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Harland KK, Peek-Asa C, Saftlas AF. Intimate Partner Violence and Controlling Behaviors Experienced by Emergency Department Patients: Differences by Sexual Orientation and Gender Identification. J Interpers Violence 2021; 36:NP6125-NP6143. [PMID: 30465625 PMCID: PMC7034778 DOI: 10.1177/0886260518812070] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The objective of this study was to estimate the prevalence of intimate partner violence (IPV) in an emergency department (ED) by sexual orientation and gender identification. We conducted a cross-sectional survey of adult patients (n = 1,136) presenting to a Level I Trauma Center ED from November 2015 to November 2016. Multivariable logistic regression analysis was used to estimate the adjusted odds ratio (aOR) of reporting any IPV or IPV subtypes (physical or sexual IPV or battering) by sexual orientation and gender identification, controlling for confounders. Overall, 11.6% (132 / 1,136) of those surveyed were IPV positive. The prevalence of IPV was significantly higher in lesbian, gay, bisexual, transgender, and questioning (LGBTQ) patients than in heterosexuals (18.3% vs. 10.8%, p = .0151); prevalence was highest among bisexuals (21.6%) and gay men (18.5%). IPV prevalence did not differ significantly in females versus males (13.5% vs. 9.2%, p = .0872). After controlling for age, the odds of reporting any IPV was highest among females (aOR = 1.67; 95% confidence interval [CI] = [1.10, 2.53]); no significant differences were found by sexual orientation. Gay patients (aOR = 5.50; 95% CI = [1.60, 18.94]) and females (aOR = 2.70; 95% CI = [1.46, 9.99]) had significantly higher odds of reporting physical or sexual IPV than heterosexuals and males, respectively. The study is among the first to report IPV prevalence by sexual orientation in an ED patient population. The reported IPV was higher among LGBTQ patients than heterosexual patients although this relationship diminished when controlling for covariates. These data begin to define the scope of IPV among LGBTQ ED patients and may be used to inform brief interventions to reduce the IPV-related morbidity experienced by ED patients.
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Affiliation(s)
- Karisa K. Harland
- University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, IA
- University of Iowa College of Public Health, Department of Epidemiology, Iowa City, IA
| | - Corinne Peek-Asa
- University of Iowa College of Public Health, Department of Occupational and Environmental Health & Injury Prevention Research Center, Iowa City, IA
| | - Audrey F. Saftlas
- University of Iowa College of Public Health, Department of Epidemiology, Iowa City, IA
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Snyder BM, Baer RJ, Oltman SP, Robinson JG, Breheny PJ, Saftlas AF, Bao W, Greiner AL, Carter KD, Rand L, Jelliffe-Pawlowski LL, Ryckman KK. Early pregnancy prediction of gestational diabetes mellitus risk using prenatal screening biomarkers in nulliparous women. Diabetes Res Clin Pract 2020; 163:108139. [PMID: 32272192 PMCID: PMC7269799 DOI: 10.1016/j.diabres.2020.108139] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/22/2020] [Accepted: 03/30/2020] [Indexed: 12/23/2022]
Abstract
AIMS To evaluate the clinical utility of first and second trimester prenatal screening biomarkers for early pregnancy prediction of gestational diabetes mellitus (GDM) risk in nulliparous women. METHODS We conducted a population-based cohort study of nulliparous women participating in the California Prenatal Screening Program from 2009 to 2011 (n = 105,379). GDM was ascertained from hospital discharge records or birth certificates. Models including maternal characteristics and prenatal screening biomarkers were developed and validated. Risk stratification and reclassification were performed to assess clinical utility of the biomarkers. RESULTS Decreased levels of first trimester pregnancy-associated plasma protein A (PAPP-A) and increased levels of second trimester unconjugated estriol (uE3) and dimeric inhibin A (INH) were associated with GDM. The addition of PAPP-A only and PAPP-A, uE3, and INH to maternal characteristics resulted in small, yet significant, increases in area under the receiver operating characteristic curve (AUC) (maternal characteristics only: AUC 0.714 (95% CI 0.703-0.724), maternal characteristics + PAPP-A: AUC 0.718 (95% CI 0.707-0.728), maternal characteristics + PAPP-A, uE3, and INH: AUC 0.722 (0.712-0.733)); however, no net improvement in classification was observed. CONCLUSIONS PAPP-A, uE3, and INH have limited clinical utility for prediction of GDM risk in nulliparous women. Utility of other readily accessible clinical biomarkers in predicting GDM risk warrants further investigation.
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Affiliation(s)
- Brittney M Snyder
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, United States
| | - Rebecca J Baer
- Department of Pediatrics, University of California San Diego, La Jolla, CA, United States; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States
| | - Scott P Oltman
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Jennifer G Robinson
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, United States
| | - Patrick J Breheny
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, United States
| | - Audrey F Saftlas
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, United States
| | - Wei Bao
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, United States
| | - Andrea L Greiner
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Knute D Carter
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, United States
| | - Larry Rand
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Laura L Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Kelli K Ryckman
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, United States; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, United States.
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Harland KK, Vakkalanka JP, Peek-Asa C, Saftlas AF. State-level teen dating violence education laws and teen dating violence victimisation in the USA: a cross-sectional analysis of 36 states. Inj Prev 2020; 27:injuryprev-2020-043657. [PMID: 32299839 PMCID: PMC8080304 DOI: 10.1136/injuryprev-2020-043657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/26/2020] [Accepted: 03/28/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Approximately 10% of teens report experiencing sexual dating violence (SDV) or physical dating violence (PDV), collectively represented as teen dating violence (TDV). This study examines the association between laws incorporating TDV education in schools on TDV prevalence. METHODS TDV prevalence was estimated using data contributed by 36 states that participated in the 2015 Youth Risk Behavioral Surveillance Survey (YRBS). Presence of TDV laws was determined using Westlaw, a legal search engine. The adjusted odds of TDV victimisation was estimated by the presence or absence of a state law and length of time the law was in effect using hierarchical regression modelling, clustering on state, controlling for individual-level and state-level covariates and incorporating the YRBS-weighted survey design. RESULTS After controlling for individual-level and state-level covariates, the presence of a law was not associated with TDV (adjusted OR (aOR) 0.97; 95% CI 0.88 to 1.06), PDV (aOR 1.12; 95% CI 0.95 to 1.33) or SDV (aOR 0.99; 95% CI 0.91 to 1.08). These odds did not differ across the length of time the policies were in effect. CONCLUSIONS This study suggest that just the presence of a law incorporating TDV education in schools is not associated with reduced TDV victimisation but further research is needed to understand the association of the content of these laws and their implementation on TDV victimisation.
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Affiliation(s)
- Karisa K Harland
- Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
- Injury Prevention Research Center, University of Iowa, Iowa City, Iowa, USA
| | - J Priyanka Vakkalanka
- Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
- Epidemiology, University of Iowa, Iowa City, Iowa, USA
| | - Corinne Peek-Asa
- Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, USA
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Donovan BM, Breheny PJ, Robinson JG, Baer RJ, Saftlas AF, Bao W, Greiner AL, Carter KD, Oltman SP, Rand L, Jelliffe-Pawlowski LL, Ryckman KK. Development and validation of a clinical model for preconception and early pregnancy risk prediction of gestational diabetes mellitus in nulliparous women. PLoS One 2019; 14:e0215173. [PMID: 30978258 PMCID: PMC6461273 DOI: 10.1371/journal.pone.0215173] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/27/2019] [Indexed: 12/18/2022] Open
Abstract
Implementation of dietary and lifestyle interventions prior to and early in pregnancy in high risk women has been shown to reduce the risk of gestational diabetes mellitus (GDM) development later in pregnancy. Although numerous risk factors for GDM have been identified, the ability to accurately identify women before or early in pregnancy who could benefit most from these interventions remains limited. As nulliparous women are an under-screened population with risk profiles that differ from their multiparous counterparts, development of a prediction model tailored to nulliparous women may facilitate timely preventive intervention and improve maternal and infant outcomes. We aimed to develop and validate a model for preconception and early pregnancy prediction of gestational diabetes mellitus based on clinical risk factors for nulliparous women. A risk prediction model was built within a large California birth cohort including singleton live birth records from 2007–2012. Model accuracy was assessed both internally and externally, within a cohort of women who delivered at University of Iowa Hospitals and Clinics between 2009–2017, using discrimination and calibration. Differences in predictive accuracy of the model were assessed within specific racial/ethnic groups. The prediction model included five risk factors: race/ethnicity, age at delivery, pre-pregnancy body mass index, family history of diabetes, and pre-existing hypertension. The area under the curve (AUC) for the California internal validation cohort was 0.732 (95% confidence interval (CI) 0.728, 0.735), and 0.710 (95% CI 0.672, 0.749) for the Iowa external validation cohort. The model performed particularly well in Hispanic (AUC 0.739) and Black women (AUC 0.719). Our findings suggest that estimation of a woman’s risk for GDM through model-based incorporation of risk factors accurately identifies those at high risk (i.e., predicted risk >6%) who could benefit from preventive intervention encouraging prompt incorporation of this tool into preconception and prenatal care.
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Affiliation(s)
- Brittney M. Donovan
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, United States of America
| | - Patrick J. Breheny
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, United States of America
| | - Jennifer G. Robinson
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, United States of America
| | - Rebecca J. Baer
- Department of Pediatrics, University of California San Diego, La Jolla, California, United States of America
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, United States of America
| | - Audrey F. Saftlas
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, United States of America
| | - Wei Bao
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, United States of America
| | - Andrea L. Greiner
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America
| | - Knute D. Carter
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, United States of America
| | - Scott P. Oltman
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Larry Rand
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, United States of America
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Laura L. Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Kelli K. Ryckman
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, United States of America
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America
- * E-mail:
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Gray KJ, Kovacheva VP, Mirzakhani H, Bjonnes AC, Almoguera B, DeWan AT, Triche EW, Saftlas AF, Hoh J, Bodian DL, Klein E, Huddleston KC, Ingles SA, Lockwood CJ, Hakonarson H, McElrath TF, Murray JC, Wilson ML, Norwitz ER, Karumanchi SA, Bateman BT, Keating BJ, Saxena R. Gene-Centric Analysis of Preeclampsia Identifies Maternal Association at PLEKHG1. Hypertension 2018; 72:408-416. [PMID: 29967039 PMCID: PMC6043396 DOI: 10.1161/hypertensionaha.117.10688] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 12/30/2017] [Accepted: 04/14/2018] [Indexed: 12/13/2022]
Abstract
The genetic susceptibility to preeclampsia, a pregnancy-specific complication with significant maternal and fetal morbidity, has been poorly characterized. To identify maternal genes associated with preeclampsia risk, we assembled 498 cases and 1864 controls of European ancestry from preeclampsia case-control collections in 5 different US sites (with additional matched population controls), genotyped samples on a cardiovascular gene-centric array composed of variants from ≈2000 genes selected based on prior genetic studies of cardiovascular and metabolic diseases and performed case-control genetic association analysis on 27 429 variants passing quality control. In silico replication testing of 9 lead signals with P<10-4 was performed in independent European samples from the SOPHIA (Study of Pregnancy Hypertension in Iowa) and Inova cohorts (212 cases, 456 controls). Multiethnic assessment of lead signals was then performed in samples of black (26 cases, 136 controls), Hispanic (132 cases, 468 controls), and East Asian (9 cases, 80 controls) ancestry. Multiethnic meta-analysis (877 cases, 3004 controls) revealed a study-wide statistically significant association of the rs9478812 variant in the pleiotropic PLEKHG1 gene (odds ratio, 1.40 [1.23-1.60]; Pmeta=5.90×10-7). The rs9478812 effect was even stronger in the subset of European cases with known early-onset preeclampsia (236 cases diagnosed <37 weeks, 1864 controls; odds ratio, 1.59 [1.27-1.98]; P=4.01×10-5). PLEKHG1 variants have previously been implicated in genome-wide association studies of blood pressure, body weight, and neurological disorders. Although larger studies are required to further define maternal preeclampsia heritability, this study identifies a novel maternal risk locus for further investigation.
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Affiliation(s)
- Kathryn J Gray
- From the Division of Maternal-Fetal Medicine (K.J.G., T.F.M.)
- Center for Genomic Medicine (K.J.G., A.C.B., R.S.)
- Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.J.G., A.C.B., R.S.)
| | | | - Hooman Mirzakhani
- Brigham and Women's Hospital, Boston, MA; Department of Anesthesia, Critical Care and Pain Medicine (H.M., B.T.B., R.S.)
| | - Andrew C Bjonnes
- Center for Genomic Medicine (K.J.G., A.C.B., R.S.)
- Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.J.G., A.C.B., R.S.)
| | - Berta Almoguera
- Center for Applied Genomics, Children's Hospital of Philadelphia, PA (B.A., H.H.)
| | | | - Elizabeth W Triche
- Yale School of Public Health, New Haven, CT; Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT (E.W.T.)
| | - Audrey F Saftlas
- Department of Epidemiology, College of Public Health, University of Iowa (A.F.S.)
| | | | - Dale L Bodian
- Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (D.L.B., E.K., K.C.H.)
| | - Elisabeth Klein
- Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (D.L.B., E.K., K.C.H.)
| | - Kathi C Huddleston
- Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (D.L.B., E.K., K.C.H.)
| | - Sue Ann Ingles
- Department of Preventative Medicine, University of Southern California, Keck School of Medicine, Los Angeles (S.A.I., M.L.W.)
| | - Charles J Lockwood
- University of South Florida, Morsani College of Medicine, Tampa (C.J.L.)
| | - Hakon Hakonarson
- Divisions of Human Genetics and Pulmonary Medicine, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.H.)
| | | | - Jeffrey C Murray
- Department of Pediatrics, Carver College of Medicine, University of Iowa (J.C.M.)
| | - Melissa L Wilson
- Department of Preventative Medicine, University of Southern California, Keck School of Medicine, Los Angeles (S.A.I., M.L.W.)
| | - Errol R Norwitz
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA (E.R.N.)
| | - S Ananth Karumanchi
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Boston, MA (S.A.K.)
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (S.A.K.)
| | - Brian T Bateman
- Brigham and Women's Hospital, Boston, MA; Department of Anesthesia, Critical Care and Pain Medicine (H.M., B.T.B., R.S.)
| | - Brendan J Keating
- Department of Surgery and Pediatrics, University of Pennsylvania, Philadelphia (B.J.K.)
| | - Richa Saxena
- Brigham and Women's Hospital, Boston, MA; Department of Anesthesia, Critical Care and Pain Medicine (H.M., B.T.B., R.S.)
- Center for Genomic Medicine (K.J.G., A.C.B., R.S.)
- Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.J.G., A.C.B., R.S.)
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TePoel MRW, Saftlas AF, Wallis AB, Harland K, Peek-Asa C. Help-Seeking Behaviors of Abused Women in an Abortion Clinic Population. J Interpers Violence 2018; 33:1604-1628. [PMID: 26729745 DOI: 10.1177/0886260515619168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Women who seek induced abortion procedures experience high rates of intimate partner violence, yet little is known about their help-seeking behaviors. Using data collected from patients attending a large Midwestern clinic who screened positive for intimate partner violence, we analyzed how help-seeking women differed from women not seeking help and those not disclosing their help-seeking behavior. We measured current and planned resource use and evaluated self-perceived helpfulness of resources. Severe battering, physical and/or sexual abuse, frequent sexual abuse, increased relationship length, and employment were positively associated with help-seeking. Nearly half of women who screened positive for abuse in the past year had already sought or planned to seek help, indicating this population is receptive to intervention.
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Donovan BM, Baer RJ, Breheny PJ, Carter KD, Robinson JG, Saftlas AF, Bao W, Rand L, Jelliffe-Pawlowski LL, Ryckman KK. 976: Improved first trimester selective screening for gestational diabetes mellitus in nulliparous women. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.11.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Peek-Asa C, Saftlas AF, Wallis AB, Harland K, Dickey P. Presence of children in the home and intimate partner violence among women seeking elective pregnancy termination. PLoS One 2017; 12:e0186389. [PMID: 29023582 PMCID: PMC5638511 DOI: 10.1371/journal.pone.0186389] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/29/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction Growing evidence identifies adverse health effects for children who witness intimate partner violence at home. Research has also identified that women seeking elective pregnancy termination are at high risk for partner violence. However, little is known about the risk for violence exposure among the children of women seeking elective pregnancy termination. Methods We conducted a cross-sectional study of 957 women seeking elective pregnancy termination at a large family planning clinic. All subjects completed a 10-minute, anonymous questionnaire administered by computer in a private room. Our main outcome was 12-month prevalence of physical and/or sexual violence by a current or former partner using the Abuse Assessment Screen instrument. The presence of children under the age of 18 living with the respondent was the main exposure variable. Results Women with children in the home had more than twice the odds of reporting physical and/or sexual IPV in the past year than women with no children, controlling for age (AOR: 2.23; 95% CI: 1.41–3.85). The increased odds of IPV among women with children as compared to women with no children was present across nearly all sociodemographic and lifestyle characteristics, and significantly higher for the youngest women (18–20 years). The highest odds for abuse occurred among women with children living at home, in a current relationship but not living with their current partner, and abused by a former partner (AOR = 10.9; 95% CI: 3.07–38.4). Conclusion Nearly one of every 14 children identified in this study lived in a home with IPV. These findings support the development of IPV interventions that are family-centered, as well as the integration of trauma-informed care into healthcare settings. Healthcare visits for contraception and pregnancy termination may be ideal opportunities for implementation of screening and family violence interventions.
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Affiliation(s)
- Corinne Peek-Asa
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA, United States of America
- * E-mail:
| | - Audrey F. Saftlas
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States of America
| | - Anne B. Wallis
- Department of Epidemiology and Population Health, School of Public Health & Information Sciences, University of Louisville, Louisville, KY, United States of America
| | - Karisa Harland
- Department of Emergency Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Penny Dickey
- Planned Parenthood of the Heartland, Des Moines, IA, United States of America
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Spracklen CN, Smith CJ, Saftlas AF, Triche EW, Bjonnes A, Keating BJ, Saxena R, Breheny PJ, Dewan AT, Robinson JG, Hoh J, Ryckman KK. Genetic predisposition to elevated levels of C-reactive protein is associated with a decreased risk for preeclampsia. Hypertens Pregnancy 2017; 36:30-35. [PMID: 27657194 PMCID: PMC5538572 DOI: 10.1080/10641955.2016.1223303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 08/03/2016] [Accepted: 08/08/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To examine the association between genetic predisposition to elevated C-reactive protein (CRP)and risk for preeclampsia using validated genetic loci for C-reactive protein. METHODS Preeclampsia cases (n = 177) and normotensive controls (n = 116) were selected from live birth certificates to nulliparous Iowa women during the period August 2002-May 2005. Disease status was verified by the medical chart review. Genetic predisposition to CRP was estimated by a genetic risk score on the basis of established loci for CRP levels. Logistic regression analyses were used to evaluate the relationships between the genotype score and preeclampsia. Replication analyses were performed in an independent, US population of preeclampsia cases (n = 516) and controls (n = 1,097) of European ancestry. RESULTS The genetic risk score (GRS) related to higher levels of CRP demonstrated a significantly decreased risk of preeclampsia (OR 0.89, 95% CI 0.82-0.96). When the GRS was analyzed by quartile, an inverse linear trend was observed (p = 0.0006). The results were similar after adjustments for the body mass index (BMI), smoking, and leisure-time physical activity. In the independent replication population, the association with the CRP GRS was also marginally significant (OR 0.97, 95% CI 0.92, 1.02). Meta-analysis of the two studies was statistically significant (OR 0.95, 95% CI 0.90, 0.99). CONCLUSION Our data suggest an inverse, counterintuitive association between the genetic predisposition to elevated levels of CRP and a decreased risk of preeclampsia. This suggests that the blood CRP level is a marker of preeclampsia, but it does not appear to be a factor on the causal pathway.
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Affiliation(s)
- Cassandra N. Spracklen
- Present address: Department of Genetics, University of North Carolina-Chapel Hill, 5100 Genetic Medicine Building, CB #7264, 120 Mason Farm Road, Chapel Hill, NC 27599 (work was performed at Department of Epidemiology, University of Iowa College of Public Health, 145 Riverside Drive, S471 CPHB, Iowa City, IA 52242)
| | - Caitlin J. Smith
- Department of Epidemiology, University of Iowa College of Public Health, 145 Riverside Drive, S471 CPHB, Iowa City, IA 52242
| | - Audrey F. Saftlas
- Department of Epidemiology, University of Iowa College of Public Health, 145 Riverside Drive, S427 CPHB, Iowa City, IA 52242
| | - Elizabeth W. Triche
- Department of Epidemiology, Division of Biology and Medicine, Brown University, 121 S. Main St., 2 floor, Box G-S121-2, Providence, Rhode Island
| | - Andrew Bjonnes
- Center for Human Genetic Research and Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 185 Cambridge Street, CPZN 5, Boston, MA 02114 and Program in Medical and Population Genetics, Broad Institute, 7 Cambridge Center, Cambridge MA 02142
| | - Brendan J. Keating
- Department of Surgery, Penn Transplant Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, Division of Genetics, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104
| | - Richa Saxena
- Center for Human Genetic Research and Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 185 Cambridge Street, CPZN 5, Boston, MA 02114 and Program in Medical and Population Genetics, Broad Institute, 7 Cambridge Center, Cambridge MA 02142
| | - Patrick J. Breheny
- Department of Biostatistics, University of Iowa College of Public Health, 145Riverside Drive, N336 CPHB, Iowa City, IA 52242
| | - Andrew T. Dewan
- Division of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, Room 403, New Haven, CT, 06520
| | - Jennifer G. Robinson
- Department of Epidemiology, University of Iowa College of Public Health, 145 Riverside Drive, S455 CPHB, Iowa City, IA 52242
| | - Josephine Hoh
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06520
| | - Kelli K. Ryckman
- Department of Epidemiology, University of Iowa College of Public Health, 145 Riverside Drive, S414 CPHB, Iowa City, IA 52242
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Baer RJ, Yang J, Chambers CD, Ryckman KK, Saftlas AF, Berghella V, Schetter CD, Shaw GM, Stevenson DK, Jelliffe-Pawlowski LL. Risk of recurrent preterm birth among women according to change in partner. J Perinat Med 2017; 45:63-70. [PMID: 27718495 PMCID: PMC5380385 DOI: 10.1515/jpm-2016-0207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/01/2016] [Indexed: 11/15/2022]
Abstract
There is well-established literature indicating change in partner as a risk for preeclampsia, yet the research on the risk of preterm birth after a change in partners has been sparse and inconsistent. Using a population of California live born singletons, we aimed to determine the risk of preterm birth after a change in partner between the first and second pregnancies. The risk of preterm and early term delivery in the second pregnancy was calculated for mothers who did or did not change partners between births with the referent group as women who delivered both pregnancies at term and did not change partners. Adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. Relative to women who delivered at 39 weeks or later in the second pregnancy and did not change partners, preterm birth risks were somewhat lower for women who changed partners between the first and second pregnancies compared to those women who did not change partners. For example, 10.6% of women who did not change partners and delivered their second pregnancy before 34 weeks also delivered their first pregnancy before 34 weeks, while 8.5% of women who changed partners delivered before 34 weeks. Findings suggest partner change may alter the risk of preterm birth.
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Affiliation(s)
- Rebecca J. Baer
- Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Juan Yang
- Genetic Disease Screening Program, California Department of Public Health, Richmond, CA
| | | | | | | | - Vincenzo Berghella
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical Center of Thomas Jefferson University, Philadelphia, PA
| | | | - Gary M. Shaw
- Department of Pediatrics, Stanford University, Stanford, CA
| | | | - Laura L. Jelliffe-Pawlowski
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA
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Donovan BM, Spracklen CN, Schweizer ML, Ryckman KK, Saftlas AF. Intimate partner violence during pregnancy and the risk for adverse infant outcomes: a systematic review and meta-analysis. BJOG 2016; 123:1289-99. [DOI: 10.1111/1471-0528.13928] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2016] [Indexed: 11/28/2022]
Affiliation(s)
- BM Donovan
- Department of Epidemiology; College of Public Health; University of Iowa; Iowa City IA USA
| | - CN Spracklen
- Department of Genetics; University of North Carolina; Chapel Hill NC USA
| | - ML Schweizer
- Department of Internal Medicine; Carver College of Medicine; University of Iowa; Iowa City IA USA
- Iowa City VA Health Care System; Iowa City IA USA
| | - KK Ryckman
- Department of Epidemiology; College of Public Health; University of Iowa; Iowa City IA USA
- Department of Pediatrics; Carver College of Medicine; University of Iowa; Iowa City IA USA
| | - AF Saftlas
- Department of Epidemiology; College of Public Health; University of Iowa; Iowa City IA USA
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Baer RJ, Yang J, Chambers CD, Ryckman K, Shaw GM, Stevenson DK, Dunkel Schetter C, Saftlas AF, Berghella V, Jelliffe-Pawlowski LL. 606: Risk of recurrent preterm birth among women according to change in paternity. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Smith CJ, Saftlas AF, Spracklen CN, Triche EW, Bjonnes A, Keating B, Saxena R, Breheny PJ, Dewan AT, Robinson JG, Hoh J, Ryckman KK. Genetic Risk Score for Essential Hypertension and Risk of Preeclampsia. Am J Hypertens 2016; 29:17-24. [PMID: 26002928 DOI: 10.1093/ajh/hpv069] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 04/23/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Preeclampsia is a hypertensive complication of pregnancy characterized by novel onset of hypertension after 20 weeks gestation, accompanied by proteinuria. Epidemiological evidence suggests that genetic susceptibility exists for preeclampsia; however, whether preeclampsia is the result of underlying genetic risk for essential hypertension has yet to be investigated. Based on the hypertensive state that is characteristic of preeclampsia, we aimed to determine if established genetic risk scores (GRSs) for hypertension and blood pressure are associated with preeclampsia. METHODS Subjects consisted of 162 preeclamptic cases and 108 normotensive pregnant controls, all of Iowa residence. Subjects' DNA was extracted from buccal swab samples and genotyped on the Affymetrix Genome-wide Human SNP Array 6.0 (Affymetrix, Santa Clara, CA). Missing genotypes were imputed using MaCH and Minimac software. GRSs were calculated for hypertension, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) using established genetic risk loci for each outcome. Regression analyses were performed to determine the association between GRS and risk of preeclampsia. These analyses were replicated in an independent US population of 516 cases and 1,097 controls of European ancestry. RESULTS GRSs for hypertension, SBP, DBP, and MAP were not significantly associated with risk for preeclampsia (P > 0.189). The results of the replication analysis also yielded nonsignificant associations. CONCLUSIONS GRSs for hypertension and blood pressure are not associated with preeclampsia, suggesting that an underlying predisposition to essential hypertension is not on the causal pathway of preeclampsia.
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Affiliation(s)
- Caitlin J Smith
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Audrey F Saftlas
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Cassandra N Spracklen
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA; Department of Genetics, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth W Triche
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Andrew Bjonnes
- Center for Human Genetic Research and Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
| | - Brendan Keating
- Department of Surgery, Penn Transplant Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Applied Genomics, Abramson Research Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Richa Saxena
- Center for Human Genetic Research and Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
| | - Patrick J Breheny
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Andrew T Dewan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Jennifer G Robinson
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Josephine Hoh
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Kelli K Ryckman
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA;
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Harland KK, Saftlas AF, Yankowitz J, Peek-Asa C. Risk factors for maternal injuries in a population-based sample of pregnant women. J Womens Health (Larchmt) 2015; 23:1033-8. [PMID: 25251144 DOI: 10.1089/jwh.2013.4560] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of injuries during pregnancy is largely underestimated, as previous research has focused on more severe injuries resulting in emergency department visits and hospitalizations. The objective of our study was to estimate the frequency, risk factors, and causes of injuries in a population-based sample of pregnant women. METHODS This article is an analysis of postpartum interviews among the control series from a case-control study (n=1,488). Maternal, pregnancy, and environmental characteristics associated with injury during pregnancy in control subjects were examined to identify population-based risk factors for injury. We collected data on self-reported injury during pregnancy, including the month of pregnancy, whether medical attention was sought, the mechanism of injury, and the number and location of bodily injuries. Logistic regression was used to calculate unadjusted and adjusted odds ratios (aORs) of injury. RESULTS Over 5% of women reported an injury during pregnancy, with falls being the most common mechanism of injury. Women at highest adjusted risk for injury had unintended pregnancies (aOR: 2.28 [1.40-3.70]) and no partner during pregnancy (aOR: 2.45 [1.16-5.17]) relative to women without injuries. CONCLUSIONS Pregnant women with risk factors for many pregnancy-related complications are also at increased risk of injury during pregnancy. Further studies of pregnancy-related injuries are needed to consider environmental and maternal characteristics on risk of injury.
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Affiliation(s)
- Karisa K Harland
- 1 Injury Prevention Research Center, University of Iowa , Iowa City, Iowa
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Spracklen CN, Saftlas AF, Triche EW, Bjonnes A, Keating B, Saxena R, Breheny PJ, Dewan AT, Robinson JG, Hoh J, Ryckman KK. Genetic Predisposition to Dyslipidemia and Risk of Preeclampsia. Am J Hypertens 2015; 28:915-23. [PMID: 25523295 DOI: 10.1093/ajh/hpu242] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/06/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Large epidemiologic studies support the role of dyslipidemia in preeclampsia; however, the etiology of preeclampsia or whether dyslipidemia plays a causal role remains unclear. We examined the association between the genetic predisposition to dyslipidemia and risk of preeclampsia using validated genetic markers of dyslipidemia. METHODS Preeclampsia cases (n = 164) and normotensive controls (n = 110) were selected from live birth certificates to nulliparous Iowa women during the period August 2002 to May 2005. Disease status was verified by medical chart review. Genetic predisposition to dyslipidemia was estimated by 4 genetic risk scores (GRS) (total cholesterol (TC), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), and triglycerides) on the basis of established loci for blood lipids. Logistic regression analyses were used to evaluate the relationships between each of the 4 genotype scores and preeclampsia. Replication analyses were performed in an independent, US population of preeclampsia cases (n = 516) and controls (n = 1,097) of European ancestry. RESULTS The GRS related to higher levels of TC, LDL-C, and triglycerides demonstrated no association with the risk of preeclampsia in either the Iowa or replication population. The GRS related to lower HDL-C was marginally associated with an increased risk for preeclampsia (odds ratio (OR) = 1.03, 95% confidence interval (CI) = 0.99-1.07; P = 0.10). In the independent replication population, the association with the HDL-C GRS was also marginally significant (OR = 1.03, 95% CI: 1.00-1.06; P = 0.04). CONCLUSIONS Our data suggest a potential effect between the genetic predisposition to dyslipidemic levels of HDL-C and an increased risk of preeclampsia, and, as such, suggest that dyslipidemia may be a component along the causal pathway to preeclampsia.
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Affiliation(s)
- Cassandra N Spracklen
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA; Present address: Department of Genetics, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Audrey F Saftlas
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Elizabeth W Triche
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Andrew Bjonnes
- Center for Human Genetic Research and Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Program in Medical and Population Genetics, Broad Institute , Cambridge, Massachusetts, USA
| | - Brendan Keating
- Department of Surgery, Penn Transplant Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Applied Genomics, Abramson Research Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Richa Saxena
- Center for Human Genetic Research and Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Program in Medical and Population Genetics, Broad Institute , Cambridge, Massachusetts, USA
| | - Patrick J Breheny
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Andrew T Dewan
- Division of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Jennifer G Robinson
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Josephine Hoh
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Kelli K Ryckman
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA;
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Saftlas AF, Spracklen CN, Ryckman KK, Stockdale CK, Penrose K, Ault K, Rubenstein LM, Pinto LA. Influence of a loop electrosurgical excision procedure (LEEP) on levels of cytokines in cervical secretions. J Reprod Immunol 2015; 109:74-83. [PMID: 25721621 DOI: 10.1016/j.jri.2015.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 11/14/2014] [Accepted: 01/08/2015] [Indexed: 10/24/2022]
Abstract
Over the past decade, there has been heightened interest in determining if there is an increased risk of adverse reproductive outcomes among women who had a loop electrosurgical excision procedure (LEEP) to remove cervical intraepithelial neoplasia (CIN). The objective of this exploratory study was to determine if the treatment of CIN with a LEEP is associated with changes in cervical soluble immune markers. Cervical cytokine concentrations were measured in women treated with LEEP and a control group of women who had colposcopy only and did not undergo LEEP. Cytokines were examined in cervical secretions collected in Merocel(®) sponges at study entry and at 6-month follow-up. Cytokines were measured using a Luminex 18-plex cytokine bead assay. The mean cytokine levels were not significantly changed from baseline to follow-up in either group, with the exception of TNF-α, which decreased among women who underwent a LEEP. When the mean levels of cytokines of the treated and untreated groups at baseline or follow-up were compared, cytokine levels tended to be lower in the treated group (particularly IFN-γ, IL-6, IL-8, and MCP-1). Findings from adjusted repeated measures analyses revealed no differences between the two groups with regard to changes in cytokine levels over time. Overall, women undergoing a LEEP showed few changes in the cervical microenvironment relative to untreated women. Future studies with additional cervical environment markers and larger sample sizes are needed to determine if a LEEP is associated with dysregulation of the cervical microenvironment.
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Affiliation(s)
- Audrey F Saftlas
- Department of Epidemiology, University of Iowa College of Public Health, 145 Riverside Drive, S427 CPHB, Iowa City, IA 52242, USA.
| | - Cassandra N Spracklen
- Department of Genetics, University of North Carolina-Chapel Hill, 5100 Genetic Medicine Building, CB #7264, 120 Mason Farm Road, Chapel Hill, NC 27599, USA.
| | - Kelli K Ryckman
- Department of Epidemiology, University of Iowa College of Public Health, 145 Riverside Drive, S435 CPHB, Iowa City, IA 52242, USA.
| | - Colleen K Stockdale
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 51214, USA.
| | - Kerri Penrose
- Department of Medicine, Division of Infectious Disease, University of Pittsburgh, S804 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
| | - Kevin Ault
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mailstop 2028, Kansas City, KS 66160, USA.
| | - Linda M Rubenstein
- Department of Epidemiology, University of Iowa College of Public Health, 145 Riverside Drive, S415 CPHB, Iowa City, IA 52242, USA.
| | - Ligia A Pinto
- Human Papillomavirus Immunology Laboratory, Leidos Biomedical Research, Incorporated, Frederick National Laboratory for Cancer Research, 1050 Boyles Street, Frederick, MD, USA.
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Ryckman KK, Spracklen CN, Smith CJ, Robinson JG, Saftlas AF. Maternal lipid levels during pregnancy and gestational diabetes: a systematic review and meta-analysis. BJOG 2015; 122:643-51. [PMID: 25612005 DOI: 10.1111/1471-0528.13261] [Citation(s) in RCA: 233] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lipid levels during pregnancy in women with gestational diabetes mellitus (GDM) have been extensively studied; however, it remains unclear whether dyslipidaemia is a potential marker of preexisting insulin resistance. OBJECTIVE To evaluate the relationship between lipid measures throughout pregnancy and GDM. SEARCH STRATEGY We searched PubMed-MedLine and SCOPUS (inception until January 2014) and reference lists of relevant studies. SELECTION CRITERIA Publications describing original data with at least one raw lipid (total cholesterol, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], or triglyceride) measurement during pregnancy in women with GDM and healthy pregnant controls were retained. DATA COLLECTION AND ANALYSIS Data extracted from 60 studies were pooled and weighted mean difference (WMD) in lipid levels was calculated using random effects models. Meta-regression was also performed to identify sources of heterogeneity. MAIN RESULTS Triglyceride levels were significantly elevated in women with GDM compared with those without GDM (WMD 30.9, 95% confidence interval [95% CI] 25.4-36.4). This finding was consistent in the first, second and third trimesters of pregnancy. HDL-C levels were significantly lower in women with GDM compared with those without GDM in the second (WMD -4.6, 95% CI -6.2 to -3.1) and third (WMD -4.1, 95% CI -6.5 to -1.7) trimesters of pregnancy. There were no differences in aggregate total cholesterol or LDL-C levels between women with GDM and those without insulin resistance. AUTHOR'S CONCLUSIONS Our meta-analysis shows that triglycerides are significantly elevated among women with GDM compared with women without insulin resistance and this finding persists across all three trimesters of pregnancy.
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Affiliation(s)
- K K Ryckman
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
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Spracklen CN, Wallace RB, Sealy-Jefferson S, Robinson JG, Freudenheim JL, Wellons MF, Saftlas AF, Snetselaar LG, Manson JE, Hou L, Qi L, Chlebowski RT, Ryckman KK. Birth weight and subsequent risk of cancer. Cancer Epidemiol 2014; 38:538-43. [PMID: 25096278 PMCID: PMC4188724 DOI: 10.1016/j.canep.2014.07.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 07/10/2014] [Accepted: 07/11/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND We aimed to determine the association between self-reported birth weight and incident cancer in the Women's Health Initiative Observational Study cohort, a large multiethnic cohort of postmenopausal women. METHODS 65,850 women reported their birth weight by category (<6 lbs, 6-7 lbs 15 oz, 8-9 lbs 15 oz, and ≥10 lbs). All self-reported, incident cancers were adjudicated by study staff. We used Cox proportional hazards regression to estimate crude and adjusted hazard ratios (aHR) for associations between birth weight and: (1) all cancer sites combined, (2) gynecologic cancers, and (3) several site-specific cancer sites. RESULTS After adjustments, birth weight was positively associated with the risk of lung cancer (p=0.01), and colon cancer (p=0.04). An inverse trend was observed between birth weight and risk for leukemia (p=0.04). A significant trend was not observed with breast cancer risk (p=0.67); however, women born weighing ≥10 lbs were less likely to develop breast cancer compared to women born between 6 lbs-7 lbs 15 oz (aHR 0.77, 95% CI 0.63, 0.94). CONCLUSION Birth weight category appears to be significantly associated with the risk of any postmenopausal incident cancer, though the direction of the association varies by cancer type.
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Affiliation(s)
- Cassandra N Spracklen
- Department of Epidemiology, University of Iowa, 145 North Riverside Drive, S471 CPHB, Iowa City, IA 52242, United States
| | - Robert B Wallace
- Department of Epidemiology, University of Iowa, 145 North Riverside Drive, S422 CPHB, Iowa City, IA 52242, United States
| | - Shawnita Sealy-Jefferson
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, 3939 Woodward Avenue, Room 319, Detroit, MI 48201, United States
| | - Jennifer G Robinson
- Department of Epidemiology, University of Iowa, 145 North Riverside Drive, S455 CPHB, Iowa City, IA 52242, United States
| | - Jo L Freudenheim
- Department of Social and Preventive Medicine, University at Buffalo, 270 Farber Hall, Buffalo, NY 14214, United States
| | - Melissa F Wellons
- Department of Medicine, Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University, 2213 Garland Avenue, Nashville, TN 37232, United States
| | - Audrey F Saftlas
- Department of Epidemiology, University of Iowa, 145 North Riverside Drive, S427 CPHB, Iowa City, IA 52242, United States
| | - Linda G Snetselaar
- Department of Epidemiology, University of Iowa, 145 North Riverside Drive, S425 CPHB, Iowa City, IA 52242, United States
| | - JoAnn E Manson
- Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, United States
| | - Lifang Hou
- Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, 608 North Lake Shore Drive, Chicago, IL 60611, United States; Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, 303 East Superior Street, Chicago, IL 60611, United States
| | - Lihong Qi
- Department of Public Health Sciences, School of Medicine, University of California at Davis, 1 Shields Avenue, Davis, CA 95616, United States
| | - Rowan T Chlebowski
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, United States
| | - Kelli K Ryckman
- Department of Epidemiology, University of Iowa, 145 North Riverside Drive, CPHB, Iowa City, IA 52242, United States.
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Spracklen CN, Smith CJ, Saftlas AF, Robinson JG, Ryckman KK. Maternal hyperlipidemia and the risk of preeclampsia: a meta-analysis. Am J Epidemiol 2014; 180:346-58. [PMID: 24989239 DOI: 10.1093/aje/kwu145] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Published reports examining lipid levels during pregnancy and preeclampsia have been inconsistent. The objective of this meta-analysis was to test the association between preeclampsia and maternal total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, and triglyceride levels measured during pregnancy. We conducted a systematic search for studies published between the index date until July 2013 reporting maternal lipid levels in women with preeclampsia and normotensive pregnant women. Seventy-four studies met all eligibility criteria and were included in the meta-analysis. Weighted mean differences in lipid levels were calculated using a random-effects model. Statistical heterogeneity was investigated using the I(2) statistic. Meta-regression was used to identify sources of heterogeneity. Preeclampsia was associated with elevated total cholesterol, non-HDL-C, and triglyceride levels, regardless of gestational age at the time of blood sampling, and with lower levels of HDL-C in the third trimester. A marginal association was found with LDL-C levels. Statistical heterogeneity was detected in all analyses. Meta-regression analyses suggested that differences in body mass index (weight (kg)/height (m)(2)) across studies may be partially responsible for the heterogeneity in the triglyceride and LDL-C analyses. This systematic review and meta-analysis demonstrates that women who develop preeclampsia have elevated levels of total cholesterol, non-HDL-C, and triglycerides during all trimesters of pregnancy, as well as lower levels of HDL-C during the third trimester.
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Abstract
OBJECTIVE A counterintuitive interaction between smoking during pregnancy and preeclampsia on birth weight for gestational age (BWGA) outcomes was recently reported. In this report, we examine the relationship between these factors in a well-documented study population with exposure data on trimester of maternal smoking. METHODS Preeclamptic (n = 238), gestational hypertensive (n = 219), and normotensive women (n = 342) were selected from live-births to nulliparous Iowa women. Disease status was verified by medical chart review, and smoking exposure was assessed by self-report. Fetal growth was assessed as z-score of BWGA. Multiple linear regression was used to test for the association of maternal smoking and preeclampsia with BWGA z-score. RESULTS There was no interaction between smoking with preeclampsia or gestational hypertension on fetal growth. BWGA z-scores were significantly lower among women with preeclampsia and those who smoked any time during pregnancy (β = -0.33, p = <0.0001 and β = -0.25, p = 0.05) compared to normotensive and non-smoking women, respectively. Infants of women with gestational hypertension were comparable in size to infants born to normotensive women. CONCLUSIONS Women who developed preeclampsia and those who smoked during pregnancy delivered infants that were significantly smaller than infants of women who did not develop preeclampsia and non-smoking women, respectively.
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Affiliation(s)
- Cassandra N Spracklen
- Department of Epidemiology, University of Iowa College of Public Health , Iowa City, IA , USA
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Spracklen CN, Harland KK, Stegmann BJ, Saftlas AF. Authors' reply: cervical surgery for cervical intraepithelial neoplasia and prolonged time to conception of a live birth. BJOG 2014; 120:1697-8. [PMID: 24588998 DOI: 10.1111/1471-0528.12457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2013] [Indexed: 11/30/2022]
Affiliation(s)
- C N Spracklen
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
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Saftlas AF, Harland KK, Wallis AB, Cavanaugh J, Dickey P, Peek-Asa C. Motivational interviewing and intimate partner violence: a randomized trial. Ann Epidemiol 2014; 24:144-50. [DOI: 10.1016/j.annepidem.2013.10.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 10/09/2013] [Accepted: 10/14/2013] [Indexed: 11/29/2022]
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Wallis AB, Tsigas EZ, Saftlas AF, Sibai BM. Prenatal education is an opportunity for improved outcomes in hypertensive disorders of pregnancy: results from an Internet-based survey. J Matern Fetal Neonatal Med 2013; 26:1565-7. [DOI: 10.3109/14767058.2013.797403] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Saftlas AF, Rubenstein L, Prater K, Harland KK, Field E, Triche EW. Cumulative exposure to paternal seminal fluid prior to conception and subsequent risk of preeclampsia. J Reprod Immunol 2013; 101-102:104-110. [PMID: 24011785 DOI: 10.1016/j.jri.2013.07.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 06/24/2013] [Accepted: 07/02/2013] [Indexed: 12/15/2022]
Abstract
A growing body of literature suggests that prior and prolonged exposure to paternal antigens in seminal fluid induces maternal tolerance to the allogeneic fetus, protecting it from rejection and facilitating successful implantation and placentation. In this case-control study of nulliparous women, we test the hypothesis that increased exposure to paternal seminal fluid via the vaginal or oral route will confer a reduced risk of preeclampsia. Preeclampsia cases (n=258) and normotensive controls (n=182) were selected from live births to Iowa women over the period August 2002 to April 2005. Disease status was verified by medical chart review. Seminal fluid exposure indexes incorporated information on type and frequency of sexual practices, contraceptive use, and ingestion practices prior to conception with the baby's father. Preeclampsia risk decreased significantly with increasing vaginal exposure to paternal semen (test for trend p<0.05). Women in the highest 10th percentile of vaginal exposure had a 70% reduced odds of preeclampsia relative to women in the lowest 25th percentile of exposure (aOR=0.3; 95% CI: 0.1-0.9). Oral seminal fluid exposure was not associated with a reduced risk of preeclampsia. These findings are congruent with the immune maladaptation hypothesis of preeclampsia causation and indicate that paternal antigen exposure via the vaginal mucosa may facilitate immune tolerance to paternal HLA. Thus, advising nulliparous women to decrease their use of barrier contraceptive methods and to increase vaginal sexual intercourse prior to conceiving may reduce their risk of preeclampsia.
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Affiliation(s)
- Audrey F Saftlas
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA 52242, USA
| | - Linda Rubenstein
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA 52242, USA
| | - Kaitlin Prater
- Department of Epidemiology, Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA 52242, USA
| | - Karisa K Harland
- Department of Occupational and Environmental Health, University of Iowa College of Public Health, Iowa City, IA 52242, USA
| | - Elizabeth Field
- Veterans Administration Medical Center, Iowa City, IA 52246, USA; Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, IA 52242, USA
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Triche EW, Harland KK, Field EH, Rubenstein LM, Saftlas AF. Maternal-fetal HLA sharing and preeclampsia: variation in effects by seminal fluid exposure in a case-control study of nulliparous women in Iowa. J Reprod Immunol 2013; 101-102:111-119. [PMID: 23998333 DOI: 10.1016/j.jri.2013.06.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/12/2013] [Accepted: 06/18/2013] [Indexed: 11/28/2022]
Abstract
Whereas histocompatibility is critical for transplantation, HLA histoincompatibility is associated with successful pregnancy. Literature on HLA sharing and preeclampsia has been inconsistent; most studies focused on maternal-paternal rather than maternal-fetal sharing. This study examines whether maternal-fetal histocompatibility is associated with preeclampsia, and whether effects vary by semen exposure history. This case-control study of nulliparous women was designed to examine associations among HLA sharing, semen exposure, and preeclampsia. 258 preeclampsia cases and 182 normotensive controls met the eligibility criteria. HLA typing for mother and baby was performed for HLA-A, -B, -C, -DRB1, and -DQB1. We further restricted our study sample to 224 mother-baby pairs who had complete HLA typing for all five genes. Seminal fluid exposure indexes incorporated information on type of practice, frequency, contraceptive use (for vaginal exposure) and ingestion practices (for oral exposure). Multivariate models were adjusted for BMI and education. HLA-A matching, Class I matching, and combined Class I and II matching were associated with increased odds of preeclampsia. Among women with low semen exposure, effects of Class I matching were amplified (HLA-A matching, OR=6.27, 95%CI=1.04, 37.97; Class I matching, OR=4.49 per one-match increase, 95%CI=1.89, 14.50). With moderate to high semen exposure, Class II matching effects predominated (HLA-DQB1, OR=3.22, 95%CI=1.04, 9.99; Class II, OR=1.76 per one-match increase, 95%CI=1.05, 2.98; and total matches, OR=1.45 per one-match increase, 95%CI=1.02, 2.06). We found consistent evidence that maternal-fetal HLA sharing was associated with preeclampsia in a pattern influenced by prior vaginal exposure to paternal seminal fluid.
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Affiliation(s)
- Elizabeth W Triche
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA.
| | - Karisa K Harland
- Department of Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA; Injury Prevention Research Center, College of Public Health, University of Iowa, Iowa City, IA 52242, USA
| | - Elizabeth H Field
- Veterans Affairs Medical Center, Iowa City, IA 52246, USA; Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Linda M Rubenstein
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Audrey F Saftlas
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
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Abstract
Metabolic syndrome is a growing problem globally, and is a contributor to non-communicable diseases such as type II diabetes and cardiovascular disease. The risk of developing specific components of the metabolic syndrome such as obesity, hyperlipidemia, hypertension, and elevated fasting blood sugar has been largely attributed to environmental stressors including poor nutrition, lack of exercise, and smoking. However, large epidemiologic cohorts and experimental animal models support the "developmental origins of adult disease" hypothesis, which posits that a significant portion of the risk for adult metabolic conditions is determined by exposures occurring in the perinatal period. Maternal obesity and the rate of complications during pregnancy such as preterm birth, preeclampsia, and gestational diabetes continue to rise. As our ability to reduce perinatal morbidity and mortality improves the long-term metabolic consequences remain uncertain, pointing to the need for further research in this area.
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Affiliation(s)
- Kelli K. Ryckman
- Department of Epidemiology, University of Iowa, 105 River St, Iowa City, IA 52242, USA
| | | | - Nisha I. Parikh
- Cardiovascular Division, The Queens Medical Center, Honolulu, HI 96813, USA
| | - Audrey F. Saftlas
- Department of Epidemiology, University of Iowa, 105 River St, Iowa City, IA 52242, USA
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Spracklen CN, Harland KK, Stegmann BJ, Saftlas AF. Cervical surgery for cervical intraepithelial neoplasia and prolonged time to conception of a live birth: a case-control study. BJOG 2013; 120:960-5. [PMID: 23489374 DOI: 10.1111/1471-0528.12209] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether women with a history of surgery for cervical intraepithelial neoplasia (CIN) are at an increased risk of subfertility, measured as a time to pregnancy of more than 12 months. DESIGN Case-control study. SETTING Iowa Health in Pregnancy Study (IHIPS), a population-based case-control study of preterm and small-for-gestational-age (SGA) live birth outcomes (from May 2002 through June 2005) in the USA. SAMPLE Women with an intended pregnancy and a history of either one prior cervical surgery (n = 152), colposcopy only (n = 151), or no prior cervical surgery or colposcopy (n = 1021). METHODS Cervical treatment history, pregnancy intention, time to pregnancy, and other variables were self-reported by computer-assisted telephone interviews. Odds ratios were calculated using logistic regression to estimate the risk of prolonged time to pregnancy among women with a history of cervical surgery or colposcopy alone, compared with untreated women (control group). MAIN OUTCOME MEASURE Prolonged time to pregnancy (i.e. >1 year). RESULTS Prolonged time to pregnancy was most prevalent among treated women (16.4%), compared with untreated women (8.4%) and women with colposcopy only (8.6%) (P = 0.039). After adjusting for covariates, women with prior cervical surgery had a more than two-fold higher risk of prolonged time to pregnancy compared with untreated women (aOR 2.09, 95% CI 1.26-3.46). In contrast, women with a history of colposcopy only had a risk equivalent to that found among untreated women (aOR 1.02, 95% CI 0.56-1.89). CONCLUSIONS Women with a history of cervical treatment for CIN are at increased risk of subfertility, measured as a time to pregnancy of more than 12 months.
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Affiliation(s)
- C N Spracklen
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
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Harland KK, Saftlas AF, Wallis AB, Yankowitz J, Triche EW, Zimmerman MB. Correction of systematic bias in ultrasound dating in studies of small-for-gestational-age birth: an example from the Iowa Health in Pregnancy Study. Am J Epidemiol 2012; 176:443-55. [PMID: 22886591 DOI: 10.1093/aje/kws120] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The authors examined whether early ultrasound dating (≤20 weeks) of gestational age (GA) in small-for-gestational-age (SGA) fetuses may underestimate gestational duration and therefore the incidence of SGA birth. Within a population-based case-control study (May 2002-June 2005) of Iowa SGA births and preterm deliveries identified from birth records (n = 2,709), the authors illustrate a novel methodological approach with which to assess and correct for systematic underestimation of GA by early ultrasound in women with suspected SGA fetuses. After restricting the analysis to subjects with first-trimester prenatal care, a nonmissing date of the last menstrual period (LMP), and early ultrasound (n = 1,135), SGA subjects' ultrasound GA was 5.5 days less than their LMP GA, on average. Multivariable linear regression was conducted to determine the extent to which ultrasound GA predicted LMP dating and to correct for systematic misclassification that results after applying standard guidelines to adjudicate differences in these measures. In the unadjusted model, SGA subjects required a correction of +1.5 weeks to the ultrasound estimate. With adjustment for maternal age, smoking, and first-trimester vaginal bleeding, standard guidelines for adjudicating differences in ultrasound and LMP dating underestimated SGA birth by 12.9% and overestimated preterm delivery by 8.7%. This methodological approach can be applied by researchers using different study populations in similar research contexts.
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Affiliation(s)
- Karisa K Harland
- Injury Prevention Research Center and Department of Epidemiology, University of Iowa, Iowa City, IA 52242-5000, USA.
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Colaizy TT, Carlson S, Saftlas AF, Morriss FH. Growth in VLBW infants fed predominantly fortified maternal and donor human milk diets: a retrospective cohort study. BMC Pediatr 2012; 12:124. [PMID: 22900590 PMCID: PMC3464178 DOI: 10.1186/1471-2431-12-124] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 06/21/2012] [Indexed: 11/10/2022] Open
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Zhao L, Triche EW, Walsh KM, Bracken MB, Saftlas AF, Hoh J, Dewan AT. Genome-wide association study identifies a maternal copy-number deletion in PSG11 enriched among preeclampsia patients. BMC Pregnancy Childbirth 2012; 12:61. [PMID: 22748001 PMCID: PMC3476390 DOI: 10.1186/1471-2393-12-61] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 06/20/2012] [Indexed: 12/02/2022] Open
Abstract
Background Specific genetic contributions for preeclampsia (PE) are currently unknown. This genome-wide association study (GWAS) aims to identify maternal single nucleotide polymorphisms (SNPs) and copy-number variants (CNVs) involved in the etiology of PE. Methods A genome-wide scan was performed on 177 PE cases (diagnosed according to National Heart, Lung and Blood Institute guidelines) and 116 normotensive controls. White female study subjects from Iowa were genotyped on Affymetrix SNP 6.0 microarrays. CNV calls made using a combination of four detection algorithms (Birdseye, Canary, PennCNV, and QuantiSNP) were merged using CNVision and screened with stringent prioritization criteria. Due to limited DNA quantities and the deleterious nature of copy-number deletions, it was decided a priori that only deletions would be selected for assay on the entire case-control dataset using quantitative real-time PCR. Results The top four SNP candidates had an allelic or genotypic p-value between 10-5 and 10-6, however, none surpassed the Bonferroni-corrected significance threshold. Three recurrent rare deletions meeting prioritization criteria detected in multiple cases were selected for targeted genotyping. A locus of particular interest was found showing an enrichment of case deletions in 19q13.31 (5/169 cases and 1/114 controls), which encompasses the PSG11 gene contiguous to a highly plastic genomic region. All algorithm calls for these regions were assay confirmed. Conclusions CNVs may confer risk for PE and represent interesting regions that warrant further investigation. Top SNP candidates identified from the GWAS, although not genome-wide significant, may be useful to inform future studies in PE genetics.
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Affiliation(s)
- Linlu Zhao
- Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT 06520, USA
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TePoel MRW, Saftlas AF, Wallis AB. Association of seasonality with hypertension in pregnancy: a systematic review. J Reprod Immunol 2011; 89:140-52. [PMID: 21513987 DOI: 10.1016/j.jri.2011.01.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 01/03/2011] [Accepted: 01/12/2011] [Indexed: 01/27/2023]
Abstract
A systematic literature review was conducted to examine all academic, peer-reviewed studies of seasonal or monthly variation in the prevalence of gestational hypertension, preeclampsia, or eclampsia. The objective was to test the hypothesis that prevalence rates are highest during the winter months in non-tropical regions and during wet or humid periods in tropical climates. The authors searched the epidemiological literature indexed in PubMed, cross-referenced bibliographic materials, and reviewed personal archives. Of 60 abstracts and articles screened, 20 met the final inclusion criteria. Studies included were published between 1938 and 2010. Despite differences in setting, data sources, study design, outcome definitions, and control of known risk factors, 16 separate studies (11 non-tropical and 5 tropical) concurred that prevalence rates were higher for winter delivery in non-tropical regions or delivery during wet or humid periods in tropical climates. Although the reasons for these patterns are unknown, seasonal variation in infectious diseases, environmental triggers of asthma, vitamin D levels, physiological responses to cold temperatures, healthcare access, and nutritional intake may all play a role.
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Affiliation(s)
- Megan R W TePoel
- Department of Epidemiology, University of Iowa College of Public Health, 200 Hawkins Drive, GH C21M, Iowa City, IA 52242, USA
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Beyer KMM, Saftlas AF, Wallis AB, Peek-Asa C, Rushton G. A probabilistic sampling method (PSM) for estimating geographic distance to health services when only the region of residence is known. Int J Health Geogr 2011; 10:4. [PMID: 21219638 PMCID: PMC3024211 DOI: 10.1186/1476-072x-10-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 01/10/2011] [Indexed: 11/30/2022] Open
Abstract
Background The need to estimate the distance from an individual to a service provider is common in public health research. However, estimated distances are often imprecise and, we suspect, biased due to a lack of specific residential location data. In many cases, to protect subject confidentiality, data sets contain only a ZIP Code or a county. Results This paper describes an algorithm, known as "the probabilistic sampling method" (PSM), which was used to create a distribution of estimated distances to a health facility for a person whose region of residence was known, but for which demographic details and centroids were known for smaller areas within the region. From this distribution, the median distance is the most likely distance to the facility. The algorithm, using Monte Carlo sampling methods, drew a probabilistic sample of all the smaller areas (Census blocks) within each participant's reported region (ZIP Code), weighting these areas by the number of residents in the same age group as the participant. To test the PSM, we used data from a large cross-sectional study that screened women at a clinic for intimate partner violence (IPV). We had data on each woman's age and ZIP Code, but no precise residential address. We used the PSM to select a sample of census blocks, then calculated network distances from each census block's centroid to the closest IPV facility, resulting in a distribution of distances from these locations to the geocoded locations of known IPV services. We selected the median distance as the most likely distance traveled and computed confidence intervals that describe the shortest and longest distance within which any given percent of the distance estimates lie. We compared our results to those obtained using two other geocoding approaches. We show that one method overestimated the most likely distance and the other underestimated it. Neither of the alternative methods produced confidence intervals for the distance estimates. The algorithm was implemented in R code. Conclusions The PSM has a number of benefits over traditional geocoding approaches. This methodology improves the precision of estimates of geographic access to services when complete residential address information is unavailable and, by computing the expected distribution of possible distances for any respondent and associated distance confidence limits, sensitivity analyses on distance access measures are possible. Faulty or imprecise distance measures may compromise decisions about service location and misdirect scarce resources.
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Affiliation(s)
- Kirsten M M Beyer
- Institute for Health and Society, Medical College of Wisconsin, Milwaukee, 53226, USA
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Saftlas AF, Triche EW, Beydoun H, Bracken MB. Does chocolate intake during pregnancy reduce the risks of preeclampsia and gestational hypertension? Ann Epidemiol 2010; 20:584-91. [PMID: 20609337 DOI: 10.1016/j.annepidem.2010.05.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 05/07/2010] [Accepted: 05/10/2010] [Indexed: 01/12/2023]
Abstract
PURPOSE Chocolate consumption is associated with favorable levels of blood pressure and other cardiovascular disease risk markers. We analyzed a prospective cohort study to determine whether regular chocolate intake during pregnancy is associated with reduced risks of preeclampsia and gestational hypertension (GH). METHODS Subjects were recruited from 13 prenatal care practices in Connecticut (1988-1991). In-person interviews were administered at <16 weeks' gestation to ascertain risk factors for adverse pregnancy outcomes. Hospital delivery and prenatal records were abstracted to classify preeclampsia (n = 58), GH (n = 158), and normotensive pregnancies (n = 2351). Chocolate consumption (servings/week) during the first and third trimesters was ascertained at initial interview and immediately postpartum, respectively. Consumers of less than 1 serving/week comprised the referent group. Adjusted odds ratios (aORs) were estimated by the use of logistic regression. RESULTS Chocolate intake was more frequent among normotensive (80.7%) than preeclamptic (62.5%) or GH women (75.8%), and associated with reduced odds of preeclampsia (first trimester: aOR, 0.55; 95% confidence interval [95% CI], 0.32-0.95; third trimester: aOR, 0.56; 95% CI, 0.32-0.97). Only first trimester intake was associated with reduced odds of GH (aOR,0.65; 95% CI, 0.45-0.87). CONCLUSIONS These findings provide additional evidence of the benefits of chocolate. Prospective studies are needed to confirm and delineate protective effects of chocolate intake on risk of preeclampsia.
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Affiliation(s)
- Audrey F Saftlas
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, USA
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Kuntz JL, Yang M, Cavanaugh J, Saftlas AF, Polgreen PM. Trends in Clostridium difficile infection among peripartum women. Infect Control Hosp Epidemiol 2010; 31:532-4. [PMID: 20350150 DOI: 10.1086/652454] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With use of the Nationwide Inpatient Sample, we conducted a study to determine whether rates of Clostridium difficile infection for delivery-associated hospitalizations are increasing. From 1998 to 2006, the number and incidence of C. difficile infection among peripartum women increased significantly. These increases were comparable to those observed in the general hospitalized population.
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Affiliation(s)
- Jennifer L Kuntz
- College of Public Health, University of Iowa, Iowa City, Iowa 52242, USA
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Saftlas AF, Wallis AB, Shochet T, Harland KK, Dickey P, Peek-Asa C. Prevalence of intimate partner violence among an abortion clinic population. Am J Public Health 2010; 100:1412-5. [PMID: 20558796 DOI: 10.2105/ajph.2009.178947] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In this cross-sectional, clinic-based study, we estimated 1-year prevalence of intimate partner violence among 986 patients who had elective abortions. We assessed physical, sexual, and battering intimate partner violence via self-administered, computer-based questionnaires. Overall, physical and sexual intimate partner violence prevalence was 9.9% and 2.5%, respectively; 8.4% of those in a current relationship reported battering. Former partners perpetrated more physical and sexual assaults than did current partners. Violence severity increased with frequency. Abortion patients experience high intimate partner violence rates, indicating the need for targeted screening and community-based referral.
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Affiliation(s)
- Audrey F Saftlas
- Department of Epidemiology, University of Iowa, Iowa City, 52242, USA.
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36
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Allegra CJ, Aberle DR, Ganschow P, Hahn SM, Lee CN, Millon-Underwood S, Pike MC, Reed SD, Saftlas AF, Scarvalone SA, Schwartz AM, Slomski C, Yothers G, Zon R. National Institutes of Health State-of-the-Science Conference statement: Diagnosis and Management of Ductal Carcinoma In Situ September 22-24, 2009. J Natl Cancer Inst 2010; 102:161-9. [PMID: 20071686 DOI: 10.1093/jnci/djp485] [Citation(s) in RCA: 172] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To provide health-care providers, patients, and the general public with a responsible assessment of currently available data on the diagnosis and management of ductal carcinoma in situ (DCIS). PARTICIPANTS A non-Department of Health and Human Services, nonadvocate, 14-member panel representing the fields of oncology, radiology, surgery (general and reconstructive), pathology, radiation oncology, internal medicine, epidemiology, biostatistics, nursing, obstetrics and gynecology, preventative medicine and population health, and social work. In addition, 22 experts from pertinent fields presented data to the panel and conference audience. EVIDENCE Presentations by experts and a systematic review of the literature prepared by the Minnesota Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience. CONFERENCE PROCESS The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the National Institutes of Health or the Federal Government. CONCLUSIONS Clearly, the diagnosis and management of DCIS is highly complex with many unanswered questions, including the fundamental natural history of untreated disease. Because of the noninvasive nature of DCIS, coupled with its favorable prognosis, strong consideration should be given to elimination of the use of the anxiety-producing term "carcinoma" from the description of DCIS. The outcomes in women treated with available therapies are excellent. Thus, the primary question for future research must focus on the accurate identification of patient subsets diagnosed with DCIS, including those persons who may be managed with less therapeutic intervention without sacrificing the excellent outcomes presently achieved. Essential in this quest will be the development and validation of accurate risk stratification methods based on a comprehensive understanding of the clinical, pathological, and biological factors associated with DCIS.
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Affiliation(s)
- Carmen J Allegra
- University of Florida Shands Cancer Center, Department of Medicine, University of Florida, Gainesville, FL 32610, USA.
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Allegra CJ, Aberle DR, Ganschow P, Hahn SM, Lee CN, Millon-Underwood S, Pike MC, Reed SD, Saftlas AF, Scarvalone SA, Schwartz AM, Slomski C, Yothers G, Zon R. NIH state-of-the-science conference statement: diagnosis and management of ductal carcinoma in situ (DCIS). NIH Consens State Sci Statements 2009; 26:1-27. [PMID: 19784089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To provide health care providers, patients, and the general public with a responsible assessment of currently available data on the diagnosis and management of ductal carcinoma in situ (DCIS). PARTICIPANTS An non-DHHS, nonadvocate 14-member panel representing the fields of fields of oncology, radiology, surgery (general and reconstructive), pathology, radiation oncology, internal medicine, epidemiology, biostatistics, nursing, obstetrics and gynecology, preventative medicine and population health, and social work. In addition, 22 experts from pertinent fields presented data to the panel and conference audience. EVIDENCE Presentations by experts and a systematic review of the literature prepared by the Minnesota Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience. CONFERENCE PROCESS The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government. CONCLUSIONS The diagnosis and management of DCIS is highly complex with many unanswered questions, including the fundamental natural history of untreated disease. Because of the noninvasive nature of DCIS, coupled with its favorable prognosis, strong consideration should be given to remove the anxiety-producing term "carcinoma" from the description of DCIS. The outcomes in women treated with available therapies are excellent. Thus, the primary question for future research must focus on the accurate identification of patient subsets diagnosed with DCIS, including those persons who may be managed with less therapeutic intervention without sacrificing the excellent outcomes presently achieved. Essential in this quest will be the development and validation of accurate risk stratification methods based on a comprehensive understanding of the clinical, radiological, pathological, and biological factors associated with DCIS.
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Affiliation(s)
- Carmen J Allegra
- University of Florida Shands Cancer Center, University of Florida, Gainesville, Florida, USA
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Abstract
Prenatal maternal stress (PNMS) has been linked with adverse health outcomes in the offspring through experimental studies using animal models and epidemiological studies of human populations. The purpose of this review article is to establish a parallel between animal and human studies, while focusing on methodological issues and gaps in knowledge. The review examines the quality of recent evidence for prevailing PNMS theoretical models, namely the biopsychosocial model for adverse pregnancy outcomes and the fetal programming model for chronic diseases. The investigators used PubMed (2000-06) to identify recently published original articles in the English language literature. A total of 103 (60 human and 43 animal) studies were examined. Most human studies originated from developed countries, thus limiting generalisability to developing nations. Most animal studies were conducted on non-primates, rendering extrapolation of findings to pregnant women less straightforward. PNMS definition and measurement were heterogeneous across studies examining similar research questions, thus precluding the conduct of meta-analyses. In human studies, physical health outcomes were often restricted to birth complications while mental health outcomes included postnatal developmental disorders and psychiatric conditions in children, adolescents and adults. Diverse health outcomes were considered in animal studies, some being useful models for depression, schizophrenia or attention deficit hyperactivity disorder in human populations. The overall evidence is consistent with independent effects of PNMS on perinatal and postnatal outcomes. Intervention studies and large population-based cohort studies combining repeated multi-dimensional and standardised PNMS measurements with biomarkers of stress are needed to further understand PNMS aetiology and pathophysiology in human populations.
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Affiliation(s)
- Hind Beydoun
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, USA
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McGinnis JM, Birt DF, Brannon PM, Carroll RJ, Gibbons RD, Hazzard WR, Kamerow DB, Levin B, Ntambi J, Paneth N, Rogers D, Saftlas AF, Vaughan W. Reply to BN Ames et al. Am J Clin Nutr 2007. [DOI: 10.1093/ajcn/86.2.523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J Michael McGinnis
- Institute of Medicine The National Academies 500 Fifth Street, NW Washington, DC 20001 E-mail:
| | | | | | | | | | | | | | - Bernard Levin
- University of Texas MD Anderson Cancer Center Houston, TX
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Beydoun H, Saftlas AF, Harland K, Triche E. Combining conditional and unconditional recruitment incentives could facilitate telephone tracing in surveys of postpartum women. J Clin Epidemiol 2006; 59:732-8. [PMID: 16765277 DOI: 10.1016/j.jclinepi.2005.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2005] [Revised: 11/10/2005] [Accepted: 11/15/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare tracing and contact rates using alternative incentives in a computer-assisted telephone interview (CATI) survey among postpartum women. METHODS In a randomized trial of 1,061 postpartum women 18-49 years of age selected from four Iowa counties, we compared the effects of: (1) unconditional $5 telephone card incentive enclosed with the introductory letter followed by $25 incentive conditional upon successful telephone tracing, contact, and completion of CATI (Group 1, n = 530) vs. (2) $30 incentive conditional upon subject completion of CATI (Group 2, n = 531). RESULTS Overall telephone tracing and contact rates achieved were 67.8% and 66.6%, respectively. Tracing (70.2 vs. 65.4%, P = .09) and contact (68.5 vs. 64.8%, P = .26) rates were consistently higher among subjects assigned the combination of a conditional and an unconditional incentive. The combined incentive type had a greater impact on telephone tracing success rates for subjects on whom we could not initially locate an active telephone number (16.7 vs. 7.3%, P = .07) when compared to subjects for whom we found an active telephone number at the time of mailing the introductory letter (78.9 vs. 75.9%, P = .30). CONCLUSIONS Combining conditional and unconditional recruitment incentives can facilitate telephone tracing efforts in surveys conducted among recently postpartum women.
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Affiliation(s)
- Hind Beydoun
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, USA
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Abstract
OBJECTIVE We sought to systematically review the impact of immunogenetic factors, specifically human leukocyte antigen (HLA) allele frequencies, maternal homozygosity, couple sharing, and maternal-fetal sharing, on the risk of preeclampsia and intrauterine growth restriction. DATA SOURCES A computerized search of PubMed databases from 1975 to 2003 was performed with the terms "preeclampsia," "eclampsia," "intrauterine growth restriction," and "human leukocyte antigens" and limited to studies of human subjects in English. No restrictions were placed on study design. All bibliographies were cross-referenced to identify additional pertinent studies. METHODS OF STUDY SELECTION Titles and abstracts were reviewed carefully. Observational and basic science research studies were selected if their main objective was to assess the relationship of any aspect of HLA genotypes with preeclampsia and related disorders of pregnancy. TABULATION, INTEGRATION, AND RESULTS Data were abstracted and tabulated from 22 original research studies. Meta-analytic techniques were not performed owing to variations in disease and exposure definitions as well as research methodologies. Studies that examined maternal, paternal, and fetal HLA allele frequencies, maternal homozygosity, and couple sharing yielded inconsistent results. Although the cumulative evidence points to the HLA-DR locus (particularly DR4) as a correlate of preeclampsia, it remains unclear whether any specific HLA allele, haplotype, or susceptibility gene in linkage disequilibrium with the HLA region is responsible. Although genetic evidence is suggestive of gene-gene interaction between mother and fetus, few studies have evaluated the influence of maternal-fetal HLA sharing. CONCLUSION In the early 1990s, HLA genotypes were dismissed as possible etiologic factors for preeclampsia, based on studies that are heterogeneous with respect to study design, outcome, and exposure assessment. Many of these studies did not take into account the interactions between maternal, paternal, and infant genotypes. Thus, adequately powered studies designed specifically to assess the effect of maternal-fetal HLA sharing on risk of preeclampsia are needed.
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Affiliation(s)
- Audrey F Saftlas
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, 52242, USA.
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Abstract
An estimated 15% of clinically recognized pregnancies abort spontaneously. Recurrent spontaneous abortion (RSA) is defined as three or more consecutive miscarriages conceived with the same partner in the absence of uterine, genetic or autoimmune abnormalities. Evidence points to human leucocyte antigens (HLA) as playing a role in the successful development of the foetus. In particular, HLA compatibility is more prevalent in couples experiencing reproductive failure, especially RSA couples, compared to fertile couples. According to the immunological hypothesis, an adequate immune response is necessary for proper implantation of the embryo; conversely, a depressed response of maternal lymphocytes to the stimulation by paternal antigens because of HLA sharing can result in disorders, such as RSA. The genetic hypothesis implicates homozygosity for recessive lethal alleles in linkage disequilibrium with specific HLA haplotypes. The specificity of HLA alleles or haplotypes responsible for or linked to other RSA susceptibility genes remains unclear. In this study, we identified 40 observational studies (32 case-control, five cohort, one cross-sectional, one case series and one basic science) that examined the associations between HLA and RSA, focusing on HLA allele couple and maternal-foetal sharing, and the special role of HLA-G. We sought to identify consistent findings among studies examining similar questions. Evidence remains divided concerning the role of HLA allele couple sharing. Of major concern is the focus of many studies on couple sharing as a proxy measure of maternal-foetal sharing. Therefore, adequately powered studies are needed, which employ standard case definitions and reproducible methodologies to directly assess the role of maternal-foetal HLA sharing on the risk of RSA.
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Affiliation(s)
- H Beydoun
- Department of Epidemiology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
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Abstract
OBJECTIVE Existing studies relating asthma and preeclampsia provide conflicting results, perhaps due to differences in study populations, varying definitions of asthma, and inadequate control for confounding, particularly asthma medication use. This prospective study examines associations between aspects of asthma (diagnosis, severity, symptoms, and medication use) and risk of preeclampsia. METHODS A total of 1,708 pregnant women, of whom 656 had asthma diagnosis and 1,052 had no asthma diagnosis, were included in this analysis. Asthma symptoms, treatment, and severity were classified according to Global Initiative for Asthma guidelines. Hospital records were abstracted, and strict criteria were applied to classify women as preeclamptic based on National Heart, Lung, and Blood Institute guidelines. RESULTS There were 568 of 656 women with diagnosed asthma and 353 of 1,052 women without asthma diagnosis who had symptoms or took asthma medication during pregnancy. Separate adjusted logistic regression models were run for different measures of asthma status: 1) asthma diagnosis; 2) overall Global Initiative for Asthma severity; 3) Global Initiative for Asthma symptom and treatment steps; and 4) Global Initiative for Asthma symptom step and medication type. Women at increased risk of preeclampsia were those classified as Global Initiative for Asthma symptom step 3/4 compared with no symptoms (odds ratio 3.36, 95% confidence interval 1.24-9.14) and theophylline users (odds ratio 1.16 for every dose/month increase in use, 95% confidence interval 1.02-1.33). In contrast, neither a history of physician-diagnosed asthma nor Global Initiative for Asthma treatment step was associated with preeclampsia status. CONCLUSION Our findings suggest that women with moderate to severe asthma symptoms, regardless of asthma diagnosis or treatment, are at increased risk of preeclampsia compared with women with no symptoms.
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Affiliation(s)
- Elizabeth W Triche
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA.
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Saftlas AF, Waldschmidt M, Logsden-Sackett N, Triche E, Field E. Optimizing buccal cell DNA yields in mothers and infants for human leukocyte antigen genotyping. Am J Epidemiol 2004; 160:77-84. [PMID: 15229120 DOI: 10.1093/aje/kwh171] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Buccal cells provide a convenient source of DNA for epidemiologic studies. Mouthwash rinses yield a higher quality and quantity of DNA than cytobrushes but are not practical for collection from infants. Although cytobrushes yield sufficient DNA for most genotyping analyses, human leukocyte antigen (HLA) analysis can require 1,000-fold more DNA. In Iowa City, Iowa, in 2002, the authors tested two cytobrush collection methods to optimize total DNA yield and purity for HLA genotyping in mothers and infants: 1) brushing the left and right inner cheeks (standard method) and 2) brushing the upper and lower "gutters", that is, the space between the gums and the inner lips/cheeks along the front and sides of the mouth (test method). Storage and mailing experiments were performed to define conditions for optimizing DNA yield and purity. Mothers' gutter samples yielded significantly higher total amounts of DNA (mean yield = 15.0 micro g/two brushes) than cheek samples (mean yield = 7.6 micro g/two brushes) (paired t test: p < 0.001), while DNA yields from cheek and gutter collections from infants were equivalent. Cytobrushes stored and/or mailed in paper envelopes yielded significantly more and higher-purity DNA than brushes in plastic bags or tubes. Cytobrush sampling of the mouth's gutter areas can enhance DNA yield in mothers but not in young infants. DNA yields can be further optimized by controlling mailing and storage conditions.
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Affiliation(s)
- Audrey F Saftlas
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA 52242, USA.
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Saftlas AF, Levine RJ, Klebanoff MA, Martz KL, Ewell MG, Morris CD, Sibai BM. Abortion, changed paternity, and risk of preeclampsia in nulliparous women. Am J Epidemiol 2003; 157:1108-14. [PMID: 12796047 DOI: 10.1093/aje/kwg101] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A prior birth confers a strong protective effect against preeclampsia, whereas a prior abortion confers a weaker protective effect. Parous women who change partners in a subsequent pregnancy appear to lose the protective effect of a prior birth. This study (Calcium for Preeclampsia Prevention Trial, 1992-1995) examines whether nulliparous women with a prior abortion who change partners also lose the protective effect of the prior pregnancy. A cohort analysis was conducted among participants in this large clinical trial of calcium supplementation to prevent preeclampsia. Subjects were nulliparous, had one prior pregnancy or less, delivered after 20 weeks' gestation, and were interviewed at 5-21 weeks about prior pregnancies and paternity. Women without a history of abortion served as the reference group in logistic regression analyses. Women with a history of abortion who conceived again with the same partner had nearly half the risk of preeclampsia (adjusted odds ratio = 0.54, 95 percent confidence interval: 0.31, 0.97). In contrast, women with an abortion history who conceived with a new partner had the same risk of preeclampsia as women without a history of abortion (adjusted odds ratio = 1.03, 95 percent confidence interval: 0.72, 1.47). Thus, the protective effect of a prior abortion operated only among women who conceived again with the same partner. An immune-based etiologic mechanism is proposed, whereby prolonged exposure to fetal antigens from a previous pregnancy protects against preeclampsia in a subsequent pregnancy with the same father.
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Affiliation(s)
- Audrey F Saftlas
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA 52242, USA.
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Abstract
This study estimates the effect of maternal caffeine consumption throughout pregnancy on fetal growth. We studied 2,714 women who delivered a liveborn infant between 1988 and 1991. Detailed information regarding coffee, tea, and soda drinking during the first and third trimesters of pregnancy was obtained. Average caffeine intake during month 1 of pregnancy was higher than for month 7 (72.4 vs 54.0 mg per day). Consumption of >300 mg caffeine per day during month 1 (adjusted odds ratio = 0.91; 95% confidence interval = 0.44--1.90) and during month 7 (adjusted odds ratio = 1.00; 95% confidence interval = 0.37--2.70) was not associated with intrauterine growth retardation. There was little evidence for any effect modification due to cigarette smoking on the caffeine associations. This study provides evidence that antenatal caffeine consumption has no adverse effect on fetal growth.
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Affiliation(s)
- L M Grosso
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06520, USA
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Saftlas AF, Koonin LM, Atrash HK. Racial disparity in pregnancy-related mortality associated with livebirth: can established risk factors explain it? Am J Epidemiol 2000; 152:413-9. [PMID: 10981453 DOI: 10.1093/aje/152.5.413] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The authors conducted a nested case-control study to determine whether the fourfold increased risk of pregnancy-related mortality for US Black women compared with White women can be explained by racial differences in sociodemographic and reproductive factors. Cases were derived from a national surveillance database of pregnancy-related deaths and were restricted to White women (n = 840) and Black women (n = 448) whose pregnancies resulted in a livebirth and who died of a pregnancy-related cause between 1979 and 1986. Controls were derived from national natality data and were randomly selected White women and Black women who delivered live infants and did not die from a pregnancy-related cause (n = 5,437). Simultaneous adjustment for risk factors by using logistic regression did not explain the racial gap in pregnancy-related mortality. The largest racial disparity occurred among women with the lowest risk of pregnancy-related death: those of low to moderate parity who delivered normal-birth-weight babies (adjusted odds ratio = 3.53, 95% confidence interval: 2.9, 4.4). In contrast, no racial disparity was found among women with the highest risk of pregnancy-related death: high-parity women who delivered low-birth-weight babies. These findings indicate that reproductive health care professionals need to develop strategies to reduce pregnancy-related deaths among both high- and low-risk Black women.
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Affiliation(s)
- A F Saftlas
- Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, CT, USA.
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Abstract
We examined the effect of abortion type, number, and gestational age on the risk of preeclampsia and transient hypertension among women who received prenatal care from 13 obstetric practices in southern Connecticut between April 1988 and December 1991 (N = 2,739). Subjects were interviewed before 16 weeks' gestation regarding reproductive history and pregnancy-related risk factors. We estimated the risk of preeclampsia (N = 44) and transient hypertension (N = 172) among nulliparous women who had had one or more abortions, with nulliparous women with no abortion as the referent group. Similar effects were seen for one spontaneous or induced abortion, when analyzed separately. A single prior abortion was associated with a decreased risk of preeclampsia [odds ratio (OR) = 0.35; 95% exact confidence interval (CI) = 0.09-1.01]. One abortion had only a small association with risk of transient hypertension (OR = 1.09, 95% exact CI = 0.68-1.72); however, a history of two or more abortions was associated with a decreased risk (OR = 0.42, 95% exact CI = 0.16-0.94). Among nulliparous women with a history of one abortion, a decreased risk of both hypertensive disorders was observed among women whose aborted pregnancy ended at > or =3 months gestation. These findings suggest that a history of abortion in nulliparous women is a protective factor against the risk of preeclampsia in the subsequent pregnancy.
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Affiliation(s)
- J L Eras
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Abstract
OBJECTIVES This study examined absolute and proportional gestational weight gain and prepregnancy body mass index as predictors of primary cesarean delivery. METHODS Data were derived from a prospective study of pregnancy outcome risk factors in 2301 women in greater New Haven, Conn, who had singleton deliveries by primary cesarean (n = 312) or vaginal delivery (n = 1989) and for whom height, prepregnancy weight, and weight gain were available. Women were divided into 4 body mass index groups (underweight, low average, high average, and obese) and further subdivided into 8 groups according to median proportional or absolute weight gain. RESULTS Risk of cesarean delivery increased with increasing body mass index and gestational weight gain greater than the median for one's body mass index. Proportional weight gain was more predictive of cesarean delivery than absolute weight gain. Underweight women gaining more than 27.8% of their prepregnancy weight had a 2-fold adjusted relative risk of cesarean delivery. CONCLUSIONS Proportional weight gain is an important predictor of cesarean delivery for underweight women; high body mass index is also predictive of increased risk.
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Affiliation(s)
- M J Shepard
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn. 06520-8034, USA
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