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Liang HW, Koistinen H, Barrett ES, Xun X, Yin Q, Kannan K, Moog NK, Ng C, O’Connor TG, Miller R, Adibi JJ. Associations of Serum Perfluoroalkyl Substances and Placental Human Chorionic Gonadotropin in Early Pregnancy, Measured in the UPSIDE Study in Rochester, New York. Environ Health Perspect 2024; 132:47008. [PMID: 38625811 PMCID: PMC11020022 DOI: 10.1289/ehp12950] [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] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 02/23/2024] [Accepted: 03/18/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) are widely detected in pregnant women and associated with adverse outcomes related to impaired placental function. Human chorionic gonadotropin (hCG) is a dimeric glycoprotein hormone that can indicate placental toxicity. OBJECTIVES Our aim was to quantify the association of serum PFAS with placental hCG, measured as an intact molecule (hCG), as free alpha-(hCG α ) and beta-subunits (hCG β ), and as a hyperglycosylated form (h-hCG), and evaluate effect measure modification by social determinants and by fetal sex. METHODS Data were collected from 326 pregnant women enrolled from 2015 to 2019 in the UPSIDE study in Rochester, New York. hCG forms were normalized for gestational age at the time of blood draw in the first trimester [multiple of the median (MoM)]. Seven PFAS were measured in second-trimester maternal serum. Multivariate imputation by chained equations and inverse probability weighting were used to evaluate robustness of linear associations. PFAS mixture effects were estimated by Bayesian kernel machine regression. RESULTS Perfluorohexane sulfonic acid (PFHxS) [hCG β : 0.29 log MoM units per log PFHxS; 95% confidence interval (CI): 0.08, 0.51] and perfluorodecanoic acid (PFDA) (hCG: - 0.09 ; 95% CI: - 0.16 , - 0.02 ) were associated with hCG in the single chemical and mixture analyses. The PFAS mixture was negatively associated with hCG α and positively with hCG β . Subgroup analyses revealed that PFAS associations with hCG differed by maternal race/ethnicity and education. Perfluoropentanoic acid (PFPeA) was associated with hCG β only in Black participants (- 0.23 ; 95% CI: - 0.37 , - 0.09 ) and in participants with high school education or less (- 0.14 ; 95% CI: - 0.26 , - 0.02 ); conversely, perfluorononanoic acid (PFNA) was negatively associated with hCG α only in White participants (- 0.15 ; 95% CI: - 0.27 , - 0.03 ) and with hCG β only in participants with a college education or greater (- 0.19 ; 95% CI: - 0.36 , - 0.01 ). These findings were robust to testing for selection bias, confounding bias, and left truncation bias where PFAS detection frequency was < 100 % . Two associations were negative in male (and null in female) pregnancies: Perfluoroundecanoic acid (PFUnDA) with hCG α , and PFNA with h-hCG. CONCLUSIONS Evidence was strongest for the association between PFHxS and PFDA with hCG in all participants and for PFPeA and PFNA within subgroups defined by social determinants and fetal sex. PFAS mixture associations with hCG α and hCG β differed, suggesting subunit-specific types of toxicity and/or regulation. Future studies will evaluate the biological, clinical and public health significance of these findings. https://doi.org/10.1289/EHP12950.
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Affiliation(s)
- Hai-Wei Liang
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Hannu Koistinen
- Department of Clinical Chemistry and Haematology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Emily S. Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York, USA
| | - Xiaoshuang Xun
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Qing Yin
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Kurunthachalam Kannan
- Department of Pediatrics, New York University, New York, USA
- Department of Environmental Medicine, New York University, New York, USA
| | - Nora K. Moog
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany
| | - Carla Ng
- Department of Civil and Environmental Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Thomas G. O’Connor
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, New York, USA
| | - Rich Miller
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jennifer J. Adibi
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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2
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Oken E, Musci RJ, Westlake M, Gachigi K, Aschner JL, Barnes KL, Bastain TM, Buss C, Camargo CA, Cordero JF, Dabelea D, Dunlop AL, Ghassabian A, Hipwell AE, Hockett CW, Karagas MR, Lugo-Candelas C, Margolis AE, O’Connor TG, Shuster CL, Straughen JK, Lyall K. Demographic and health characteristics associated with fish and n-3 fatty acid supplement intake during pregnancy: results from pregnancy cohorts in the ECHO programme. Public Health Nutr 2024; 27:e94. [PMID: 38410088 PMCID: PMC10993063 DOI: 10.1017/s136898002400051x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/30/2023] [Revised: 01/16/2024] [Accepted: 02/13/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE n-3 fatty acid consumption during pregnancy is recommended for optimal pregnancy outcomes and offspring health. We examined characteristics associated with self-reported fish or n-3 supplement intake. DESIGN Pooled pregnancy cohort studies. SETTING Cohorts participating in the Environmental influences on Child Health Outcomes (ECHO) consortium with births from 1999 to 2020. PARTICIPANTS A total of 10 800 pregnant women in twenty-three cohorts with food frequency data on fish consumption; 12 646 from thirty-five cohorts with information on supplement use. RESULTS Overall, 24·6 % reported consuming fish never or less than once per month, 40·1 % less than once a week, 22·1 % 1-2 times per week and 13·2 % more than twice per week. The relative risk (RR) of ever (v. never) consuming fish was higher in participants who were older (1·14, 95 % CI 1·10, 1·18 for 35-40 v. <29 years), were other than non-Hispanic White (1·13, 95 % CI 1·08, 1·18 for non-Hispanic Black; 1·05, 95 % CI 1·01, 1·10 for non-Hispanic Asian; 1·06, 95 % CI 1·02, 1·10 for Hispanic) or used tobacco (1·04, 95 % CI 1·01, 1·08). The RR was lower in those with overweight v. healthy weight (0·97, 95 % CI 0·95, 1·0). Only 16·2 % reported n-3 supplement use, which was more common among individuals with a higher age and education, a lower BMI, and fish consumption (RR 1·5, 95 % CI 1·23, 1·82 for twice-weekly v. never). CONCLUSIONS One-quarter of participants in this large nationwide dataset rarely or never consumed fish during pregnancy, and n-3 supplement use was uncommon, even among those who did not consume fish.
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Affiliation(s)
- Emily Oken
- Division of Chronic Disease research across the Lifecourse, Department of
Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care
Institute, 401 Park Drive, Suite 401 East, Boston,
MA, USA
| | - Rashelle J Musci
- Department of Mental Health, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD,
USA
| | | | - Kennedy Gachigi
- Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, USA
| | - Judy L Aschner
- Department of Pediatrics, Joseph M. Sanzari Children’s Hospital,
Hackensack Meridian School of Medicine, Nutley,
NJ, USA
- Albert Einstein College of Medicine, Bronx,
NY, USA
| | | | - Theresa M Bastain
- Department of Population and Public Health Sciences,
University of Southern California, Los Angeles,
CA, USA
| | - Claudia Buss
- Department of Medical Psychology, Charité University of
Medicine Berlin, Berlin, Germany
- Development, Health, Disease Research Program, University of
California Irvine, Irvine, CA,
USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital,
Harvard Medical School, Boston, MA,
USA
| | - Jose F Cordero
- Department of Epidemiology and Biostatistics, College of Public Health,
University of Georgia, Athens, GA,
USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center,
University of Colorado Anschutz Medical Campus,
Aurora, CO, USA
| | - Anne L Dunlop
- Department of Gynecology & Obstetrics, Emory University
School of Medicine, Atlanta, GA,
USA
| | - Akhgar Ghassabian
- Department of Pediatrics, New York University Grossman
School of Medicine, New York, NY,
USA
| | - Alison E Hipwell
- Department of Psychiatry, University of
Pittsburgh, Pittsburgh, PA,
USA
| | | | - Margaret R Karagas
- Department of Epidemiology, Geisel School of Medicine at
Dartmouth, Lebanon, NH, USA
| | | | - Amy E Margolis
- Columbia University Irving Medical center, New York,
NY, USA
| | - Thomas G O’Connor
- Departments of Psychiatry, Psychology, Neuroscience, Obstetrics and
Gynecology, University of Rochester, Rochester,
NY, USA
| | - Coral L Shuster
- Brown Center for the Study of Children at Risk, Women and
Infants Hospital, Providence, RI,
USA
| | - Jennifer K Straughen
- Department of Public Health Sciences, Henry Ford Health
System, Detroit, MI, USA
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3
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Bragg MG, Westlake M, Alshawabkeh AN, Bekelman TA, Camargo CA, Catellier DJ, Comstock SS, Dabelea D, Dunlop AL, Hedderson MM, Hockett CW, Karagas MR, Keenan K, Kelly NR, Kerver JM, MacKenzie D, Mahabir S, Maldonado LE, McCormack LA, Melough MM, Mueller NT, Nelson ME, O’Connor TG, Oken E, O’Shea TM, Switkowski KM, Sauder KA, Wright RJ, Wright RO, Zhang X, Zhu Y, Lyall K. Opportunities for Examining Child Health Impacts of Early-Life Nutrition in the ECHO Program: Maternal and Child Dietary Intake Data from Pregnancy to Adolescence. Curr Dev Nutr 2023; 7:102019. [PMID: 38035205 PMCID: PMC10681943 DOI: 10.1016/j.cdnut.2023.102019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/22/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 12/02/2023] Open
Abstract
Background Longitudinal measures of diet spanning pregnancy through adolescence are needed from a large, diverse sample to advance research on the effect of early-life nutrition on child health. The Environmental influences on Child Health Outcomes (ECHO) Program, which includes 69 cohorts, >33,000 pregnancies, and >31,000 children in its first 7-y cycle, provides such data, now publicly available. Objectives This study aimed to describe dietary intake data available in the ECHO Program as of 31 August, 2022 (end of year 6 of Cycle 1) from pregnancy through adolescence, including estimated sample sizes, and to highlight the potential for future analyses of nutrition and child health. Methods We identified and categorized ECHO Program dietary intake data, by assessment method, participant (pregnant person or child), and life stage of data collection. We calculated the number of maternal-child dyads with dietary data and the number of participants with repeated measures. We identified diet-related variables derived from raw dietary intake data and nutrient biomarkers measured from biospecimens. Results Overall, 66 cohorts (26,941 pregnancies, 27,103 children, including 22,712 dyads) across 34 US states/territories provided dietary intake data. Dietary intake assessments included 24-h recalls (1548 pregnancies and 1457 children), food frequency questionnaires (4902 and 4117), dietary screeners (8816 and 23,626), and dietary supplement use questionnaires (24,798 and 26,513). Repeated measures were available for ∼70%, ∼30%, and ∼15% of participants with 24-h recalls, food frequency questionnaires, and dietary screeners, respectively. The available diet-related variables describe nutrient and food intake, diet patterns, and breastfeeding practices. Overall, 17% of participants with dietary intake data had measured nutrient biomarkers. Conclusions ECHO cohorts have collected longitudinal dietary intake data spanning pregnancy through adolescence from a geographically, socioeconomically, and ethnically diverse US sample. As data collection continues in Cycle 2, these data present an opportunity to advance the field of nutrition and child health.
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Affiliation(s)
- Megan G. Bragg
- AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, United States
| | - Matt Westlake
- RTI International, Research Triangle Park, NC, United States
| | | | - Traci A. Bekelman
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Carlos A. Camargo
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | | | - Sarah S. Comstock
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, United States
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Anne L. Dunlop
- Department of Gynecology & Obstetrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Monique M. Hedderson
- Kaiser Permanente Northern California Division of Research, Oakland, CA, United States
| | - Christine W. Hockett
- Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States
| | - Margaret R. Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Kate Keenan
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, United States
| | - Nichole R. Kelly
- Department of Counseling Psychology and Human Services, College of Education, University of Oregon, Eugene, OR, United States
| | - Jean M. Kerver
- Departments of Epidemiology & Biostatistics and Pediatrics & Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Debra MacKenzie
- Community Environmental Health Program, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Somdat Mahabir
- National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Luis E. Maldonado
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Lacey A. McCormack
- Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States
| | - Melissa M. Melough
- Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, DE, United States
- Department of Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Noel T. Mueller
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | | | - Thomas G. O’Connor
- Departments of Psychiatry, Neuroscience, Obstetrics and Gynecology, University of Rochester, Rochester, NY, United States
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - T Michael O’Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Karen M. Switkowski
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - Katherine A. Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Rosalind J. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Robert O. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Xueying Zhang
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Yeyi Zhu
- Kaiser Permanente Northern California Division of Research, Oakland, CA, United States
| | - Kristen Lyall
- AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, United States
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4
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Shuffrey LC, Morales S, Jacobson MH, Enlow MB, Ghassabian A, Margolis AE, Lucchini M, Carroll KN, Crum RM, Dabelea D, Deutsch A, Fifer WP, Goldson B, Hockett CW, Mason WA, Jacobson LT, O’Connor TG, Pini N, Rayport Y, Sania A, Trasande L, Wright RJ, Lee S, Monk C. Association of Gestational Diabetes Mellitus and Perinatal Maternal Depression with Early Childhood Behavioral Problems: An Environmental Influences on Child Health Outcomes (ECHO) Study. Child Dev 2023; 94:1595-1609. [PMID: 37132048 PMCID: PMC10620104 DOI: 10.1111/cdev.13938] [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] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 03/16/2023] [Accepted: 03/31/2023] [Indexed: 05/04/2023]
Abstract
This study examined the association of gestational diabetes mellitus (GDM), prenatal, and postnatal maternal depressive symptoms with externalizing, internalizing, and autism spectrum problems on the Preschool Child Behavior Checklist in 2379 children aged 4.12 ± 0.60 (48% female; 47% White, 32% Black, 15% Mixed Race, 4% Asian, <2% American Indian/Alaskan Native, <2% Native Hawaiian; 23% Hispanic). Data were collected from the NIH Environmental influences on Child Health Outcomes (ECHO) Program from 2009-2021. GDM, prenatal, and postnatal maternal depressive symptoms were each associated with increased child externalizing and internalizing problems. GDM was associated with increased autism behaviors only among children exposed to perinatal maternal depressive symptoms above the median level. Stratified analyses revealed a relation between GDM and child outcomes in males only.
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Affiliation(s)
- Lauren C. Shuffrey
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Santiago Morales
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Melanie H. Jacobson
- Department of Pediatrics, Division of Environmental Pediatrics, New York University School of Medicine, New York, New York, USA
| | - Michelle Bosquet Enlow
- Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Akhgar Ghassabian
- Department of Pediatrics, New York University School of Medicine, New York, New York, USA
| | - Amy E. Margolis
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Maristella Lucchini
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Kecia N. Carroll
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rosa M. Crum
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - William P. Fifer
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- Division of Developmental Neuroscience, New York State Psychiatric Institute
| | - Brandon Goldson
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christine W. Hockett
- Avera Research Institute; Sioux Falls, South Dakota, USA
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, South Dakota, USA
| | - W. Alex Mason
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Lisette T. Jacobson
- Department of Population Health, Department of Obstetrics & Gynecology, University of Kansas School of Medicine, Wichita, Kansas, USA
| | - Thomas G O’Connor
- Departments of Psychiatry, Psychology, Neuroscience, and Obstetrics and Gynecology, University of Rochester, Rochester, New York, USA
| | - Nicolò Pini
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Yael Rayport
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Ayesha Sania
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Leonardo Trasande
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, USA
| | | | - Seonjoo Lee
- Mailman School of Public Health, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Catherine Monk
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- Departments of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
- Division of Behavioral Medicine, New York State Psychiatric Institute, New York, New York, USA
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5
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Blackwell CK, Sherlock P, Jackson KL, Hofheimer JA, Cella D, Algermissen MA, Alshawabkeh AN, Avalos LA, Bastain T, Blair C, Enlow MB, Brennan PA, Breton C, Bush NR, Chandran A, Collazo S, Conradt E, Crowell SE, Deoni S, Elliott AJ, Frazier JA, Ganiban JM, Gold DR, Herbstman JB, Joseph C, Karagas MR, Lester B, Lasky-Su JA, Leve LD, LeWinn KZ, Mason WA, McGowan EC, McKee KS, Miller RL, Neiderhiser JM, O’Connor TG, Oken E, O’Shea TM, Pagliaccio D, Schmidt RJ, Singh AM, Stanford JB, Trasande L, Wright RJ, Duarte CS, Margolis AE. Development and psychometric validation of the Pandemic-Related Traumatic Stress Scale for children and adults. Psychol Assess 2023; 35:1054-1067. [PMID: 37902671 PMCID: PMC10773574 DOI: 10.1037/pas0001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 10/31/2023]
Abstract
To assess the public health impact of the COVID-19 pandemic on mental health, investigators from the National Institutes of Health Environmental influences on Child Health Outcomes (ECHO) research program developed the Pandemic-Related Traumatic Stress Scale (PTSS). Based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) acute stress disorder symptom criteria, the PTSS is designed for adolescent (13-21 years) and adult self-report and caregiver-report on 3-12-year-olds. To evaluate psychometric properties, we used PTSS data collected between April 2020 and August 2021 from non-pregnant adult caregivers (n = 11,483), pregnant/postpartum individuals (n = 1,656), adolescents (n = 1,795), and caregivers reporting on 3-12-year-olds (n = 2,896). We used Mokken scale analysis to examine unidimensionality and reliability, Pearson correlations to evaluate relationships with other relevant variables, and analyses of variance to identify regional, age, and sex differences. Mokken analysis resulted in a moderately strong, unidimensional scale that retained nine of the original 10 items. We detected small to moderate positive associations with depression, anxiety, and general stress, and negative associations with life satisfaction. Adult caregivers had the highest PTSS scores, followed by adolescents, pregnant/postpartum individuals, and children. Caregivers of younger children, females, and older youth had higher PTSS scores compared to caregivers of older children, males, and younger youth, respectively. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Courtney K. Blackwell
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Phillip Sherlock
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Kathryn L. Jackson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Julie A. Hofheimer
- Department of Pediatrics, University of North Carolina School of Medicine
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | | | - Akram N. Alshawabkeh
- Department of Civil and Environmental Engineering, College of Engineering, Northeastern University
| | - Lyndsay A. Avalos
- Kaiser Permanente North California, Division of Research, Oakland, California, United States
| | - Tracy Bastain
- Clinical Population and Public Health Sciences, Keck School of Medicine of the University of Southern California
| | - Clancy Blair
- New York University Grossman School of Medicine
- Department of Population Health, New York University Grossman School of Medicine
| | - Michelle Bosquet Enlow
- Boston Children’s Hospital, Boston, Massachusetts, United States
- Department of Psychiatry, Harvard Medical School
| | | | - Carrie Breton
- Clinical Population and Public Health Sciences, Keck School of Medicine of the University of Southern California
| | - Nicole R. Bush
- Department of Psychiatry, University of California, San Francisco
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
| | - Shaina Collazo
- Icahn School of Medicine at Mount Sinai
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai
| | | | | | - Sean Deoni
- Bill and Melinda Gates Foundation, Seattle, Washington, United States
| | - Amy J. Elliott
- Avera Research Institute, Sioux Falls, South Dakota, United States
- Department of Pediatrics, University of South Dakota School of Medicine
| | - Jean A. Frazier
- Department of Psychiatry, University of Massachusetts Chan Medical School
| | - Jody M. Ganiban
- Department of Clinical/Developmental Psychology, George Washington University
| | - Diane R. Gold
- Department of Psychiatry, Harvard Medical School
- Department of Medicine, Harvard Medical School
- Harvard University T.H. Chan School of Public Health
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health
- Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Julie B. Herbstman
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health
| | | | | | - Barry Lester
- Women & Infants Hospital, Providence, Rhode Island, United States
- Department of Psychiatry and Human Behavior, Brown University
- Department of Pediatrics, Brown University
| | - Jessica A. Lasky-Su
- Department of Psychiatry, Harvard Medical School
- Department of Medicine, Harvard Medical School
- Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Leslie D. Leve
- Department of Counseling Psychology and Human Services, University of Oregon College of Education
| | - Kaja Z. LeWinn
- Department of Psychiatry, University of California, San Francisco
| | - W. Alex Mason
- Department of Child, Youth, and Family Studies, College of Education and Human Sciences, University of Nebraska—Lincoln
| | - Elisabeth C. McGowan
- Women & Infants Hospital, Providence, Rhode Island, United States
- Department of Pediatrics, Brown University
| | - Kimberly S. McKee
- Department of Family Medicine, University of Michigan Medical School
| | - Rachel L. Miller
- Icahn School of Medicine at Mount Sinai
- Department of Medicine, Icahn School of Medicine at Mount Sinai
| | | | | | - Emily Oken
- Department of Psychiatry, Harvard Medical School
- Harvard University T.H. Chan School of Public Health
- Brigham and Women’s Hospital, Boston, Massachusetts, United States
- Department of Population Medicine, Harvard Medical School
- Department of Nutrition, Harvard University T.H. Chan School of Public Health
- Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
| | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina School of Medicine
| | - David Pagliaccio
- Columbia University Irving Medical Center
- New York State Psychiatric Institute, New York, New York, United States
| | - Rebecca J. Schmidt
- Department of Public Health Services, University of California—Davis School of Medicine
| | - Anne Marie Singh
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health
| | - Joseph B. Stanford
- Department of Family and Preventative Medicine, University of Utah School of Medicine
| | - Leonardo Trasande
- New York University Grossman School of Medicine
- Department of Pediatrics, New York University Grossman School of Medicine
| | - Rosalind J. Wright
- Icahn School of Medicine at Mount Sinai
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai
| | - Cristiane S. Duarte
- Columbia University Irving Medical Center
- Department of Psychiatry, Columbia University
| | - Amy E. Margolis
- Columbia University Irving Medical Center
- Department of Psychiatry, Columbia University
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6
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Aris IM, Perng W, Dabelea D, Padula AM, Alshawabkeh A, Vélez-Vega CM, Aschner JL, Camargo CA, Sussman TJ, Dunlop AL, Elliott AJ, Ferrara A, Joseph CLM, Singh AM, Breton CV, Hartert T, Cacho F, Karagas MR, Lester BM, Kelly NR, Ganiban JM, Chu SH, O’Connor TG, Fry RC, Norman G, Trasande L, Restrepo B, Gold DR, James P, Oken E. Neighborhood Opportunity and Vulnerability and Incident Asthma Among Children. JAMA Pediatr 2023; 177:1055-1064. [PMID: 37639269 PMCID: PMC10463174 DOI: 10.1001/jamapediatrics.2023.3133] [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: 06/05/2023] [Accepted: 06/29/2023] [Indexed: 08/29/2023]
Abstract
Background The extent to which physical and social attributes of neighborhoods play a role in childhood asthma remains understudied. Objective To examine associations of neighborhood-level opportunity and social vulnerability measures with childhood asthma incidence. Design, Setting, and Participants This cohort study used data from children in 46 cohorts participating in the Environmental Influences on Child Health Outcomes (ECHO) Program between January 1, 1995, and August 31, 2022. Participant inclusion required at least 1 geocoded residential address from birth and parent or caregiver report of a physician's diagnosis of asthma. Participants were followed up to the date of asthma diagnosis, date of last visit or loss to follow-up, or age 20 years. Exposures Census tract-level Child Opportunity Index (COI) and Social Vulnerability Index (SVI) at birth, infancy, or early childhood, grouped into very low (<20th percentile), low (20th to <40th percentile), moderate (40th to <60th percentile), high (60th to <80th percentile), or very high (≥80th percentile) COI or SVI. Main Outcomes and Measures The main outcome was parent or caregiver report of a physician's diagnosis of childhood asthma (yes or no). Poisson regression models estimated asthma incidence rate ratios (IRRs) associated with COI and SVI scores at each life stage. Results The study included 10 516 children (median age at follow-up, 9.1 years [IQR, 7.0-11.6 years]; 52.2% male), of whom 20.6% lived in neighborhoods with very high COI and very low SVI. The overall asthma incidence rate was 23.3 cases per 1000 child-years (median age at asthma diagnosis, 6.6 years [IQR, 4.1-9.9 years]). High and very high (vs very low) COI at birth, infancy, or early childhood were associated with lower subsequent asthma incidence independent of sociodemographic characteristics, parental asthma history, and parity. For example, compared with very low COI, the adjusted IRR for asthma was 0.87 (95% CI, 0.75-1.00) for high COI at birth and 0.83 (95% CI, 0.71-0.98) for very high COI at birth. These associations appeared to be attributable to the health and environmental and the social and economic domains of the COI. The SVI during early life was not significantly associated with asthma incidence. For example, compared with a very high SVI, the adjusted IRR for asthma was 0.88 (95% CI, 0.75-1.02) for low SVI at birth and 0.89 (95% CI, 0.76-1.03) for very low SVI at birth. Conclusions In this cohort study, high and very high neighborhood opportunity during early life compared with very low neighborhood opportunity were associated with lower childhood asthma incidence. These findings suggest the need for future studies examining whether investing in health and environmental or social and economic resources in early life would promote health equity in pediatric asthma.
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Affiliation(s)
- Izzuddin M. Aris
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Wei Perng
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
| | - Amy M. Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Akram Alshawabkeh
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts
| | - Carmen M. Vélez-Vega
- University of Puerto Rico (UPR) Graduate School of Public Health, UPR Medical Sciences Campus, San Juan, Puerto Rico
| | - Judy L. Aschner
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, New Jersey
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Carlos A. Camargo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Tamara J. Sussman
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York
| | - Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Amy J. Elliott
- Avera Research Institute, Sioux Falls, South Dakota
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland
| | | | - Anne Marie Singh
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Wisconsin–Madison
| | - Carrie V. Breton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Tina Hartert
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ferdinand Cacho
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Margaret R. Karagas
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Barry M. Lester
- Department of Pediatrics, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Nichole R. Kelly
- Department of Counseling Psychology and Human Services, Prevention Science Institute, University of Oregon, Eugene
| | - Jody M. Ganiban
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC
| | - Su H. Chu
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Rebecca C. Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill
| | - Gwendolyn Norman
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Wayne State University, Detroit, Michigan
| | - Leonardo Trasande
- Department of Pediatrics, Grossman School of Medicine, New York University, New York
| | - Bibiana Restrepo
- Department of Pediatrics, School of Medicine, University of California, Davis, Sacramento
| | - Diane R. Gold
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Peter James
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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7
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Meng Y, Thornburg LL, Hoeger KM, Núñez ZR, Kautz A, Evans AT, Wang C, Miller RK, Groth SW, O’Connor TG, Barrett ES. Association between sex steroid hormones and subsequent hyperglycemia during pregnancy. Front Endocrinol (Lausanne) 2023; 14:1213402. [PMID: 37766683 PMCID: PMC10520461 DOI: 10.3389/fendo.2023.1213402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/08/2023] [Indexed: 09/29/2023] Open
Abstract
Objective Sex steroid hormones may play a role in insulin resistance and glucose dysregulation. However, evidence regarding associations between early-pregnancy sex steroid hormones and hyperglycemia during pregnancy is limited. The primary objective of this study was to assess the relationships between first trimester sex steroid hormones and the subsequent development of hyperglycemia during pregnancy; with secondary evaluation of sex steroid hormones levels in mid-late pregnancy, concurrent with and subsequent to diagnosis of gestational diabetes. Methods Retrospective analysis of a prospective pregnancy cohort study was conducted. Medically low-risk participants with no known major endocrine disorders were recruited in the first trimester of pregnancy (n=319). Sex steroid hormones in each trimester, including total testosterone, free testosterone, estrone, estradiol, and estriol, were assessed using high-performance liquid chromatography and tandem mass spectrometry. Glucose levels of the 1-hour oral glucose tolerance test and gestational diabetes diagnosis were abstracted from medical records. Multivariable linear regression models were fitted to assess the associations of individual first trimester sex steroids and glucose levels. Results In adjusted models, first trimester total testosterone (β=5.24, 95% CI: 0.01, 10.46, p=0.05) and free testosterone (β=5.98, 95% CI: 0.97, 10.98, p=0.02) were positively associated with subsequent glucose concentrations and gestational diabetes diagnosis (total testosterone: OR=3.63, 95% CI: 1.50, 8.78; free testosterone: OR=3.69; 95% CI: 1.56, 8.73). First trimester estrone was also positively associated with gestational diabetes (OR=3.66, 95% CI: 1.56, 8.55). In mid-late pregnancy, pregnant people with gestational diabetes had lower total testosterone levels (β=-0.19, 95% CI: -0.36, -0.02) after adjustment for first trimester total testosterone. Conclusion Early-pregnancy sex steroid hormones, including total testosterone, free testosterone, and estrone, were positively associated with glucose levels and gestational diabetes in mid-late pregnancy. These hormones may serve as early predictors of gestational diabetes in combination with other risk factors.
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Affiliation(s)
- Ying Meng
- School of Nursing, University of Rochester, Rochester, NY, United States
| | - Loralei L. Thornburg
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Kathleen M. Hoeger
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Zorimar Rivera- Núñez
- Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, United States
| | - Amber Kautz
- Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Adam T. Evans
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Christina Wang
- Division of Endocrinology, Department of Medicine and Clinical and Translational Science Institue, The Lundquist Institute at Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, United States
| | - Richard K. Miller
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Susan W. Groth
- School of Nursing, University of Rochester, Rochester, NY, United States
| | - Thomas G. O’Connor
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
- Department of Psychiatry, University of Rochester, Rochester, NY, United States
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, United States
- Wynne Center for Family Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Emily S. Barrett
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
- Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, United States
- Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
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8
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Avalos LA, Chandran A, Churchill ML, Gao X, Ames JL, Nozadi SS, Roubinov D, Brennan PA, Bush NR, Camargo CA, Carroll KN, Cioffi CC, Ferrara A, Goldson B, Hedderson MM, Hipwell AE, Kerver JM, O’Connor TG, Porucznik CA, Shuffrey LC, Talavera-Barber MM, Wright RJ, Zhu Y, Croen LA. Prenatal depression and risk of child autism-related traits among participants in the Environmental influences on Child Health Outcomes program. Autism Res 2023; 16:1825-1835. [PMID: 37526980 PMCID: PMC10857745 DOI: 10.1002/aur.2988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/21/2022] [Accepted: 06/30/2023] [Indexed: 08/03/2023]
Abstract
This study evaluated the association between prenatal depression and offspring autism-related traits. The sample comprised 33 prenatal/pediatric cohorts participating in the Environmental influences on Child Health Outcomes program who contributed information on prenatal depression and autism-related traits. Autism-related traits were assessed continuously and at the diagnostic cut-off using the Social Responsiveness Scale for children up to 12 years of age. Main analyses included 3994 parent-child pairs with prenatal depression diagnoses data; secondary analyses included 1730 parent-child pairs with depression severity data. After confounder adjustment, we observed an increase in autism-related traits among children of individuals with prenatal depression compared to those without (adjusted β = 1.31 95% CI: 0.65, 1.98). Analyses stratified by child sex documented a similar significant association among boys (aβ = 1.34 95%CI: 0.36, 2.32) and girls (aβ = 1.26 95% CI: 0.37, 2.15). Prenatal depression was also associated with increased odds of moderate to severe autism-related traits (adjusted odds ratio: 1.64, 95%CI: 1.09, 2.46), the screening threshold considered high risk of autism spectrum disorder (ASD) diagnosis. Findings highlight the importance of prenatal depression screening and preventive interventions for children of pregnant individuals with depression to support healthy development. Future research is needed to clarify whether these findings reflect overlap in genetic risk for depression and ASD-related traits or another mechanism.
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Affiliation(s)
- Lyndsay A. Avalos
- Division of Research, Kaiser Permanente Northern California, Oakland CA
| | | | | | | | - Jennifer L. Ames
- Division of Research, Kaiser Permanente Northern California, Oakland CA
| | - Sara S. Nozadi
- Department of Pharmaceutical Sciences, Health Sciences Center, University of New Mexico
| | - Danielle Roubinov
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | | | - Nicole R. Bush
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Department of Pediatrics, University of California, San Francisco
| | | | - Kecia N. Carroll
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland CA
| | - Brandon Goldson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Jean M. Kerver
- Departments of Epidemiology & Biostatistics and Pediatrics and Human Development, College of Human Medicine, Michigan State University
| | - Thomas G. O’Connor
- Departments of Psychiatry, Psychology, Neuroscience, Obstetrics and Gynecology, University of Rochester
| | | | - Lauren C. Shuffrey
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Maria M. Talavera-Barber
- Avera McKennan Hospital and University Health Center, Avera Research Institute, Sioux Falls, SD, USA
| | - Rosalind J. Wright
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland CA
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, Oakland CA
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9
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Knapp EA, Kress AM, Parker CB, Page GP, McArthur K, Gachigi KK, Alshawabkeh AN, Aschner JL, Bastain TM, Breton CV, Bendixsen CG, Brennan PA, Bush NR, Buss C, Camargo, Jr. CA, Catellier D, Cordero JF, Croen L, Dabelea D, Deoni S, D’Sa V, Duarte CS, Dunlop AL, Elliott AJ, Farzan SF, Ferrara A, Ganiban JM, Gern JE, Giardino AP, Towe-Goodman NR, Gold DR, Habre R, Hamra GB, Hartert T, Herbstman JB, Hertz-Picciotto I, Hipwell AE, Karagas MR, Karr CJ, Keenan K, Kerver JM, Koinis-Mitchell D, Lau B, Lester BM, Leve LD, Leventhal B, LeWinn KZ, Lewis J, Litonjua AA, Lyall K, Madan JC, McEvoy CT, McGrath M, Meeker JD, Miller RL, Morello-Frosch R, Neiderhiser JM, O’Connor TG, Oken E, O’Shea M, Paneth N, Porucznik CA, Sathyanarayana S, Schantz SL, Spindel ER, Stanford JB, Stroustrup A, Teitelbaum SL, Trasande L, Volk H, Wadhwa PD, Weiss ST, Woodruff TJ, Wright RJ, Zhao Q, Jacobson LP, Influences on Child Health Outcomes ,OBOPCFE. The Environmental Influences on Child Health Outcomes (ECHO)-Wide Cohort. Am J Epidemiol 2023; 192:1249-1263. [PMID: 36963379 PMCID: PMC10403303 DOI: 10.1093/aje/kwad071] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [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: 08/31/2022] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 03/26/2023] Open
Abstract
The Environmental Influences on Child Health Outcomes (ECHO)-Wide Cohort Study (EWC), a collaborative research design comprising 69 cohorts in 31 consortia, was funded by the National Institutes of Health (NIH) in 2016 to improve children's health in the United States. The EWC harmonizes extant data and collects new data using a standardized protocol, the ECHO-Wide Cohort Data Collection Protocol (EWCP). EWCP visits occur at least once per life stage, but the frequency and timing of the visits vary across cohorts. As of March 4, 2022, the EWC cohorts contributed data from 60,553 children and consented 29,622 children for new EWCP data and biospecimen collection. The median (interquartile range) age of EWCP-enrolled children was 7.5 years (3.7-11.1). Surveys, interviews, standardized examinations, laboratory analyses, and medical record abstraction are used to obtain information in 5 main outcome areas: pre-, peri-, and postnatal outcomes; neurodevelopment; obesity; airways; and positive health. Exposures include factors at the level of place (e.g., air pollution, neighborhood socioeconomic status), family (e.g., parental mental health), and individuals (e.g., diet, genomics).
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Affiliation(s)
- Emily A Knapp
- Correspondence to Dr. Emily Knapp, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 700 E. Pratt Street, Suite 1000, Baltimore, Maryland 21202 (e-mail: )
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10
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LeWinn KZ, Trasande L, Law A, Blackwell CK, Bekelman TA, Arizaga JA, Sullivan AA, Bastain TM, Breton CV, Karagas MR, Elliott AJ, Karr CJ, Carroll KN, Dunlop AL, Croen LA, Margolis AE, Alshawabkeh AN, Cordero JF, Singh AM, Seroogy CM, Jackson DJ, Wood RA, Hartert TV, Kim YS, Duarte CS, Schweitzer JB, Lester BM, McEvoy CT, O’Connor TG, Oken E, Bornkamp N, Brown ED, Porucznik CA, Ferrara A, Camargo CA, Zhao Q, Ganiban JM, Jacobson LP. Sociodemographic Differences in COVID-19 Pandemic Experiences Among Families in the United States. JAMA Netw Open 2023; 6:e2330495. [PMID: 37610749 PMCID: PMC10448300 DOI: 10.1001/jamanetworkopen.2023.30495] [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: 06/22/2023] [Accepted: 07/17/2023] [Indexed: 08/24/2023] Open
Abstract
Importance Few population-based studies in the US collected individual-level data from families during the COVID-19 pandemic. Objective To examine differences in COVID-19 pandemic-related experiences in a large sociodemographically diverse sample of children and caregivers. Design, Setting, and Participants The Environmental influences on Child Health Outcomes (ECHO) multi-cohort consortium is an ongoing study that brings together 64 individual cohorts with participants (24 757 children and 31 700 caregivers in this study) in all 50 US states and Puerto Rico. Participants who completed the ECHO COVID-19 survey between April 2020 and March 2022 were included in this cross-sectional analysis. Data were analyzed from July 2021 to September 2022. Main Outcomes and Measures Exposures of interest were caregiver education level, child life stage (infant, preschool, middle childhood, and adolescent), and urban or rural (population <50 000) residence. Dependent variables included COVID-19 infection status and testing; disruptions to school, child care, and health care; financial hardships; and remote work. Outcomes were examined separately in logistic regression models mutually adjusted for exposures of interest and race, ethnicity, US Census division, sex, and survey administration date. Results Analyses included 14 646 children (mean [SD] age, 7.1 [4.4] years; 7120 [49%] female) and 13 644 caregivers (mean [SD] age, 37.6 [7.2] years; 13 381 [98%] female). Caregivers were racially (3% Asian; 16% Black; 12% multiple race; 63% White) and ethnically (19% Hispanic) diverse and comparable with the US population. Less than high school education (vs master's degree or more) was associated with more challenges accessing COVID-19 tests (adjusted odds ratio [aOR], 1.88; 95% CI, 1.06-1.58), lower odds of working remotely (aOR, 0.04; 95% CI, 0.03-0.07), and more food access concerns (aOR, 4.14; 95% CI, 3.20-5.36). Compared with other age groups, young children (age 1 to 5 years) were least likely to receive support from schools during school closures, and their caregivers were most likely to have challenges arranging childcare and concerns about work impacts. Rural caregivers were less likely to rank health concerns (aOR, 0.77; 95% CI, 0.69-0.86) and social distancing (aOR, 0.82; 95% CI, 0.73-0.91) as top stressors compared with urban caregivers. Conclusions Findings in this cohort study of US families highlighted pandemic-related burdens faced by families with lower socioeconomic status and young children. Populations more vulnerable to public health crises should be prioritized in recovery efforts and future planning.
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Affiliation(s)
- Kaja Z. LeWinn
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
| | - Leonardo Trasande
- Department of Pediatrics, New York University Grossman School of Medicine, New York
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Andrew Law
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Traci A. Bekelman
- Department of Epidemiology, Lifecourse Epidemiology of Adiposity & Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora
| | - Jessica A. Arizaga
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
| | - Alexis A. Sullivan
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
| | - Theresa M. Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Carrie V. Breton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Margaret R. Karagas
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire
| | | | | | - Kecia N. Carroll
- Jack and Lucy Clark Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anne L. Dunlop
- Department of Gynecology & Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | | | - Amy E. Margolis
- Columbia University Irving Medical Center, New York State Psychiatric Institute, New York
| | | | - Jose F. Cordero
- Department of Epidemiology & Biostatistics, College of Public Health, University of Georgia, Athens
| | - Anne Marie Singh
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Christine M. Seroogy
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Daniel J. Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Robert A. Wood
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tina V. Hartert
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Young Shin Kim
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
| | - Cristiane S. Duarte
- Columbia University Irving Medical Center, New York State Psychiatric Institute, New York
| | - Julie B. Schweitzer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
- The MIND Institute, University of California, Davis, Sacramento
| | - Barry M. Lester
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women & Infants Hospital, Providence, Rhode Island
| | - Cynthia T. McEvoy
- Department of Pediatrics, Oregon Health and Science University School of Medicine, Portland
| | - Thomas G. O’Connor
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Emily Oken
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Nicole Bornkamp
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Eric D. Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Christina A. Porucznik
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City
| | | | | | - Qi Zhao
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Jody M. Ganiban
- Department of Psychological & Brain Sciences, Columbian College of Arts & Sciences, George Washington University, Washington, DC
| | - Lisa P. Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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11
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Martenies SE, Zhang M, Corrigan AE, Kvit A, Shields T, Wheaton W, Around Him D, Aschner J, Talavera-Barber MM, Barrett ES, Bastain TM, Bendixsen C, Breton CV, Bush NR, Cacho F, Camargo CA, Carroll KN, Carter BS, Cassidy-Bushrow AE, Cowell W, Croen LA, Dabelea D, Duarte CS, Dunlop AL, Everson TM, Habre R, Hartert TV, Helderman JB, Hipwell AE, Karagas MR, Lester BM, LeWinn KZ, Magzamen S, Morello-Frosch R, O’Connor TG, Padula AM, Petriello M, Sathyanarayana S, Stanford JB, Woodruff TJ, Wright RJ, Kress AM. Developing a National-Scale Exposure Index for Combined Environmental Hazards and Social Stressors and Applications to the Environmental Influences on Child Health Outcomes (ECHO) Cohort. Int J Environ Res Public Health 2023; 20:6339. [PMID: 37510572 PMCID: PMC10379099 DOI: 10.3390/ijerph20146339] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 05/26/2023] [Revised: 06/12/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023]
Abstract
Tools for assessing multiple exposures across several domains (e.g., physical, chemical, and social) are of growing importance in social and environmental epidemiology because of their value in uncovering disparities and their impact on health outcomes. Here we describe work done within the Environmental influences on Child Health Outcomes (ECHO)-wide Cohort Study to build a combined exposure index. Our index considered both environmental hazards and social stressors simultaneously with national coverage for a 10-year period. Our goal was to build this index and demonstrate its utility for assessing differences in exposure for pregnancies enrolled in the ECHO-wide Cohort Study. Our unitless combined exposure index, which collapses census-tract level data into a single relative measure of exposure ranging from 0-1 (where higher values indicate higher exposure to hazards), includes indicators for major air pollutants and air toxics, features of the built environment, traffic exposures, and social determinants of health (e.g., lower educational attainment) drawn from existing data sources. We observed temporal and geographic variations in index values, with exposures being highest among participants living in the West and Northeast regions. Pregnant people who identified as Black or Hispanic (of any race) were at higher risk of living in a "high" exposure census tract (defined as an index value above 0.5) relative to those who identified as White or non-Hispanic. Index values were also higher for pregnant people with lower educational attainment. Several recommendations follow from our work, including that environmental and social stressor datasets with higher spatial and temporal resolutions are needed to ensure index-based tools fully capture the total environmental context.
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Affiliation(s)
- Sheena E. Martenies
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
| | - Mingyu Zhang
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Anne E. Corrigan
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Anton Kvit
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Timothy Shields
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - William Wheaton
- Research Triangle Institute, Research Triangle Park, NC 27709, USA
| | | | - Judy Aschner
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | | | - Emily S. Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - Theresa M. Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | | | - Carrie V. Breton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Nicole R. Bush
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA 94143, USA
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94143, USA
| | - Ferdinand Cacho
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Carlos A. Camargo
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Kecia N. Carroll
- Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Brian S. Carter
- Department of Pediatrics-Neonatology, Children’s Mercy Hospital, Kansas City, MO 64108, USA
| | | | - Whitney Cowell
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA;
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Cristiane S. Duarte
- New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA
| | - Anne L. Dunlop
- Department of Obstetrics and Gynecology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Todd M. Everson
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA
| | - Rima Habre
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Tina V. Hartert
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
| | - Jennifer B. Helderman
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Margaret R. Karagas
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, NH 03756, USA
| | - Barry M. Lester
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Kaja Z. LeWinn
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA 94143, USA
| | - Sheryl Magzamen
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Rachel Morello-Frosch
- Department of Environmental Science, Policy and Management and School of Public Health, University of California Berkeley, Berkeley, CA 94720, USA
| | - Thomas G. O’Connor
- Departments of Psychiatry, Psychology, Neuroscience, and Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY 41642, USA
| | - Amy M. Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Michael Petriello
- Institute of Environmental Health Sciences and Department of Pharmacology, Wayne State University, Detroit, MI 48202, USA
| | - Sheela Sathyanarayana
- Seattle Children’s Research Institute, Seattle, WA 98105, USA
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Joseph B. Stanford
- Department of Pediatrics, Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Tracey J. Woodruff
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Rosalind J. Wright
- Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Amii M. Kress
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Rivera-Núñez Z, Hansel M, Capurro C, Kozlosky D, Wang C, Doherty CL, Buckley B, Ohman-Strickland P, Miller RK, O’Connor TG, Aleksunes LM, Barrett ES. Prenatal Cadmium Exposure and Maternal Sex Steroid Hormone Concentrations across Pregnancy. Toxics 2023; 11:589. [PMID: 37505555 PMCID: PMC10384739 DOI: 10.3390/toxics11070589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023]
Abstract
Cadmium exposure has been associated with adverse perinatal outcomes. One possible mechanism is endocrine disruption. Studies of non-pregnant adults suggest that cadmium impacts androgen production; here, we examined these associations during pregnancy. Participants in the Understanding Pregnancy Signals and Infant Development (UPSIDE) cohort provided biospecimens and questionnaire data in each trimester (n = 272). We quantified urinary cadmium, serum total testosterone (TT), estrone, estradiol, and estriol and serum free testosterone (fT). In adjusted longitudinal models, we examined sex steroid concentrations across pregnancy in relation to specific gravity-adjusted, ln-transformed cadmium concentrations. Additionally, we examined trimester-specific associations and stratified models by fetal sex. Results are presented as percent change (%∆) in hormone concentrations. In longitudinal models, higher cadmium concentrations were associated with lower fT across pregnancy (%∆ = -5.19, 95%CI: -8.33, -1.93), with no differences in other hormones observed. In trimester-specific models, higher cadmium concentrations were associated with lower TT in trimester 2 (%∆ = -15.26, 95%CI: -25.15, -4.06) and lower fT in trimester 3 (%∆ = -14.35, 95%CI: -19.75, -8.59). Associations with TT were stronger in pregnancies carrying female fetuses. Maternal cadmium exposure may be associated with reduced testosterone in pregnancy. Additional work is necessary to understand how alterations in gestational testosterone activity may impact pregnancy and child health.
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Affiliation(s)
- Zorimar Rivera-Núñez
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA; (M.H.); (C.C.); (P.O.-S.); (E.S.B.)
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 08854, USA; (D.K.); (C.L.D.); (B.B.); (L.M.A.)
| | - Megan Hansel
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA; (M.H.); (C.C.); (P.O.-S.); (E.S.B.)
| | - Camila Capurro
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA; (M.H.); (C.C.); (P.O.-S.); (E.S.B.)
| | - Danielle Kozlosky
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 08854, USA; (D.K.); (C.L.D.); (B.B.); (L.M.A.)
| | - Christina Wang
- Clinical and Translational Science Institute, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA;
| | - Cathleen L. Doherty
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 08854, USA; (D.K.); (C.L.D.); (B.B.); (L.M.A.)
| | - Brian Buckley
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 08854, USA; (D.K.); (C.L.D.); (B.B.); (L.M.A.)
| | - Pamela Ohman-Strickland
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA; (M.H.); (C.C.); (P.O.-S.); (E.S.B.)
| | - Richard K. Miller
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY 14620, USA; (R.K.M.); (T.G.O.)
- Department of Environmental Medicine, Pediatrics and Pathology, University of Rochester, New York, NY 14642, USA
| | - Thomas G. O’Connor
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY 14620, USA; (R.K.M.); (T.G.O.)
- Departments of Psychiatry, Psychology, Neuroscience, University of Rochester, New York, NY 14620, USA
| | - Lauren M. Aleksunes
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 08854, USA; (D.K.); (C.L.D.); (B.B.); (L.M.A.)
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ 08854, USA
| | - Emily S. Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA; (M.H.); (C.C.); (P.O.-S.); (E.S.B.)
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 08854, USA; (D.K.); (C.L.D.); (B.B.); (L.M.A.)
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY 14620, USA; (R.K.M.); (T.G.O.)
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13
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Panisch LS, Murphy HR, Wu Q, Brunner JL, Duberstein ZT, Arnold MS, Best M, Barrett ES, Miller RK, Qiu X, O’Connor TG. Adverse Childhood Experiences Predict Diurnal Cortisol Throughout Gestation. Psychosom Med 2023; 85:507-516. [PMID: 37199406 PMCID: PMC10524578 DOI: 10.1097/psy.0000000000001218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Adverse childhood experiences (ACEs) are associated with negative prenatal and perinatal health outcomes and may, via these pathways, have intergenerational effects on child health and development. We examine the impact of ACEs on maternal salivary cortisol, a key measure of prenatal biology previously linked with pregnancy-related health outcomes. METHODS Leveraging assessments across three trimesters, we used linear mixed-effects models to analyze the influence of ACEs on maternal prenatal diurnal cortisol patterns in a diverse cohort of pregnant women (analytic sample, n = 207). Covariates included comorbid prenatal depression, psychiatric medications, and sociodemographic factors. RESULTS Maternal ACEs were significantly associated with flatter diurnal cortisol slopes (i.e., less steep decline), after adjusting for covariates, with effects consistent across gestation (estimate = 0.15, standard error = 0.06, p = .008). CONCLUSIONS ACEs experienced before pregnancy may have a robust and lasting influence on maternal prenatal hypothalamic-pituitary-adrenal activity throughout gestation, a key biological marker associated with perinatal and child health outcomes. The findings suggest one route of intergenerational transmission of early adverse experiences and underscore the potential value of assessing prepregnancy adverse experiences for promoting perinatal and maternal and child health.
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Affiliation(s)
- Lisa S. Panisch
- Wayne State University School of Social Work, 5447 Woodward Ave., Detroit, MI, 48202, USA
| | - Hannah R. Murphy
- Translational Biomedical Science, University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave., Rochester, New York, 14642, USA
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Ave., Rochester, New York, 14642, USA
| | - Qiuyi Wu
- Biostatistics and Computational Biology, University of Rochester Medical Center, Saunders Research Building, 265 Crittenden Blvd., Box 630, Rochester, NY 14642
| | - Jessica L. Brunner
- Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, New York, 14642, USA
| | - Zoe T. Duberstein
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Ave., Rochester, New York, 14642, USA
- Psychology, University of Rochester, Meliora Hall, P.O. Box 270266, Rochester, New York, 14627, USA
| | - Molly S. Arnold
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Ave., Rochester, New York, 14642, USA
- Psychology, University of Rochester, Meliora Hall, P.O. Box 270266, Rochester, New York, 14627, USA
| | - Meghan Best
- Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, New York, 14642, USA
| | - Emily S. Barrett
- Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, New York, 14642, USA
- Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, New Jersey, 08854, USA
- Environmental and Occupational Health Sciences Institute, Rutgers University, 170 Frelinghuysen Rd., Piscataway, New Jersey, 08854, USA
| | - Richard K. Miller
- Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, New York, 14642, USA
| | - Xing Qiu
- Biostatistics and Computational Biology, University of Rochester Medical Center, Saunders Research Building, 265 Crittenden Blvd., Box 630, Rochester, NY 14642
| | - Thomas G. O’Connor
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Ave., Rochester, New York, 14642, USA
- Obstetrics and Gynecology, University of Rochester, 601 Elmwood Ave., Rochester, New York, 14642, USA
- Psychology, University of Rochester, Meliora Hall, P.O. Box 270266, Rochester, New York, 14627, USA
- Neuroscience, University of Rochester, 601 Elmwood Avenue, Box 603, KMRB G.9602, Rochester, New York, 14642, USA
- Psychiatry, University of Rochester, 300 Crittenden Blvd., Rochester, New York, 14642, USA
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14
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Liu Y, Wosu AC, Fleisch AF, Dunlop AL, Starling AP, Ferrara A, Dabelea D, Oken E, Buckley JP, Chatzi L, Karagas MR, Romano ME, Schantz S, O’Connor TG, Woodruff TJ, Zhu Y, Hamra GB, Braun JM. Associations of Gestational Perfluoroalkyl Substances Exposure with Early Childhood BMI z-Scores and Risk of Overweight/Obesity: Results from the ECHO Cohorts. Environ Health Perspect 2023; 131:67001. [PMID: 37283528 PMCID: PMC10246497 DOI: 10.1289/ehp11545] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Gestational per- and polyfluoroalkyl substances (PFAS) exposure may be associated with adiposity and increased risk of obesity among children and adolescents. However, results from epidemiological studies evaluating these associations are inconsistent. OBJECTIVES We estimated the associations of pregnancy PFAS concentrations with child body mass index (BMI) z -scores and risk of overweight/obesity in eight U.S. cohorts. METHODS We used data from 1,391 mother-child pairs who enrolled in eight Environmental influences on Child Health Outcomes (ECHO) cohorts (enrolled: 1999-2019). We quantified concentrations of seven PFAS in maternal plasma or serum in pregnancy. We measured child weight and height between the ages of 2 and 5 y and calculated age- and sex-specific BMI z -scores; 19.6% children had more than one BMI measurement. We estimated covariate-adjusted associations of individual PFAS and their mixture with child BMI z -scores and risk of overweight/obesity using linear mixed models, modified Poisson regression models, and Bayesian approaches for mixtures. We explored whether child sex modified these associations. RESULTS We observed a pattern of subtle positive associations of PFAS concentrations in pregnancy with BMI z -scores and risk of overweight/obesity. For instance, each doubling in perfluorohexane sulfonic acid concentrations was associated with higher BMI z -scores (β = 0.07 ; 95% CI: 0.01, 0.12). Each doubling in perfluroundecanoic acid [relative risk ( RR ) = 1.10 ; 95% CI: 1.04, 1.16] and N -methyl perfluorooctane sulfonamido acetic acid (RR = 1.06 ; 95% CI: 1.00, 1.12) was associated with increased risk of overweight/obesity, with some evidence of a monotonic dose-response relation. We observed weaker and more imprecise associations of the PFAS mixture with BMI or risk of overweight/obesity. Associations did not differ by child sex. DISCUSSION In eight U.S.-based prospective cohorts, gestational exposure to higher levels of PFAS were associated with slightly higher childhood BMI z -score and risk of overweight or obesity. Future studies should examine associations of gestational exposure to PFAS with adiposity and related cardiometabolic consequences in older children. https://doi.org/10.1289/EHP11545.
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Affiliation(s)
- Yun Liu
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Adaeze C. Wosu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Abby F. Fleisch
- Pediatric Endocrinology and Diabetes, Maine Medical Center and Maine Medical Center Research Institute, Portland, Maine, USA
- Center for Outcomes Research and Evaluation, Maine Medical Center and Maine Medical Center Research Institute, Portland, Maine, USA
| | - Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anne P. Starling
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Jessie P. Buckley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Leda Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Margaret R. Karagas
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Megan E. Romano
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Susan Schantz
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Thomas G. O’Connor
- Department of Psychiatry, University of Rochester, Rochester, New York, USA
| | - Tracey J. Woodruff
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Yeyi Zhu
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ghassan B. Hamra
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joseph M. Braun
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - and the program collaborators for Environmental influences on Child Health Outcomes
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Pediatric Endocrinology and Diabetes, Maine Medical Center and Maine Medical Center Research Institute, Portland, Maine, USA
- Center for Outcomes Research and Evaluation, Maine Medical Center and Maine Medical Center Research Institute, Portland, Maine, USA
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Psychiatry, University of Rochester, Rochester, New York, USA
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
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15
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Ames JL, Burjak M, Avalos LA, Braun JM, Bulka CM, Croen LA, Dunlop AL, Ferrara A, Fry RC, Hedderson MM, Karagas MR, Liang D, Lin PID, Lyall K, Moore B, Morello-Frosch R, O’Connor TG, Oh J, Padula AM, Woodruff TJ, Zhu Y, Hamra GB. Prenatal Exposure to Per- and Polyfluoroalkyl Substances and Childhood Autism-related Outcomes. Epidemiology 2023; 34:450-459. [PMID: 36630444 PMCID: PMC10074577 DOI: 10.1097/ede.0000000000001587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 01/12/2023]
Abstract
BACKGROUND Epidemiologic evidence linking prenatal exposure to per- and polyfluoroalkyl substances (PFAS) with altered neurodevelopment is inconclusive, and few large studies have focused on autism-related outcomes. We investigated whether blood concentrations of PFAS in pregnancy are associated with child autism-related outcomes. METHODS We included 10 cohorts from the National Institutes of Health (NIH)-funded Environmental influences on Child Health Outcomes (ECHO) program (n = 1,429). We measured 14 PFAS analytes in maternal blood collected during pregnancy; eight analytes met detection criteria for analysis. We assessed quantitative autism-related traits in children via parent report on the Social Responsiveness Scale (SRS). In multivariable linear models, we examined relationships of each PFAS (natural log-transformed) with SRS scores. We further modeled PFAS as a complex mixture using Bayesian methods and examined modification of these relationships by child sex. RESULTS Most PFAS in maternal blood were not associated with child SRS T-scores. Perfluorononanoic acid (PFNA) showed the strongest and most consistent association: each 1-unit increase in ln-transformed PFNA was associated with greater autism-related traits (adjusted β [95% confidence interval (CI)] = 1.5 [-0.1, 3.0]). The summed mixture, which included six PFAS detected in >70% of participants, was not associated with SRS T-scores (adjusted β [95% highest posterior density interval] = 0.7 [-1.4, 3.0]). We did not observe consistent evidence of sex differences. CONCLUSIONS Prenatal blood concentrations of PFNA may be associated with modest increases in child autism-related traits. Future work should continue to examine the relationship between exposures to both legacy and emerging PFAS and additional dimensional, quantitative measures of childhood autism-related outcomes.
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Affiliation(s)
- Jennifer L. Ames
- Division of Research, Kaiser Permanente Northern California, Oakland, CA USA
| | | | - Lyndsay A. Avalos
- Division of Research, Kaiser Permanente Northern California, Oakland, CA USA
| | - Joseph M. Braun
- Department of Epidemiology, Brown University, Providence, RI USA
| | | | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA USA
| | - Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA USA
| | - Rebecca C. Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
| | | | | | - Donghai Liang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Pi-I D. Lin
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA USA
| | - Kristen Lyall
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA USA
| | - Brianna Moore
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Jiwon Oh
- Department of Public Health Sciences, University of California, Davis, Davis CA, USA
| | - Amy M. Padula
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA USA
| | - Tracey J. Woodruff
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA USA
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA USA
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16
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McGowan EC, McGrath M, Law A, O’Shea TM, Aschner JL, Blackwell CK, Fry RC, Ganiban JM, Higgins R, Margolis A, Sathyanarayana S, Taylor G, Alshawabkeh AN, Cordero JF, Spillane NT, Hudak ML, Camargo CA, Dabelea D, Dunlop AL, Elliott AJ, Ferrara AM, Talavera-Barber M, Singh AM, Karagas MR, Karr C, O’Connor TG, Paneth N, Wright RJ, Wright RO, Cowell W, Stanford JB, Bendixsen C, Lester BM. Health Care Utilization During the COVID-19 Pandemic Among Individuals Born Preterm. JAMA Netw Open 2023; 6:e2310696. [PMID: 37115545 PMCID: PMC10148204 DOI: 10.1001/jamanetworkopen.2023.10696] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/02/2022] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
Importance Limited data exist on pediatric health care utilization during the COVID-19 pandemic among children and young adults born preterm. Objective To investigate differences in health care use related to COVID-19 concerns during the pandemic among children and young adults born preterm vs those born at term. Design, Setting, and Participants In this cohort study, questionnaires regarding COVID-19 and health care utilization were completed by 1691 mother-offspring pairs from 42 pediatric cohorts in the National Institutes of Health Environmental Influences on Child Health Outcomes Program. Children and young adults (ages 1-18 years) in these analyses were born between 2003 and 2021. Data were recorded by the August 31, 2021, data-lock date and were analyzed between October 2021 and October 2022. Exposures Premature birth (<37 weeks' gestation). Main Outcomes and Measures The main outcome was health care utilization related to COVID-19 concerns (hospitalization, in-person clinic or emergency department visit, phone or telehealth evaluations). Individuals born preterm vs term (≥37 weeks' gestation) and differences among preterm subgroups of individuals (<28 weeks', 28-36 weeks' vs ≥37 weeks' gestation) were assessed. Generalized estimating equations assessed population odds for health care used and related symptoms, controlling for maternal age, education, and psychiatric disorder; offspring history of bronchopulmonary dysplasia (BPD) or asthma; and timing and age at COVID-19 questionnaire completion. Results Data from 1691 children and young adults were analyzed; among 270 individuals born preterm, the mean (SD) age at survey completion was 8.8 (4.4) years, 151 (55.9%) were male, and 193 (71.5%) had a history of BPD or asthma diagnosis. Among 1421 comparison individuals with term birth, the mean (SD) age at survey completion was 8.4 (2.4) years, 749 (52.7%) were male, and 233 (16.4%) had a history of BPD or asthma. Preterm subgroups included 159 individuals (58.5%) born at less than 28 weeks' gestation. In adjusted analyses, individuals born preterm had a significantly higher odds of health care utilization related to COVID-19 concerns (adjusted odds ratio [aOR], 1.70; 95% CI, 1.21-2.38) compared with term-born individuals; similar differences were also seen for the subgroup of individuals born at less than 28 weeks' gestation (aOR, 2.15; 95% CI, 1.40-3.29). Maternal history of a psychiatric disorder was a significant covariate associated with health care utilization for all individuals (aOR, 1.44; 95% CI, 1.17-1.78). Conclusions and Relevance These findings suggest that during the COVID-19 pandemic, children and young adults born preterm were more likely to have used health care related to COVID-19 concerns compared with their term-born peers, independent of a history of BPD or asthma. Further exploration of factors associated with COVID-19-related health care use may facilitate refinement of care models.
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Affiliation(s)
- Elisabeth C. McGowan
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Monica McGrath
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrew Law
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Judy L. Aschner
- Albert Einstein College of Medicine, New York, New York
- Hackensack University Medical Center and Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | | | - Rebecca C. Fry
- The University of North Carolina at Chapel Hill, Chapel Hill
| | - Jody M. Ganiban
- George Washington University, Washington, District of Columbia
| | - Rosemary Higgins
- Department of Global and Community Health, College of Health and Human Sciences, George Mason University, Fort Myers, Florida
- Marieb College of Health and Human Services, Florida Gulf Coast University, Fort Myers
| | - Amy Margolis
- Columbia University Irving Medical Center, New York, New York
| | - Sheela Sathyanarayana
- University of Washington, Seattle
- Seattle Children’s Research Institute, Seattle, Washington
| | | | | | - José F. Cordero
- Department of Epidemiology and Biostatistics, University of Georgia, Athens
| | - Nicole T. Spillane
- Hackensack University Medical Center and Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | - Mark L. Hudak
- Department of Pediatrics, University of Florida College of Medicine, Jacksonville
| | | | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora
| | | | | | | | - Maria Talavera-Barber
- Avera McKennan Hospital, Sioux Falls, South Dakota
- University Health Center, Avera Research Institute, Sioux Falls, South Dakota
| | - Anne Marie Singh
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | | | - Catherine Karr
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle
| | | | - Nigel Paneth
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing
| | - Rosalind J. Wright
- Institute for Exposomic Research, Icahn School of Medicine Mount Sinai, New York, New York
| | - Robert O. Wright
- Institute for Exposomic Research, Icahn School of Medicine Mount Sinai, New York, New York
| | - Whitney Cowell
- Department of Pediatrics, NYU Grossman School of Medicine, New York, New York
| | | | - Casper Bendixsen
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, Wisconsin
| | - Barry M. Lester
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
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17
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Noroña-Zhou A, Coccia M, Sullivan A, O’Connor TG, Collett BR, Derefinko K, Renner LM, Loftus CT, Roubinov D, Carroll KN, Nguyen RHN, Karr CJ, Sathyanarayana S, Barrett ES, Mason WA, LeWinn KZ, Bush NR. A Multi-Cohort Examination of the Independent Contributions of Maternal Childhood Adversity and Pregnancy Stressors to the Prediction of Children's Anxiety and Depression. Res Child Adolesc Psychopathol 2023; 51:497-512. [PMID: 36462137 PMCID: PMC10017630 DOI: 10.1007/s10802-022-01002-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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] [Accepted: 11/18/2022] [Indexed: 12/05/2022]
Abstract
Women's social experiences can have long-term implications for their offspring's health, but little is known about the potential independent contributions of multiple periods of stress exposures over time. This study examined associations of maternal exposure to adversity in childhood and pregnancy with children's anxiety and depression symptoms in a large, sociodemographically diverse sample. Participants were 1389 mother-child dyads (child age M = 8.83 years; SD = 0.66; 42% Black, 42% White; 6% Hispanic) in the ECHO-PATHWAYS Consortium's three U.S. pregnancy cohorts. Women reported their exposure to childhood traumatic events (CTE) and pregnancy stressful life events (PSLE). Children self-reported on their symptoms of anxiety and depression at age 8-9 years. Regression analyses estimated associations between maternal stressors and children's internalizing problems, adjusting for confounders, and examined child sex as a modifier. Exploratory interaction analyses examined whether geospatially-linked postnatal neighborhood quality buffered effects. In adjusted models, PSLE counts positively predicted levels of children's anxiety and depression symptoms ([ßAnxiety=0.08, 95%CI [0.02, 0.13]; ßDepression=0.09, 95%CI [0.03, 0.14]); no significant associations were observed with CTE. Each additional PSLE increased odds of clinically significant anxiety symptoms by 9% (95%CI [0.02, 0.17]). Neither sex nor neighborhood quality moderated relations. Maternal stressors during pregnancy appear to have associations with middle childhood anxiety and depression across diverse sociodemographic contexts, whereas maternal history of childhood adversity may not. Effects appear comparable for boys and girls. Policies and programs addressing prevention of childhood internalizing symptoms may benefit from considering prenatal origins and the potential two-generation impact of pregnancy stress prevention and intervention.
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Affiliation(s)
- Amanda Noroña-Zhou
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA USA
- Department of Pediatrics, UCSF, San Francisco, CA USA
- Center for Health and Community, UCSF, San Francisco, CA USA
| | - Michael Coccia
- Center for Health and Community, UCSF, San Francisco, CA USA
| | - Alexis Sullivan
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA USA
| | - Thomas G. O’Connor
- Departments of Psychiatry, Psychology, Neuroscience, Department of Obstetrics & Gynecology, University of Rochester, Rochester, NY USA
| | - Brent R. Collett
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle Children’s Research Institute, Seattle, WA USA
| | - Karen Derefinko
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN USA
| | | | - Christine T. Loftus
- Department of Occupational and Environmental Health Sciences, University of Washington, Seattle, WA USA
| | - Danielle Roubinov
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA USA
| | - Kecia N. Carroll
- Departments of Environmental Medicine and Public Health and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Ruby H. N. Nguyen
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN USA
| | - Catherine J. Karr
- Department of Occupational and Environmental Health Sciences, Department of Pediatrics, University of Washington, Seattle, WA USA
| | - Sheela Sathyanarayana
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle Children’s Research Institute, Seattle, WA USA
| | - Emily S. Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Environmental and Occupational Health Sciences Institute, Rutgers University, New Brunswick, NJ USA
| | - W. Alex Mason
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN USA
| | - Kaja Z. LeWinn
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA USA
| | - Nicole R. Bush
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA USA
- Department of Pediatrics, UCSF, San Francisco, CA USA
- Center for Health and Community, UCSF, San Francisco, CA USA
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18
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Padula AM, Ning X, Bakre S, Barrett ES, Bastain T, Bennett DH, Bloom MS, Breton CV, Dunlop AL, Eick SM, Ferrara A, Fleisch A, Geiger S, Goin DE, Kannan K, Karagas MR, Korrick S, Meeker JD, Morello-Frosch R, O’Connor TG, Oken E, Robinson M, Romano ME, Schantz SL, Schmidt RJ, Starling AP, Zhu Y, Hamra GB, Woodruff TJ. Birth Outcomes in Relation to Prenatal Exposure to Per- and Polyfluoroalkyl Substances and Stress in the Environmental Influences on Child Health Outcomes (ECHO) Program. Environ Health Perspect 2023; 131:37006. [PMID: 36920051 PMCID: PMC10015888 DOI: 10.1289/ehp10723] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/01/2022] [Accepted: 02/06/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) are persistent and ubiquitous chemicals associated with risk of adverse birth outcomes. Results of previous studies have been inconsistent. Associations between PFAS and birth outcomes may be affected by psychosocial stress. OBJECTIVES We estimated risk of adverse birth outcomes in relation to prenatal PFAS concentrations and evaluate whether maternal stress modifies those relationships. METHODS We included 3,339 participants from 11 prospective prenatal cohorts in the Environmental influences on the Child Health Outcomes (ECHO) program to estimate the associations of five PFAS and birth outcomes. We stratified by perceived stress scale scores to examine effect modification and used Bayesian Weighted Sums to estimate mixtures of PFAS. RESULTS We observed reduced birth size with increased concentrations of all PFAS. For a 1-unit higher log-normalized exposure to perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS), we observed lower birthweight-for-gestational-age z-scores of β = - 0.15 [95% confidence interval (CI): - 0.27 , - 0.03 ], β = - 0.14 (95% CI: - 0.28 , - 0.002 ), β = - 0.22 (95% CI: - 0.23 , - 0.10 ), β = - 0.06 (95% CI: - 0.18 , 0.06), and β = - 0.25 (95% CI: - 0.37 , - 0.14 ), respectively. We observed a lower odds ratio (OR) for large-for-gestational-age: OR PFNA = 0.56 (95% CI: 0.38, 0.83), OR PFDA = 0.52 (95% CI: 0.35, 0.77). For a 1-unit increase in log-normalized concentration of summed PFAS, we observed a lower birthweight-for-gestational-age z-score [- 0.28 ; 95% highest posterior density (HPD): - 0.44 , - 0.14 ] and decreased odds of large-for-gestational-age (OR = 0.49 ; 95% HPD: 0.29, 0.82). Perfluorodecanoic acid (PFDA) explained the highest percentage (40%) of the summed effect in both models. Associations were not modified by maternal perceived stress. DISCUSSION Our large, multi-cohort study of PFAS and adverse birth outcomes found a negative association between prenatal PFAS and birthweight-for-gestational-age, and the associations were not different in groups with high vs. low perceived stress. This study can help inform policy to reduce exposures in the environment and humans. https://doi.org/10.1289/EHP10723.
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Affiliation(s)
- Amy M. Padula
- Program for Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Xuejuan Ning
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shivani Bakre
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Emily S. Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Environmental and Occupational Health Sciences Institute, Piscataway, New Jersey, USA
| | - Tracy Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Deborah H. Bennett
- Department of Public Health Sciences, University of California, Davis, Davis, California, USA
| | - Michael S. Bloom
- Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
| | - Carrie V. Breton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stephanie M. Eick
- Program for Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Abby Fleisch
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sarah Geiger
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - Dana E. Goin
- Program for Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Kurunthachalam Kannan
- Department of Pediatrics and Department of Environmental Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Margaret R. Karagas
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Susan Korrick
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - John D. Meeker
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Rachel Morello-Frosch
- School of Public Health and Department of Environmental Science, Policy and Management, University of California, Berkeley, Berkeley, California, USA
| | - Thomas G. O’Connor
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Morgan Robinson
- Department of Pediatrics and Department of Environmental Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Megan E. Romano
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Susan L. Schantz
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - Rebecca J. Schmidt
- Department of Public Health Sciences, University of California, Davis, Davis, California, USA
| | - Anne P. Starling
- Center for Lifecourse Epidemiology of Adiposity and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Ghassan B. Hamra
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tracey J. Woodruff
- Program for Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
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19
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Nozadi SS, Li X, Kong X, Rennie B, Kanda D, MacKenzie D, Luo L, Posner J, Blackwell CK, Croen LA, Ferrara A, O’Connor TG, Zimmerman E, Ghassabian A, Leve LD, Elliott AJ, Schmidt RJ, Sprowles JLN, Lewis JL. Effects of COVID-19 Financial and Social Hardships on Infants' and Toddlers' Development in the ECHO Program. Int J Environ Res Public Health 2023; 20:1013. [PMID: 36673770 PMCID: PMC9858743 DOI: 10.3390/ijerph20021013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The financial hardships and social isolation experienced during the COVID-19 pandemic have been found to adversely affect children's developmental outcomes. While many studies thus far have focused on school-aged children and the pandemic-related impacts on their academic skills and behavior problems, relatively less is known about pandemic hardships and associations with children's development during their early years. Using a racially and economically diverse sample, we examined whether hardships experienced during the pandemic were associated with children's development with a particular focus on communication and socioemotional development. METHODS Participants from eight cohorts of the Environmental influences on Child Health Outcomes program provided data on pandemic-related financial and social hardships as well as child developmental outcomes. Financial hardship was defined as at least one parent experiencing job loss or change, and social hardship was defined as families' quarantining from household members or extended family and friends. The development of children under 4 was assessed longitudinally, before and during the pandemic (N = 684), using the Ages and Stages Questionnaire (ASQ). The Generalized Estimating Equations, which accounted for within-child correlation, were used for analysis. RESULTS Families from minority backgrounds and low socioeconomic status disproportionately experienced pandemic-related hardships. Male children had higher odds of experiencing negative changes in communication and personal social skills from pre- to during-pandemic visits (ORs ranged between 2.24 and 3.03 in analysis with binary ASQ outcomes and ranged from -0.34-0.36 in analyses with ASQ z-scores, ps = 0.000). Pandemic-related hardships in the social and financial areas did not explain within-individual changes in children's developmental outcomes. CONCLUSION Negative developmental changes from pre- to during-pandemic were found in boys, yet we did not find any associations between increased experience of pandemic-related hardships and children's development. E how pandemic hardships affect development using a larger sample size and with longer follow-up is warranted.
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Affiliation(s)
- Sara S. Nozadi
- Community Environmental Health Program, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Ximin Li
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Xiangrong Kong
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Wilmer Eye Institute, School of Medicine, Johns Hopkins University, Baltimore, MD 21087, USA
| | - Brandon Rennie
- Department of Pediatrics, Center for Development and Disability, University of New Mexico Health Sciences Center, Albuquerque, NM 87107, USA
| | - Deborah Kanda
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM 87106, USA
| | - Debra MacKenzie
- Community Environmental Health Program, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Li Luo
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM 87106, USA
| | - Jonathan Posner
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Duke University, Durham, NC 27705, USA
| | - Courtney K. Blackwell
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA
| | - Thomas G. O’Connor
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Emily Zimmerman
- Department of Communication Sciences and Disorder, Northeastern University, Boston, MA 02115, USA
| | - Akhgar Ghassabian
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Leslie D. Leve
- Department of Counseling Psychology, College of Education, University of Oregon, Eugene, OR 97403, USA
| | - Amy J. Elliott
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD 57105, USA
- Avera Research Institute, Sioux Falls, SD 57108, USA
| | - Rebecca J. Schmidt
- Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, CA 95616, USA
| | - Jenna L. N. Sprowles
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
- International Classification of Functioning, Disability, and Health, Durham, NC 27713, USA
| | - Johnnye L. Lewis
- Community Environmental Health Program, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
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20
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Aris IM, Perng W, Dabelea D, Padula AM, Alshawabkeh A, Vélez-Vega CM, Aschner JL, Camargo CA, Sussman TJ, Dunlop AL, Elliott AJ, Ferrara A, Zhu Y, Joseph CLM, Singh AM, Hartert T, Cacho F, Karagas MR, North-Reid T, Lester BM, Kelly NR, Ganiban JM, Chu SH, O’Connor TG, Fry RC, Norman G, Trasande L, Restrepo B, James P, Oken E. Associations of Neighborhood Opportunity and Social Vulnerability With Trajectories of Childhood Body Mass Index and Obesity Among US Children. JAMA Netw Open 2022; 5:e2247957. [PMID: 36547983 PMCID: PMC9857328 DOI: 10.1001/jamanetworkopen.2022.47957] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/30/2022] [Indexed: 12/24/2022] Open
Abstract
Importance Physical and social neighborhood attributes may have implications for children's growth and development patterns. The extent to which these attributes are associated with body mass index (BMI) trajectories and obesity risk from childhood to adolescence remains understudied. Objective To examine associations of neighborhood-level measures of opportunity and social vulnerability with trajectories of BMI and obesity risk from birth to adolescence. Design, Setting, and Participants This cohort study used data from 54 cohorts (20 677 children) participating in the Environmental Influences on Child Health Outcomes (ECHO) program from January 1, 1995, to January 1, 2022. Participant inclusion required at least 1 geocoded residential address and anthropometric measure (taken at the same time or after the address date) from birth through adolescence. Data were analyzed from February 1 to June 30, 2022. Exposures Census tract-level Child Opportunity Index (COI) and Social Vulnerability Index (SVI) linked to geocoded residential addresses at birth and in infancy (age range, 0.5-1.5 years), early childhood (age range, 2.0-4.8 years), and mid-childhood (age range, 5.0-9.8 years). Main Outcomes and Measures BMI (calculated as weight in kilograms divided by length [if aged <2 years] or height in meters squared) and obesity (age- and sex-specific BMI ≥95th percentile). Based on nationwide distributions of the COI and SVI, Census tract rankings were grouped into 5 categories: very low (<20th percentile), low (20th percentile to <40th percentile), moderate (40th percentile to <60th percentile), high (60th percentile to <80th percentile), or very high (≥80th percentile) opportunity (COI) or vulnerability (SVI). Results Among 20 677 children, 10 747 (52.0%) were male; 12 463 of 20 105 (62.0%) were White, and 16 036 of 20 333 (78.9%) were non-Hispanic. (Some data for race and ethnicity were missing.) Overall, 29.9% of children in the ECHO program resided in areas with the most advantageous characteristics. For example, at birth, 26.7% of children lived in areas with very high COI, and 25.3% lived in areas with very low SVI; in mid-childhood, 30.6% lived in areas with very high COI and 28.4% lived in areas with very low SVI. Linear mixed-effects models revealed that at every life stage, children who resided in areas with higher COI (vs very low COI) had lower mean BMI trajectories and lower risk of obesity from childhood to adolescence, independent of family sociodemographic and prenatal characteristics. For example, among children with obesity at age 10 years, the risk ratio was 0.21 (95% CI, 0.12-0.34) for very high COI at birth, 0.31 (95% CI, 0.20-0.51) for high COI at birth, 0.46 (95% CI, 0.28-0.74) for moderate COI at birth, and 0.53 (95% CI, 0.32-0.86) for low COI at birth. Similar patterns of findings were observed for children who resided in areas with lower SVI (vs very high SVI). For example, among children with obesity at age 10 years, the risk ratio was 0.17 (95% CI, 0.10-0.30) for very low SVI at birth, 0.20 (95% CI, 0.11-0.35) for low SVI at birth, 0.42 (95% CI, 0.24-0.75) for moderate SVI at birth, and 0.43 (95% CI, 0.24-0.76) for high SVI at birth. For both indices, effect estimates for mean BMI difference and obesity risk were larger at an older age of outcome measurement. In addition, exposure to COI or SVI at birth was associated with the most substantial difference in subsequent mean BMI and risk of obesity compared with exposure at later life stages. Conclusions and Relevance In this cohort study, residing in higher-opportunity and lower-vulnerability neighborhoods in early life, especially at birth, was associated with a lower mean BMI trajectory and a lower risk of obesity from childhood to adolescence. Future research should clarify whether initiatives or policies that alter specific components of neighborhood environment would be beneficial in preventing excess weight in children.
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Affiliation(s)
- Izzuddin M. Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Wei Perng
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
| | - Amy M. Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco
| | - Akram Alshawabkeh
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts
| | - Carmen M. Vélez-Vega
- UPR Medical Sciences Campus, University of Puerto Rico Graduate School of Public Health, San Juan
| | - Judy L. Aschner
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, New Jersey
- Department of Pediatrics, Albert Einstein College of Medicine, New York, New York
| | - Carlos A. Camargo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Tamara J. Sussman
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, New York
| | - Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Amy J. Elliott
- Avera Research Institute, Sioux Falls, South Dakota
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland
| | | | - Anne Marie Singh
- Division of Allergy, Immunology and Rheumatology, University of Wisconsin–Madison, Madison
| | - Tina Hartert
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ferdinand Cacho
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Margaret R. Karagas
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Tiffany North-Reid
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Barry M. Lester
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nichole R. Kelly
- Department of Counseling Psychology and Human Services, Prevention Science Institute, University of Oregon, Eugene
| | - Jody M. Ganiban
- Department of Psychological and Brain Sciences, George Washington University, Washington, District of Columbia
| | - Su H. Chu
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Rebecca C. Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Gwendolyn Norman
- Institute for Environmental Health Sciences, Wayne State University School of Medicine, Detroit, Michigan
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Leonardo Trasande
- Department of Pediatrics, New York University Grossman School of Medicine, New York
| | - Bibiana Restrepo
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento
- MIND Institute, University of California Davis, Sacramento, California
| | - Peter James
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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21
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Lucchini M, O’Brien LM, Kahn LG, Brennan PA, Glazer Baron K, Knapp EA, Lugo-Candelas C, Shuffrey L, Dunietz GL, Zhu Y, Wright RJ, Wright RO, Duarte C, Karagas MR, Ngai P, O’Connor TG, Herbstman JB, Dioni S, Singh AM, Alcantara C, Fifer WP, Elliott AJ. Racial/ethnic disparities in subjective sleep duration, sleep quality, and sleep disturbances during pregnancy: an ECHO study. Sleep 2022; 45:zsac075. [PMID: 35724979 PMCID: PMC9453625 DOI: 10.1093/sleep/zsac075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/19/2022] [Revised: 03/23/2022] [Indexed: 01/10/2023] Open
Abstract
In the United States, racial/ethnic minoritized groups experience worse sleep than non-Hispanic Whites (nHW), but less is known about pregnant people. This is a key consideration since poor sleep during pregnancy is common and associated with increased risk of adverse perinatal outcomes. This study reports the prevalence of subjective sleep measures in a multi-racial/ethnic pregnant population from the Environmental influences on Child Health Outcomes (ECHO) program. Participants' self-reported race and ethnicity were grouped into: nHW, non-Hispanic Black/African American (nHB/AA), Hispanic, non-Hispanic Asian (nHA). Analyses examined trimester-specific (first (T1), second (T2), third (T3)) nocturnal sleep duration, quality, and disturbances (Pittsburgh Sleep Quality Index and ECHO maternal sleep health questionnaire). Linear or multinomial regressions estimated the associations between race/ethnicity and each sleep domain by trimester, controlling for body mass index and age, with nHW as reference group. We repeated analyses within maternal education strata. nHB/AA participants reported shorter sleep duration (T2: β = -0.55 [-0.80,-0.31]; T3: β = -0.65 [-0.99,-0.31]) and more sleep disturbances (T2: β = 1.92 [1.09,2.75]; T3: β = 1.41 [0.09,2.74]). Hispanic participants reported longer sleep duration (T1: β = 0.22 [0.00004,0.44]; T2: β = 0.61 [0.47,0.76]; T3: β = 0.46 [0.22,0.70]), better sleep quality (Reference group: Very good. Fairly good T1: OR = 0.48 [0.32,0.73], T2: OR = 0.36 [0.26,0.48], T3: OR = 0.31 [0.18,0.52]. Fairly bad T1: OR = 0.27 [0.16,0.44], T2: OR = 0.46 [0.31, 0.67], T3: OR = 0.31 [0.17,0.55]), and fewer sleep disturbances (T2: β = -0.5 [-1.0,-0.12]; T3: β = -1.21 [-2.07,-0.35]). Differences persisted within the high-SES subsample. Given the stark racial/ethnic disparities in perinatal outcomes and their associations with sleep health, further research is warranted to investigate the determinants of these disparities.
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Affiliation(s)
- Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Louise M O’Brien
- Division of Sleep Medicine, Department of Neurology, and Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Linda G Kahn
- Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Kelly Glazer Baron
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Emily A Knapp
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claudia Lugo-Candelas
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Lauren Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Galit Levi Dunietz
- Division of Sleep Medicine, Department of Neurology, and Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Rosalind J Wright
- Department of Environmental Medicine and Public Health and Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert O Wright
- Department of Environmental Medicine and Public Health and Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cristiane Duarte
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Margaret R Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Pakkay Ngai
- Division of Pediatric Pulmonology, Department of Pediatrics, Hackensack Meridian School of Medicine, Hackensack, NJ, USA
| | - Thomas G O’Connor
- Departments of Psychiatry, Psychology, Neuroscience, and Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Julie B Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, New York NY, USA
| | - Sean Dioni
- Department of Pediatrics, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Anne Marie Singh
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - William P Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
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22
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Knapp EA, Dong Y, Dunlop AL, Aschner JL, Stanford JB, Hartert T, Teitelbaum SL, Hudak ML, Carroll K, O’Connor TG, McEvoy CT, O’Shea TM, Carnell S, Karagas MR, Herbstman JB, Dabelea D, Ganiban JM, Ferrara A, Hedderson M, Bekelman TA, Rundle AG, Alshawabkeh A, Gilbert-Diamond D, Fry RC, Chen Z, Gilliland FD, Wright RJ, Camargo CA, Jacobson L, Lester BM, Hockett CW, Hodges ML, Chandran A. Changes in BMI During the COVID-19 Pandemic. Pediatrics 2022; 150:e2022056552. [PMID: 35768891 PMCID: PMC9444980 DOI: 10.1542/peds.2022-056552] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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] [Accepted: 06/08/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Experts hypothesized increased weight gain in children associated with the coronavirus disease 2019 (COVID-19) pandemic. Our objective was to evaluate whether the rate of change of child body mass index (BMI) increased during the COVID-19 pandemic compared with prepandemic years. METHODS The study population of 1996 children ages 2 to 19 years with at least 1 BMI measure before and during the COVID-19 pandemic was drawn from 38 pediatric cohorts across the United States participating in the Environmental Influences on Child Health Outcomes-wide cohort study. We modeled change in BMI using linear mixed models, adjusting for age, sex, race, ethnicity, maternal education, income, baseline BMI category, and type of BMI measure. Data collection and analysis were approved by the local institutional review board of each institution or by the central Environmental Influences on Child Health Outcomes institutional review board. RESULTS BMI increased during the COVID-19 pandemic compared with previous years (0.24 higher annual gain in BMI during the pandemic compared with previous years, 95% confidence interval 0.02 to 0.45). Children with BMI in the obese range compared with the healthy weight range were at higher risk for excess BMI gain during the pandemic, whereas children in higher-income households were at decreased risk of BMI gain. CONCLUSIONS One effect of the COVID-19 pandemic is an increase in annual BMI gain during the COVID-19 pandemic compared with the 3 previous years among children in our national cohort. This increased risk among US children may worsen a critical threat to public health and health equity.
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Affiliation(s)
| | - Yanan Dong
- Johns Hopkins School of Public Health, Baltimore, MD
| | | | - Judy L. Aschner
- Hackensack Meridian School of Medicine and Albert Einstein
College of Medicine, Bronx, NY
| | | | - Tina Hartert
- Vanderbilt University School of Medicine, Nashville,
TN
| | | | - Mark L. Hudak
- University of Florida College of Medicine –
Jacksonville, Jacksonville, FL
| | - Kecia Carroll
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | - Susan Carnell
- Johns Hopkins University School of Medicine, Baltimore,
MD
| | | | | | | | | | | | | | | | - Andrew G. Rundle
- Columbia University Mailman School of Public Health, New
York, New York
| | - Akram Alshawabkeh
- Civil and Environmental Engineering, Northeastern
University, Boston, MA
| | | | | | - Zhanghua Chen
- University of Southern California, Keck School of
Medicine, Los Angeles, CA
| | - Frank D. Gilliland
- University of Southern California, Keck School of
Medicine, Los Angeles, CA
| | | | | | - Lisa Jacobson
- Johns Hopkins School of Public Health, Baltimore, MD
| | | | - Christine W. Hockett
- Avera Research Institute; University of South Dakota
School of Medicine, Sioux Falls, SD
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23
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Lyall K, Ning X, Aschner JL, Avalos LA, Bennett DH, Bilder DA, Bush NR, Carroll KN, Chu SH, Croen LA, Dabelea D, Daniels JL, Duarte C, Elliott AJ, Fallin MD, Ferrara A, Hertz-Picciotto I, Hipwell AE, Jensen ET, Johnson SL, Joseph RM, Karagas M, Kelly RS, Lester BM, Margolis A, McEvoy CT, Messinger D, Neiderhiser JM, O’Connor TG, Oken E, Sathyanarayana S, Schmidt RJ, Sheinkopf SJ, Talge NM, Turi KN, Wright RJ, Zhao Q, Newschaffer C, Volk HE, Ladd-Acosta C, Environmental Influences on Child Health Outcomes OBOPCF. Cardiometabolic Pregnancy Complications in Association With Autism-Related Traits as Measured by the Social Responsiveness Scale in ECHO. Am J Epidemiol 2022; 191:1407-1419. [PMID: 35362025 PMCID: PMC9614927 DOI: 10.1093/aje/kwac061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/19/2021] [Revised: 03/07/2022] [Accepted: 03/25/2022] [Indexed: 01/28/2023] Open
Abstract
Prior work has examined associations between cardiometabolic pregnancy complications and autism spectrum disorder (ASD) but not how these complications may relate to social communication traits more broadly. We addressed this question within the Environmental Influences on Child Health Outcomes program, with 6,778 participants from 40 cohorts conducted from 1998-2021 with information on ASD-related traits via the Social Responsiveness Scale. Four metabolic pregnancy complications were examined individually, and combined, in association with Social Responsiveness Scale scores, using crude and adjusted linear regression as well as quantile regression analyses. We also examined associations stratified by ASD diagnosis, and potential mediation by preterm birth and low birth weight, and modification by child sex and enriched risk of ASD. Increases in ASD-related traits were associated with obesity (β = 4.64, 95% confidence interval: 3.27, 6.01) and gestational diabetes (β = 5.21, 95% confidence interval: 2.41, 8.02), specifically, but not with hypertension or preeclampsia. Results among children without ASD were similar to main analyses, but weaker among ASD cases. There was not strong evidence for mediation or modification. Results suggest that common cardiometabolic pregnancy complications may influence child ASD-related traits, not only above a diagnostic threshold relevant to ASD but also across the population.
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Affiliation(s)
- Kristen Lyall
- Correspondence to Dr. Kristen Lyall, 3020 Market Street, Suite 560, Philadelphia, PA 19104 (e-mail: )
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24
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Buckley J, Kuiper JR, Bennett DH, Barrett ES, Bastain T, Breton CV, Chinthakindi S, Dunlop AL, Farzan SF, Herbstman JB, Karagas MR, Marsit CJ, Meeker JD, Morello-Frosch R, O’Connor TG, Romano ME, Schantz S, Schmidt RJ, Watkins DJ, Zhu H, Pellizzari ED, Kannan K, Woodruff TJ. Exposure to Contemporary and Emerging Chemicals in Commerce among Pregnant Women in the United States: The Environmental influences on Child Health Outcome (ECHO) Program. Environ Sci Technol 2022; 56:6560-6573. [PMID: 35536918 PMCID: PMC9118548 DOI: 10.1021/acs.est.1c08942] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [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] [Received: 12/30/2021] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 05/10/2023]
Abstract
Prenatal chemical exposures can influence maternal and child health; however, few industrial chemicals are routinely biomonitored. We assessed an extensive panel of contemporary and emerging chemicals in 171 pregnant women across the United States (U.S.) and Puerto Rico in the Environmental influences on Child Health Outcomes (ECHO) Program. We simultaneously measured urinary concentrations of 89 analytes (103 total chemicals representing 73 parent compounds) in nine chemical groups: bactericides, benzophenones, bisphenols, fungicides and herbicides, insecticides, organophosphate esters (OPEs), parabens, phthalates/alternative plasticizers, and polycyclic aromatic hydrocarbons (PAHs). We estimated associations of creatinine-adjusted concentrations with sociodemographic and specimen characteristics. Among our diverse prenatal population (60% non-Hispanic Black or Hispanic), we detected 73 of 89 analytes in ≥1 participant and 36 in >50% of participants. Five analytes not currently included in the U.S. biomonitoring were detected in ≥90% of samples: benzophenone-1, thiamethoxam, mono-2-(propyl-6-carboxy-hexyl) phthalate, monocarboxy isooctyl phthalate, and monohydroxy-iso-decyl phthalate. Many analyte concentrations were higher among women of Hispanic ethnicity compared to those of non-Hispanic White women. Concentrations of certain chemicals decreased with the calendar year, whereas concentrations of their replacements increased. Our largest study to date identified widespread exposures to prevalent and understudied chemicals in a diverse sample of pregnant women in the U.S.
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Affiliation(s)
- Jessie
P. Buckley
- Department
of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21218, United States
| | - Jordan R. Kuiper
- Department
of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21218, United States
| | - Deborah H. Bennett
- Department
of Public Health Sciences, University of California Davis, Davis, California 95616, United States
| | - Emily S. Barrett
- Department
of Biostatistics and Epidemiology, Rutgers
School of Public Health, Piscataway, New Jersey 08854, United States
| | - Tracy Bastain
- Department
of Population and Public Health Sciences, University of Southern California, Los Angeles, California 90032, United States
| | - Carrie V. Breton
- Department
of Population and Public Health Sciences, University of Southern California, Los Angeles, California 90032, United States
| | - Sridhar Chinthakindi
- Department
of Pediatrics and Department of Environmental Medicine, New York University School of Medicine, New York, New York 10016, United States
| | - Anne L. Dunlop
- Department
of Gynecology and Obstetrics, Emory University
School of Medicine, Atlanta, Georgia 30322, United States
| | - Shohreh F. Farzan
- Department
of Population and Public Health Sciences, University of Southern California, Los Angeles, California 90032, United States
| | - Julie B. Herbstman
- Department
of Environmental Health Sciences, Columbia, New York, NY 10032, United States
| | - Margaret R. Karagas
- Department
of Epidemiology, Dartmouth Geisel School
of Medicine, Lebanon, New Hampshire 03756, United States
| | - Carmen J. Marsit
- Department
of Environmental Health, Rollins School
of Public Health, Emory University, Atlanta, Georgia 30322, United States
| | - John D. Meeker
- Department
of Environmental Health Sciences, University
of Michigan School of Public Health, Ann Arbor, Michigan 48109, United States
| | - Rachel Morello-Frosch
- Department
of Environmental Science, Policy and Management and School of Public
Health, University of California, Berkeley California 94720, United States
| | - Thomas G. O’Connor
- Department
of Psychiatry, University of Rochester, Rochester, New York 14627, United States
| | - Megan E. Romano
- Department
of Epidemiology, Dartmouth Geisel School
of Medicine, Lebanon, New Hampshire 03756, United States
| | - Susan Schantz
- Beckman
Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, Illinois 61801, United States
| | - Rebecca J. Schmidt
- Department
of Public Health Sciences, University of California Davis, Davis, California 95616, United States
| | - Deborah J. Watkins
- Department
of Environmental Health Sciences, University
of Michigan School of Public Health, Ann Arbor, Michigan 48109, United States
| | - Hongkai Zhu
- Department
of Pediatrics and Department of Environmental Medicine, New York University School of Medicine, New York, New York 10016, United States
| | - Edo D. Pellizzari
- RTI International, Research Triangle
Park, North Carolina 27709, United States
| | - Kurunthachalam Kannan
- Department
of Pediatrics and Department of Environmental Medicine, New York University School of Medicine, New York, New York 10016, United States
| | - Tracey J. Woodruff
- Department
of Obstetrics, Gynecology, and Reproductive Sciences and the Philip
R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California 94143, United States
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25
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Rasmussen JM, Graham AM, Gyllenhammer LE, Entringer S, Chow DS, O’Connor TG, Fair DA, Wadhwa PD, Buss C. Neuroanatomical Correlates Underlying the Association Between Maternal Interleukin 6 Concentration During Pregnancy and Offspring Fluid Reasoning Performance in Early Childhood. Biol Psychiatry Cogn Neurosci Neuroimaging 2022; 7:24-33. [PMID: 33766778 PMCID: PMC8458517 DOI: 10.1016/j.bpsc.2021.03.007] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Maternal inflammation during pregnancy can alter offspring brain development and influence risk for disorders commonly accompanied by deficits in cognitive functioning. We therefore examined associations between maternal interleukin 6 (IL-6) concentrations during pregnancy and offspring cognitive ability and concurrent magnetic resonance imaging-based measures of brain anatomy in early childhood. We further examined newborn brain anatomy in secondary analyses to consider whether effects are evident soon after birth and to increase capacity to differentiate effects of pre- versus postnatal exposures. METHODS IL-6 concentrations were quantified in early (12.6 ± 2.8 weeks), mid (20.4 ± 1.5 weeks), and late (30.3 ± 1.3 weeks) pregnancy. Offspring nonverbal fluid intelligence (Gf) was assessed at 5.2 ± 0.6 years using a spatial reasoning task (Wechsler Preschool and Primary Scale of Intelligence-Matrix) (n = 49). T1-weighted magnetic resonance imaging scans were acquired at birth (n = 89, postmenstrual age = 42.9 ± 2.0 weeks) and in early childhood (n = 42, scan age = 5.1 ± 1.0 years). Regional cortical volumes were examined for a joint association between maternal IL-6 and offspring Gf performance. RESULTS Average maternal IL-6 concentration during pregnancy was inversely associated with offspring Gf performance after adjusting for socioeconomic status and the quality of the caregiving and learning environment (R2 = 13%; p = .02). Early-childhood pars triangularis volume was jointly associated with maternal IL-6 and childhood Gf (pcorrected < .001). An association also was observed between maternal IL-6 and newborn pars triangularis volume (R2 = 6%; p = .02). CONCLUSIONS These findings suggest that the origins of variation in child cognitive ability can, in part, trace back to maternal conditions during the intrauterine period of life and support the role of inflammation as an important component of this putative biological pathway.
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Affiliation(s)
- Jerod M. Rasmussen
- Development, Health and Disease Research Program, University of California, Irvine, California, USA 92697.,Department of Pediatrics, University of California, Irvine, California, USA 92697.,Corresponding Authors: Claudia Buss, PhD, Institute for Medical Psychology, Charité University Medicine, Luisenstr. 57, 10117 Berlin, Germany, Tel: +49 (0)30 450 529 222, Fax: +49 (0)30 450 529 990, ; Jerod M. Rasmussen, PhD., UC Irvine Development, Health and Disease Research Program, University of California, Irvine, School of Medicine, 3117 Gillespie Neuroscience Research Facility (GNRF), 837 Health Sciences Road, Irvine, CA 92697,
| | - Alice M. Graham
- Department of Behavioral Neuroscience,Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, United States
| | - Lauren E. Gyllenhammer
- Development, Health and Disease Research Program, University of California, Irvine, California, USA 92697.,Department of Pediatrics, University of California, Irvine, California, USA 92697
| | - Sonja Entringer
- Development, Health and Disease Research Program, University of California, Irvine, California, USA 92697.,Department of Pediatrics, University of California, Irvine, California, USA 92697.,Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Medical Psychology, Berlin, Germany
| | - Daniel S. Chow
- Department of Radiology, University of California, Irvine, California, USA 92697
| | - Thomas G. O’Connor
- Departments of Psychiatry, Psychology, Neuroscience and Obstetrics & Gynecology, University of Rochester Medical Center, Rochester, New York, USA 14642
| | - Damien A. Fair
- Department of Behavioral Neuroscience,Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, United States
| | - Pathik D. Wadhwa
- Development, Health and Disease Research Program, University of California, Irvine, California, USA 92697.,Department of Pediatrics, University of California, Irvine, California, USA 92697.,Departments of Psychiatry and Human Behavior, Obstetrics & Gynecology, Epidemiology, University of California, Irvine, California, USA 92697
| | - Claudia Buss
- Development, Health and Disease Research Program, University of California, Irvine, California, USA 92697.,Department of Pediatrics, University of California, Irvine, California, USA 92697.,Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Medical Psychology, Berlin, Germany.,Corresponding Authors: Claudia Buss, PhD, Institute for Medical Psychology, Charité University Medicine, Luisenstr. 57, 10117 Berlin, Germany, Tel: +49 (0)30 450 529 222, Fax: +49 (0)30 450 529 990, ; Jerod M. Rasmussen, PhD., UC Irvine Development, Health and Disease Research Program, University of California, Irvine, School of Medicine, 3117 Gillespie Neuroscience Research Facility (GNRF), 837 Health Sciences Road, Irvine, CA 92697,
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26
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Stratakis N, Garcia E, Chandran A, Hsu T, Alshawabkeh A, Aris IM, Aschner JL, Breton C, Burbank A, Camargo CA, Carroll KN, Chen Z, Claud EC, Dabelea D, Dunlop AL, Elliott AJ, Ferrara A, Ganiban JM, Gern JE, Gold DR, Gower WA, Hertz-Picciotto I, Karagas MR, Karr CJ, Lester B, Leve LD, Litonjua AA, Ludena Y, McEvoy CT, Miller RL, Mueller NT, O’Connor TG, Oken E, O’Shea TM, Perera F, Stanford JB, Rivera-Spoljaric K, Rundle A, Trasande L, Wright RJ, Zhang Y, Zhu Y, Berhane K, Gilliland F, Chatzi L. The Role of Childhood Asthma in Obesity Development: A Nationwide US Multicohort Study. Epidemiology 2022; 33:131-140. [PMID: 34561347 PMCID: PMC8633057 DOI: 10.1097/ede.0000000000001421] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
RATIONALE Asthma and obesity often co-occur. It has been hypothesized that asthma may contribute to childhood obesity onset. OBJECTIVES To determine if childhood asthma is associated with incident obesity and examine the role of asthma medication in this association. METHODS We studied 8,716 children between ages 6 and 18.5 years who were nonobese at study entry participating in 18 US cohorts of the Environmental influences on Child Health Outcomes program (among 7,299 children with complete covariate data mean [SD] study entry age = 7.2 [1.6] years and follow up = 5.3 [3.1] years). MEASUREMENTS AND MAIN RESULTS We defined asthma based on caregiver report of provider diagnosis. Incident obesity was defined as the first documented body mass index ≥95th percentile for age and sex following asthma status ascertainment. Over the study period, 26% of children had an asthma diagnosis and 11% developed obesity. Cox proportional hazards models with sex-specific baseline hazards were fitted to assess the association of asthma diagnosis with obesity incidence. Children with asthma had a 23% (95% confidence intervals [CI] = 4, 44) higher risk for subsequently developing obesity compared with those without asthma. A novel mediation analysis was also conducted to decompose the total asthma effect on obesity into pathways mediated and not mediated by asthma medication use. Use of asthma medication attenuated the total estimated effect of asthma on obesity by 64% (excess hazard ratios = 0.64; 95% CI = -1.05, -0.23). CONCLUSIONS This nationwide study supports the hypothesis that childhood asthma is associated with later risk of obesity. Asthma medication may reduce this association and merits further investigation as a potential strategy for obesity prevention among children with asthma.
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Affiliation(s)
- Nikos Stratakis
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Erika Garcia
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Tingju Hsu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Akram Alshawabkeh
- Department of Civil and Environmental Engineering, Northeastern University, Boston, MA
| | - Izzuddin M. Aris
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston MA
| | - Judy L. Aschner
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley NJ and the Albert Einstein College of Medicine, Bronx, NY
| | - Carrie Breton
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Allison Burbank
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kecia N. Carroll
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Zhanghua Chen
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Erika C. Claud
- Departments of Pediatrics and Medicine, The University of Chicago, Chicago, IL
| | - Dana Dabelea
- University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Anne L. Dunlop
- Nell Hodgson Woodruff School of Nursing and Department of Family & Preventive Medicine, Emory University, Atlanta, GA
| | | | | | - Jody M. Ganiban
- Department of Psychology The George Washington University, Washington, DC
| | - James E. Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Diane R Gold
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - William A. Gower
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | - Catherine J. Karr
- Department of Pediatrics & Environmental and Occupational Health Sciences, University of Washington, WA
| | - Barry Lester
- Department of Psychiatry and Human Behavior and Department of Pediatrics, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI
| | - Leslie D. Leve
- Department of Education, University of Oregon, Eugene, OR
| | - Augusto A. Litonjua
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
| | - Yunin Ludena
- University of California, Davis, School of Medicine, CA
| | - Cindy T. McEvoy
- Department of Pediatrics, Oregon Health and Science University, Portland, OR
| | - Rachel L. Miller
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Noel T. Mueller
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Thomas G. O’Connor
- Departments of Psychiatry, Psychology, Neuroscience and Obstetrics and Gynecology, University of Rochester, NY
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston MA
| | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Frederica Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Joseph B. Stanford
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
| | - Katherine Rivera-Spoljaric
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of PediatricsSt. Louis Children’s Hospital, Washington University School of Medicine St. Louis, MO
| | - Andrew Rundle
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Leonardo Trasande
- Departments of Pediatrics, Environmental Medicine and Population Health, New York University School of Medicine, NY
| | - Rosalind J. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yue Zhang
- Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Yeyi Zhu
- Kaiser Permanente Northern California Division of Research
| | - Kiros Berhane
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Frank Gilliland
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Lida Chatzi
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
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27
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Winter MA, Greenlee J, Al Ghriwati N, Garr KN, Sahler OJZ, O’Connor TG. Children's appraisals of threat in pediatric cancer. SSM - Mental Health 2021; 1. [PMID: 35252903 PMCID: PMC8896501 DOI: 10.1016/j.ssmmh.2021.100037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Marcia A. Winter
- Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA, 23284, USA
- Corresponding author. Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA, 23284-2033. (M.A. Winter)
| | - Jessica Greenlee
- Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA, 23284, USA
| | - Nour Al Ghriwati
- Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA, 23284, USA
| | - Katlyn N. Garr
- Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA, 23284, USA
| | - Olle Jane Z. Sahler
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Thomas G. O’Connor
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, 14642, USA
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28
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Gustafsson HC, Nolvi S, Sullivan EL, Rasmussen JM, Gyllenhammer LE, Entringer S, Wadhwa PD, O’Connor TG, Karlsson L, Karlsson H, Korja R, Buss C, Graham AM, Nigg JT. Early development of negative and positive affect: Implications for ADHD symptomatology across three birth cohorts. Dev Psychopathol 2021; 33:1837-1848. [PMID: 36238202 PMCID: PMC9555229 DOI: 10.1017/s0954579421001012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
High levels of early emotionality (of either negative or positive valence) are hypothesized to be important precursors to early psychopathology, with attention-deficit/hyperactivity disorder (ADHD) a prime early target. The positive and negative affect domains are prime examples of Research Domain Criteria (RDoC) concepts that may enrich a multilevel mechanistic map of psychopathology risk. Utilizing both variable-centered and person-centered approaches, the current study examined whether levels and trajectories of infant negative and positive emotionality, considered either in isolation or together, predicted children's ADHD symptoms at 4 to 8 years of age. In variable-centered analyses, higher levels of infant negative affect (at as early as 3 months of age) were associated with childhood ADHD symptoms. Findings for positive affect failed to reach statistical threshold. Results from person-centered trajectory analyses suggest that additional information is gained by simultaneously considering the trajectories of positive and negative emotionality. Specifically, only when exhibiting moderate, stable or low levels of positive affect did negative affect and its trajectory relate to child ADHD symptoms. These findings add to a growing literature that suggests that infant negative emotionality is a promising early life marker of future ADHD risk and suggest secondarily that moderation by positive affectivity warrants more consideration.
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Affiliation(s)
- Hanna C. Gustafsson
- Department of Psychiatry, Oregon Health and Science
University, Portland, OR, USA
| | - Saara Nolvi
- Department of Psychology and Speech-Language Pathology,
Turku Institute for Advanced Studies, University of Turku, Turku, Finland
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center,
Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Elinor L. Sullivan
- Department of Psychiatry, Oregon Health and Science
University, Portland, OR, USA
- Divisions of Neuroscience and Cardiometabolic Health,
Oregon National Primate Research Center, Beaverton, OR, USA
| | - Jerod M. Rasmussen
- Development, Health, and Disease Research Program,
University of California Irvine, Irvine, CA, USA
- Department of Pediatrics, School of Medicine, University of
California Irvine, Irvine, CA, USA
| | - Lauren E. Gyllenhammer
- Development, Health, and Disease Research Program,
University of California Irvine, Irvine, CA, USA
- Department of Pediatrics, School of Medicine, University of
California Irvine, Irvine, CA, USA
| | - Sonja Entringer
- Development, Health, and Disease Research Program,
University of California Irvine, Irvine, CA, USA
- Department of Pediatrics, School of Medicine, University of
California Irvine, Irvine, CA, USA
- Institute of Medical Psychology, Charité University,
Berlin, Germany
| | - Pathik D. Wadhwa
- Development, Health, and Disease Research Program,
University of California Irvine, Irvine, CA, USA
- Department of Pediatrics, School of Medicine, University of
California Irvine, Irvine, CA, USA
- Department of Psychiatry and Human Behavior, School of
Medicine, University of California Irvine, Irvine, CA, USA
- Department of Obstetrics and Gynecology, School of
Medicine, University of California Irvine, Irvine, CA, USA
- Department of Epidemiology, School of Medicine,
University of California Irvine, Irvine, CA, USA
| | - Thomas G. O’Connor
- Departments of Psychiatry, Psychology, Neuroscience, and
Obstetrics & Gynecology, University of Rochester Medical Center, Rochester, NY,
USA
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center,
Department of Clinical Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University
Hospital and University of Turku, Turku, Finland
- Department of Paediatrics and Adolescent Medicine, Turku
University Hospital and University of Turku, Turku, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center,
Department of Clinical Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University
Hospital and University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital and
University of Turku, Turku, Finland
| | - Riikka Korja
- Department of Psychology and Speech-Language Pathology,
Turku Institute for Advanced Studies, University of Turku, Turku, Finland
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center,
Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Claudia Buss
- Development, Health, and Disease Research Program,
University of California Irvine, Irvine, CA, USA
- Institute of Medical Psychology, Charité University,
Berlin, Germany
| | - Alice M. Graham
- Department of Psychiatry, Oregon Health and Science
University, Portland, OR, USA
- Department of Behavioral Neuroscience, Oregon Health and
Science University, Portland, OR, USA
| | - Joel T. Nigg
- Department of Psychiatry, Oregon Health and Science
University, Portland, OR, USA
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29
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Groth SW, Fernandez ID, Block RC, Thurston SW, Wong E, Brunner J, Mayo N, Kapula N, Yu Y, Meng Y, Yeh KL, Kinkade CW, Thornburg LL, O’Connor TG, Barrett ES. Biological changes in the pregnancy-postpartum period and subsequent cardiometabolic risk-UPSIDE MOMS: A research protocol. Res Nurs Health 2021; 44:608-619. [PMID: 33993510 PMCID: PMC8378197 DOI: 10.1002/nur.22141] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/05/2021] [Accepted: 05/02/2021] [Indexed: 01/21/2023]
Abstract
Multiple physiological changes occur in pregnancy as a woman's body adapts to support the growing fetus. These pregnancy-induced changes are essential for fetal growth, but the extent to which they reverse after pregnancy remains in question. For some women, physiological changes persist after pregnancy and may increase long-term cardiometabolic disease risk. The National Institutes of Health-funded study described in this protocol addresses a scientific gap by characterizing weight and biological changes during pregnancy and an extended postpartum period in relation to cardiometabolic risk. We use a longitudinal repeated measures design to prospectively examine maternal health from early pregnancy until 3 years postpartum. The aims are: (1) identify maternal weight profiles in the pregnancy-postpartum period that predict adverse cardiometabolic risk profiles three years postpartum; (2) describe immune, endocrine, and metabolic biomarker profiles in the pregnancy-postpartum period, and determine their associations with cardiometabolic risk; and (3) determine how modifiable postpartum health behaviors (diet, physical activity, breastfeeding, sleep, stress) (a) predict weight and cardiometabolic risk in the postpartum period; and (b) moderate associations between postpartum weight retention and downstream cardiometabolic risk. The proposed sample is 250 women. This study of mothers is conducted in conjunction with the Understanding Pregnancy Signals and Infant Development study, which examines child health outcomes. Biological and behavioral data are collected in each trimester and at 6, 12, 24, and 36 months postpartum. Findings will inform targeted health strategies that promote health and reduce cardiometabolic risk in childbearing women.
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Affiliation(s)
- Susan W Groth
- University of Rochester, School of Nursing, Rochester NY
| | - I Diana Fernandez
- University of Rochester School of Medicine and Dentistry, Department of Public Health Sciences
| | - Robert C Block
- University of Rochester, Departments of Public Health Sciences, Cardiology, and Medicine
| | - Sally W Thurston
- University of Rochester, Department of Biostatistics and Computational Biology
| | - Eunyoung Wong
- University of Rochester, School of Nursing, Rochester NY
| | - Jessica Brunner
- University of Rochester Medical Center, Department of Obstetrics and Gynecology
| | - Nicole Mayo
- University of Rochester School of Medicine and Dentistry, Department of Public Health Sciences
| | - Ntemena Kapula
- University of Rochester Medical Center, Department of Obstetrics and Gynecology
| | - Yang Yu
- University of Rochester, School of Nursing, Rochester NY
| | - Ying Meng
- University of Rochester, School of Nursing, Rochester NY
| | - Kuan-Lin Yeh
- University of Rochester, School of Nursing, Rochester NY
| | - Carolyn W Kinkade
- Rutgers University, Exposure Science and Epidemiology, Environmental and Occupational Health Sciences Institute
| | - Loralei L Thornburg
- University of Rochester Medical Center, Department of Obstetrics and Gynecology
| | - Thomas G O’Connor
- University of Rochester, Departments of Psychiatry, Psychology, Neuroscience, Obstetrics and Gynecology, and Wynne Center for Family Research
| | - Emily S Barrett
- University of Rochester Medical Center, Department of Obstetrics and Gynecology
- Rutgers University, Exposure Science and Epidemiology, Environmental and Occupational Health Sciences Institute
- Rutgers School of Public Health, Biostatistics and Epidemiology
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30
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Adibi JJ, Layden AJ, Birru RL, Miragaia A, Xun X, Smith MC, Yin Q, Millenson ME, O’Connor TG, Barrett ES, Snyder NW, Peddada S, Mitchell RT. First trimester mechanisms of gestational sac placental and foetal teratogenicity: a framework for birth cohort studies. Hum Reprod Update 2021; 27:747-770. [PMID: 33675653 PMCID: PMC8222765 DOI: 10.1093/humupd/dmaa063] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/18/2020] [Revised: 12/18/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The function of the gestational sac (GS) and the placenta in the closely related processes of embryogenesis and teratogenicity in the first trimester has been minimally described. The prevailing assumption is that direct teratogenic effects are mediated by the critical extraembryonic organ, the placenta, which either blocks or transfers exposures to the foetus. Placental transfer is a dominant mechanism, but there are other paradigms by which the placenta can mediate teratogenic effects. Knowledge of these paradigms and first trimester human developmental biology can be useful to the epidemiologist in the conduct of biomarker-based studies of both maternal and child health. OBJECTIVE AND RATIONALE Our aim is to provide a causal framework for modelling the teratogenic effects of first trimester exposures on child health outcomes mediated by the GS and placenta using biomarker data collected in the first trimester. We initially present first trimester human developmental biology for the sake of informing and strengthening epidemiologic approaches. We then propose analytic approaches of modelling placental mechanisms by way of causal diagrams using classical non-embryolethal teratogens (diethylstilboestrol [DES], folic acid deficiency and cytomegalovirus [CMV]) as illustrative examples. We extend this framework to two chronic exposures of particular current interest, phthalates and maternal adiposity. SEARCH METHODS Information on teratogens was identified by a non-systematic, narrative review. For each teratogen, we included papers that answered the five following questions: (i) why were these exposures declared teratogens? (ii) is there a consensus on biologic mechanism? (iii) is there reported evidence of a placental mechanism? (iv) can we construct a theoretical model of a placental mechanism? and (v) can this knowledge inform future work on measurement and modelling of placental-foetal teratogenesis? We prioritized literature specific to human development, the organogenesis window in the first trimester and non-embryolethal mechanisms. OUTCOMES As a result of our review of the literature on five exposures considered harmful in the first trimester, we developed four analytic strategies to address first trimester placental mechanisms in birth cohort studies: placental transfer and direct effects on the foetus (DES and maternal adiposity), indirect effects through targeted placental molecular pathways (DES and phthalates), pre-placental effects through disruptions in embryonic and extraembryonic tissue layer differentiation (folic acid deficiency), and multi-step mechanisms that involve maternal, placental and foetal immune function and inflammation (DES and CMV). WIDER IMPLICATIONS The significance of this review is to offer a causal approach to classify the large number of potentially harmful exposures in pregnancy when the exposure occurs in the first trimester. Our review will facilitate future research by advancing knowledge of the first trimester mechanisms necessary for researchers to effectively associate environmental exposures with child health outcomes.
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Affiliation(s)
- Jennifer J Adibi
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alexander J Layden
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rahel L Birru
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alexandra Miragaia
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Xiaoshuang Xun
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Megan C Smith
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Qing Yin
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Thomas G O’Connor
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | - Emily S Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Nathaniel W Snyder
- Department of Microbiology and Immunology, Center for Metabolic Disease Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Shyamal Peddada
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rod T Mitchell
- MRC Centre for Reproductive Health, The University of Edinburgh, Queens Medical Research Institute, Edinburgh, UK
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31
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Dunlop AL, Essalmi AG, Alvalos L, Breton C, Camargo CA, Cowell WJ, Dabelea D, Dager SR, Duarte C, Elliott A, Fichorova R, Gern J, Hedderson MM, Thepaksorn EH, Huddleston K, Karagas MR, Kleinman K, Leve L, Li X, Li Y, Litonjua A, Ludena-Rodriguez Y, Madan JC, Nino JM, McEvoy C, O’Connor TG, Padula AM, Paneth N, Perera F, Sathyanarayana S, Schmidt RJ, Schultz RT, Snowden J, Stanford JB, Trasande L, Volk HE, Wheaton W, Wright RJ, McGrath M. Racial and geographic variation in effects of maternal education and neighborhood-level measures of socioeconomic status on gestational age at birth: Findings from the ECHO cohorts. PLoS One 2021; 16:e0245064. [PMID: 33418560 PMCID: PMC7794036 DOI: 10.1371/journal.pone.0245064] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 05/13/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022] Open
Abstract
Preterm birth occurs at excessively high and disparate rates in the United States. In 2016, the National Institutes of Health (NIH) launched the Environmental influences on Child Health Outcomes (ECHO) program to investigate the influence of early life exposures on child health. Extant data from the ECHO cohorts provides the opportunity to examine racial and geographic variation in effects of individual- and neighborhood-level markers of socioeconomic status (SES) on gestational age at birth. The objective of this study was to examine the association between individual-level (maternal education) and neighborhood-level markers of SES and gestational age at birth, stratifying by maternal race/ethnicity, and whether any such associations are modified by US geographic region. Twenty-six ECHO cohorts representing 25,526 mother-infant pairs contributed to this disseminated meta-analysis that investigated the effect of maternal prenatal level of education (high school diploma, GED, or less; some college, associate's degree, vocational or technical training [reference category]; bachelor's degree, graduate school, or professional degree) and neighborhood-level markers of SES (census tract [CT] urbanicity, percentage of black population in CT, percentage of population below the federal poverty level in CT) on gestational age at birth (categorized as preterm, early term, full term [the reference category], late, and post term) according to maternal race/ethnicity and US region. Multinomial logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CIs). Cohort-specific results were meta-analyzed using a random effects model. For women overall, a bachelor's degree or above, compared with some college, was associated with a significantly decreased odds of preterm birth (aOR 0.72; 95% CI: 0.61-0.86), whereas a high school education or less was associated with an increased odds of early term birth (aOR 1.10, 95% CI: 1.00-1.21). When stratifying by maternal race/ethnicity, there were no significant associations between maternal education and gestational age at birth among women of racial/ethnic groups other than non-Hispanic white. Among non-Hispanic white women, a bachelor's degree or above was likewise associated with a significantly decreased odds of preterm birth (aOR 0.74 (95% CI: 0.58, 0.94) as well as a decreased odds of early term birth (aOR 0.84 (95% CI: 0.74, 0.95). The association between maternal education and gestational age at birth varied according to US region, with higher levels of maternal education associated with a significantly decreased odds of preterm birth in the Midwest and South but not in the Northeast and West. Non-Hispanic white women residing in rural compared to urban CTs had an increased odds of preterm birth; the ability to detect associations between neighborhood-level measures of SES and gestational age for other race/ethnic groups was limited due to small sample sizes within select strata. Interventions that promote higher educational attainment among women of reproductive age could contribute to a reduction in preterm birth, particularly in the US South and Midwest. Further individual-level analyses engaging a diverse set of cohorts are needed to disentangle the complex interrelationships among maternal education, neighborhood-level factors, exposures across the life course, and gestational age at birth outcomes by maternal race/ethnicity and US geography.
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Affiliation(s)
- Anne L. Dunlop
- Woodruff Health Sciences Center, School of Medicine and Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States of America
| | - Alicynne Glazier Essalmi
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - Lyndsay Alvalos
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Carrie Breton
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Carlos A. Camargo
- Department of Epidemiology Harvard University, Cambridge, Massachusetts, United States of America
| | - Whitney J. Cowell
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Dana Dabelea
- Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Stephen R. Dager
- Department of Radiology and Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Cristiane Duarte
- Department of Psychiatry, Columbia University, New York, New York, United States of America
| | - Amy Elliott
- Avera Research Institute Center for Pediatric & Community Research, Sioux Falls, South Dakota, United States of America
| | - Raina Fichorova
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - James Gern
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Monique M. Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Elizabeth Hom Thepaksorn
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Kathi Huddleston
- College of Health and Human Services, George Mason University, Fairfax, Virginia, United States of America
| | - Margaret R. Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - Ken Kleinman
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Leslie Leve
- Prevention Science Institute, University of Oregon, Eugene, Oregon, United States of America
| | - Ximin Li
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland United States of America
| | - Yijun Li
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland United States of America
| | - Augusto Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children’s Hospital at Strong, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Yunin Ludena-Rodriguez
- Division of Environmental and Occupational Health, Public Health Sciences, School of Medicine, University of California, Davis, California, United States of America
| | - Juliette C. Madan
- Department of Epidemiology Geisel School of Medicine at Dartmouth Hitchcock Medical Center, Hanover, New Hampshire, United States of America
| | - Julio Mateus Nino
- Obstetrics and Gynecology, Maternal and Fetal Medicine, Atrium Health, Charlotte, North Carolina, United States of America
| | - Cynthia McEvoy
- Division of Neonatal, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Thomas G. O’Connor
- Department of Psychiatry, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Amy M. Padula
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Nigel Paneth
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - Frederica Perera
- Department of Psychiatry, Columbia University, New York, New York, United States of America
| | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington & Seattle Children’s Research Institute, Seattle, Washington, United States of America
| | - Rebecca J. Schmidt
- Division of Environmental and Occupational Health, Public Health Sciences, School of Medicine, University of California, Davis, California, United States of America
| | - Robert T. Schultz
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Jessica Snowden
- Department of Pediatrics, University of Arkansas Medical Sciences, Little Rock, Arkansas, United States of America
| | - Joseph B. Stanford
- Department of Family Preventative Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Leonardo Trasande
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Heather E. Volk
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland United States of America
| | - William Wheaton
- Science and Technology Program, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Rosalind J. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Monica McGrath
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland United States of America
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O’Connor TG, Willoughby MT, Moynihan JA, Messing S, Vallejo Sefair A, Carnahan J, Yin X, Caserta MT. Early childhood risk exposures and inflammation in early adolescence. Brain Behav Immun 2020; 86:22-29. [PMID: 31059804 PMCID: PMC6825880 DOI: 10.1016/j.bbi.2019.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 02/07/2019] [Revised: 04/26/2019] [Accepted: 05/02/2019] [Indexed: 02/06/2023] Open
Abstract
There is now reliable evidence that early psychosocial stress exposures are associated with behavioral health in children; the degree to which these same kinds of stress exposures predict physical health outcomes is not yet clear. We investigated the links between economic adversity, family and caregiving stress in early childhood and several markers of immune function in early adolescence. The sample is derived from the Family Life Project, a prospective longitudinal study of at-risk families. Socio-demographic and psychosocial risks have been assessed at regular intervals since the children were first assessed at 2 months of age. When the children were early adolescents, we conducted an in-depth health assessment of a subsample of families; blood samples were collected from venipuncture for interleukin(IL)-6, Tumor Necrosis Factor (TNF)-alpha, and C-reactive protein (CRP), as well as glucocorticoid resistance. Results indicated limited but reliable evidence of an association between early risk exposure and inflammation in adolescence. Specifically, caregiver depressive symptoms in early childhood predicted elevated CRP almost a decade later, and the prediction was significant after accounting for multiple covariates such as socio-economic adversity, health behaviors and body mass index. Our findings provide strong but limited evidence that early stress exposures may be associated with inflammation, suggesting one mechanism linking early stress exposure to compromised behavioral and somatic health.
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Affiliation(s)
| | | | - Jan A Moynihan
- Department of Psychiatry, University of Rochester Medical Center
| | - Susan Messing
- Department of Statistics and Bioinformatics, University of Rochester Medical Center
| | | | | | - Xiajuan Yin
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill
| | - Mary T Caserta
- Department of Pediatrics, University of Rochester Medical Center
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O’Donnell KJ, Glover V, Lahti J, Lahti M, Edgar RD, Räikkönen K, O’Connor TG. Maternal prenatal anxiety and child COMT genotype predict working memory and symptoms of ADHD. PLoS One 2017; 12:e0177506. [PMID: 28614354 PMCID: PMC5470664 DOI: 10.1371/journal.pone.0177506] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 09/30/2016] [Accepted: 04/30/2017] [Indexed: 12/31/2022] Open
Abstract
Maternal prenatal anxiety is an important risk factor for altered child neurodevelopment but there is uncertainty concerning the biological mechanisms involved and sources of individual differences in children's responses. We sought to determine the role of functional genetic variation in COMT, which encodes catechol-O-methyltransferase, in the association between maternal prenatal anxiety and child symptoms of ADHD and working memory. We used the prospectively-designed ALSPAC cohort (n = 6,969) for our primary data analyses followed by replication analyses in the PREDO cohort (n = 425). Maternal prenatal anxiety was based on self-report measures; child symptoms of ADHD were collected from 4-15 years of age; working memory was assessed from in-person testing at age 8 years; and genetic variation in COMT at rs4680 was determined in both mothers and children. The association between maternal prenatal anxiety and child attention/hyperactivity symptoms and working memory was moderated by the child's rs4680 genotype, with stronger effects obtained for the val/val (G:G) genotype relative to val/met (A:G) (all p<0.01) and met/met (A:A) groups (all p<0.05). Similar findings were observed in the PREDO cohort where maternal prenatal anxiety interacted with child rs4680 to predict symptoms of ADHD at 3.5 years of age. The findings, from two cohorts, show a robust gene-environment interaction, which may contribute to inter-individual differences in the effects of maternal prenatal anxiety on developmental outcomes from childhood to mid-adolescence.
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Affiliation(s)
- Kieran J. O’Donnell
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Hospital Research Centre, Department of Psychiatry, McGill University, Montreal, Canada
- Child and Brain Development Program, Canadian Institute for Advanced Research, Toronto, Canada
| | - Vivette Glover
- Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom
| | - Jari Lahti
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
- Helsinki Collegium for Advanced Studies, University of Helsinki, Finland
| | - Marius Lahti
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
- Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - Rachel D. Edgar
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Katri Räikkönen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
- Queen's Medical Research Institute, University of Edinburgh, United Kingdom
| | - Thomas G. O’Connor
- Wynne Center for Family Research, Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, United States of America
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Kung KTF, Spencer D, Pasterski V, Neufeld S, Glover V, O’Connor TG, Hindmarsh PC, Hughes IA, Acerini CL, Hines M. No relationship between prenatal androgen exposure and autistic traits: convergent evidence from studies of children with congenital adrenal hyperplasia and of amniotic testosterone concentrations in typically developing children. J Child Psychol Psychiatry 2016; 57:1455-1462. [PMID: 27460188 PMCID: PMC6100761 DOI: 10.1111/jcpp.12602] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [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] [Accepted: 05/23/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND There is a marked male preponderance in autism spectrum conditions. The extreme male brain theory and the fetal androgen theory of autism suggest that elevated prenatal testosterone exposure is a key contributor to autistic traits. The current paper reports findings from two separate studies that test this hypothesis. METHODS A parent-report questionnaire, the Childhood Autism Spectrum Test (CAST), was employed to measure autistic traits in both studies. The first study examined autistic traits in young children with congenital adrenal hyperplasia (CAH), a condition causing unusually high concentrations of testosterone prenatally in girls. Eighty one children with CAH (43 girls) and 72 unaffected relatives (41 girls), aged 4-11 years, were assessed. The second study examined autistic traits in relation to amniotic testosterone in 92 typically developing children (48 girls), aged 3-5 years. RESULTS Findings from neither study supported the association between prenatal androgen (testosterone) exposure and autistic traits. Specifically, young girls with and without CAH did not differ significantly in CAST scores and amniotic testosterone concentrations were not significantly associated with CAST scores in boys, girls, or the whole sample. CONCLUSIONS These studies do not support a relationship between prenatal testosterone exposure and autistic traits. These findings augment prior research suggesting no consistent relationship between early androgen exposure and autistic traits.
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Affiliation(s)
| | | | - Vickie Pasterski
- Department of Psychology, University of Cambridge,Department of Paediatrics, University of Cambridge, UK
| | | | - Vivette Glover
- Institute of Reproductive and Developmental Biology, Imperial College London
| | - Thomas G. O’Connor
- School of Medicine and Dentistry, University of Rochester Medical Center, NY, USA
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Blackmore ER, Putnam FW, Pressman EK, Rubinow DR, Putnam KT, Matthieu MM, Gilchrist MA, Jones I, O’Connor TG. The Effects of Trauma History and Prenatal Affective Symptoms on Obstetric Outcomes. J Trauma Stress 2016; 29:245-52. [PMID: 27276162 PMCID: PMC4902169 DOI: 10.1002/jts.22095] [Citation(s) in RCA: 26] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 02/22/2016] [Accepted: 02/26/2016] [Indexed: 12/14/2022]
Abstract
Prenatal maternal mood may inform the adverse obstetric outcomes seen in disadvantaged populations. The contribution of having a trauma history is not well studied. We examined the impact of trauma exposure and mood symptoms on obstetric outcomes in 358 women. Women with antecedent trauma were more likely to have a history of depression, odds ratio = 2.83, 95% confidence interval [1.81, 4.42], were younger at their first pregnancy, 18.86 years versus 20.10 years, and had a higher number of previous pregnancies, 2.01 versus 1.54, compared to those with no trauma exposure. Women with prenatal anxiety had significantly smaller babies than nonanxious women, 3,313.17 g, (SD = 441.58) versus 3,429.27 g, (SD = 437.82) Trauma history magnified the effects of maternal prenatal mood on birthweight; the moderating effect was limited to those who first experienced a trauma under 18 years of age. Childhood trauma exposure increased vulnerability for low birthweight delivery associated with prenatal mood disturbance. Screening pregnant women for trauma history and current mood symptoms is indicated.
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Affiliation(s)
- Emma Robertson Blackmore
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA,Department of Psychiatry, University of Florida, Jacksonville, Florida, USA
| | - Frank W Putnam
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Eva K Pressman
- Department of Obstetrics & Gynecology, University of Rochester Medical Center, Rochester, New York, USA
| | - David R Rubinow
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Karen T Putnam
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Monica M Matthieu
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
| | - Michelle A Gilchrist
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Ian Jones
- Department of Psychological Medicine, Cardiff University, Cardiff, Wales
| | - Thomas G O’Connor
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA,Wynne Center for Family Research, University of Rochester Medical Center, Rochester, New York, USA
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Blackmore ER, Gustafsson H, Gilchrist M, Wyman C, O’Connor TG. Pregnancy-related anxiety: Evidence of distinct clinical significance from a prospective longitudinal study. J Affect Disord 2016; 197:251-8. [PMID: 26999549 PMCID: PMC4837058 DOI: 10.1016/j.jad.2016.03.008] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [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: 11/20/2015] [Revised: 02/20/2016] [Accepted: 03/06/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Pregnancy-related anxiety (PrA) has attracted considerable research attention, but questions remain about its distinctiveness from conventional constructs and measures. In a high psychosocial risk, ethnically diverse sample, we examine the degree to which PrA is distinct from continuous and diagnostic measures of anxiety and worry in terms of longitudinal course, associations with psychosocial and perinatal risk, and prediction of postnatal mood disturbance. METHODS 345 women oversampled for prenatal anxiety and depression were selected from an urban obstetrics clinic serving a predominantly low-income, ethnically diverse population. PrA was assessed at 20 and 32 weeks gestation; anxiety and depression symptoms were assessed from questionnaire and from clinical interview at 20 and 32 weeks gestation and again at 2 and 6 months postnatally. Data relevant to psychosocial and obstetric risks were ascertained from interview, medical exam, and chart review. RESULTS Two distinct factors of PrA were identified, indexing specific concerns about the child's health and about the birth; these two PrA factors showed distinct longitudinal patterns in the prenatal period, and modest associations with general measures of anxiety and depression from questionnaire and clinical interview. PrA was also distinguished from conventional symptom measures in its associated features and prediction of birth weight and postnatal mood. LIMITATIONS The sample was at high psychosocial risk and ethnically diverse; findings may not generalize to other samples. CONCLUSIONS PrA can be distinguished from general measures of anxiety in pregnancy in terms of longitudinal course, associated features, and prediction to postnatal mood disturbance, and may warrant specific clinical attention.
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Affiliation(s)
| | | | | | - Claire Wyman
- Department of Pediatrics, University of Rochester Medical Center
| | - Thomas G O’Connor
- Wynne Center for Family Research, Department of Psychiatry, University of Rochester Medical Center,Correspondence to: Thomas O’Connor, Wynne Center for Family Research, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642;
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Capron LE, Glover V, Pearson RM, Evans J, O’Connor TG, Stein A, Murphy SE, Ramchandani PG. Associations of maternal and paternal antenatal mood with offspring anxiety disorder at age 18 years. J Affect Disord 2015; 187:20-6. [PMID: 26301478 PMCID: PMC4595479 DOI: 10.1016/j.jad.2015.08.012] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Maternal antenatal depression and anxiety are associated with increased risk of childhood behavioural and emotional problems in offspring; it remains unclear to what extent this is due to a maternal biological impact on foetal development. Here, we compare associations between maternal and paternal antenatal depression and anxiety with offspring anxiety disorders, thus controlling for some genetic and shared environmental factors. METHODS We used data from the ALSPAC population cohort including measures of antenatal parental depression and anxiety. At 18 years, offspring completed the CIS-R interview, yielding diagnoses for anxiety disorders. Results were adjusted for confounding variables including parental postnatal depression and anxiety. RESULTS Children of women with antenatal depression (18 weeks gestation), had an increased risk of anxiety disorders at 18 years of age (11.1% vs. 6.2%; adj. OR 1.75 (1.19, 2.58); p=0.01). Children of women with antenatal anxiety had increased risk of co-morbid anxiety and depression (adj. OR 1.39 (1.06, 1.82); p=0.02). No such associations were found with paternal antenatal depression or anxiety. LIMITATIONS There was a high attrition rate from the original cohort to the CIS-R completion at 18 years postpartum. Parental mood was only assessed together at one time point during the antenatal period. CONCLUSIONS The differences in the association between maternal and paternal mood during pregnancy and child outcomes supports the hypothesis that foetal programming may account, at least in part, for this association. We highlight the potential opportunity for preventative intervention by optimising antenatal mental health.
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Affiliation(s)
| | | | | | - Jonathan Evans
- Academic Unit of Psychiatry, University of Bristol, Bristol, UK
| | - Thomas G. O’Connor
- Wynne Center for Family Research and Department of Psychiatry, University of Rochester Medical Center, New York, NY, USA
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Paul G. Ramchandani
- Centre of Mental Health, Imperial College London, London, UK,Correspondence to: The Centre for Mental Health, Imperial College London, 7th Floor Commonwealth Building, Hammersmith Hospital Campus, London W12 0NN, UK. Fax: +44 208 383 4160.The Centre for Mental Health, Imperial College London7th Floor Commonwealth Building, Hammersmith Hospital CampusLondonW12 0NNUK
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Carnegie R, Araya R, Ben-Shlomo Y, Glover V, O’Connor TG, O’Donnell KJ, Pearson R, Lewis G. Cortisol awakening response and subsequent depression: prospective longitudinal study. Br J Psychiatry 2014; 204:137-43. [PMID: 24311550 PMCID: PMC3909839 DOI: 10.1192/bjp.bp.113.126250] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Some studies have found an association between elevated cortisol and subsequent depression, but findings are inconsistent. The cortisol awakening response may be a more stable measure of hypothalamic-pituitary-adrenal function and potentially of stress reactivity. AIMS To investigate whether salivary cortisol, particularly the cortisol awakening response, is associated with subsequent depression in a large population cohort. METHOD Young people (aged 15 years, n = 841) from the Avon Longitudinal Study of Parents and Children (ALSPAC) collected salivary cortisol at four time points for 3 school days. Logistic regression was used to calculate odds ratios for developing depression meeting ICD-10 criteria at 18 years. RESULTS We found no evidence for an association between salivary cortisol and subsequent depression. Odds ratios for the cortisol awakening response were 1.24 per standard deviation (95% CI 0.93-1.66, P = 0.14) before and 1.12 (95% CI 0.73-1.72, P = 0.61) after adjustment for confounding factors. There was no evidence that the other cortisol measures, including cortisol at each time point, diurnal drop and area under the curve, were associated with subsequent depression. CONCLUSIONS Our findings do not support the hypothesis that elevated salivary cortisol increases the short-term risk of subsequent depressive illness. The results suggest that if an association does exist, it is small and unlikely to be of clinical significance.
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O’Connor TG, Barrett ES. Mechanisms of prenatal programing: identifying and distinguishing the impact of steroid hormones. Front Endocrinol (Lausanne) 2014; 5:52. [PMID: 24782831 PMCID: PMC3995034 DOI: 10.3389/fendo.2014.00052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/28/2014] [Indexed: 12/12/2022] Open
Abstract
Developmental programing is gaining considerable leverage as a conceptual framework for understanding individual variability in human behavioral and somatic health. The current mini-review examines some of the key conceptual and methodological challenges for developmental programing research focused on fetal sex steroid exposure and physical, behavioral, physiological, and health outcomes. Specifically, we consider the bases for focusing on sex steroids, methods for assessing prenatal steroid hormone exposure, confounding factors, and the most relevant postnatal outcomes. We conclude with a brief consideration, based on current knowledge, of the applications of the existing findings for further research and practice.
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Affiliation(s)
- Thomas G. O’Connor
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- *Correspondence: Thomas G. O’Connor, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642, USA e-mail:
| | - Emily S. Barrett
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA
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Matias C, O’Connor TG, Futh A, Scott S. Observational attachment theory-based parenting measures predict children’s attachment narratives independently from social learning theory-based measures. Attach Hum Dev 2013; 16:77-92. [DOI: 10.1080/14616734.2013.851333] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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O’Donnell KJ, Glover V, Jenkins J, Browne D, Ben-Shlomo Y, Golding J, O’Connor TG. Prenatal maternal mood is associated with altered diurnal cortisol in adolescence. Psychoneuroendocrinology 2013; 38:1630-8. [PMID: 23433748 PMCID: PMC3695029 DOI: 10.1016/j.psyneuen.2013.01.008] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [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: 10/02/2012] [Revised: 01/14/2013] [Accepted: 01/23/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Experimental animal work shows that prenatal stress has a persisting effect on the hypothalamic-pituitary-adrenal (HPA) axis of offspring. The implications of these findings for human health and development are not yet clear. METHODS The data are based on the ALSPAC cohort, a prospective longitudinal study of a community sample that has followed mothers and children from pregnancy. When the children were aged 15 years, diurnal cortisol samples were collected at wake-up, 30 min post-awakening and at afternoon and evening times on up to three consecutive days on n=889 adolescents. Diurnal cortisol was predicted from prenatal anxiety and depression, obstetric, life-style, socio-demographic, and postnatal covariates. RESULTS Multilevel model analysis indicated that maternal prenatal anxiety was associated with a modest alteration of diurnal cortisol, indexed by a reduced cortisol awakening response and flatter diurnal slope. The effects were independent of psychosocial and obstetric covariates and measures of maternal postnatal anxiety; effects were similar for prenatal maternal depression. There was no association between adolescent cortisol and paternal prenatal anxiety. CONCLUSIONS There are small but persisting associations between maternal prenatal mood and diurnal cortisol in the child that persist into adolescence and may constitute a programming effect.
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Affiliation(s)
| | - Vivette Glover
- Institute of Reproductive and Developmental Biology, Imperial College London, UK
| | | | | | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, UK
| | - Jean Golding
- School of Social and Community Medicine, University of Bristol, UK
| | - Thomas G. O’Connor
- Wynne Center for Family Research, Department of Psychiatry, University of Rochester Medical Center, NY, USA
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O’Connor TG, Winter MA, Hunn J, Carnahan J, Pressman EK, Glover V, Robertson-Blackmore E, Moynihan JA, Lee FEH, Caserta MT. Prenatal maternal anxiety predicts reduced adaptive immunity in infants. Brain Behav Immun 2013; 32:21-8. [PMID: 23439080 PMCID: PMC3686987 DOI: 10.1016/j.bbi.2013.02.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [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: 12/15/2012] [Revised: 01/30/2013] [Accepted: 02/11/2013] [Indexed: 01/29/2023] Open
Abstract
Prenatal anxiety has been linked with altered immune function in offspring in animal studies, but the relevance for human health is unknown. We examined prenatal maternal anxiety as a predictor of adaptive immunity in infants at 2 and 6 months of age as part of a prospective longitudinal study. The humoral immune response to hepatitis B vaccine was assessed at 2 months (n=80) and 6 months (n=76) of age. Prenatal anxiety predicted lower hepatitis B antibody titers at 6 months of age independent of obstetric and socio-demographic covariates; the effects were limited to those infants who had not completed the 3-dose vaccine series (for transformed titer values, r=-.36, p<.05). Cell-mediated immune responses at 2 (n=56) and 6 (n=54) months of age were examined by ELISpot assays for interferon(IFN)-γ, interleukin(IL)-2, and IL-4 responder cell frequencies to three antigens: hepatitis B surface antigen, tetanus toxoid, and phytohaemagglutinin (PHA). Prenatal maternal anxiety was associated with reduced IFN-γ and increased IL-4 responder cell frequencies at 6 months of age, independent of obstetric and socio-demographic covariates. No effect of prenatal anxiety was found on adaptive immunity at 2 months of age. The findings provide the first demonstration in humans that prenatal anxiety alters adaptive immunity in the infant.
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Affiliation(s)
- Thomas G O’Connor
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, 14642
| | - Marcia A Winter
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, 14642
| | - Julianne Hunn
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, 14642
| | - Jennifer Carnahan
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, 14642
| | - Eva K Pressman
- Department of Obstetrics, University of Rochester Medical Center, Rochester, NY, 14642
| | - Vivette Glover
- Institute of Reproductive and Developmental Biology, Imperial College London, UK
| | | | - Jan A Moynihan
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, 14642
| | | | - Mary T Caserta
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, 14642
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Blackmore ER, Rubinow DR, O’Connor TG, Liu X, Tang W, Craddock N, Jones I. Reproductive outcomes and risk of subsequent illness in women diagnosed with postpartum psychosis. Bipolar Disord 2013; 15:394-404. [PMID: 23651079 PMCID: PMC3740048 DOI: 10.1111/bdi.12071] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [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: 05/22/2012] [Accepted: 01/12/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Women who experience postpartum psychosis (PP) seek guidance on further pregnancies and risk of illness; however, empirical data are limited. This study describes reproductive and mental health outcomes in women diagnosed with PP and examines clinical risk factors as predictors of further illness. METHODS A retrospective cohort design was used; 116 women who experienced episodes of mania or depression with psychotic features within six weeks of childbirth were recruited. All subjects underwent clinical diagnostic interviews and medical case notes were reviewed. RESULTS Only 33% of women had an antecedent history, of which 34% had bipolar disorder and 55% unipolar depression. Only 58% of those with PP in their first pregnancy had a subsequent pregnancy, and 18% of marriages ended following the PP episode. Clinical presentation at the time of initial episode did not influence the timing of the onset of symptoms, treatment, or recovery. Although 86% of patients received treatment within 30 days of onset, 26% of women reported ongoing symptoms at a year after delivery. The recurrence rate of PP was 54.4%; a longer duration of the index episode (p < 0.05) and longer latency between the index PP and next pregnancy predicted a subsequent PP. The rate of subsequent non-puerperal episodes was 69%, and all these episodes were bipolar. CONCLUSIONS Postpartum psychosis is difficult to predict in women with no antecedent history and is associated with a high rate of subsequent puerperal and non-puerperal illness. Risk of further illness needs to be conveyed in order to allow fully informed decisions to be made regarding future pregnancies.
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Affiliation(s)
- Emma Robertson Blackmore
- Departments of Psychiatry and Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - David R Rubinow
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas G O’Connor
- Departments of Psychiatry and Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - Xiang Liu
- Departments of Psychiatry and Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - Wan Tang
- Departments of Psychiatry and Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - Nick Craddock
- Department of Psychological Medicine, Cardiff University, Cardiff, UK
| | - Ian Jones
- Department of Psychological Medicine, Cardiff University, Cardiff, UK
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Gregory AM, Eley TC, O’Connor TG, Rijsdijk FV, Plomin R. Family influences on the association between sleep problems and anxiety in a large sample of pre-school aged twins. Personality and Individual Differences 2005. [DOI: 10.1016/j.paid.2005.06.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Deater‐Deckard K, Pike A, Petrill SA, Cutting AL, Hughes C, O’Connor TG. Nonshared environmental processes in social‐emotional development: an observational study of identical twin differences in the preschool period. Dev Sci 2001. [DOI: 10.1111/1467-7687.00157] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Alison Pike
- Psychology Group, School of Cognitive & Computing Sciences, University of Sussex, UK,
| | | | | | - Claire Hughes
- Centre for Family Research, University of Cambridge, UK,
| | - Thomas G. O’Connor
- Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, Kings College London, UK
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