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Eriksen CB, Minja DT, Christensen DL, Bygbjerg IC, Damm P, Schmiegelow C, Grunnet LG, Hjort L. Do WHO criteria for gestational diabetes fit a rural population in Tanzania? - A follow-up study assessing mother and child health six years after a pregnancy diagnosed with gestational diabetes. Diabetes Res Clin Pract 2024; 211:111657. [PMID: 38583780 DOI: 10.1016/j.diabres.2024.111657] [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: 01/23/2024] [Revised: 03/23/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
AIMS AND METHODS In low- and middle- income countries (LMICs) consequences of gestational diabetes (GDM) is understudied. Using a prospective cohort of mothers (n = 197)and children (n = 251), from rural north-eastern Tanzania, we assessed prediabetes and type 2 diabetes (T2D) prevalence six years after a pregnancy with/without GDM. RESULTS The prevalence of prediabetes (49.4 % vs. 46.4 %) orT2D (20.0 % vs. 16.1 %), p ≥ 0.36, based on fasting plasma glucose (FPG) or HbA1clevels (prediabetes: 16.9 % vs. 13.8 % and T2D 1.2 % vs. 0 %, p = 0.47), andcardio-metabolic health parameters,weresimilar between women with/without previous GDM. These results were supported by similar perinatal outcomes and child health at follow-up.The overall prevalence ofprediabetes/T2D was high, but no differences in other cardio-metabolic risk markers were observed in women with prediabetes/T2D compared to women with normal glucose tolerance. CONCLUSIONS Despite high prevalence of GDM amongTanzanian women, the diagnosis was not associated with adverse pregnancy outcomes, nor with increased risk of prediabetes or T2D at follow-up. FPG and HbA1c may be poor markers for diabetes in this population, and further follow-up studies with longer time intervals are warranted to evaluate which GDM diagnostic criteria are most optimal for women in rural Tanzania and similar LMIC settings.
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Affiliation(s)
- Camilla Byskou Eriksen
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Daniel Thomas Minja
- National Institute for Medical Research, Tanga Centre, P.O. Box 5004, Tanga, Tanzania.
| | - Dirk Lund Christensen
- Global Health Section, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1353 Copenhagen, Denmark.
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1353 Copenhagen, Denmark.
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.
| | - Christentze Schmiegelow
- Centre for Translational Medicine and Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark; Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Gynecology and Obstetrics, Copenhagen University Hospital - North Zealand, Dyrehavevej 29, 3400 Hilleroed, Denmark.
| | - Louise Groth Grunnet
- Global Health Section, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1353 Copenhagen, Denmark; Clinical and Translational Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark.
| | - Line Hjort
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Novo Nordisk Foundation Center for Basic Metabolic Research, Metabolic Epigenetics Group, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100 Copenhagen, Denmark.
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Huang M, Prasad RB, Coral DE, Hjort L, Minja DT, Mulder H, Franks PW, Kalamajski S. Human Genetic Variation at rs10071329 Correlates With Adiposity-Related Traits, Modulates PPARGC1B Expression, and Alters Brown Adipocyte Function. Diabetes 2024; 73:637-645. [PMID: 38190589 PMCID: PMC10958585 DOI: 10.2337/db23-0531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024]
Abstract
Human genetic variation in PPARGC1B has been associated with adiposity, but the genetic variants that affect PPARGC1B expression have not been experimentally determined. Here, guided by previous observational data, we used clustered regularly interspaced short palindromic repeats/CRISPR associated protein 9 (CRISPR/Cas9) to scarlessly edit the alleles of the candidate causal genetic variant rs10071329 in a human brown adipocyte cell line. Switching the rs10071329 genotype from A/A to G/G enhanced PPARGC1B expression throughout the adipogenic differentiation, identifying rs10071329 as a cis-expression quantitative trait loci (eQTL). The higher PPARGC1B expression in G/G cells coincided with greater accumulation of triglycerides and higher expression of mitochondria-encoded genes, but without significant effects on adipogenic marker expression. Furthermore, G/G cells had improved basal- and norepinephrine-stimulated mitochondrial respiration, possibly relating to enhanced mitochondrial gene expression. The G/G cells also exhibited increased norepinephrine-stimulated glycerol release, indicating improved lipolysis. Altogether, our results showed that rs10071329 is a cis-eQTL, with the G/G genotype conferring enhanced PPARGC1B expression, with consequent improved mitochondrial function and response to norepinephrine in brown adipocytes. This genetic variant, and as yet undetermined eQTLs, at PPARGC1B could prove useful in genotype-based precision medicine for obesity treatment. ARTICLE HIGHLIGHTS
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Affiliation(s)
- Mi Huang
- Genetic and Molecular Epidemiology Unit, Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden
| | - Rashmi B. Prasad
- Genomics, Diabetes and Endocrinology Unit, Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden
- Institute for Molecular Medicine, Helsinki University, Helsinki, Finland
| | - Daniel E. Coral
- Genetic and Molecular Epidemiology Unit, Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden
| | - Line Hjort
- Department of Obstetrics, Center for Pregnant Women with Diabetes, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Metabolic Epigenetics Group, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Daniel T.R. Minja
- National Institute for Medical Research, Tanga Center, Tanga, Tanzania
| | - Hindrik Mulder
- Unit of Molecular Metabolism, Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden
| | - Paul W. Franks
- Genetic and Molecular Epidemiology Unit, Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sebastian Kalamajski
- Genetic and Molecular Epidemiology Unit, Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden
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Schmiegelow C, Møller SL, Yde AM, Nielsen BB, Hjort L, Theander TG, Lusingu JPA, Minja DTR, Bygbjerg IC. Anaemia in the first trimester and poor physiological plasma expansion during pregnancy negatively impact foetal weight and newborn anthropometrics: An observational cohort study in Tanzania. Trop Med Int Health 2024; 29:243-255. [PMID: 38191232 DOI: 10.1111/tmi.13967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVES Anaemia during pregnancy is a major health challenge affecting pregnancy outcome worldwide. The objectives of this study were to investigate the impact of severe-moderate anaemia in the first trimester, as well as changes in haemoglobin during pregnancy among non-anaemic women, on foetal weight, placental blood flow and newborn anthropometrics. METHODS In a prospective cohort study, 346 women residing in rural Tanzania were followed throughout pregnancy with serial ultrasound and newborn anthropometrics assessed within 24 h of delivery. Associations between placental blood flow, foetal weight and newborn anthropometrics with either first trimester severe-moderate anaemia (haemoglobin≤9.5 g/dL) or changes in haemoglobin from the first to the third trimester among non-anaemic women, were assessed by mixed model regression and multiple linear regression, adjusting for maternal and foetal co-variables. Foetal weights and birthweight were converted to z-scores using a population based sex-specific weight reference. RESULTS Severe-moderate anaemia in the first trimester was associated with significantly reduced foetal weight z-scores (adjusted mean difference (aMD) -0.44 (95% CI -0.81, -0.07)) and newborn anthropometric indices (birth weight z-score aMD -0.55 (-0.9, -0.13), abdominal circumference aMD -11 mm (95% CI -20, -3)). There were no association between first trimester severe-moderate anaemia and placental blood flow. Among women who were non-anaemic in the first trimester, women with the least reduction in haemoglobin (Δ ≥ -0.3 g/dL) delivered significantly smaller newborns (birthweight z-score aMD -0.55 (-0.91, -0.20), abdominal circumference aMD -10 mm (95% CI -17, -3), compared to women with the greatest reduction (Δ haemoglobin ≤ -1.4 g/dL)). CONCLUSIONS Severe-moderate anaemia in early pregnancy was associated with smaller newborn anthropometrics which was reflected in smaller mean foetal weights in the second and third trimester. Furthermore, among women who were non-anaemic in the first trimester, there was an association between smaller newborn anthropometrics and limited haemoglobin decrease during pregnancy, possibly reflecting insufficient plasma expansion.
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Affiliation(s)
- Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital-North Zealand, Hilleroed, Denmark
| | - Sofie Lykke Møller
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anna Mathilde Yde
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | | | - Line Hjort
- Department of Gynecology and Obstetrics, Julianne Marie Centre, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Metabolic Epigenetics Group, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thor Grundtvig Theander
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - John Peter Andrea Lusingu
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- National Institute for Medical Research Tanga Centre, Korogwe, Tanzania
| | | | - Ib Christian Bygbjerg
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Hazel EA, Erchick DJ, Katz J, Lee ACC, Diaz M, Wu LSF, West KP, Shamim AA, Christian P, Ali H, Baqui AH, Saha SK, Ahmed S, Roy AD, Silveira MF, Buffarini R, Shapiro R, Zash R, Kolsteren P, Lachat C, Huybregts L, Roberfroid D, Zhu Z, Zeng L, Gebreyesus SH, Tesfamariam K, Adu-Afarwuah S, Dewey KG, Gyaase S, Poku-Asante K, Boamah Kaali E, Jack D, Ravilla T, Tielsch J, Taneja S, Chowdhury R, Ashorn P, Maleta K, Ashorn U, Mangani C, Mullany LC, Khatry SK, Ramokolo V, Zembe-Mkabile W, Fawzi WW, Wang D, Schmiegelow C, Minja D, Msemo OA, Lusingu JPA, Smith ER, Masanja H, Mongkolchati A, Keentupthai P, Kakuru A, Kajubi R, Semrau K, Hamer DH, Manasyan A, Pry JM, Chasekwa B, Humphrey J, Black RE. Neonatal mortality risk of vulnerable newborns by fine stratum of gestational age and birthweight for 230 679 live births in nine low- and middle-income countries, 2000-2017. BJOG 2024. [PMID: 38228570 DOI: 10.1111/1471-0528.17743] [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: 07/31/2023] [Revised: 11/29/2023] [Accepted: 12/13/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To describe the mortality risks by fine strata of gestational age and birthweight among 230 679 live births in nine low- and middle-income countries (LMICs) from 2000 to 2017. DESIGN Descriptive multi-country secondary data analysis. SETTING Nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America. POPULATION Liveborn infants from 15 population-based cohorts. METHODS Subnational, population-based studies with high-quality birth outcome data were invited to join the Vulnerable Newborn Measurement Collaboration. All studies included birthweight, gestational age measured by ultrasound or last menstrual period, infant sex and neonatal survival. We defined adequate birthweight as 2500-3999 g (reference category), macrosomia as ≥4000 g, moderate low as 1500-2499 g and very low birthweight as <1500 g. We analysed fine strata classifications of preterm, term and post-term: ≥42+0 , 39+0 -41+6 (reference category), 37+0 -38+6 , 34+0 -36+6 ,34+0 -36+6 ,32+0 -33+6 , 30+0 -31+6 , 28+0 -29+6 and less than 28 weeks. MAIN OUTCOME MEASURES Median and interquartile ranges by study for neonatal mortality rates (NMR) and relative risks (RR). We also performed meta-analysis for the relative mortality risks with 95% confidence intervals (CIs) by the fine categories, stratified by regional study setting (sub-Saharan Africa and Southern Asia) and study-level NMR (≤25 versus >25 neonatal deaths per 1000 live births). RESULTS We found a dose-response relationship between lower gestational ages and birthweights with increasing neonatal mortality risks. The highest NMR and RR were among preterm babies born at <28 weeks (median NMR 359.2 per 1000 live births; RR 18.0, 95% CI 8.6-37.6) and very low birthweight (462.8 per 1000 live births; RR 43.4, 95% CI 29.5-63.9). We found no statistically significant neonatal mortality risk for macrosomia (RR 1.1, 95% CI 0.6-3.0) but a statistically significant risk for all preterm babies, post-term babies (RR 1.3, 95% CI 1.1-1.5) and babies born at 370 -386 weeks (RR 1.2, 95% CI 1.0-1.4). There were no statistically significant differences by region or underlying neonatal mortality. CONCLUSIONS In addition to tracking vulnerable newborn types, monitoring finer categories of birthweight and gestational age will allow for better understanding of the predictors, interventions and health outcomes for vulnerable newborns. It is imperative that all newborns from live births and stillbirths have an accurate recorded weight and gestational age to track maternal and neonatal health and optimise prevention and care of vulnerable newborns.
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Affiliation(s)
- Elizabeth A Hazel
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel J Erchick
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanne Katz
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne C C Lee
- Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Diaz
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lee S F Wu
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Keith P West
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Parul Christian
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hasmot Ali
- JiVitA Maternal and Child Health Research Project, Rangpur, Bangladesh
| | - Abdullah H Baqui
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | - Mariângela F Silveira
- Post-Graduate Program in Epidemiology-Federal University of Pelotas, Pelotas, Brazil
| | - Romina Buffarini
- Post-Graduate Program in Epidemiology-Federal University of Pelotas, Pelotas, Brazil
| | - Roger Shapiro
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rebecca Zash
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Dominique Roberfroid
- Namur University, Namur, Belgium
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| | - Zhonghai Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Seifu H Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kokeb Tesfamariam
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Kathryn G Dewey
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, California, USA
| | | | | | - Ellen Boamah Kaali
- Kintampo Health Research Centre, Kintampo, Ghana
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Darby Jack
- Columbia University's Mailman School of Public Health, New York, New York, USA
| | | | - James Tielsch
- George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Per Ashorn
- Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Kenneth Maleta
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Ulla Ashorn
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Charles Mangani
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Luke C Mullany
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Vundli Ramokolo
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Gertrude H Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Wanga Zembe-Mkabile
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- College Graduate of Studies, University of South Africa, Pretoria, South Africa
| | - Wafaie W Fawzi
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Dongqing Wang
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia, USA
| | - Christentze Schmiegelow
- Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel Minja
- National Institute of Medical Research, Tanga, Tanzania
| | | | | | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
| | | | | | - Paniya Keentupthai
- College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani, Thailand
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Richard Kajubi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Katherine Semrau
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Albert Manasyan
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jake M Pry
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jean Humphrey
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert E Black
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Hjort L, Wewer Albrechtsen NJ, Minja D, Rasmussen C, Møller SL, Lusingu J, Theander T, Bygbjerg IC, Schmiegelow C, Grunnet LG. Cord Blood FGF-21 and GDF-15 Levels Are Affected by Maternal Exposure to Moderate to Severe Anemia and Malaria. J Endocr Soc 2023; 7:bvad120. [PMID: 37795192 PMCID: PMC10546908 DOI: 10.1210/jendso/bvad120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Indexed: 10/06/2023] Open
Abstract
Context Anemia and malaria are global health problems affecting >50% of pregnant women in sub-Saharan Africa and are associated with intrauterine growth restriction. The hormones fibroblast growth factor 21 (FGF-21) and growth differentiation factor 15 (GDF-15) are involved in metabolic regulation and are expressed in the placenta. No studies exist on FGF-21 and GDF-15 responses to exposures of malaria and anemia in pregnancy. Objective and Methods Using a prospective, longitudinal pregnancy and birth cohort of women with an average age of 26 years from a rural region in northeastern Tanzania, we examined if FGF-21 and GDF-15 levels in maternal blood at week 33 ± 2 (n = 301) and in cord blood at birth (n = 353), were associated with anemia and malaria exposure at different time points in pregnancy and with neonatal anthropometry. Results Among mothers at gestation week 33 ± 2, lower FGF-21 levels were observed after exposure to malaria in the first trimester, but not anemia, whereas GDF-15 levels at week 33 ± 2 were not associated with malaria nor anemia. In cord blood, moderate to severe anemia at any time point in pregnancy was associated with higher levels of FGF-21, whereas malaria exposure in the third trimester was associated with lower FGF-21 levels in cord blood. Negative associations were observed between cord blood FGF-21 and GDF-15 levels and neonatal skinfold thicknesses and birthweight. Conclusion Our results suggest that moderate to severe anemia throughout pregnancy associates with higher FGF-21 levels, and malaria in last trimester associates with lower FGF-21 levels, in the neonates, thereby potentially affecting the future cardiometabolic health of the child.
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Affiliation(s)
- Line Hjort
- Department of Obstetrics, Copenhagen University Hospital, Copenhagen 2100, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Metabolic Epigenetics Group, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Nicolai J Wewer Albrechtsen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
- Departments of Clinical Biochemistry, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen 2200, Denmark
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Daniel Minja
- National Institute for Medical Research, Tanga Center, Tanga 5004, Tanzania
| | - Christine Rasmussen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
- Departments of Clinical Biochemistry, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen 2200, Denmark
| | - Sofie Lykke Møller
- Department of Public Health, Section of Global Health, University of Copenhagen, Copenhagen 2200, Denmark
| | - John Lusingu
- National Institute for Medical Research, Tanga Center, Tanga 5004, Tanzania
| | - Thor Theander
- Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen 2200, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen 2100, Denmark
| | - Ib Christian Bygbjerg
- Department of Public Health, Section of Global Health, University of Copenhagen, Copenhagen 2200, Denmark
| | - Christentze Schmiegelow
- Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen 2200, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen 2100, Denmark
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6
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Hazel EA, Erchick DJ, Katz J, Lee ACC, Diaz M, Wu LSF, West KP, Shamim AA, Christian P, Ali H, Baqui AH, Saha SK, Ahmed S, Roy AD, Silveira MF, Buffarini R, Shapiro R, Zash R, Kolsteren P, Lachat C, Huybregts L, Roberfroid D, Zhu Z, Zeng L, Gebreyesus SH, Tesfamariam K, Adu-Afarwuah S, Dewey KG, Gyaase S, Poku-Asante K, Boamah Kaali E, Jack D, Ravilla T, Tielsch J, Taneja S, Chowdhury R, Ashorn P, Maleta K, Ashorn U, Mangani C, Mullany LC, Khatry SK, Ramokolo V, Zembe-Mkabile W, Fawzi WW, Wang D, Schmiegelow C, Minja D, Msemo OA, Lusingu JPA, Smith ER, Masanja H, Mongkolchati A, Keentupthai P, Kakuru A, Kajubi R, Semrau K, Hamer DH, Manasyan A, Pry JM, Chasekwa B, Humphrey J, Black RE. Neonatal mortality risk of vulnerable newborns: A descriptive analysis of subnational, population-based birth cohorts for 238 203 live births in low- and middle-income settings from 2000 to 2017. BJOG 2023. [PMID: 37156238 DOI: 10.1111/1471-0528.17518] [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: 01/10/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE We aimed to understand the mortality risks of vulnerable newborns (defined as preterm and/or born weighing smaller or larger compared to a standard population), in low- and middle-income countries (LMICs). DESIGN Descriptive multi-country, secondary analysis of individual-level study data of babies born since 2000. SETTING Sixteen subnational, population-based studies from nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America. POPULATION Live birth neonates. METHODS We categorically defined five vulnerable newborn types based on size (large- or appropriate- or small-for-gestational age [LGA, AGA, SGA]), and term (T) and preterm (PT): T + LGA, T + SGA, PT + LGA, PT + AGA, and PT + SGA, with T + AGA (reference). A 10-type definition included low birthweight (LBW) and non-LBW, and a four-type definition collapsed AGA/LGA into one category. We performed imputation for missing birthweights in 13 of the studies. MAIN OUTCOME MEASURES Median and interquartile ranges by study for the prevalence, mortality rates and relative mortality risks for the four, six and ten type classification. RESULTS There were 238 203 live births with known neonatal status. Four of the six types had higher mortality risk: T + SGA (median relative risk [RR] 2.6, interquartile range [IQR] 2.0-2.9), PT + LGA (median RR 7.3, IQR 2.3-10.4), PT + AGA (median RR 6.0, IQR 4.4-13.2) and PT + SGA (median RR 10.4, IQR 8.6-13.9). T + SGA, PT + LGA and PT + AGA babies who were LBW, had higher risk compared with non-LBW babies. CONCLUSIONS Small and/or preterm babies in LIMCs have a considerably increased mortality risk compared with babies born at term and larger. This classification system may advance the understanding of the social determinants and biomedical risk factors along with improved treatment that is critical for newborn health.
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Affiliation(s)
- Elizabeth A Hazel
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel J Erchick
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanne Katz
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne C C Lee
- Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Diaz
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lee S F Wu
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Keith P West
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Parul Christian
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hasmot Ali
- JiVitA Maternal and Child Health Research Project, Rangpur, Bangladesh
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | - Mariângela F Silveira
- Post-Graduate Program in Epidemiology - Federal University of Pelotas, Pelotas, Brazil
| | - Romina Buffarini
- Post-Graduate Program in Epidemiology - Federal University of Pelotas, Pelotas, Brazil
| | - Roger Shapiro
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rebecca Zash
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Dominique Roberfroid
- Namur University, Namur, Belgium
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| | - Zhonghai Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Seifu H Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kokeb Tesfamariam
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Kathryn G Dewey
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, California, USA
| | | | | | - Ellen Boamah Kaali
- Kintampo Health Research Centre, Kintampo, Ghana
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Darby Jack
- Columbia University's Mailman School of Public Health, New York, New York, USA
| | | | - James Tielsch
- George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Per Ashorn
- Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Kenneth Maleta
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Ulla Ashorn
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Charles Mangani
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Luke C Mullany
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Vundli Ramokolo
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Gertrude H Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Wanga Zembe-Mkabile
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- South African Research Chair in Social Policy at College Graduate of Studies, University of South Africa, Pretoria, South Africa
| | - Wafaie W Fawzi
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Dongqing Wang
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia, USA
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, and Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel Minja
- National Institute of Medical Research, Tanga, Tanzania
| | | | | | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
| | | | | | - Paniya Keentupthai
- College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani, Thailand
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Richard Kajubi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Katherine Semrau
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Albert Manasyan
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jake M Pry
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jean Humphrey
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert E Black
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Goedecke JH, Pheiffer C, Mendham AE. Environmental exposures are important for type 2 diabetes pathophysiology in sub-Saharan African populations. Reply to Christensen D, Hjort L, Mpagama S et al [letter]. Diabetologia 2023; 66:780-782. [PMID: 36692507 DOI: 10.1007/s00125-022-05859-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/05/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Julia H Goedecke
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa.
- South African Medical Research Council/WITS Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), FIMS International Collaborating Centre of Sports Medicine, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Carmen Pheiffer
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa
| | - Amy E Mendham
- South African Medical Research Council/WITS Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), FIMS International Collaborating Centre of Sports Medicine, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Msemo OA, Pérez-Alós L, Minja DT, Hansen CB, Gesase S, Mtove G, Mbwana J, Larsen VML, Bøgestad ECS, Grunnet LG, Christensen DL, Bygbjerg IC, Burgner D, Schmiegelow C, Garred P, Hjort L. High anti-SARS-CoV-2 seroprevalence among unvaccinated mother-child pairs from a rural setting in north-eastern Tanzania during the second wave of COVID-19. IJID REGIONS 2023; 6:48-57. [PMID: 36466214 PMCID: PMC9709504 DOI: 10.1016/j.ijregi.2022.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
Background The reported infection rates and burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in low- and middle-income countries, including those in sub-Saharan Africa, are relatively low compared to the rates and burden in Europe and America, partly due to limited testing capability. Unlike many countries, Tanzania has implemented neither mass screening nor restrictive measures such as lockdowns to date. The prevalence of SARS-CoV-2 infection in rural mainland Tanzania is largely unknown. Methods A cross-sectional study was conducted between April and October 2021 to assess the anti-SARS-CoV-2 seroprevalence among mother-child pairs (n = 634 children, n = 518 mothers) in a rural setting in north-eastern Tanzania. Results A very high prevalence of anti-SARS-CoV-2 antibody titres was found, with seroprevalence rates ranging from 29% among mothers and 40% among children, with a dynamic peak in seropositivity incidence at the end of July/early August being revealed. Significant differences in age, socioeconomic status, and body composition were associated with seropositivity in mothers and children. No significant associations were observed between seropositivity and comorbidities, including anaemia, diabetes, malaria, and HIV. Conclusions The transmission of SARS-CoV-2 in a rural region of Tanzania during 2021 was high, indicating a much higher infection rate in rural Tanzania compared to that reported in the UK and USA during the same period. Ongoing immune surveillance may be vital to monitoring the burden of viral infection in rural settings without access to molecular genotyping, where the load of communicable diseases may mask COVID-19. Surveillance could be implemented in tandem with the intensification of vaccination strategies.
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Affiliation(s)
- Omari Abdul Msemo
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Laura Pérez-Alós
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Daniel T.R. Minja
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Cecilie Bo Hansen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Samwel Gesase
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - George Mtove
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Joyce Mbwana
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Victoria Marie Linderod Larsen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark,Department of Technology, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Emilie Caroline Skuladottir Bøgestad
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark,Department of Technology, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | | | - Dirk Lund Christensen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - David Burgner
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia,Department of Paediatrics, Melbourne University, Melbourne, Victoria, Australia
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark,Department of Obstetrics, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Line Hjort
- Novo Nordisk Foundation Centre for Basic Metabolic Research, Metabolic Epigenetics Group, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Corresponding author: Line Hjort, he Novo Nordisk Foundation Centre for Basic Metabolic Research, Metabolic Epigenetics Group, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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9
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Raghavan SSR, Dagil R, Lopez-Perez M, Conrad J, Bassi MR, Quintana MDP, Choudhary S, Gustavsson T, Wang Y, Gourdon P, Ofori MF, Christensen SB, Minja DTR, Schmiegelow C, Nielsen MA, Barfod L, Hviid L, Salanti A, Lavstsen T, Wang K. Cryo-EM reveals the conformational epitope of human monoclonal antibody PAM1.4 broadly reacting with polymorphic malarial protein VAR2CSA. PLoS Pathog 2022; 18:e1010924. [PMCID: PMC9668162 DOI: 10.1371/journal.ppat.1010924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
Malaria during pregnancy is a major global health problem caused by infection with Plasmodium falciparum parasites. Severe effects arise from the accumulation of infected erythrocytes in the placenta. Here, erythrocytes infected by late blood-stage parasites adhere to placental chondroitin sulphate A (CS) via VAR2CSA-type P. falciparum erythrocyte membrane protein 1 (PfEMP1) adhesion proteins. Immunity to placental malaria is acquired through exposure and mediated through antibodies to VAR2CSA. Through evolution, the VAR2CSA proteins have diversified in sequence to escape immune recognition but retained their overall macromolecular structure to maintain CS binding affinity. This structural conservation may also have allowed development of broadly reactive antibodies to VAR2CSA in immune women. Here we show the negative stain and cryo-EM structure of the only known broadly reactive human monoclonal antibody, PAM1.4, in complex with VAR2CSA. The data shows how PAM1.4’s broad VAR2CSA reactivity is achieved through interactions with multiple conserved residues of different sub-domains forming conformational epitope distant from the CS binding site on the VAR2CSA core structure. Thus, while PAM1.4 may represent a class of antibodies mediating placental malaria immunity by inducing phagocytosis or NK cell-mediated cytotoxicity, it is likely that broadly CS binding-inhibitory antibodies target other epitopes at the CS binding site. Insights on both types of broadly reactive monoclonal antibodies may aid the development of a vaccine against placental malaria.
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Affiliation(s)
- Sai Sundar Rajan Raghavan
- Centre for Medical Parasitology at Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Robert Dagil
- Centre for Medical Parasitology at Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Mary Lopez-Perez
- Centre for Medical Parasitology at Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Julian Conrad
- Swedish National Cryo-EM Facility, Science for Life Laboratories, Solna, Sweden
| | - Maria Rosaria Bassi
- Centre for Medical Parasitology at Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Maria del Pilar Quintana
- Centre for Medical Parasitology at Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Swati Choudhary
- Centre for Medical Parasitology at Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Tobias Gustavsson
- Centre for Medical Parasitology at Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Yong Wang
- Joint Research Centre for Engineering Biology, Zhejiang University-University of Edinburgh Institute, College of Life Sciences, Zhejiang University, Hangzhou, Zhejiang, China
| | - Pontus Gourdon
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Michael Fokuo Ofori
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Sebastian Boje Christensen
- Centre for Medical Parasitology at Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | - Christentze Schmiegelow
- Centre for Medical Parasitology at Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Morten Agertoug Nielsen
- Centre for Medical Parasitology at Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Lea Barfod
- Centre for Medical Parasitology at Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Lars Hviid
- Centre for Medical Parasitology at Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Ali Salanti
- Centre for Medical Parasitology at Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Lavstsen
- Centre for Medical Parasitology at Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
- * E-mail: (TL); (KW)
| | - Kaituo Wang
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- * E-mail: (TL); (KW)
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10
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HIV Prevalence among Injury Patients Compared to Other High-Risk Groups in Tanzania. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2030041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Sixty-eight percent of persons infected with HIV live in Africa, but as few as 67% of those know their infection status. The emergency department (ED) might be a critical access point to HIV testing. This study sought to measure and compare HIV prevalence in an ED injury population with other clinical and nonclinical populations across Tanzania. Adults (≥18 years) presenting to Kilimanjaro Christian Medical Center ED with acute injury of any severity were enrolled in a trauma registry. A systematic review and meta-analysis was conducted to compare HIV prevalence in the trauma registry with other population groups. Further, 759 injury patients were enrolled in the registry; 78.6% were men and 68.2% consented to HIV counseling and testing. The HIV prevalence was 5.02% (tested), 6.25% (self-report), and 5.31% (both). The systematic review identified 79 eligible studies reporting HIV prevalence (tested) in 33 clinical and 12 nonclinical population groups. Notable groups included ED injury patients (3.53%, 95% CI), multiple injury patients (10.67%, 95% CI), and people who inject drugs (17.43%, 95% CI). These findings suggest that ED injury patients might be at higher HIV risk compared to the general population, and the ED is a potential avenue to increasing HIV testing among young adults, particularly men.
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11
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Hatem G, Hjort L, Asplund O, Minja DTR, Msemo OA, Møller SL, Lavstsen T, Groth-Grunnet L, Lusingu JPA, Hansson O, Christensen DL, Vaag AA, Artner I, Theander T, Groop L, Schmiegelow C, Bygbjerg IC, Prasad RB. Mapping the Cord Blood Transcriptome of Pregnancies Affected by Early Maternal Anemia to Identify Signatures of Fetal Programming. J Clin Endocrinol Metab 2022; 107:1303-1316. [PMID: 35021220 PMCID: PMC9016468 DOI: 10.1210/clinem/dgac010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Anemia during early pregnancy (EP) is common in developing countries and is associated with adverse health consequences for both mothers and children. Offspring of women with EP anemia often have low birth weight, which increases risk for cardiometabolic diseases, including type 2 diabetes (T2D), later in life. OBJECTIVE We aimed to elucidate mechanisms underlying developmental programming of adult cardiometabolic disease, including epigenetic and transcriptional alterations potentially detectable in umbilical cord blood (UCB) at time of birth. METHODS We leveraged global transcriptome- and accompanying epigenome-wide changes in 48 UCB from newborns of EP anemic Tanzanian mothers and 50 controls to identify differentially expressed genes (DEGs) in UCB exposed to maternal EP anemia. DEGs were assessed for association with neonatal anthropometry and cord insulin levels. These genes were further studied in expression data from human fetal pancreas and adult islets to understand their role in beta-cell development and/or function. RESULTS The expression of 137 genes was altered in UCB of newborns exposed to maternal EP anemia. These putative signatures of fetal programming, which included the birth weight locus LCORL, were potentially mediated by epigenetic changes in 27 genes and associated with neonatal anthropometry. Among the DEGs were P2RX7, PIK3C2B, and NUMBL, which potentially influence beta-cell development. Insulin levels were lower in EP anemia-exposed UCB, supporting the notion of developmental programming of pancreatic beta-cell dysfunction and subsequently increased risk of T2D in offspring of mothers with EP anemia. CONCLUSIONS Our data provide proof-of-concept on distinct transcriptional and epigenetic changes detectable in UCB from newborns exposed to maternal EP anemia.
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Affiliation(s)
- Gad Hatem
- Genomics, Diabetes and Endocrinology, Department of Clinical Sciences, Clinical Research Centre, Lund University Diabetes Centre, 205 02, Malmö, Sweden
| | - Line Hjort
- Department of Obstetrics, Center for Pregnant Women with Diabetes, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Endocrinology (Diabetes and Bone-Metabolic Research Unit), 2100 Copenhagen, Denmark
| | - Olof Asplund
- Genomics, Diabetes and Endocrinology, Department of Clinical Sciences, Clinical Research Centre, Lund University Diabetes Centre, 205 02, Malmö, Sweden
| | - Daniel T R Minja
- National Institute for Medical Research, Tanga Center, 0255 Tanga, Tanzania
| | - Omari Abdul Msemo
- National Institute for Medical Research, Tanga Center, 0255 Tanga, Tanzania
| | - Sofie Lykke Møller
- Section of Global Health, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
| | - Thomas Lavstsen
- Center for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Louise Groth-Grunnet
- Department of Endocrinology (Diabetes and Bone-Metabolic Research Unit), 2100 Copenhagen, Denmark
- Section of Global Health, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
| | - John P A Lusingu
- National Institute for Medical Research, Tanga Center, 0255 Tanga, Tanzania
- Center for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Ola Hansson
- Genomics, Diabetes and Endocrinology, Department of Clinical Sciences, Clinical Research Centre, Lund University Diabetes Centre, 205 02, Malmö, Sweden
| | - Dirk Lund Christensen
- Section of Global Health, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
| | - Allan A Vaag
- Steno Diabetes Center Copenhagen, 2730 Gentofte, Denmark
| | - Isabella Artner
- Genomics, Diabetes and Endocrinology, Department of Clinical Sciences, Clinical Research Centre, Lund University Diabetes Centre, 205 02, Malmö, Sweden
| | - Thor Theander
- Center for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Leif Groop
- Genomics, Diabetes and Endocrinology, Department of Clinical Sciences, Clinical Research Centre, Lund University Diabetes Centre, 205 02, Malmö, Sweden
- Finnish Institute of Molecular Medicine (FIMM), 00290 Helsinki, Finland
| | - Christentze Schmiegelow
- Center for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Ib Christian Bygbjerg
- Section of Global Health, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
| | - Rashmi B Prasad
- Genomics, Diabetes and Endocrinology, Department of Clinical Sciences, Clinical Research Centre, Lund University Diabetes Centre, 205 02, Malmö, Sweden
- Finnish Institute of Molecular Medicine (FIMM), 00290 Helsinki, Finland
- Correspondence: Rashmi B Prasad, PhD, Genomics, Diabetes and Endocrinology, Department of Clinical Sciences, Clinical Research Centre, Lund University Diabetes Centre, Jan Waldenströms gata 35, 205 02 Malmö, Sweden.
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Hansson H, Saidi Q, Alifrangis M. Preservation and Extraction of Malaria Parasite DNA from Dried Blood Spots. Methods Mol Biol 2022; 2470:27-36. [PMID: 35881336 DOI: 10.1007/978-1-0716-2189-9_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Molecular studies related to diagnosis and research rely on collection of blood samples and extraction of high-quality DNA. In Africa, where the populations carried 94% of the total burden of cases and deaths due to malaria in 2019, collection of samples is often challenged by remote study areas and lack of a cold chain to transport and store samples. Collection of blood on filter paper is a technique that is less invasive and has simpler requirements regarding training of staff, storage, and transport of samples than collection of venous blood samples. Dried blood spots (DBS) are therefore commonly used in many research projects. However, DNA quality can be affected by duration and conditions of storage. The quality of the DNA for molecular analyses also depends on a DNA extraction methodology that provides high-quality DNA with high purity and yield. Several protocols for DNA extraction have been described, and many comparative studies have analyzed and optimized the different methodologies to find an alternative to the more costly commercial extraction kits. This chapter describes recommendations for storage and preservation of DBS, and a Chelex-based protocol for extraction of DNA from DBS.
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Affiliation(s)
- Helle Hansson
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen N, Denmark.
| | - Queen Saidi
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen N, Denmark
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Michael Alifrangis
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen N, Denmark
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13
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Bone JN, Pickerill K, Woo Kinshella ML, Vidler M, Craik R, Poston L, Stones W, Sevene E, Temmerman M, Koech Etyang A, Roca A, Russell D, Tribe RM, von Dadelszen P, Magee LA. Pregnancy cohorts and biobanking in sub-Saharan Africa: a systematic review. BMJ Glob Health 2021; 5:bmjgh-2020-003716. [PMID: 33243854 PMCID: PMC7692823 DOI: 10.1136/bmjgh-2020-003716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022] Open
Abstract
Background Technological advances and high throughput biological assays can facilitate discovery science in biobanks from population cohorts, including pregnant women. Biological pathways associated with health outcomes differ depending on geography, and high-income country data may not generalise to low-resource settings. We conducted a systematic review to identify prospective pregnancy cohorts in sub-Saharan Africa (SSA) that include biobanked samples with potential to enhance discovery science opportunity. Methods Inclusion criteria were prospective data collection during pregnancy, with associated biobanking in SSA. Data sources included: scientific databases (with comprehensive search terms), grey literature, hand searching applicable reference lists and expert input. Results were screened in a three-stage process based on title, abstract and full text by two independent reviewers. The review is registered on PROSPERO (CRD42019147483). Results Fourteen SSA studies met the inclusion criteria from database searches (n=8), reference list searches (n=2) and expert input (n=4). Three studies have ongoing data collection. The most represented countries were South Africa and Mozambique (Southern Africa) (n=3), Benin (Western Africa) (n=4) and Tanzania (Eastern Africa) (n=4); including an estimated 31 763 women. Samples commonly collected were blood, cord blood and placenta. Seven studies collected neonatal samples. Common clinical outcomes included maternal and perinatal mortality, malaria and preterm birth. Conclusions Increasingly numerous pregnancy cohorts in SSA that include biobanking are generating a uniquely valuable resource for collaborative discovery science, and improved understanding of the high regional risks of maternal, fetal and neonatal morbidity and mortality. Future studies should align protocols and consider their added value and distinct contributions.
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Affiliation(s)
- Jeffrey N Bone
- Department of Obstetrics and Gynaecology, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Kelly Pickerill
- Department of Obstetrics and Gynaecology, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Rachel Craik
- Department of Women and Children's Health, King's College London, School of Life Course Sciences, Faculty of Life Sciences and Medicine, London, UK
| | - Lucilla Poston
- Department of Women and Children's Health, King's College London, School of Life Course Sciences, Faculty of Life Sciences and Medicine, London, UK
| | - William Stones
- Centre for Reproductive Health, University of Malawi College of Medicine, Blantyre, Malawi
| | - Esperanca Sevene
- Centro de Investigação em Saúde de Manhiça, Manhiça, Maputo, Mozambique.,Department of Physiologic Sciences, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Angela Koech Etyang
- Department of Obstetrics and Gynaecology, Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Anna Roca
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Rachel M Tribe
- Department of Women and Children's Health, King's College London, School of Life Course Sciences, Faculty of Life Sciences and Medicine, London, UK
| | - Peter von Dadelszen
- Department of Women and Children's Health, King's College London, School of Life Course Sciences, Faculty of Life Sciences and Medicine, London, UK
| | - Laura A Magee
- Department of Women and Children's Health, King's College London, School of Life Course Sciences, Faculty of Life Sciences and Medicine, London, UK
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14
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Abstract
One strategy for improving detection of fetal growth restriction (FGR) is developing biosensors identifying placental dysfunction as a leading pathogenesis for FGR. The aim of this pilot study was to investigate the performance of a biosensor specified to detect placental dysfunction by means of maternal arterial turbulence acoustics in a low-resource setting. A cohort of 147 singleton pregnant women were prospectively followed with double-blinded biosensor tests, sonographic estimation of fetal weight (EFW) and Doppler flow at 26–28, 32–34 and 37–39 weeks of pregnancy. Full term live births with recorded birth weights (BWs) and without major congenital malformations were included. Outcomes were defined as (A) a solitary biometric measure (BW < 3rd centile) and as (B) a biometric measure and contributory functional measure (BW < 10th centile and antenatally detected umbilical artery pulsatility index > 95th centile). Data from 118 women and 262 antenatal examinations were included. Mean length of pregnancy was 40 weeks (SD ± 8 days), mean BW was 3008 g (SD ± 410 g). Outcome (A) was identified in seven (6%) pregnancies, whereas outcome (B) was identified in one (0.8%) pregnancy. The biosensor tested positive in five (4%) pregnancies. The predictive performance for outcome (A) was sensitivity = 0.29, specificity = 0.97, p = 0.02, positive predictive value (PPV) was 0.40 and negative predictive value (NPV) was 0.96. The predictive performance was higher for outcome (B) with sensitivity = 1.00, specificity = 0.97, p = 0.04, PPV = 0.20 and NPV = 1.00. Conclusively, these pilot-study results show future potential for biosensors as screening modality for FGR in a low-resource setting.
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15
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Hansson H, Minja DTR, Moeller SL, Lusingu JPA, Bygbjerg IC, Yde AM, Jensen RW, Nag S, Msemo OA, Theander TG, Alifrangis M, Schmiegelow C. Reduced birth weight caused by sextuple drug resistant Plasmodium falciparum infection in early 2nd trimester. J Infect Dis 2021; 224:1605-1613. [PMID: 33684211 DOI: 10.1093/infdis/jiab117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/26/2021] [Indexed: 11/12/2022] Open
Abstract
Mutations in the Plasmodium falciparum genes Pfdhfr and Pfdhps, particularly the sextuple mutant haplotype threatens the antimalarial effectiveness of sulfadoxine-pyrimethamine as intermittent preventive treatment during pregnancy (IPTp). To explore the impact of sextuple mutant haplotype infections on outcome measures after provision of IPTp-SP, we monitored birth outcomes in women followed from prior to conception or from the first trimester until delivery. Women infected with sextuple haplotypes in early 2 nd trimester specifically, delivered newborns with a lower birth weight (-267g, 95% CI -454; -59, p=0·01) compared to women who did not have malaria during pregnancy and women infected with less SP resistant haplotypes (-461g, 95% CI -877; -44, p=0·03). Thus, sextuple haplotype infections seems to impact the effectiveness of SP for IPTp and directly impact birth outcome by lowering birth weight. Close monitoring and targeted malaria control during early pregnancy is therefore crucial to improve birth outcomes.
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Affiliation(s)
- Helle Hansson
- Department of Immunology and Microbiology, University of Copenhagen, Denmark and Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej, Copenhagen N, Denmark
| | - Daniel T R Minja
- National Institute for Medical Research, Tanga Research Centre, Bombo Area, Tanga, Tanzania
| | - Sofie L Moeller
- Department of Immunology and Microbiology, University of Copenhagen, Denmark and Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej, Copenhagen N, Denmark.,Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade, Copenhagen K, Denmark
| | - John P A Lusingu
- National Institute for Medical Research, Tanga Research Centre, Bombo Area, Tanga, Tanzania
| | - Ib C Bygbjerg
- Department of Immunology and Microbiology, University of Copenhagen, Denmark and Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej, Copenhagen N, Denmark.,Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade, Copenhagen K, Denmark
| | - Anna-Mathilde Yde
- Department of Immunology and Microbiology, University of Copenhagen, Denmark and Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej, Copenhagen N, Denmark
| | - Rasmus W Jensen
- Department of Immunology and Microbiology, University of Copenhagen, Denmark and Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej, Copenhagen N, Denmark
| | - Sidsel Nag
- Department of Immunology and Microbiology, University of Copenhagen, Denmark and Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej, Copenhagen N, Denmark
| | - Omari A Msemo
- National Institute for Medical Research, Tanga Research Centre, Bombo Area, Tanga, Tanzania
| | - Thor G Theander
- Department of Immunology and Microbiology, University of Copenhagen, Denmark and Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej, Copenhagen N, Denmark
| | - Michael Alifrangis
- Department of Immunology and Microbiology, University of Copenhagen, Denmark and Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej, Copenhagen N, Denmark
| | - Christentze Schmiegelow
- Department of Immunology and Microbiology, University of Copenhagen, Denmark and Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej, Copenhagen N, Denmark
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16
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High Prevalence of Gestational Diabetes Mellitus in Rural Tanzania-Diagnosis Mainly Based on Fasting Blood Glucose from Oral Glucose Tolerance Test. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093109. [PMID: 32365670 PMCID: PMC7246425 DOI: 10.3390/ijerph17093109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/16/2022]
Abstract
Gestational diabetes mellitus (GDM) is associated with poor pregnancy outcomes and increased long-term risk of metabolic diseases for both mother and child. In Tanzania, GDM prevalence increased from 0% in 1991 to 19.5% in 2016. Anaemia has been proposed to precipitate the pathogenesis of GDM. We aimed to examine the prevalence of GDM in a rural area of Tanzania with a high prevalence of anaemia and to examine a potential association between haemoglobin concentration and blood glucose during pregnancy. The participants were included in a population-based preconception, pregnancy and birth cohort study. In total, 538 women were followed during pregnancy and scheduled for an oral glucose tolerance test (OGTT) at week 32-34 of gestation. Gestational diabetes mellitus was diagnosed according to the WHO 2013 guidelines. Out of 392 women screened, 39% (95% CI: 34.2-44.1) had GDM, the majority of whom (94.1%) were diagnosed based solely on the fasting blood sample from the OGTT. No associations were observed between haemoglobin or ferritin and glucose measurements during pregnancy. A very high prevalence of GDM was found in rural Tanzania. In view of the laborious, costly and inconvenient OGTT, alternative methods such as fasting blood glucose should be considered when screening for GDM in low- and middle-income countries.
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