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Meeker JD, McArthur KL, Adibi JJ, Alshawabkeh AN, Barrett ES, Brubaker SG, Cordero JF, Dabelea D, Dunlop AL, Herbstman JB, Kahn LG, Karr CJ, Mehta-Lee S, O'Connor TG, Sathyanarayana S, Trasande L, Kuiper JR. Urinary concentrations of phthalate metabolites in relation to preeclampsia and other hypertensive disorders of pregnancy in the environmental influences on child health outcomes (ECHO) program. Environ Int 2024; 187:108678. [PMID: 38696977 DOI: 10.1016/j.envint.2024.108678] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/01/2024] [Accepted: 04/17/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Phthalate exposure may contribute to hypertensive disorders of pregnancy (HDP), including preeclampsia/eclampsia (PE/E), but epidemiologic studies are lacking. OBJECTIVES To evaluate associations of pregnancy phthalate exposure with development of PE/E and HDP. METHODS Using data from 3,430 participants in eight Environmental influences on Child Health Outcomes (ECHO) Program cohorts (enrolled from 1999 to 2019), we quantified concentrations of 13 phthalate metabolites (8 measured in all cohorts, 13 in a subset of four cohorts) in urine samples collected at least once during pregnancy. We operationalized outcomes as PE/E and composite HDP (PE/E and/or gestational hypertension). After correcting phthalate metabolite concentrations for urinary dilution, we evaluated covariate-adjusted associations of individual phthalates with odds of PE/E or composite HDP via generalized estimating equations, and the phthalate mixture via quantile-based g-computation. We also explored effect measure modification by fetal sex using stratified models. Effect estimates are reported as odds ratios (OR) with 95% confidence intervals (95% CIs). RESULTS In adjusted analyses, a doubling of mono-benzyl phthalate (MBzP) and of mono (3-carboxypropyl) phthalate (MCPP) concentrations was associated with higher odds of PE/E as well as composite HDP, with somewhat larger associations for PE/E. For example, a doubling of MCPP was associated with 1.12 times the odds of PE/E (95%CI 1.00, 1.24) and 1.02 times the odds of composite HDP (95%CI 1.00, 1.05). A quartile increase in the phthalate mixture was associated with 1.27 times the odds of PE/E (95%CI 0.94, 1.70). A doubling of mono-carboxy isononyl phthalate (MCiNP) and of mono-carboxy isooctyl phthalate (MCiOP) concentrations were associated with 1.08 (95%CI 1.00, 1.17) and 1.11 (95%CI 1.03, 1.19) times the odds of PE/E. Effect estimates for PE/E were generally larger among pregnancies carrying female fetuses. DISCUSSION In this study, multiple phthalates were associated with higher odds of PE/E and HDP. Estimates were precise and some were low in magnitude. Interventions to reduce phthalate exposures during pregnancy may help mitigate risk of these conditions.
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Affiliation(s)
- John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Kristen L McArthur
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Jennifer J Adibi
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | | | - Emily S Barrett
- Department of Biostatistics and Epidemiology, Rutgers University School of Public Health, Environmental and Occupational Health Institute, Piscataway, NJ, USA.
| | - Sara G Brubaker
- Division of Maternal-Fetal Medicine, New York University Grossman School of Medicine, New York, NY, USA.
| | - Jose F Cordero
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens, GA, USA.
| | - Dana Dabelea
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Anne L Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Julie B Herbstman
- Department of Environmental Health Sciences, Columbia University, New York, NY, USA.
| | - Linda G Kahn
- Division of Environmental Pediatrics, New York University Grossman School of Medicine, New York, NY, USA.
| | - Catherine J Karr
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA.
| | - Shilpi Mehta-Lee
- Division of Maternal-Fetal Medicine, New York University Grossman School of Medicine, New York, NY, USA.
| | - Thomas G O'Connor
- Departments of Psychiatry, Neuroscience and Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA.
| | - Sheela Sathyanarayana
- Department of Pediatrics, Department of Environmental and Occupational Health Sciences, Department of Epidemiology University of Washington and Seattle Children's Research Institute, Seattle, WA, USA.
| | | | - Jordan R Kuiper
- Department of Environmental and Occupational Health, The George Washington University, Washington, D.C., USA.
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Towe-Goodman N, McArthur KL, Willoughby M, Swingler MM, Wychgram C, Just AC, Kloog I, Bennett DH, Berry D, Hazlehurst MF, James P, Jimenez MP, Lai JS, Leve LD, Gatzke-Kopp L, Schweitzer JB, Bekelman TA, Calub C, Carnell S, Deoni S, D’Sa V, Kelly C, Koinis-Mitchell D, Petriello M, Thapaliya G, Wright RJ, Zhang X, Kress AM. Green Space and Internalizing or Externalizing Symptoms Among Children. JAMA Netw Open 2024; 7:e245742. [PMID: 38598238 PMCID: PMC11007572 DOI: 10.1001/jamanetworkopen.2024.5742] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/08/2024] [Indexed: 04/11/2024] Open
Abstract
Importance Evidence suggests that living near green space supports mental health, but studies examining the association of green space with early mental health symptoms among children are rare. Objective To evaluate the association between residential green space and early internalizing (eg, anxiety and depression) and externalizing (eg, aggression and rule-breaking) symptoms. Design, Setting, and Participants Data for this cohort study were drawn from the Environmental Influences on Child Health Outcomes cohort; analysis was conducted from July to October 2023. Children born between 2007 and 2013 with outcome data in early (aged 2-5 years) and/or middle (aged 6-11 years) childhood who resided in 41 states across the US, drawing from clinic, hospital, and community-based cohorts, were included. Cohort sites were eligible if they recruited general population participants and if at least 30 children had outcome and residential address data to measure green space exposure. Nine cohorts with 13 sites met these criteria. Children diagnosed with autism or developmental delay were excluded, and 1 child per family was included. Exposures Green space exposure was measured using a biannual (ie, summer and winter) Normalized Difference Vegetation Index, a satellite image-based indicator of vegetation density assigned to monthly residential history from birth to outcome assessment. Main Outcome and Measures Child internalizing and externalizing symptoms were assessed using the Child Behavior Checklist for Ages 1½ to 5 or 6 to 18. The association between green space and internalizing and externalizing symptoms was modeled with multivariable linear regression using generalized estimating equations, adjusting for birthing parent educational level, age at delivery, child sex, prematurity, and neighborhood socioeconomic vulnerability. Models were estimated separately for early and middle childhood samples. Results Among 2103 children included, 1061 (50.5%) were male; 606 (29.1%) identified as Black, 1094 (52.5%) as White, 248 (11.9%) as multiple races, and 137 (6.6%) as other races. Outcomes were assessed at mean (SD) ages of 4.2 (0.6) years in 1469 children aged 2 to 5 years and 7.8 (1.6) years in 1173 children aged 6 to 11 years. Greater green space exposure was associated with fewer early childhood internalizing symptoms in fully adjusted models (b = -1.29; 95% CI, -1.62 to -0.97). No associations were observed between residential green space and internalizing or externalizing symptoms in middle childhood. Conclusions and Relevance In this study of residential green space and children's mental health, the association of green space with fewer internalizing symptoms was observed only in early childhood, suggesting a sensitive period for nature exposure. Policies protecting and promoting access to green space may help alleviate early mental health risk.
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Affiliation(s)
- Nissa Towe-Goodman
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill
| | - Kristen L. McArthur
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Michael Willoughby
- Education and Workforce Development, RTI International, Research Triangle Park, North Carolina
| | - Margaret M. Swingler
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill
| | - Cara Wychgram
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Allan C. Just
- Department of Epidemiology, Institute at Brown for Environment and Society, Brown University, Providence, Rhode Island
| | - Itai Kloog
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Deborah H. Bennett
- Department of Public Health Sciences, University of California, Davis, Sacramento
| | - Daniel Berry
- Institute of Child Development, University of Minnesota, Minneapolis
| | - Marnie F. Hazlehurst
- Department of Environmental & Occupational Health Sciences, School of Public Health, University of Washington, Seattle
| | - Peter James
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health, Boston, Massachusetts
| | - Marcia Pescador Jimenez
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Jin-Shei Lai
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Leslie D. Leve
- Prevention Science Institute, University of Oregon, Eugene
| | - Lisa Gatzke-Kopp
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park
| | - Julie B. Schweitzer
- Department of Public Health Sciences, University of California, Davis, Sacramento
| | - Traci A. Bekelman
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora
| | - Catrina Calub
- Department of Public Health Sciences, University of California, Davis, Sacramento
| | - Susan Carnell
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Sean Deoni
- Maternal, Newborn, and Child Health Discovery & Tools, Bill & Melinda Gates Foundation, Seattle, Washington
| | - Viren D’Sa
- Department of Pediatrics, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Carrie Kelly
- Department of Pediatrics, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Daphne Koinis-Mitchell
- Department of Pediatrics, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Michael Petriello
- Institute of Environmental Health Sciences, Department of Pharmacology, Wayne State University, Detroit, Michigan
| | - Gita Thapaliya
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Rosalind J. Wright
- Department of Epidemiology, Institute at Brown for Environment and Society, Brown University, Providence, Rhode Island
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Xueying Zhang
- Education and Workforce Development, RTI International, Research Triangle Park, North Carolina
| | - Amii M. Kress
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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McArthur KL, Zhang M, Hong X, Wang G, Buckley JP, Wang X, Mueller NT. Trimethylamine N-Oxide and Its Precursors Are Associated with Gestational Diabetes Mellitus and Pre-Eclampsia in the Boston Birth Cohort. Curr Dev Nutr 2022; 6:nzac108. [PMID: 35949367 PMCID: PMC9356535 DOI: 10.1093/cdn/nzac108] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/14/2022] [Accepted: 06/08/2022] [Indexed: 12/01/2022] Open
Abstract
Background Trimethylamine N-oxide (TMAO) and its precursors choline, betaine, and carnitine have been associated with cardiometabolic disease in nonpregnant adults. However, studies examining TMAO and its precursors in relation to cardiometabolic conditions during pregnancy are lacking. Objectives The primary objective was to estimate the association of TMAO and its precursors in maternal and cord plasma with gestational diabetes mellitus (GDM) and pre-eclampsia (PE) among women in the Boston Birth Cohort. A secondary objective was to determine whether associations vary by race/ethnicity. Methods ORs for each outcome according to tertiles and to an SD increment of TMAO, choline, betaine, and carnitine were estimated using logistic regression. Final models were adjusted for covariates. Results Among 1496 women, 115 women had GDM and 159 had PE during the index pregnancy. Intermetabolite correlations of TMAO and its precursors were stronger within cord plasma (r = 0.38-0.87) than within maternal plasma (r = 0.08-0.62). Maternal TMAO was associated with higher odds of GDM (third compared with first tertile OR: 1.75; 95% CI: 1.04, 2.94), whereas maternal choline, betaine, and carnitine were not associated with GDM. Maternal TMAO and choline were not associated with PE, whereas carnitine was associated with higher (OR: 1.86; 95% CI: 1.18, 2.94) and betaine with lower odds of PE (OR: 0.37; 95% CI: 0.23, 0.59). In cord plasma, TMAO was not associated with GDM or PE, but choline, betaine, and carnitine were associated with higher odds of PE (OR: 3.11; 95% CI: 1.62, 5.96; OR: 2.65; 95% CI: 1.42, 4.93; OR: 2.56; 95% CI: 1.39, 4.69, respectively). Cord choline was associated with lower odds of GDM (OR: 0.52; 95% CI: 0.27, 0.99), whereas other cord metabolites were not significantly associated with GDM. Associations did not vary by race/ethnicity. Conclusions TMAO and its precursors were associated with GDM and PE, but the associations differed based on the metabolite medium (maternal compared with cord plasma).This trial was registered at clinicaltrials.gov as NCT03228875.
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Affiliation(s)
- Kristen L McArthur
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mingyu Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Xiumei Hong
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Guoying Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessie P Buckley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Noel T Mueller
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
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McArthur KL, Zhang M, Hong X, Wang G, Wang X, Mueller NT. Abstract MP47: Maternal Trimethylamine-n-oxide Is Associated With Risk Of Gestational Diabetes Mellitus In A Low-income, Urban, Multi-ethnic Population. Circulation 2021. [DOI: 10.1161/circ.143.suppl_1.mp47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Trimethylamine-N-oxide (TMAO) is a metabolite influenced by gut microbiota composition and diet (e.g. eggs and red meat). While TMAO has been associated with type 2 diabetes in adults, it is still unclear whether TMAO is associated with risk of gestational diabetes (GDM). Results from the two case-control studies conducted on this topic in China were mixed, with one showing a U-shaped association and the other showing a linear association between TMAO and GDM. There is need to examine this association in a distinct population, in which the sources of TMAO may vary.
Hypothesis:
We hypothesized that higher TMAO concentration in both maternal and umbilical cord blood plasma (collected within 24-72 hours of birth) is associated with higher odds of GDM.
Methods:
We used data from the women in the Boston Birth Cohort (enrolled from 1998 to 2013) and fitted logistic regression models to examine the association of maternal and cord blood TMAO concentration with odds of GDM. TMAO was inversely normalized and was modeled in tertiles and as a continuous variable. GDM was diagnosed by a physician; women with pre-pregnancy diabetes were excluded from analyses. Final models were adjusted for covariates (see Table footnote).
Results:
Among our analytic sample (n=1405 participants), 1248 contributed maternal blood and 865 contributed cord blood. A total of 123 women developed GDM. Before and after adjustment for covariates, higher concentration of TMAO in maternal blood was associated with higher odds of GDM. After adjustment for potential confounders, the highest vs. lowest tertile of TMAO was associated with 1.75 times (95% CI 1.04, 2.96) the odds of GDM (Table). We found no association between cord blood TMAO and GDM (Table).
Conclusion:
In a population of predominantly low-income, urban mothers, higher maternal TMAO concentration measured in maternal blood (but not cord), was associated with higher odds of GDM. Our findings need to be replicated in prospective cohort studies that measure TMAO in early pregnancy.
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McArthur KL, Zakir M, Haque A, Dickman JD. Spatial and temporal characteristics of vestibular convergence. Neuroscience 2011; 192:361-71. [PMID: 21756981 DOI: 10.1016/j.neuroscience.2011.06.070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 06/22/2011] [Accepted: 06/23/2011] [Indexed: 11/24/2022]
Abstract
In all species studied, afferents from semicircular canals and otolith organs converge on central neurons in the brainstem. However, the spatial and temporal relationships between converging inputs and how these contribute to vestibular behaviors is not well understood. In the current study, we used discrete rotational and translational motion stimuli to characterize canal- and otolith-driven response components of convergent non-eye movement (NEM) neurons in the vestibular nuclear complex of alert pigeons. When compared to afferent responses, convergent canal signals had similar gain and phase ranges but exhibited greater spatial variability in their axes of preferred rotation. Convergent otolith signals also had similar mean gain and phase values to the afferent population but were spatially well-matched with the corresponding canal signals, cell-by-cell. However, neither response component alone nor a simple linear combination of these components was sufficient to predict actual net responses during combined canal-otolith stimulation. We discuss these findings in the context of previous studies of pigeon vestibular behaviors, and we compare our findings to similar studies in other species.
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Affiliation(s)
- K L McArthur
- Department of Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, MO, USA
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