1
|
Power GM, Sanderson E, Pagoni P, Fraser A, Morris T, Prince C, Frayling TM, Heron J, Richardson TG, Richmond R, Tyrrell J, Warrington N, Davey Smith G, Howe LD, Tilling KM. Methodological approaches, challenges, and opportunities in the application of Mendelian randomisation to lifecourse epidemiology: A systematic literature review. Eur J Epidemiol 2024; 39:501-520. [PMID: 37938447 PMCID: PMC7616129 DOI: 10.1007/s10654-023-01032-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/21/2023] [Indexed: 11/09/2023]
Abstract
Diseases diagnosed in adulthood may have antecedents throughout (including prenatal) life. Gaining a better understanding of how exposures at different stages in the lifecourse influence health outcomes is key to elucidating the potential benefits of disease prevention strategies. Mendelian randomisation (MR) is increasingly used to estimate causal effects of exposures across the lifecourse on later life outcomes. This systematic literature review explores MR methods used to perform lifecourse investigations and reviews previous work that has utilised MR to elucidate the effects of factors acting at different stages of the lifecourse. We conducted searches in PubMed, Embase, Medline and MedRXiv databases. Thirteen methodological studies were identified. Four studies focused on the impact of time-varying exposures in the interpretation of "standard" MR techniques, five presented methods for repeat measures of the same exposure, and four described methodological approaches to handling multigenerational exposures. A further 127 studies presented the results of an applied research question. Over half of these estimated effects in a single generation and were largely confined to the exploration of questions regarding body composition. The remaining mostly estimated maternal effects. There is a growing body of research focused on the development and application of MR methods to address lifecourse research questions. The underlying assumptions require careful consideration and the interpretation of results rely on select conditions. Whilst we do not advocate for a particular strategy, we encourage practitioners to make informed decisions on how to approach a research question in this field with a solid understanding of the limitations present and how these may be affected by the research question, modelling approach, instrument selection, and data availability.
Collapse
Affiliation(s)
- Grace M Power
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia.
| | - Eleanor Sanderson
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Panagiota Pagoni
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Tim Morris
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
| | - Claire Prince
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Timothy M Frayling
- Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Jon Heron
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Tom G Richardson
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Rebecca Richmond
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Jessica Tyrrell
- Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Nicole Warrington
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
- Frazer Institute, University of Queensland, Woolloongabba, Queensland, Australia
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
- NIHR Bristol Biomedical Research Centre Bristol, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Laura D Howe
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Kate M Tilling
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| |
Collapse
|
2
|
Bersain R, Mishra D, Juneja M, Kumar D, Garg S. Comparison of Neurodevelopmental Status in Early Infancy of Infants of Women With and Without Gestational Diabetes Mellitus. Indian J Pediatr 2023; 90:1083-1088. [PMID: 37256447 DOI: 10.1007/s12098-023-04639-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/24/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To study the neurodevelopmental status of offsprings of mothers with gestational diabetes (OGDM) aged 3½ mo. METHODS This cross-sectional study was conducted at a tertiary hospital, New Delhi which included infants aged 3½ mo (+1 wk) who were either offsprings of women with gestational diabetes (cases) or infants of mothers without gestational diabetes mellitus presenting to tertiary care public hospital in India from January, 2018 through March, 2019, with enrollment of infants done between 10 April, 2018 and 30 March, 2019. RESULTS The development quotient (DQ) using Developmental Assessment Scales for Indian Infants (DASII) was calculated as Motor DQ, Mental DQ and a composite DQ. The mean motor DQ of the enrolled infants was 101.7 (12.02); it was significantly lower for OGDM than controls [101 (1.41) vs. 109.5 (10.6); P <0.001]. The mean mental DQ of the enrolled infants was 88.9 (12.0); it was significantly lower for OGDM than the control group [84 (9.89 vs. 88 (8.48); P = 0.03]. The total development quotient for the enrolled infants was 95.3 (11.3). The total development quotient for study group was significantly lower than the control group [92.5 (5.65) vs. 98.75 (9.54); P = 0.001]. CONCLUSIONS The mean motor, mental total DQ of offsprings of mothers with GDM were significantly lower than those born to mothers without GDM. Hence follow up, early intervention should be considered for this high risk group.
Collapse
Affiliation(s)
- Rimjhim Bersain
- Department of Pediatrics, Maulana Azad Medical College & Associated Lok Nayak Hospital (Delhi University), New Delhi, India
| | - Devendra Mishra
- Department of Pediatrics, Maulana Azad Medical College & Associated Lok Nayak Hospital (Delhi University), New Delhi, India.
| | - Monica Juneja
- Department of Pediatrics, Maulana Azad Medical College & Associated Lok Nayak Hospital (Delhi University), New Delhi, India
- Child Development Center, Department of Pediatrics, Maulana Azad Medical College & Associated Lok Nayak Hospital (Delhi University), New Delhi, India
| | - Devender Kumar
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College & Associated Lok Nayak Hospital (Delhi University), New Delhi, India
| | - Sandeep Garg
- Department of Internal Medicine, Maulana Azad Medical College & Associated Lok Nayak Hospital (Delhi University), New Delhi, India
| |
Collapse
|
3
|
de Lima RMS, Barth B, Mar Arcego D, de Mendonça Filho EJ, Patel S, Wang Z, Pokhvisneva I, Parent C, Levitan RD, Kobor MS, de Vasconcellos Bittencourt APS, Meaney MJ, Dalmaz C, Silveira PP. Leptin receptor co-expression gene network moderates the effect of early life adversity on eating behavior in children. Commun Biol 2022; 5:1092. [PMID: 36241774 PMCID: PMC9568584 DOI: 10.1038/s42003-022-03992-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 09/13/2022] [Indexed: 12/02/2022] Open
Abstract
Leptin influences eating behavior. Exposure to early adversity is associated with eating behaviour disorders and metabolic syndrome, but the role of the leptin receptor on this relationship is poorly explored. We investigated whether individual differences in brain region specific leptin receptor (LepR) gene networks could moderate the effects of early adversity on eating behavior and metabolism. We created an expression-based polygenic risk score (ePRS) reflecting variations in the function of LepR gene network in prefrontal cortex and hypothalamus to investigate the interactions between a cumulative index of postnatal adversity on eating behavior in two independent birth cohorts (MAVAN and GUSTO). To explore whether variations in the prefrontal cortex or hypothalamic genetic scores could be associated with metabolic measurements, we also assessed the relationship between LepR-ePRS and fasting blood glucose and leptin levels in a third independent cohort (ALSPAC). We identified significant interaction effects between postnatal adversity and prefrontal-based LepR-ePRS on the Child Eating Behavior Questionnaire scores. In MAVAN, we observed a significant interaction effect on food enjoyment at 48 months (β = 61.58, p = 0.015) and 72 months (β = 97.78, p = 0.001); food responsiveness at 48 months (β = 83.79, p = 0.009) satiety at 48 months (β = −43.63, p = 0.047). Similar results were observed in the GUSTO cohort, with a significant interaction effect on food enjoyment (β = 30.48, p = 0.006) food fussiness score (β = −24.07, p = 0.02) and satiety score at 60 months (β = −17.00, p = 0.037). No effects were found when focusing on the hypothalamus-based LepR-ePRS on eating behavior in MAVAN and GUSTO cohorts, and there was no effect of hypothalamus and prefrontal cortex based ePRSs on metabolic measures in ALSPAC. Our study indicated that exposure to postnatal adversity interacts with prefrontal cortex LepR-ePRS to moderate eating behavior, suggesting a neurobiological mechanism associated with the development of eating behavior problems in response to early adversity. The knowledge of these mechanisms may guide the understanding of eating patterns associated with risk for obesity in response to fluctuations in stress exposure early in life. An expression-based polygenic risk score analysis of leptin receptor (LepR) genes suggests that LepR-specific genes co-expressed in the prefrontal cortex interact with exposure to postnatal adversity, potentially modulating eating behavior in children.
Collapse
Affiliation(s)
- Randriely Merscher Sobreira de Lima
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde (ICBS), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Barbara Barth
- Integrated Program in Neuroscience (IPN), McGill University, Montreal, QC, Canada
| | - Danusa Mar Arcego
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Euclides José de Mendonça Filho
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Programa de Pós-Graduação em Psicologia, Instituto de Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Sachin Patel
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, QC, Canada
| | - Zihan Wang
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, QC, Canada
| | - Irina Pokhvisneva
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, QC, Canada
| | - Carine Parent
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, QC, Canada
| | - Robert D Levitan
- Department of Psychiatry, University of Toronto and Centre for Addiction and Mental Health, 250 College St, Toronto, Ontario, Canada
| | - Michael S Kobor
- Centre for Molecular Medicine and Therapeutics, BC Children's Hospital Research Institute, Department of Medical Genetics, The University of British Columbia, 938 West 28th Avenue, Vancouver, BC, Canada
| | | | - Michael J Meaney
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Carla Dalmaz
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde (ICBS), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Programa de Pós-graduação em Ciências Biológicas: Bioquímica, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Patrícia Pelufo Silveira
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada. .,Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, QC, Canada.
| |
Collapse
|
4
|
Cohen CC, Sekkarie A, Figueroa J, Gillespie SE, Vos MB, Welsh JA. Longitudinal associations of total and trunk fat in childhood and adolescence and risk of hepatic steatosis at 24 years. Pediatr Obes 2021; 16:e12773. [PMID: 33559403 DOI: 10.1111/ijpo.12773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The importance of body fat distribution in the development of nonalcoholic fatty liver disease (NAFLD) is unclear. OBJECTIVE To examine whether total and truncal fat deposition patterns in childhood/adolescence are associated with NAFLD risk at 24 years. METHODS Data were from 1657 participants in the Avon Longitudinal Study of Parents and Children. Transient elastography was used to assess hepatic steatosis (low/moderate/severe) at 24 years and dual-energy X-ray absorptiometry was used to assess total body fat percent (TBF%) and trunk fat percent (TrF%) at 9, 13, 15, 17, and/or 24 years. Linear mixed models were constructed with quadratic age to examine trajectories of TBF% and TrF% by steatosis at 24 years, adjusting for confounders. RESULTS In both sexes, TBF% trajectories from 9 to 24 years followed a similar pattern based on steatosis group (P = .83 for boys and P = .14 for girls for age2 *steatosis fixed effect). However, at all ages TBF% was higher for moderate/severe vs low steatosis at 24 years (P < .05). In contrast, TrF% trajectories diverged based on steatosis group (P = .001 for boys and P = .0002 for girls for age2 *steatosis fixed effect), such that, in both sexes, participants with moderate/severe steatosis at 24 yrs exhibited less decline in TrF% from adolescence to adulthood compared to participants with low steatosis at 24 yrs. Similar to TBF%, TrF% was higher at nearly all ages for moderate/severe vs low steatosis. Results were similar after adjusting for BMI category at each age, except in boys some differences for TrF% were attenuated. CONCLUSIONS These findings suggest that sex-specific body fat distribution patterns in childhood/adolescence may help to identify those at risk of developing NAFLD in adulthood.
Collapse
Affiliation(s)
- Catherine C Cohen
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ahlia Sekkarie
- Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Atlanta, Georgia, USA
| | - Janet Figueroa
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Scott E Gillespie
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Miriam B Vos
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Atlanta, Georgia, USA.,Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jean A Welsh
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Atlanta, Georgia, USA.,Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| |
Collapse
|
5
|
Estimation of Parental Effects Using Polygenic Scores. Behav Genet 2021; 51:264-278. [PMID: 33387133 PMCID: PMC8093180 DOI: 10.1007/s10519-020-10032-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/20/2020] [Indexed: 12/11/2022]
Abstract
Offspring resemble their parents for both genetic and environmental reasons. Understanding the relative magnitude of these alternatives has long been a core interest in behavioral genetics research, but traditional designs, which compare phenotypic covariances to make inferences about unmeasured genetic and environmental factors, have struggled to disentangle them. Recently, Kong et al. (2018) showed that by correlating offspring phenotypic values with the measured polygenic score of parents' nontransmitted alleles, one can estimate the effect of "genetic nurture"-a type of passive gene-environment covariation that arises when heritable parental traits directly influence offspring traits. Here, we instantiate this basic idea in a set of causal models that provide novel insights into the estimation of parental influences on offspring. Most importantly, we show how jointly modeling the parental polygenic scores and the offspring phenotypes can provide an unbiased estimate of the variation attributable to the environmental influence of parents on offspring, even when the polygenic score accounts for a small fraction of trait heritability. This model can be further extended to (a) account for the influence of different types of assortative mating, (b) estimate the total variation due to additive genetic effects and their covariance with the familial environment (i.e., the full genetic nurture effect), and (c) model situations where a parental trait influences a different offspring trait. By utilizing structural equation modeling techniques developed for extended twin family designs, our approach provides a general framework for modeling polygenic scores in family studies and allows for various model extensions that can be used to answer old questions about familial influences in new ways.
Collapse
|
6
|
D'souza N, Behere RV, Patni B, Deshpande M, Bhat D, Bhalerao A, Sonawane S, Shah R, Ladkat R, Yajnik P, Bandyopadhyay SK, Kumaran K, Fall C, Yajnik CS. Pre-conceptional Maternal Vitamin B12 Supplementation Improves Offspring Neurodevelopment at 2 Years of Age: PRIYA Trial. Front Pediatr 2021; 9:755977. [PMID: 34956975 PMCID: PMC8697851 DOI: 10.3389/fped.2021.755977] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/08/2021] [Indexed: 12/04/2022] Open
Abstract
Background: The first thousand days window does not include the pre-conceptional period. Maternal pre-conceptional health has a profound influence on early embryonic development (implantation, gastrulation, placentation etc). Nutrition provided by B-complex vitamins is important for fetal growth, especially neural development. We report effects of a maternal pre-conceptional vitamin B12 and multi micronutrient (MMN) supplementation on offspring neurodevelopmental performance. Methods: In the Pune Rural Intervention in Young Adolescents trial (PRIYA), adolescents (N = 557, 226 females) were provided with vitamin B12 (2 μg/day) with or without multiple micronutrients, or a placebo, from preconception until delivery. All groups received mandatory iron and folic acid. We used the Bayley's Scale of Infant Development (BSID-III) at 24-42 months of age to investigate effects on offspring neurodevelopment. Results: Participants had similar baseline B12 levels. The levels improved in the B12 supplemented groups during pre-conception and pregnancy (28 weeks gestation), and were reflected in higher cord blood holotranscobalamin (holo-TC) levels compared to the placebo group. Neurodevelopmental outcomes in the B12 alone group (n = 21) were better than the placebo (n = 27) in cognition (p = 0.044) and language (p = 0.020) domains (adjusted for maternal baseline B12 levels). There was no difference in neurodevelopmental outcomes between the B12 + MMN (n = 26) and placebo group. Cord blood Brain Derived Neurotrophic Factor (BDNF) levels were highest in the B12 alone group, though not significant. Conclusion: Pre-conceptional vitamin B12 supplementation improved maternal B12 status and offspring neurodevelopment at 2 years of age. The usefulness of cord BDNF as a marker of brain development needs further investigation. Our results highlight the importance of intervening during pre-conception.
Collapse
Affiliation(s)
- Naomi D'souza
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | - Rishikesh V Behere
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | - Bindu Patni
- Terre des Hommes Rehabilitation and Morris Child Development Centre at KEM Hospital, Pune, India
| | - Madhavi Deshpande
- Terre des Hommes Rehabilitation and Morris Child Development Centre at KEM Hospital, Pune, India
| | - Dattatray Bhat
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | - Aboli Bhalerao
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | - Swapnali Sonawane
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | - Rohan Shah
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | - Rasika Ladkat
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | - Pallavi Yajnik
- Diabetes Unit, King Edward Memorial Hospital Research Center, Pune, India
| | | | - Kalyanaraman Kumaran
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Caroline Fall
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | | |
Collapse
|
7
|
Diemer EW, Labrecque JA, Neumann A, Tiemeier H, Swanson SA. Mendelian randomisation approaches to the study of prenatal exposures: A systematic review. Paediatr Perinat Epidemiol 2021; 35:130-142. [PMID: 32779786 PMCID: PMC7891574 DOI: 10.1111/ppe.12691] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Mendelian randomisation (MR) designs apply instrumental variable techniques using genetic variants to study causal effects. MR is increasingly used to evaluate the role of maternal exposures during pregnancy on offspring health. OBJECTIVES We review the application of MR to prenatal exposures and describe reporting of methodologic challenges in this area. DATA SOURCES We searched PubMed, EMBASE, Medline Ovid, Cochrane Central, Web of Science, and Google Scholar. STUDY SELECTION AND DATA EXTRACTION Eligible studies met the following criteria: (a) a maternal pregnancy exposure; (b) an outcome assessed in offspring of the pregnancy; and (c) a genetic variant or score proposed as an instrument or proxy for an exposure. SYNTHESIS We quantified the frequency of reporting of MR conditions stated, techniques used to examine assumption plausibility, and reported limitations. RESULTS Forty-three eligible studies were identified. When discussing challenges or limitations, the most common issues described were known potential biases in the broader MR literature, including population stratification (n = 29), weak instrument bias (n = 18), and certain types of pleiotropy (n = 30). Of 22 studies presenting point estimates for the effect of exposure, four defined their causal estimand. Twenty-four studies discussed issues unique to prenatal MR, including selection on pregnancy (n = 1) and pleiotropy via postnatal exposure (n = 10) or offspring genotype (n = 20). CONCLUSIONS Prenatal MR studies frequently discuss issues that affect all MR studies, but rarely discuss problems specific to the prenatal context, including selection on pregnancy and effects of postnatal exposure. Future prenatal MR studies should report and attempt to falsify their assumptions, with particular attention to issues specific to prenatal MR. Further research is needed to evaluate the impacts of biases unique to prenatal MR in practice.
Collapse
Affiliation(s)
- Elizabeth W. Diemer
- Department of Child and Adolescent PsychiatryErasmus MCRotterdamThe Netherlands
| | | | - Alexander Neumann
- Department of Child and Adolescent PsychiatryErasmus MCRotterdamThe Netherlands,Lady Davis Institute for Medical ResearchJewish General HospitalMontrealQCCanada
| | - Henning Tiemeier
- Department of Child and Adolescent PsychiatryErasmus MCRotterdamThe Netherlands,Department of Social and Behavioral ScienceHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Sonja A. Swanson
- Department of EpidemiologyErasmus MCRotterdamThe Netherlands,Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMAUSA
| |
Collapse
|
8
|
Li C, Zhou P, Cai Y, Peng B, Liu Y, Yang T, Li Y, Hu Y, Fu Y, Wang Z, Peng H, Zhang Y, Chen J, Li T, Chen L. Associations between gestational diabetes mellitus and the neurodevelopment of offspring from 1 month to 72 months: study protocol for a cohort study. BMJ Open 2020; 10:e040305. [PMID: 33234643 PMCID: PMC7689080 DOI: 10.1136/bmjopen-2020-040305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is a common gestational disease and an important global public health problem. GDM may affect the short-term and long-term health of offspring, but the associations between GDM and the neurodevelopment of offspring of mothers with GDM (OGDM) are still unclear, and studies based on the Chinese population are lacking. We aim to determine the associations between GDM and the neurodevelopment of OGDM by studying a cohort of OGDM and offspring of non-GDM mothers. METHODS AND ANALYSIS The single-centre prospective cohort study is being conducted in China over 7 years. A total of 490 OGDM (GDM group) and 490 fromof healthy mothers (control group) will be enrolled during the same period. Baseline characteristics, neuropsychological development scores and clinical data at specific time points (at 0, 1, 3, 6, 12, 24, 36, 48, 60 and 72 months old) will be collected from the children in both groups until the age of 6 years. The associations between GDM and the neurodevelopment of OGDM from infancy to preschool age will be analysed using a multiple linear regression model adjusted for confounders. In addition, we will compare longitudinal data to further assess the effects of GDM on neurodevelopmental trajectories. ETHICS AND DISSEMINATION The study has been approved by the Ethics Committee of the Children's Hospital of Chongqing Medical University (Approval Number: (2019) Institutional Review Board (IRB) (STUDY) No. 85). The findings of this study will be disseminated through open access journals, peer-reviewed journals and scientific meetings. TRIAL REGISTRATION NUMBER NCT03997396.
Collapse
Affiliation(s)
- Chao Li
- Growth, Development and Mental Health Center of Children and Adolescents, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
- Department of Child Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Ping Zhou
- Growth, Development and Mental Health Center of Children and Adolescents, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Yixi Cai
- Department of Child Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Bin Peng
- Department of Health Statistics, Chongqing Medical University, Chongqing, China
| | - Yongfang Liu
- Growth, Development and Mental Health Center of Children and Adolescents, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Ting Yang
- Growth, Development and Mental Health Center of Children and Adolescents, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Yinying Li
- Department of Child Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Yirong Hu
- Department of Outpatient, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Yajun Fu
- Department of Obstetrics, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Zhenming Wang
- Department of Obstetrics, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Hong Peng
- Department of Child Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Yue Zhang
- Department of Child Care, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, China
| | - Jie Chen
- Growth, Development and Mental Health Center of Children and Adolescents, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Tingyu Li
- Growth, Development and Mental Health Center of Children and Adolescents, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Li Chen
- Growth, Development and Mental Health Center of Children and Adolescents, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| |
Collapse
|
9
|
Systemic endocrinopathies (thyroid conditions and diabetes): impact on postnatal life of the offspring. Fertil Steril 2019; 111:1076-1091. [PMID: 31155115 DOI: 10.1016/j.fertnstert.2019.04.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 12/22/2022]
Abstract
Fetal programming may influence childhood and adult life, determining the risk of specific diseases. During earlier stages of pregnancy, the transfer of maternal thyroid hormones to the fetus is vital for adequate neurologic development. The presence of severe maternal thyroid dysfunction, particularly severe iodine deficiency, is devastating, leading to irreversible neurologic sequelae. Moreover, mild maternal thyroid conditions, such as a mild-to-moderate iodine deficiency, may also lead to milder neurologic and behavioral conditions later during the life of the offspring. Maternal dysglycemia due to pregestational or gestational diabetes mellitus is another common situation in which fetal development encounters a hostile environment. Hyperglycemia in utero may trigger metabolic conditions in the offspring, including abnormalities of glucose tolerance and weight excess. Physicians assisting pregnant women have to be aware about these conditions, because they may go unnoticed if not properly screened. Because an early diagnosis and appropriate management may prevent most of the possible negative consequences for the progeny, the prevention, early diagnosis, and proper management of these endocrine conditions should be offered to all women undergoing pregnancy. Here, we comprehensively review the current evidence about the effects of maternal thyroid dysfunction and maternal dysglycemia on the cognitive function and carbohydrate metabolism in the offspring, two prevalent conditions of utmost importance for the child's health and development.
Collapse
|
10
|
Caramaschi D, Sharp GC, Nohr EA, Berryman K, Lewis SJ, Davey Smith G, Relton CL. Exploring a causal role of DNA methylation in the relationship between maternal vitamin B12 during pregnancy and child's IQ at age 8, cognitive performance and educational attainment: a two-step Mendelian randomization study. Hum Mol Genet 2018; 26:3001-3013. [PMID: 28453778 PMCID: PMC5703349 DOI: 10.1093/hmg/ddx164] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/24/2017] [Indexed: 12/15/2022] Open
Abstract
An adequate intake of vitamin B12 during pregnancy plays an important role in
offspring neurodevelopment, potentially via epigenetic processes. We used a two-step
Mendelian randomization approach to assess whether DNA methylation plays a mediating and
causal role in associations between maternal vitamin B12 status and offspring’s
cognition. Firstly, we estimated the causal effect of maternal vitamin B12
levels on cord blood DNA methylation using the maternal FUT2 genotypes
rs492602:A > G and rs1047781:A > T as proxies for circulating vitamin B12
levels in the Avon Longitudinal Study of Parents and Children (ALSPAC) and we tested the
observed associations in a replication cohort. Secondly, we estimated the causal effect of
DNA methylation on IQ using the offspring genotype at sites close to the methylated CpG
site as a proxy for DNA methylation in ALSPAC and in a replication sample. The first step
Mendelian randomization estimated that maternal vitamin B12 had a small causal
effect on DNA methylation in offspring at three CpG sites, which was replicated for one of
the sites. The second step Mendelian randomization found weak evidence of a causal effect
of DNA methylation at two of these sites on childhood performance IQ which was replicated
for one of the sites. The findings support a causal effect of maternal vitamin
B12 levels on cord blood DNA methylation, and a causal effect of vitamin
B12-responsive DNA methylation changes on children’s cognition. Some
limitations were identified and future studies using a similar approach should aim to
overcome such issues.
Collapse
Affiliation(s)
- Doretta Caramaschi
- Medical Research Council Integrative Epidemiology Unit, School of Social and Community Medicine
| | - Gemma C Sharp
- Medical Research Council Integrative Epidemiology Unit, School of Social and Community Medicine.,School of Oral and Dental Sciences, The Cleft Collective, University of Bristol, Bristol BS8 2BN, UK
| | - Ellen A Nohr
- Research Unit for Gynaecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense 5000C, Denmark
| | - Katie Berryman
- School of Social and Community Medicine, University of Bristol, Bristol BS8?2BN, UK
| | - Sarah J Lewis
- School of Social and Community Medicine, University of Bristol, Bristol BS8?2BN, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, School of Social and Community Medicine
| | - Caroline L Relton
- Medical Research Council Integrative Epidemiology Unit, School of Social and Community Medicine
| |
Collapse
|
11
|
Taylor CM, Kordas K, Golding J, Emond AM. WITHDRAWN: Data relating to prenatal lead exposure and child IQ at 4 and 8 years old in the Avon Longitudinal Study of Parents and Children. Data Brief 2017. [DOI: 10.1016/j.dib.2017.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
12
|
Data relating to prenatal lead exposure and child IQ at 4 and 8 years old in the Avon Longitudinal Study of Parents and Children. Neurotoxicology 2017; 62:224-230. [PMID: 28765090 PMCID: PMC5630198 DOI: 10.1016/j.neuro.2017.07.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/14/2017] [Indexed: 11/24/2022]
Abstract
As part of the Avon Longitudinal Study of Parents and Children (ALSPAC), measures of child IQ were collected by trained psychologists. The Wechsler Pre-school and Primary Scale of Intelligence – Revised UK edition (WPPSI) was used at age 4 years in a subsample of children enrolled in ALSPAC (the Children in Focus cohort), chosen at random from the last 6 months of ALSPAC births (about 10% of the participants). At age 8 years all children enrolled in the main cohort were invited to complete a short form of the Wechsler Intelligence Scale for Children (WISC)-III UK. Prenatal blood lead (B-Pb) concentrations were measured by inductively-couple plasma mass spectrometry in samples from women at a median gestation age of 11 weeks. Child blood lead was measured by atomic absorption spectrometry in samples from children attending the Children in Focus clinic at age 30 months. Maternal reports at 32 weeks’ gestation were used to generate data on a range of potential confounders. The data were used to determine the associations between prenatal exposure to lead and child IQ at 4 and 8 years. The effect of child B-Pb at 3 years as a moderator of these associations was tested. (For results, please see doi:10.1016/j.neuro.2017.07.003 Taylor et al., (2017)).
Collapse
|
13
|
Daraki V, Roumeliotaki T, Koutra K, Georgiou V, Kampouri M, Kyriklaki A, Vafeiadi M, Papavasiliou S, Kogevinas M, Chatzi L. Effect of parental obesity and gestational diabetes on child neuropsychological and behavioral development at 4 years of age: the Rhea mother-child cohort, Crete, Greece. Eur Child Adolesc Psychiatry 2017; 26:703-714. [PMID: 28050707 DOI: 10.1007/s00787-016-0934-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 12/16/2016] [Indexed: 02/06/2023]
Abstract
Studies have suggested an association between maternal obesity pre-pregnancy and gestational diabetes (GDM) with impaired offspring neurodevelopment, but it is not clear if these associations are explained by shared familiar characteristics. We aimed to assess the associations of maternal and paternal obesity, maternal glucose intolerance in early pregnancy and GDM, with offspring neurodevelopment at 4 years of age. We included 772 mother-child pairs from the "Rhea" Mother-Child cohort in Crete, Greece. Data on maternal/paternal body mass index (BMI) and maternal fasting serum samples for glucose and insulin measurements were collected at 12 weeks of gestation. GDM screening was performed at 24-28 weeks. Neurodevelopment at 4 years was assessed using the McCarthy Scales of Children's Abilities. Behavioral difficulties were assessed by Strengths and Difficulties Questionnaire and Attention Deficit Hyperactivity Disorder Test. Multivariate linear regression analyses showed that maternal obesity was associated with a significant score reduction in general cognitive ability (β-coeff -4.03, 95% CI: -7.08, -0.97), perceptual performance (β-coeff -4.60, 95% CI: -7.74, -1.47), quantitative ability (β-coeff -4.43, 95% CI: -7.68, -1.18), and executive functions (β-coeff -4.92, 95% CI: -8.06, -1.78) at 4 years of age, after adjustment for several confounders and paternal BMI. Maternal obesity was also associated with increased behavioral difficulties (β-coeff 1.22, 95% CI: 0.09, 2.34) and ADHD symptoms (β-coeff 4.28, 95% CI: 1.20, 7.36) at preschool age. Paternal obesity maternal glucose intolerance in early pregnancy and GDM was not associated with child neurodevelopment. These findings suggest that maternal obesity may impair optimal child neurodevelopment at preschool age independently of family shared characteristics.
Collapse
Affiliation(s)
- Vasiliki Daraki
- Department of Social Medicine, Faculty of Medicine, University of Crete, PO Box 2208, 71003, Heraklion, Crete, Greece.
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital of Crete, Heraklion, Crete, Greece.
| | - Theano Roumeliotaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, PO Box 2208, 71003, Heraklion, Crete, Greece
| | - Katerina Koutra
- Department of Social Medicine, Faculty of Medicine, University of Crete, PO Box 2208, 71003, Heraklion, Crete, Greece
| | - Vaggelis Georgiou
- Department of Social Medicine, Faculty of Medicine, University of Crete, PO Box 2208, 71003, Heraklion, Crete, Greece
| | - Mariza Kampouri
- Department of Social Medicine, Faculty of Medicine, University of Crete, PO Box 2208, 71003, Heraklion, Crete, Greece
| | - Andriani Kyriklaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, PO Box 2208, 71003, Heraklion, Crete, Greece
| | - Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, PO Box 2208, 71003, Heraklion, Crete, Greece
| | - Stathis Papavasiliou
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital of Crete, Heraklion, Crete, Greece
| | - Manolis Kogevinas
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Leda Chatzi
- Department of Social Medicine, Faculty of Medicine, University of Crete, PO Box 2208, 71003, Heraklion, Crete, Greece
- Department of Genetics and Cell Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, PO Box 616, 6229 ER, Maastricht, The Netherlands
| |
Collapse
|
14
|
Lawlor D, Richmond R, Warrington N, McMahon G, Davey Smith G, Bowden J, Evans DM. Using Mendelian randomization to determine causal effects of maternal pregnancy (intrauterine) exposures on offspring outcomes: Sources of bias and methods for assessing them. Wellcome Open Res 2017; 2:11. [PMID: 28405635 PMCID: PMC5386135 DOI: 10.12688/wellcomeopenres.10567.1] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2017] [Indexed: 01/10/2023] Open
Abstract
Mendelian randomization (MR), the use of genetic variants as instrumental variables (IVs) to test causal effects, is increasingly used in aetiological epidemiology. Few of the methodological developments in MR have considered the specific situation of using genetic IVs to test the causal effect of exposures in pregnant women on postnatal offspring outcomes. In this paper, we describe specific ways in which the IV assumptions might be violated when MR is used to test such intrauterine effects. We highlight the importance of considering the extent to which there is overlap between genetic variants in offspring that influence their outcome with genetic variants used as IVs in their mothers. Where there is overlap, and particularly if it generates a strong association of maternal genetic IVs with offspring outcome via the offspring genotype, the exclusion restriction assumption of IV analyses will be violated. We recommend a set of analyses that ought to be considered when MR is used to address research questions concerned with intrauterine effects on post-natal offspring outcomes, and provide details of how these can be undertaken and interpreted. These additional analyses include the use of genetic data from offspring and fathers, examining associations using maternal non-transmitted alleles, and using simulated data in sensitivity analyses (for which we provide code). We explore the extent to which new methods that have been developed for exploring violation of the exclusion restriction assumption in the two-sample setting (MR-Egger and median based methods) might be used when exploring intrauterine effects in one-sample MR. We provide a list of recommendations that researchers should use when applying MR to test the effects of intrauterine exposures on postnatal offspring outcomes and use an illustrative example with real data to demonstrate how our recommendations can be applied and subsequent results appropriately interpreted.
Collapse
Affiliation(s)
- Deborah Lawlor
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rebecca Richmond
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Nicole Warrington
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Australia
| | - George McMahon
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jack Bowden
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - David M Evans
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia
| |
Collapse
|
15
|
Bytoft B, Knorr S, Vlachova Z, Jensen RB, Mathiesen ER, Beck-Nielsen H, Gravholt CH, Jensen DM, Clausen TD, Mortensen EL, Damm P. Long-term Cognitive Implications of Intrauterine Hyperglycemia in Adolescent Offspring of Women With Type 1 Diabetes (the EPICOM Study). Diabetes Care 2016; 39:1356-63. [PMID: 27271191 DOI: 10.2337/dc16-0168] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/17/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Exposure to maternal diabetes in utero may have a negative impact on the developing brain. The objective was to examine long-term cognitive consequences of intrauterine hyperglycemia in adolescent offspring of women with type 1 diabetes and to ascertain a possible association with maternal HbA1c. RESEARCH DESIGN AND METHODS Offspring of a prospectively followed cohort of women with type 1 diabetes (n = 277) participated in a follow-up examination at the age of 13-19 years. A control group from the background population was identified (n = 301). Cognitive function was evaluated using Reynolds Intellectual Assessment Scales and classified into indices of composite intelligence, verbal and nonverbal intelligence, and composite memory. Frequencies of reading and writing problems and attendance to classes for children with learning difficulties were assessed. RESULTS Offspring of women with type 1 diabetes scored lower in all normalized and standardized intelligence indices compared with controls: composite intelligence (95.7 vs. 100, P = 0.001), verbal intelligence (96.2 vs. 100, P = 0.004), nonverbal intelligence (96.4 vs. 100, P = 0.008), and composite memory (95.7 vs. 100, P = 0.001). A higher frequency of diabetes-exposed offspring had parent-reported learning difficulties in primary school. Differences between groups remained after adjustment for confounders and potential mediators. We found no direct association between maternal HbA1c and offspring cognitive function in the exposed group. CONCLUSIONS Adolescent offspring of women with type 1 diabetes had lower cognitive function compared with a control group, also after adjustment for confounders and potential mediators. These differences may reflect direct harmful effects of maternal diabetes on neurodevelopment in the offspring.
Collapse
Affiliation(s)
- Birgitte Bytoft
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sine Knorr
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Zuzana Vlachova
- Department of Endocrinology, Odense University Hospital, Odense, Denmark Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Rikke B Jensen
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | | | - Claus H Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Dorte M Jensen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Tine D Clausen
- Department of Gynecology and Obstetrics, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Erik L Mortensen
- Section of Environmental Health, Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
16
|
Adane AA, Mishra GD, Tooth LR. Diabetes in Pregnancy and Childhood Cognitive Development: A Systematic Review. Pediatrics 2016; 137:peds.2015-4234. [PMID: 27244820 DOI: 10.1542/peds.2015-4234] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The effect of diabetes during pregnancy on the cognitive development of offspring is unclear because of inconsistent findings from limited studies. OBJECTIVE This review was aimed to provide the best available scientific evidence on the associations between maternal pregnancy diabetes and the cognitive development of offspring. DATA SOURCES A search was conducted in the Embase, CINAHL, PubMed, PsycINFO, and Scopus databases. STUDY SELECTION Studies addressing the cognitive development of offspring (aged ≤12 years) as outcome and any diabetes in pregnancy as an exposure were included. DATA EXTRACTION Data were extracted and evaluated for quality by 2 independent reviewers. RESULTS Fourteen articles were eligible for the review. Ten studies investigated the associations between maternal pregestational diabetes or both pregestational and gestational diabetes and offspring's cognitive development; 6 studies found at least 1 negative association. Four studies exclusively examined the relationships between gestational diabetes and offspring's cognitive development; 2 studies found a negative association, 1 a positive association, and 1 a null association. The use of diverse cognitive and diabetes assessment tools/criteria, as well as statistical power, contributed to the inconsistent findings. LIMITATIONS The English-language restriction and publication bias in the included studies are potential limitations. CONCLUSIONS Although there are few data available regarding the associations between maternal pregnancy diabetes and offspring's cognitive development, this review found that maternal diabetes during pregnancy seems to be negatively associated with offspring's cognitive development. Large prospective studies that address potential confounders are needed to confirm the independent effect of maternal diabetes during pregnancy.
Collapse
Affiliation(s)
- Akilew Awoke Adane
- Centre for Longitudinal and Life Course Research, School of Public Health, the University of Queensland, Australia
| | - Gita D Mishra
- Centre for Longitudinal and Life Course Research, School of Public Health, the University of Queensland, Australia
| | - Leigh R Tooth
- Centre for Longitudinal and Life Course Research, School of Public Health, the University of Queensland, Australia
| |
Collapse
|
17
|
Boef AGC, Dekkers OM, le Cessie S. Mendelian randomization studies: a review of the approaches used and the quality of reporting. Int J Epidemiol 2015; 44:496-511. [PMID: 25953784 DOI: 10.1093/ije/dyv071] [Citation(s) in RCA: 261] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mendelian randomization (MR) studies investigate the effect of genetic variation in levels of an exposure on an outcome, thereby using genetic variation as an instrumental variable (IV). We provide a meta-epidemiological overview of the methodological approaches used in MR studies, and evaluate the discussion of MR assumptions and reporting of statistical methods. METHODS We searched PubMed, Medline, Embase and Web of Science for MR studies up to December 2013. We assessed (i) the MR approach used; (ii) whether the plausibility of MR assumptions was discussed; and (iii) whether the statistical methods used were reported adequately. RESULTS Of 99 studies using data from one study population, 32 used genetic information as a proxy for the exposure without further estimation, 44 performed a formal IV analysis, 7 compared the observed with the expected genotype-outcome association, and 1 used both the latter two approaches. The 80 studies using data from multiple study populations used many different approaches to combine the data; 52 of these studies used some form of IV analysis; 44% of studies discussed the plausibility of all three MR assumptions in their study. Statistical methods used for IV analysis were insufficiently described in 14% of studies. CONCLUSIONS Most MR studies either use the genotype as a proxy for exposure without further estimation or perform an IV analysis. The discussion of underlying assumptions and reporting of statistical methods for IV analysis are frequently insufficient. Studies using data from multiple study populations are further complicated by the combination of data or estimates. We provide a checklist for the reporting of MR studies.
Collapse
Affiliation(s)
- Anna G C Boef
- Department of Clinical Epidemiology, Department of Endocrinology and Metabolic Diseases, and Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Department of Endocrinology and Metabolic Diseases, and Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands. Department of Clinical Epidemiology, Department of Endocrinology and Metabolic Diseases, and Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Department of Endocrinology and Metabolic Diseases, and Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands. Department of Clinical Epidemiology, Department of Endocrinology and Metabolic Diseases, and Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands
| |
Collapse
|
18
|
Luciano M, Mõttus R, Harris SE, Davies G, Payton A, Ollier WER, Horan MA, Starr JM, Porteous DJ, Pendleton N, Deary IJ. Predicting cognitive ability in ageing cohorts using Type 2 diabetes genetic risk. Diabet Med 2014; 31:714-20. [PMID: 24344862 DOI: 10.1111/dme.12389] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 10/29/2013] [Accepted: 12/12/2013] [Indexed: 02/06/2023]
Abstract
AIMS To investigate whether there is overlap in the genetic determinants of Type 2 diabetes and cognitive ageing by testing whether a genetic risk score for Type 2 diabetes can predict variation in cognitive function in older people without dementia. METHODS Type 2 diabetes genetic risk scores were estimated using various single nucleotide polymorphism significance inclusion criteria from an initial genome-wide association study, the largest in Type 2 diabetes to date. Scores were available for 2775-3057 individuals, depending on the cognitive trait. RESULTS Type 2 diabetes genetic risk was associated with self-reported diabetes mellitus. Across varying single nucleotide polymorphism-inclusion levels, a significant association between Type 2 diabetes genetic risk and change in general cognitive function was found (median r = 0.04); however, this was such that higher Type 2 diabetes genetic risk related to higher cognitive scores. CONCLUSIONS To investigate more fully the source of the often observed comorbidity between Type 2 diabetes and cognitive impairment, one direction for future research will be to use cognitive ability polygenic risk scores to predict Type 2 diabetes in line with the reverse causation hypothesis that people with lower pre-morbid cognitive ability are more likely to develop Type 2 diabetes.
Collapse
Affiliation(s)
- M Luciano
- Department of Psychology, The University of Edinburgh, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, UK
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Fraser A, Almqvist C, Larsson H, Långström N, Lawlor DA. Maternal diabetes in pregnancy and offspring cognitive ability: sibling study with 723,775 men from 579,857 families. Diabetologia 2014; 57:102-9. [PMID: 24065154 PMCID: PMC3857877 DOI: 10.1007/s00125-013-3065-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 09/06/2013] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to investigate the association between maternal diabetes in pregnancy and offspring cognitive ability and also to assess whether the association was due to intrauterine mechanisms or shared familial characteristics. METHODS We linked national registers and conducted a prospective cohort study of singleton Swedish-born men to explore associations between maternal pregnancy diabetes and educational achievement at age 16 years, the age of completing compulsory education in Sweden (n = 391,545 men from 337,174 families, graduating in 1988-1997 and n = 326,033 men from 282,079 families, graduating in 1998-2009), and intelligence quotient (IQ) at the mandatory conscription examination at 18 years of age (n = 664,871 from 543,203 families). RESULTS Among non-siblings, maternal diabetes in pregnancy was associated with lower offspring cognitive ability even after adjustment for maternal age at birth, parity, education, early-pregnancy BMI, offspring birth year, gestational age and birthweight. For example, in non-siblings, the IQ of men whose mothers had diabetes in their pregnancy was on average 1.36 points lower (95% CI -2.12, -0.60) than men whose mothers did not have diabetes. In comparison, we found no such association within sibships (mean difference 1.70; 95% CI -1.80, 5.21). CONCLUSIONS/INTERPRETATION The association between maternal diabetes in pregnancy and offspring cognitive outcomes is likely explained by shared familial characteristics and not by an intrauterine mechanism.
Collapse
Affiliation(s)
- Abigail Fraser
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK,
| | | | | | | | | |
Collapse
|
20
|
Abstract
In this review, we critically assess recent evidence from human studies regarding the potential implications of exposure to maternal diabetes in-utero for long-term adiposity, cardiometabolic outcomes, and cognitive ability of the offspring. Evidence supports a direct causal role for exposure to maternal diabetes in utero in determining offspring long-term greater adiposity and adverse cardiometabolic health. Although a majority of observational studies report associations of exposure to maternal pregnancy diabetes with lower cognitive ability, there is also evidence supporting an opposite 'protective' intrauterine effect of exposure to maternal pregnancy diabetes on offspring cognitive ability. Epigenetic modification has been suggested as a mediator on the pathways from maternal pregnancy diabetes to long-term offspring outcomes and several recent studies that are reviewed here lend some support to this notion, but research in this area is still too novel to be conclusive.
Collapse
Affiliation(s)
- Abigail Fraser
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK,
| | | |
Collapse
|
21
|
Longitudinal follow-up of the relationship between dietary intake and growth and development in the Lifeways cross-generation cohort study 2001-2013. Proc Nutr Soc 2013; 73:118-31. [PMID: 24300176 DOI: 10.1017/s002966511300373x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In this paper we will review evidence on the early life and familial influences on childhood growth and development, with particular reference to the Lifeways cross-generation cohort study in the Republic of Ireland. The Lifeways cross-generation cohort study was established in 2001-2013 through two maternity hospitals in the Republic of Ireland and was one of many new cohort studies established worldwide in the millennium period. Mothers were recruited at first booking visit, completing a self-administered questionnaire, which included a 147 item semi-quantitative FFQ. Longitudinal follow-up is ongoing in 2013, with linkage data to hospital and general practice records and examination of children when aged 5 and 9 years. The study is one of very few containing data on grandparents of both lineages with at least one grandparent recruited at baseline. There have been consistent associations between parental and grandparental health status characteristics and children's outcomes, including infant birth-weight, BMI when child was aged 5 years and childhood wheeze or asthma when child was aged 3 and aged 5 years. In conclusion, empirical evidence to date shows consistent familial and cross-generational patterns, particularly in the maternal line.
Collapse
|
22
|
Clausen TD, Mortensen EL, Schmidt L, Mathiesen ER, Hansen T, Jensen DM, Damm P. Cognitive function in adult offspring of women with gestational diabetes--the role of glucose and other factors. PLoS One 2013; 8:e67107. [PMID: 23840595 PMCID: PMC3695979 DOI: 10.1371/journal.pone.0067107] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 05/15/2013] [Indexed: 12/04/2022] Open
Abstract
Objective We aimed to evaluate cognitive function in adult offspring of women with diet-treated gestational diabetes and to study potential associations with maternal glucose values. Materials and Methods In 2003–2005 cognitive function was assessed in a cohort of 18–27 year old offspring of women with diet-treated gestational diabetes mellitus (n = 153) and offspring from the background population (n = 118). The main outcome measure was global cognitive score derived from Raven’s Progressive Matrices and three verbal subtests from the Weschler Adult Intelligence Scale. Maternal fasting- and 2-hour blood glucose values from the diagnostic oral glucose tolerance test were used as exposure variables. Results Offspring of women with gestational diabetes mellitus had a lower global cognitive score, than offspring from the background population (93.1 vs. 100.0, P<0.001). However, when adjusted for maternal age at delivery, parity, smoking during pregnancy, pre-pregnancy overweight, family social class, parental educational level, gender, birth weight, gestational age, perinatal complications and offspring age at follow-up, the difference was no longer statistically significant. Offspring global cognitive score decreased significantly with increasing maternal fasting glucose (β = −4.5, 95% CI −8.0 to −0.9, P = 0.01) and 2-hour glucose (β = −1.5, −2.9 to −0.2, P = 0.03) in univariate general linear models, but not when adjusted for family social class and parental educational level. Conclusions Lower cognitive test scores in adult offspring of women with diet-treated gestational diabetes were explained by well known predictors of cognitive function, but not by maternal hyperglycaemia during pregnancy. We find it reassuring that mild intrauterine hyperglycaemia does not seem to have adverse effect on offspring cognitive function.
Collapse
Affiliation(s)
- Tine D Clausen
- Department of Gynecology and Obstetrics, Hilleroed Hospital, University of Copenhagen, Copenhagen, Denmark.
| | | | | | | | | | | | | |
Collapse
|