLs, and the correlation of identified DNA methylation sites with the expression levels of relevant genes in the placenta.

Multiomic QTL mapping reveals phenotypic complexity of GWAS loci and prioritizes putative causal variants

Most GWAS loci are presumed to affect gene regulation; however, only ∼43% colocalize with expression quantitative trait loci (eQTLs). To address this colocalization gap, we map eQTLs, chromatin accessibility QTLs (caQTLs), and histone acetylation QTLs (haQTLs) using molecular samples from three early developmental-like tissues. Through colocalization, we annotate 10.4% (n = 540) of GWAS loci in 15 traits by QTL phenotype, temporal specificity, and complexity. We show that integration of chromatin QTLs results in a 2.3-fold higher annotation rate of GWAS loci because they capture distal GWAS loci missed by eQTLs, and that 5.4% (n = 13) of GWAS colocalizing eQTLs are early developmental specific. Finally, we utilize the iPSCORE multiomic QTLs to prioritize putative causal variants overlapping transcription factor motifs to elucidate the potential genetic underpinnings of 296 GWAS-QTL colocalizations.

Setting a research agenda for examining early risk for elevated cognitive disengagement syndrome symptoms using data from the ABCD cohort

Little research has examined early life risk for symptoms of cognitive disengagement syndrome (CDS) despite a well-established literature regarding co-occurring outcomes (e.g., attention-deficit/hyperactivity disorder). The current study estimated bivariate associations between early life risk factors and CDS in a large and representative sample of U.S. children. We conducted secondary analyses of baseline data from the Adolescent Brain Cognitive Development (ABCD) study (N = 8,096 children, 9-10 years old). Birthing parents reported early life risk factors on a developmental history questionnaire, including parental, prenatal, delivery and birth, and developmental milestone information. They also completed the Child Behavior Checklist, which includes a CDS subscale that was dichotomized to estimate the odds of elevated CDS symptoms (i.e., T-score > 70) in children related to risk indices. We observed significantly elevated odds of CDS related to parental risk factors (i.e., unplanned pregnancy, pregnancy awareness after 6 weeks, teenage parenthood), birthing parent illnesses in pregnancy (i.e., severe nausea, proteinuria, pre-eclampsia/toxemia, severe anemia, urinary tract infection), pregnancy complications (i.e., bleeding), prenatal substance exposures (i.e., prescription medication, tobacco, illicit drugs), delivery and birth risk factors (i.e., child blue at delivery, child not breathing, jaundice, incubation after delivery), and late motor and speech milestones in children. Several early-life risk factors were associated with elevated odds of CDS at ages 9-10 years; study design prevents the determination of causality. Further investigation is warranted regarding early life origins of CDS with priority given to risk indices that have upstream commonalities (i.e., that restrict fetal growth, nutrients, and oxygen).

Maternal dietary DHA and EPA supplementation ameliorates adverse cardiac outcomes in THC-exposed rat offspring

Cannabis use in pregnancy is associated with low birthweight outcomes. Recent preclinical data suggests that maternal Δ9-tetrahydrocannabinol (THC) exposure leads to decreases in birthweight followed by early cardiac deficits in offspring. Currently, no studies have explored an intervention for these maternal THC-induced deficits. Omega-3 fatty acids have been shown to exhibit cardioprotective effects. In this present study, we demonstrated that maternal dietary supplementation of omega-3 fatty acids ameliorates both THC-induced fetal growth and postnatal cardiac deficits in offspring. Our data indicates this may be underpinned by alterations in cardiac and hepatic fatty acids and reduction in markers of cardiac collagen deposition. Interestingly, the cardioprotective effects of omega-3s may be further underscored by decreased signaling of the cardiac endocannabinoid system. With increasing rates of cannabis use in pregnancy and recent evidence of subsequent cardiometabolic aberrations in offspring, our data suggests a potential intervention for THC-induced fetal growth and cardiac disturbances in offspring.

Experiences of Australian anaesthetists and anaesthetic trainees of working whilst pregnant: Results of a national survey

Changing medical workforce demographics emphasise the need to understand and effectively manage pregnancy in the workplace. An Australian survey exploring pregnancy experiences of specialists and trainees working in anaesthesia received 242 responses describing 549 pregnancies. One hundred and sixty-two (67%) of these respondents were aged 31-40 years, 185 (76%) were specialists and 159 (66%) reported one or two pregnancies. Reported pregnancy complication rates were similar to national averages. Potentially harmful exposures included working >40 h per week (n = 298, 55%), ionising radiation and unscavenged gases. Other than ergonomic hazards and stress, exposures were not associated with an increase in self-reported complications. Moving heavy patients on a daily to weekly basis (n = 278, 53%) was associated with an increased risk for any maternal complication; odds ratio (OR) 2.13, 95% confidence interval (CI) 1.37 to 3.33, P < 0.001. High or debilitating stress levels were associated with any maternal complication, OR 2.93, 95% CI 2.06 to 4.17, P < 0.001, and any adverse neonatal/fetal outcome, OR 1.72, 95% CI 1.10 to 2.69, P = 0.018. The most common stress contributors were 'work-related', 'exams' and 'pregnancy anxiety'. Ninety-one (38%) respondents reported experiencing stigma or negative attitudes toward their pregnancy from anaesthetic colleagues. Overall, 171 (71%) of respondents were satisfied with their experience of working in anaesthesia whilst pregnant. Thematic analysis of free text comments identified three major themes: workplace culture, maternal and fetal wellbeing, and career impacts on both pregnancy and family planning. Development of multilevel mechanisms to guide and support pregnant trainees and specialists in anaesthesia is recommended to address these findings.

Children-specific environmental protection strategies are needed in China

China, home to over 250 million children, has witnessed remarkable economic development in recent decades, successfully addressing many issues related to basic hygiene and sanitation in children, thereby altering the childhood disease spectrum. However, the emergence of environment-related disorders among children has become a significant concern. Despite the rapid accumulation of scientific knowledge on the adverse effects of environmental pollution on child health, the availability of children-specific protective strategies and actions remains alarmingly low. This commentary synthesizes the information and viewpoints presented and discussed by experts at the International Forum on Children's Environmental Health in China. It summarizes the strategies and actions proposed to reduce adverse environmental exposure and protect children's short- and long-term health and a call for more children-centered evidence-action transformation. The following four specific actions were proposed: (1) strengthen health education in parents, caregivers, and children, and personal protection for children; (2) monitor child exposure and environment-related health status; (3) set up child-specific interventions and regulations; and (4) conduct more research on environment exposures and child health.

Multiethnic growth standards for fetal body composition and organ volumes derived from 3D ultrasonography

BACKGROUND

A major goal of contemporary obstetrical practice is to optimize fetal growth and development throughout pregnancy. To date, fetal growth during prenatal care is assessed by performing ultrasonographic measurement of 2-dimensional fetal biometry to calculate an estimated fetal weight. Our group previously established 2-dimensional fetal growth standards using sonographic data from a large cohort with multiple sonograms. A separate objective of that investigation involved the collection of fetal volumes from the same cohort.

OBJECTIVE

The Fetal 3D Study was designed to establish standards for fetal soft tissue and organ volume measurements by 3-dimensional ultrasonography and compare growth trajectories with conventional 2-dimensional measures where applicable.

STUDY DESIGN

The National Institute of Child Health and Human Development Fetal 3D Study included research-quality images of singletons collected in a prospective, racially and ethnically diverse, low-risk cohort of pregnant individuals at 12 U.S. sites, with up to 5 scans per fetus (N=1730 fetuses). Abdominal subcutaneous tissue thickness was measured from 2-dimensional images and fetal limb soft tissue parameters extracted from 3-dimensional multiplanar views. Cerebellar, lung, liver, and kidney volumes were measured using virtual organ computer aided analysis. Fractional arm and thigh total volumes, and fractional lean limb volumes were measured, with fractional limb fat volume calculated by subtracting lean from total. For each measure, weighted curves (fifth, 50th, 95th percentiles) were derived from 15 to 41 weeks' using linear mixed models for repeated measures with cubic splines.

RESULTS

Subcutaneous thickness of the abdomen, arm, and thigh increased linearly, with slight acceleration around 27 to 29 weeks. Fractional volumes of the arm, thigh, and lean limb volumes increased along a quadratic curvature, with acceleration around 29 to 30 weeks. In contrast, growth patterns for 2-dimensional humerus and femur lengths demonstrated a logarithmic shape, with fastest growth in the second trimester. The mid-arm area curve was similar in shape to fractional arm volume, with an acceleration around 30 weeks, whereas the curve for the lean arm area was more gradual. The abdominal area curve was similar to the mid-arm area curve with an acceleration around 29 weeks. The mid-thigh and lean area curves differed from the arm areas by exhibiting a deceleration at 39 weeks. The growth curves for the mid-arm and thigh circumferences were more linear. Cerebellar 2-dimensional diameter increased linearly, whereas cerebellar 3-dimensional volume growth gradually accelerated until 32 weeks followed by a more linear growth. Lung, kidney, and liver volumes all demonstrated gradual early growth followed by a linear acceleration beginning at 25 weeks for lungs, 26 to 27 weeks for kidneys, and 29 weeks for liver.

CONCLUSION

Growth patterns and timing of maximal growth for 3-dimensional lean and fat measures, limb and organ volumes differed from patterns revealed by traditional 2-dimensional growth measures, suggesting these parameters reflect unique facets of fetal growth. Growth in these three-dimensional measures may be altered by genetic, nutritional, metabolic, or environmental influences and pregnancy complications, in ways not identifiable using corresponding 2-dimensional measures. Further investigation into the relationships of these 3-dimensional standards to abnormal fetal growth, adverse perinatal outcomes, and health status in postnatal life is warranted.

Epigenetic signatures of intergenerational exposure to violence in three generations of Syrian refugees

Maternal trauma influences infant and adult health outcomes and may impact future generations through epigenetic modifications such as DNA methylation (DNAm). Research in humans on the intergenerational epigenetic transmission of trauma effects is limited. In this study, we assessed DNAm signatures of war-related violence by comparing germline, prenatal, and direct exposures to violence across three generations of Syrian refugees. We compared families in which a pregnant grandmother versus a pregnant mother was exposed to violence and included a control group with no exposure to war. We collected buccal swab samples and survey data from mothers and 1-2 children in each of 48 families (n = 131 participants). Based on an epigenome-wide association study (EWAS), we identified differentially methylated regions (DMPs): 14 were associated with germline and 21 with direct exposure to violence. Most DMPs showed the same directionality in DNAm change across germline, prenatal, and direct exposures, suggesting a common epigenetic response to violence. Additionally, we identified epigenetic age acceleration in association with prenatal exposure to violence in children, highlighting the critical period of in utero development. This is the first report of an intergenerational epigenetic signature of violence, which has important implications for understanding the inheritance of trauma.

The Fetal Effect of Maternal Caffeine Consumption During Pregnancy-A Review

Caffeine is commonly used to excess by the general public, and most pregnant women drink caffeine on a daily basis, which can become a habit. Maternal caffeine intake during pregnancy is associated with severe gestational outcomes. Due to its lipophilic nature, caffeine can cross the blood-brain barrier, placental barrier, and even amniotic fluid. It can be found in substantive amounts in breast milk and semen. There has been a reported drop in neonatal anthropometric measurements with increased caffeine consumption in some cohort studies. This narrative review using literature titles and abstracts from the electronic databases of PubMed, Embase, and Scopus investigates the data linking maternal caffeine use to unfavorable pregnancy outcomes. It also evaluates the validity of the recommendations made by health professionals on caffeine consumption by mothers from the available literature. The results of our comprehensive literature search of case-control studies, cohort studies, randomized control trials, and meta-analyses, imply that caffeine use during pregnancy is linked to miscarriage, stillbirth, low birth weight, and babies that are small for gestational age. It was also found that there may be effects on the neurodevelopment of the child and links to obesity and acute leukemia. These effects can even be seen at doses well below the daily advised limit of 200 mg. The genetic variations in caffeine metabolism and epigenetic changes may play a role in the differential response to caffeine doses. It is crucial that women obtain solid, evidence-based guidance regarding the possible risks associated with caffeine.

Single-cell and spatial transcriptomes reveal the impact of maternal low protein diet on follicular cell composition and ovarian micro-environment in the offspring

Maternal low protein diet around pregnancy reduces the primordial follicles in offspring ovary. Resolving cellular and molecular mechanisms associated with low protein diet is therefore urgently needed for the guidance of dietary interventions. Here, we utilized single-cell and spatial RNA-seq to create transcriptomic atlases of offspring ovaries from maternal low protein diet mice. Analysis of cell type specific low protein diet associated transcriptional changes revealed increased unfolded protein and decreased oxidative phosphorylation defense as a hallmark of low protein diet effects. Altered pathways included hedgehog signaling in granulosa cells, BMP signaling in theca cells and PTN signaling in early theca cells. Notably, the disordered follicular cell function and ovarian microenvironment may closely corelated with decreased follicular number and quality. Collectively, our findings depict the transcriptomic atlases of the offspring ovary derived from maternal low protein diet group and provide candidate molecular mechanisms underlying the complex ovarian cell changes conferred by low protein diet.

The long-run and intergenerational impact of early exposure to the Great Chinese Famine of 1959-61 on mental health

We study the effects of early exposure to the Great Chinese Famine on the mental health and subjective well-being of survivors as well as their offspring using data from the 2010 and 2014 waves of the China Family Panel Studies. Our analysis focuses on K6 scores, severe mental illness, and life dissatisfaction. We find that early exposure to the famine has impaired the mental health outcomes of women, but not men (i.e., the first generation). For the second generation, negative effects only show up among the sons of male famine survivors. Some preliminary evidence suggests that the mechanism for such transmission may have to do with the cultural son preference.

Reproductive and Metabolic Health Following Exposure to Environmental Chemicals: Mechanistic Insights from Mammalian Models

The decline in human reproductive and metabolic health over the past 50 years is associated with exposure to complex mixtures of anthropogenic environmental chemicals (ECs). Real-life EC exposure has varied over time and differs across geographical locations. Health-related issues include declining sperm quality, advanced puberty onset, premature ovarian insufficiency, cancer, obesity, and metabolic syndrome. Prospective animal studies with individual and limited EC mixtures support these observations and provide a means to investigate underlying physiological and molecular mechanisms. The greatest impacts of EC exposure are through programming of the developing embryo and/or fetus, with additional placental effects reported in eutherian mammals. Single-chemical effects and mechanistic studies, including transgenerational epigenetic inheritance, have been undertaken in rodents. Important translational models of human exposure are provided by companion animals, due to a shared environment, and sheep exposed to anthropogenic chemical mixtures present in pastures treated with sewage sludge (biosolids). Future animal research should prioritize EC mixtures that extend beyond a single developmental stage and/or generation. This would provide a more representative platform to investigate genetic and underlying mechanisms that explain sexually dimorphic and individual effects that could facilitate mitigation strategies.

Fetal Growth Restriction and Its Metabolism-Related Long-Term Outcomes-Underlying Mechanisms and Clinical Implications

The developmental origins of adult disease theory support the concept that undernourished fetuses are at risk of developing metabolic syndrome due to the energy-saving 'Thrifty Phenotype'. This metabolic plasticity represents an evolutionary adaptation that allows individuals to resist the intense pressure caused by cyclically recurring periods of nutritional deprivation. A comprehensive review was conducted following an extensive literature search in the PubMed/Medline and EMBASE databases concerning reports on fetal/intrauterine growth restriction and its metabolic-related long-term outcomes. We only included articles written in English that were published before 1 July 2024. There are several underlying mechanisms and metabolic and endocrine adjustments shaped by the perinatal environment, and they all contribute to progression towards adult disease. From in utero malnutrition or other insults during the fetal period to fetal programing and postnatal catch-up growth, it is difficult to identify the exact moment when this adaptative phenomenon meant to assure fetal survival and to set children on their own physiological growth curves lose its beneficial effect, establishing the trajectory to obesity, insulin resistance, and other hallmarks of metabolic syndrome. With clinical correspondence to an altered body mass, composition, and eating behaviors, it is evident that the metabolic complications linked to FGR are intricate and arise from disturbances in several pathways and organs, but the underlying processes responsible for the long-term consequences are just starting to be understood. The lack of continuity in perinatal-to-pediatric FGR research sets the challenge of exploring new directions in future scientific opportunities. These will hopefully represent a cornerstone in the management of FGR-related metabolic disorders in children, preventing these disorders from evolving into adult disease.

The Molecular Biology of Placental Transport of Calcium to the Human Foetus

From fertilisation to delivery, calcium must be transported into and within the foetoplacental unit for intracellular signalling. This requires very rapid, precisely located Ca2+ transfers. In addition, from around the eighth week of gestation, increasing amounts of calcium must be routed directly from maternal blood to the foetus for bone mineralisation through a flow-through system, which does not impact the intracellular Ca2+ concentration. These different processes are mediated by numerous membrane-sited Ca2+ channels, transporters, and exchangers. Understanding the mechanisms is essential to direct interventions to optimise foetal development and postnatal bone health and to protect the mother and foetus from pre-eclampsia. Ethical issues limit the availability of human foetal tissue for study. Our insight into the processes of placental Ca2+ handling is advancing rapidly, enabled by developing genetic, analytical, and computer technology. Because of their diverse sources, the reports of new findings are scattered. This review aims to pull the data together and to highlight areas of uncertainty. Areas needing clarification include trafficking, membrane expression, and recycling of channels and transporters in the placental microvilli; placental metabolism of vitamin D in gestational diabetes and pre-eclampsia; and the vascular effects of increased endothelial Orai expression by pregnancy-specific beta-1-glycoproteins PSG1 and PSG9.

Secular Trends in Birth Weight in Chile and Its Regions Between 1990 and 2021

OBJECTIVE

The objective is to analyze secular trends in birth weight (BW) for Chile from 1990 to 2021, focusing on the mean BW and low birth weight (LBW) prevalence, and to assess differences across Chilean regions.

METHODS

Our sample, obtained from the Chilean National Statistics Office, contains information on 7 822 975 births, including the total births that took place in Chile from 1990 to 2021. We calculated mean BW and LBW prevalence at a national and a regional level. We also gathered national aggregates from 1974 to 1989 from secondary sources.

RESULTS

At a national level, mean BW increased sharply in Chile from 1983 to 1994 (6%), remained stagnant thereafter, and fell slightly during the last decade and a half. LBW prevalence declined substantially from the mid-1970s to the mid-1990s, from 12% to 5%. It stagnated during the early 1990s, after which there was a small but continuous increase to over 6.5%. Antofagasta is the only outlier: its mean BW and the percentage of LBW are permanently lower and higher, respectively.

CONCLUSIONS

A sharp increase in mean BW from the mid-1980s to the mid-1990s, together with the declining percentage of LBW from the mid-1970s to the mid-1990s, should be due to the better nutritional status of mothers. The decline in mean BW from the early 2000s (as well as the increasing percentage of LBW) may be due to an increasing proportion of preterm births and the increase in the age of women giving birth. The relatively poor performance of Antofagasta is explained by the region's high altitude, which affected large numbers of the population.

Investigation of newborn blood metabolomics in varying intrauterine growth conditions

OBJECTIVES

This study aimed to investigate changes in the blood metabolic profiles of newborns with varying intrauterine growth conditions. Specifically, we analyzed the levels of amino acids, carnitine, and succinylacetone among full-term newborns, including small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA). We aim to identify differential metabolites and metabolic pathways that may offer insights into clinical interventions.

METHODS

A total of 5106 full-term newborns were included in the study. Blood samples were obtained from all newborns between 3 and 5 days after birth and analyzed using tandem mass spectrometry to detect blood metabolites. Subsequently, we screened for different metabolites and metabolic pathways among the groups using the MetaboAnalystR package (Version 1.0.1) in R software (R-3.6.0).

RESULTS

The levels of blood amino acids and carnitine metabolism differed significantly among newborns with varying intrauterine growth conditions. Full-term SGA newborns exhibited a decrease in multiple amino acids and an increase in multiple carnitines, while full-term LGA newborns showed an increase in multiple amino acids and acylcarnitines.

CONCLUSION

Continuous monitoring of the short-term and long-term growth and metabolic status of full-term SGA and LGA newborns is warranted with individualized dietary and nutritional adjustments to promote healthy growth in a timely manner. The findings of this research contribute to the broader understanding of SGA/LGA and shall inform future research on metabolomics, interventions, and long-term outcomes.

Impaired maternal central hemodynamics precede the onset of vascular disorders of pregnancy at high altitude

Hypertensive disorders of pregnancy represent an escalating global health concern with increasing incidence in low- to middle-income countries and high-income countries alike. The current lack of methods to detect the subclinical stages of preeclampsia (PE) and fetal growth restriction (FGR), two common vascular disorders of pregnancy, limits treatment options to minimize acute- and long-term adverse outcomes for both mother and child. To determine whether impaired maternal cardiovascular or uteroplacental vascular function precedes the onset of PE and/or FGR (PE-FGR), we used noninvasive techniques to obtain serial measurements of maternal cardiac output (CO), stroke volume (SV), systemic vascular resistance (SVR), and uterine and fetal arterial resistance at gestational weeks 10-16, 20-24, and 30-34 for 79 maternal-infant pairs in La Paz-El Alto, Bolivia (3,850 m), where the chronic hypoxia of high altitude increases the incidence of PE and FGR. Compared with controls (n = 55), PE-FGR cases (n = 24) had lower SV, higher SVR, and greater uterine artery resistance at 10-16 wk. In addition, fetuses of women with lower SV and higher SVR at 10-16 wk showed evidence of brain sparing at 30-34 wk and had lower birth weights, respectively. Although the trajectory of SV and SVR across pregnancy was similar between groups, PE-FGR cases had a comparatively blunted rise in CO from the first to the third visit. Impaired maternal central hemodynamics and increased uteroplacental resistance precede PE-FGR onset, highlighting the potential use of such measures for identifying high-risk pregnancies at high altitudes.NEW & NOTEWORTHY In this prospective study of maternal central hemodynamics at high altitude, pregnancies later affected by preeclampsia (PE) and/or fetal growth restriction (FGR) show elevated systemic and uterine vascular resistance and reduced stroke volume as early as 10-16 wk gestation. Maternal hemodynamic assessments could facilitate early detection of high-risk pregnancies, improving resource allocation and reducing adverse outcomes. We propose an integrated model linking maternal cardiovascular performance to placental insufficiency, enhancing the understanding of PE-FGR in high-altitude settings.

Contributions of subjective status to eating behaviors, obesity, and metabolic health across development

Subjective status is the evaluation of one's social or socioeconomic status relative to others. Lower subjective status has been associated with risk of overweight/obesity, poorer metabolic health, and obesogenic food preferences and eating behaviors. However, these findings are predominantly based on studies of adolescents and young adults. This indicates major gaps in knowledge and application of this social determinant of obesity and metabolic health, given that perceived status develops throughout the life course along with food environments and eating habits. Here, we review the relationships that subjective status shares with the outcomes of eating behaviors, obesity, and metabolic health across milestones and periods of development: during the prenatal period, as caregivers who feed children, during childhood (prior to age 10) and from adolescence into emerging adulthood (until mid-20's). For each developmental period, we explore why the period critically contributes to these outcomes and how subjective status may affect eating behaviors and metabolic health. We propose that subjective status contributes to eating/feeding behaviors and metabolic health both within and across developmental periods, such that the effect of low subjective status at an earlier period may contribute to obesogenic eating behaviors and metabolic health in later developmental periods and intergenerationally. The influence of low subjective status on higher body weight may also threaten subjective status later in development through heightened vulnerability to social stressors, such as weight-based stigma. Overall, subjective status may be a broadly influential factor to consider when examining social determinants of obesity and metabolic health across development.

Perspectives of Midwives and Nurse Practitioners in Kentucky on Exercise Counseling During Pregnancy: A Qualitative Study

Introduction

Healthcare professionals are in an optimal position to deliver exercise information to pregnant women, yet previous research suggests this seldom happens. Midwives and nurse practitioners, who may have more time with pregnant women, are particularly well suited for this role.

Objectives

This qualitative study examined the exercise advice and counseling provided by midwives and nurse practitioners in Kentucky, focusing on the barriers they face.

Methods

Twenty-one midwives and nurse practitioners were recruited until the sample size reached saturation. A survey with open-ended questions was distributed to potential participants in regional hospitals, universities, and professional associations. The framework method was employed to identify common themes in the responses from participants.

Results

Five main themes emerged: nature of advice, discussing exercise benefits, safety concerns, barriers to counseling, and suggestions for improvement. Findings revealed that midwives and nurse practitioners recommend moderate exercise, aiming for 150 min weekly, monitoring heart rate for intensity, continuing prepregnancy exercise routines, starting low-intensity exercise during pregnancy such as walking, slowing down as pregnancy advances, and avoiding heavy lifting and vigorous activities. Many midwives and nurse practitioners in our sample took a reactive approach to exercise counseling, providing exercise advice if pregnant women asked questions or if they were at high risk for hypokinetic diseases. It was also observed that midwives and nurse practitioners discussed the maternal benefits of exercise more than the fetal benefits. Only a few nurse practitioners and midwives were content with their counseling, while the majority did not feel their counseling was effective.

Conclusions

Many midwives and nurse practitioners in Kentucky provided comprehensive and accurate physical activity guidelines to pregnant women. However, there is room for them to improve: proactive counseling should include discussions on fetal benefits and using the "talk test" for exercise intensity. Advising patients to slow down as pregnancy progresses should be reconsidered, and evidence-based guidance on specific exercises should be prioritized.

Maternal high glucose and fat diet exposure impaired vascular constriction via miR-325-3P/SHIP2/NOX2 pathway axis in offspring vessels

BACKGROUND AND OBJECTIVES

Maternal western-style diets that are high in glucose and fat have well-known cardiovascular effects on offspring, yet the combined influence of such diets during pregnancy is relatively less comprehended. This study investigates the impact of maternal high glucose and fat diet (HGF) on vascular constriction in offspring and the underlying mechanisms.

METHODS AND RESULTS

Pregnant Sprague-Dawley rats were provided with either HGF or control diets. The assessment of fetal and postnatal vascular function disclosed an enhanced sensitivity to angiotensin II-induced vascular constriction in the offspring exposed to HGF. This was ascribed to increased oxidative stress via upregulated NOX2 expression, which was due to downregulated SHIP2 expression that was influenced by upregulated miR-325-3p. The maternal HGF diet elevated miR-325-3p, suppressed SHIP2 and enhanced NOX2 expression in fetal vascular tissues, thereby resulting in vascular dysfunction. These alterations persist into adulthood, heightening the risk of vascular diseases.

CONCLUSION

The present study is the first to demonstrate that maternal HGF diet impairs vascular constriction function in offspring through the miR-325-3p/SHIP2/NOX2 pathway. These novel findings indicate that the detrimental effects of maternal HGF diet on fetal vascular function can persist into adulthood, advancing our knowledge on the impact of maternal diet on offspring vascular health and the early stages of fetal-origin vascular diseases.

The Camden Study-A Pregnancy Cohort Study of Pregnancy Complications and Birth Outcomes in Camden, New Jersey, USA

BACKGROUND

Pregnancy is a unique stage of the life course characterized by trade-offs between the nutritional, immune, and metabolic needs of the mother and fetus. The Camden Study was originally initiated to examine nutritional status, growth, and birth outcomes in adolescent pregnancies and expanded to study dietary and molecular predictors of pregnancy complications and birth outcomes in young women.

METHODS

From 1985-2006, 4765 pregnant participants aged 12 years and older were recruited from Camden, NJ, one of the poorest cities in the US. The cohort reflects a population under-represented in perinatal cohort studies (45% Hispanic, 38% non-Hispanic Black, 17% White participants; 98% using Medicaid in pregnancy). Study visits, including questionnaires, dietary assessments, and biospecimen collection, occurred in early and late pregnancy as well as at delivery. Medical records were abstracted, and a subset of mothers and infants participated in a six-week postpartum visit.

RESULTS

Findings from the Camden Study have added to the understanding of adolescent and young adult maternal health and perinatal outcomes. These include associations of adolescent linear growth while pregnant with smaller neonatal birth size, low dietary zinc intake in early pregnancy with increased risk of delivery <33 gestational weeks, and higher circulating fatty acid levels with greater insulin resistance. More recent analyses have begun to unpack the biochemical pathways in pregnancy that may be shaped by race as an indicator of systemic racism.

CONCLUSIONS

The Camden Study data and biorepositories are well-positioned to support future research aimed at better understanding perinatal health in under-represented women and infants. Linkages to subsequent health and administrative records and the potential for recontacting participants over 18-39 years after initial participation may provide key insights into the trajectories of maternal and child health across the life course.