Continuous glucose monitoring-derived glycemic metrics and adverse pregnancy outcomes among women with gestational diabetes: a prospective cohort study

Background

Continuous glucose monitoring (CGM) has shown potential in improving maternal and neonatal outcomes in individuals with type 1/2 diabetes, but data in gestational diabetes mellitus (GDM) is limited. We aimed to explore the relationship between CGM-derived metrics during pregnancy and pregnancy outcomes among women with GDM.

Methods

We recruited 1302 pregnant women with GDM at a mean gestational age of 26.0 weeks and followed them until delivery. Participants underwent a 14-day CGM measurement upon recruitment. The primary outcome was any adverse pregnancy outcome, defined as having at least one of the outcomes: preterm birth, large-for-gestational-age (LGA) birth, fetal distress, premature rupture of membranes, and neonatal intensive care unit (NICU) admission. The individual outcomes included in the primary outcome were considered as secondary outcomes. We conducted multivariable logistic regression to evaluate the association of CGM-derived metrics with these outcomes.

Findings

Per 1-SD difference in time above range (TAR), glucose area under the curve (AUC), nighttime mean blood glucose (MBG), daytime MBG, and daily MBG was associated with higher risk of any adverse pregnancy outcome, with odds ratio: 1.22 (95% CI 1.08-1.36), 1.22 (95% CI 1.09-1.37), 1.18 (95% CI 1.05-1.32), 1.21 (95% CI 1.07-1.35), and 1.22 (95% CI 1.09-1.37), respectively. Time in range, TAR, AUC, nighttime MBG, daytime MBG, daily MBG, and mean amplitude of glucose excursions were positively associated, while time blow range was inversely associated with the risk of LGA. Additionally, higher value for TAR was associated with higher risk of NICU admission. We further summarized the potential thresholds of TAR (2.5%) and daily MBG (4.8 mmol/L) to distinguish individuals with and without any adverse pregnancy outcome.

Interpretation

The CGM-derived metrics may help identify individuals at higher risk of adverse pregnancy outcomes. These CGM biomarkers could serve as potential new intervention targets to maintain a healthy pregnancy status among women with GDM.

Funding

National Key R&D Program of China, National Natural Science Foundation of China, and Westlake Laboratory of Life Sciences and Biomedicine.

Effect of prenatal exposure to organophosphates and pyrethroid pesticides on neonatal anthropometric measures and gestational age

Several studies have examined the association between prenatal exposure to organophosphate and pyrethroid pesticides and their impact on foetal growth and newborn anthropometry; however, the available evidence is limited and inconclusive. This study examined whether prenatal organophosphate and pyrethroid pesticide exposure was associated with anthropometric measures at birth (weight, length, head circumference), ponderal index, gestational age, and prematurity in 537 mother-child pairs. These were randomly selected from the 800 pairs participating in the prospective birth cohort GENEIDA (Genetics, early life environmental exposures and infant development in Andalusia). Six non-specific organophosphate metabolites (dialkylphosphates, DAPs), one metabolite relatively specific to chlorpyrifos (3,5,6-trichloro-2-pyridinol, TCPy) and a common metabolite to several pyrethroids (3-phenoxybenzoic acid, 3-PBA) were measured in maternal urine from the 1st and 3rd pregnancy trimesters. Information on anthropometric measures at birth, gestational age and prematurity was retrieved from medical records. The sum on a molar basis of DAPs with methyl (ƩDMs) and ethyl (ƩDEs) moieties and the sum of the 6 DAPs metabolites (ƩDAPs) was calculated for both trimesters of pregnancy. High urinary levels of dimethyl phosphate (DMP) during the 3rd trimester were associated with a decrease in birth weight (β = -0.24; 95% CI: 0.41; -0.06) and birth length (β = -0.20; 95% CI: 0.41; 0.02). Likewise, ΣDMs during 3rd trimester were near-significantly associated with decreased birth weight (β = -0.18; 95% CI: 0.37; 0.01). In turn, increased urinary TCPy during 1st trimester was associated with a decreased head circumference (β = -0.31; 95% CI: 0.57; -0.06). Finally, an increase in 3-PBA in the 1st trimester was associated with a decreased gestational age (β = -0.36 95% CI: 0.65-0.08), whereas increased 3-PBA at 1st and 3rd trimester was associated with prematurity. These results indicate that prenatal exposure to organophosphate and pyrethroid insecticides could affect normal foetal growth, shorten gestational age and alter anthropometric measures at birth.

Developing and evaluating Birthing on Country services for First Nations Australians: the Building On Our Strengths (BOOSt) prospective mixed methods birth cohort study protocol

BACKGROUND

With the impact of over two centuries of colonisation in Australia, First Nations families experience a disproportionate burden of adverse pregnancy and birthing outcomes. First Nations mothers are 3-5 times more likely than other mothers to experience maternal mortality; babies are 2-3 times more likely to be born preterm, low birth weight or not to survive their first year. 'Birthing on Country' incorporates a multiplicity of interpretations but conveys a resumption of maternity services in First Nations Communities with Community governance for the best start to life. Redesigned services offer women and families integrated, holistic care, including carer continuity from primary through tertiary services; services coordination and quality care including safe and supportive spaces. The overall aim of Building On Our Strengths (BOOSt) is to facilitate and assess Birthing on Country expansion into two settings - urban and rural; with scale-up to include First Nations-operated birth centres. This study will build on our team's earlier work - a Birthing on Country service established and evaluated in an urban setting, that reported significant perinatal (and organisational) benefits, including a 37% reduction in preterm births, among other improvements.

METHODS

Using community-based, participatory action research, we will collaborate to develop, implement and evaluate new Birthing on Country care models. We will conduct a mixed-methods, prospective birth cohort study in two settings, comparing outcomes for women having First Nations babies with historical controls. Our analysis of feasibility, acceptability, clinical and cultural safety, effectiveness and cost, will use data including (i) women's experiences collected through longitudinal surveys (three timepoints) and yarning interviews; (ii) clinical records; (iii) staff and stakeholder views and experiences; (iv) field notes and meeting minutes; and (v) costs data. The study includes a process, impact and outcome evaluation of this complex health services innovation.

DISCUSSION

Birthing on Country applies First Nations governance and cultural safety strategies to support optimum maternal, infant, and family health and wellbeing. Women's experiences, perinatal outcomes, costs and other operational implications will be reported for Communities, service providers, policy advisors, and for future scale-up.

TRIAL REGISTRATION

Australia & New Zealand Clinical Trial Registry # ACTRN12620000874910 (2 September 2020).

Potential determinants of T helper 2 markers and their distribution in school-aged children

BACKGROUND

There is growing data on T helper 2 (Th2) biomarker determinants in adult populations. However, the determinants and typical range of these biomarkers have not been well studied in general populations of children. Therefore, we assessed the determinants and typical range of three Th2 biomarkers, including blood eosinophils, FeNO, and serum total IgE in 9-11-year-old children in a prospective birth cohort.

METHODS

We examined the pre- and postnatal factors associated with Th2 biomarkers using multivariable logistic regression analysis (n = 428) and extended the results to the original cohort (n = 17,009) using inverse probability weighting. We also measured typical Th2 biomarker distribution in all examined children and healthy participants without allergic diseases (n = 180).

RESULTS

At age 9-11, wheeze (odds ratio (OR) 7.63), rhinitis (OR 3.14), and eczema (OR 2.46) were significantly associated with increased blood eosinophils. All three allergic conditions were associated with FeNO and total serum IgE, but the ORs were smaller than those for blood eosinophils. Secondhand smoking was inversely associated with the blood eosinophils (OR, 0.38). Similar results were found in the original cohort. Male sex and prenatal factors (maternal smoking and parental history of allergies) were not independent predictors of high Th2 levels.

CONCLUSIONS

In addition to wheezing and rhinitis, eczema and secondhand smoke exposure are independent factors for Th2 biomarker interpretation in children. Furthermore, the typical values and cutoff values of blood eosinophils in adults may not be applicable to children.

Joint association of prenatal bisphenol-A and phthalates exposure with risk of atopic dermatitis in 6-month-old infants

BACKGROUND

Prenatal exposure to bisphenol A (BPA) and phthalates could trigger immune response. Few studies have investigated the association between prenatal BPA and phthalate exposure and atopic dermatitis (AD) in infants.

OBJECTIVE

We aimed to clarify the joint association of prenatal exposure to BPA and phthalate metabolites with AD incidence in 6-month-old infants.

METHODS

We included 413 mother-child pairs from the Mothers and Children's Environmental Health (MOCEH) in a prospective birth cohort study. Maternal urinary BPA, mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP), mono-2-ethyl-5-oxohexyl phthalate (MEOHP), and mono-n-butyl phthalate (MnBP) concentrations were measured during early and late pregnancy. We applied the Bayesian kernel machine regression (BKMR) with probit regression to estimate the association of BPA and phthalate metabolites with AD incidence after adjusting for potential confounders. Individual association was estimated by differences in predicted probabilities comparing each individual chemical concentration at 75th versus 25th percentiles, while other chemicals were set at their median. Overall joint effect was estimated by differences in predicted probabilities comparing all chemical concentrations at 75th versus 25th percentiles.

RESULTS

Individual effect of MEHHP in late pregnancy was strongly associated with incident AD [Difference: 0.244 (95% credible interval: -0.066, 0.554)] in the model including both early and late exposures. Furthermore, we confirmed overall joint association of urinary BPA and phthalate metabolites during pregnancy with a higher risk of AD [0.347 (0.168, 0.526) for late pregnancy exposure, and 0.307 (0.094, 0.521) for both early and late pregnancy]. Additionally, the joint association was more prominent among girls than that in boys.

CONCLUSIONS

The joint association of prenatal exposure to BPA and phthalates could be associated with the incident AD in 6-month-old infants. Further studies are needed to confirm the synergistic effect of BPA and phthalate exposures on AD in children.

IgE responses to multiple allergen components among school-aged children in a general population birth cohort in Tokyo

BACKGROUND

Response patterns to allergen components among Japanese children have not been studied extensively.

OBJECTIVE

Our aim was to examine the differences in sensitization patterns at ages 5 years and 9 years to identify longitudinal changes in the degree and patterns of sensitization in a birth cohort of Japanese children.

METHODS

Our study enrolled 984 children at aged 5 years between 2008 and 2010, and 729 children aged 9 years between 2012 and 2014. Allergic diseases were assessed using the ISAAC and UK Working Party's Diagnostic Criteria. Serum-specific IgE titers to allergen components were measured by multiplex array ImmunoCAP ISAC when the children were aged 5 and 9 years. Principal component analysis (PCA) was performed to characterize IgE sensitization to allergen components.

RESULTS

The prevalence of allergic rhinitis increased considerably over time (10.6%-31.2%). Furthermore, the sensitization prevalence to allergen-specific IgE (sIgE) also increased from 57.8% at age 5 years to 74.8% at age 9 years. IgE sensitization prevalence to Der f 1 (mites) was 42.1% at age 5 years and 54.3% at age 9 years. Furthermore, children were highly sensitized to Cry j 1 (Japanese cedar) (32.8% at age 5 years and 57.8% at age 9 years). Principle component analysis showed that sensitization to PR-10 cross-reactive components was independent of sensitization to mite and that no children acquired sensitization to pollen before acquiring sensitization to mite.

CONCLUSIONS

The prevalence of allergic rhinitis and related allergen components increased from age 5 years to age 9 years in Japanese children.

Anthropometric measures at age 3 years in associations with prenatal and postnatal exposures to chlorophenols

BACKGROUND

Chlorophenols (CPs), suspected as endocrine disrupting chemicals, exposure during early life may contribute to body size. However, limited human data with inconsistent findings have examined the developmental effects of CPs exposure.

OBJECTIVE

To explore associations between prenatal and postnatal CPs exposure and anthropometric parameters in children aged 3 years.

METHODS

A subset of 377 mother-child pairs with urinary five CP concentrations were enrolled from a prospective birth cohort. Generalized linear models were conducted to evaluate associations of CPs exposure with children's anthropometric measures.

RESULTS

Maternal urinary 2,4,6-trichlorophenol (2,4,6-TCP) concentrations were significantly negatively associated with weight z scores [regression coefficient (β) = -0.51, 95% confidence interval (CI): -0.96, -0.05; p = 0.01], weight for height z scores (β = -0.54, 95% CI: -1.02, -0.06; p = 0.01) and body mass index (BMI) z scores (β = -0.53, 95% CI: -1.03, -0.03; p = 0.01) of children aged 3 years, after adjustment for potential confounders and postnatal CPs exposure. In the sex-stratified analyses, these inverse associations remained among boys, while in girls, positive associations of prenatal 2,4,6-TCP exposure with weight for height z scores and BMI z scores were observed. Postnatal exposure to 2,5-diclorophenol (2,5-DCP) was positively associated with weight z scores (β = 0.26, 95% CI: 0.02, 0.50; p = 0.04), after controlling for possible confounders and maternal CPs exposure during pregnancy. Considering potential sex-specific effects, these associations were only observed in girls.

CONCLUSIONS

Our findings indicate that prenatal 2,4,6-TCP exposure and postnatal 2,5-DCP exposure may have adverse and sex-specific effects on children's physical development.

The Indigenous Birthing in an Urban Setting study: the IBUS study : A prospective birth cohort study comparing different models of care for women having Aboriginal and Torres Strait Islander babies at two major maternity hospitals in urban South East Queensland, Australia

BACKGROUND

With persisting maternal and infant health disparities, new models of maternity care are needed to meet the needs of Aboriginal and Torres Strait Islander people in Australia. To date, there is limited evidence of successful and sustainable programs. Birthing on Country is a term used to describe an emerging evidence-based and community-led model of maternity care for Indigenous families; its impact requires evaluation.

METHODS

Mixed-methods prospective birth cohort study comparing different models of care for women having Aboriginal and Torres Strait Islander babies at two major maternity hospitals in urban South East Queensland (2015-2019). Includes women's surveys (approximately 20 weeks gestation, 36 weeks gestation, two and six months postnatal) and infant assessments (six months postnatal), clinical outcomes and cost comparison, and qualitative interviews with women and staff.

DISCUSSION

This study aims to evaluate the feasibility, acceptability, sustainability, clinical and cost-effectiveness of a Birthing on Country model of care for Aboriginal and Torres Strait Islander families in an urban setting. If successful, findings will inform implementation of the model with similar communities.

TRIAL REGISTRATION

Australian New Zealand Clinical Trial Registry # ACTRN12618001365257 . Registered 14 August 2018 (retrospectively registered).

Contrasting associations of maternal smoking and pre-pregnancy BMI with wheeze and eczema in children

BACKGROUND

Childhood allergies are dynamic and associated with environmental factors. The influence of prenatal maternal smoking and obesity on childhood allergies and their comorbidities remains unclear, especially in prospective cohorts with serial longitudinal observations.

OBJECTIVE

We examined time trends in the prevalence and comorbidity of childhood allergies, including wheeze, eczema, and rhinoconjunctivitis, using a large-scale, population-based birth cohort in Japan, and assessed the effects of prenatal maternal smoking and BMI on the risk of childhood allergies.

METHODS

Parents completed the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires about symptoms of allergies and their risk factors at age 1, 2, 4, and 7 years. Complete data from all pre- and postnatal questionnaires at age 1, 2, 4, and 7 were available for 3296 mother-child pairs.

RESULTS

We observed significant overlap of childhood allergies at 1, 2, 4, and 7 years. Maternal serum cotinine during pregnancy was associated with increased risk of wheezing in the children at age 1, 2, and 4 but disappeared at age 7. In contrast, maternal cotinine levels were inversely associated with the prevalence of eczema in children at age 7. We additionally observed that maternal pre-pregnancy BMI, not children's BMI, had a positive association with wheeze and an inverse association with eczema in 7-year-old children, respectively. We did not find any association of examined maternal factors and rhinoconjunctivitis.

CONCLUSIONS

We demonstrated contrasting association of prenatal maternal smoking and high BMI with postnatal wheeze and eczema. For precise assessment of allergy-associated risk factors, we need to contrast risk factors for different allergic diseases since focusing solely on one allergic disease may result in misleading information on the role of different risk factors.

Rate of eating in early life is positively associated with current and later body mass index among young Japanese children: the Osaka Maternal and Child Health Study

The possible effect of eating rate on promoting obesity has attracted considerable attention among various age groups, but little is known about these associations in an early stage of life. We investigated the hypothesis that eating rate in early childhood influences current and later body mass index (BMI) among young Japanese children. The study participants were 492 Japanese mother-child pairs from a prospective birth cohort study. Information on rate of eating (slow, medium, or fast), macronutrient intake (protein, fat, and carbohydrate), and dietary fiber intake were collected from the mothers using a diet history questionnaire when the children were aged 29 to 39 months. Height and weight as measured at 30 and 42 months of age were used to calculate BMI at each age. Multiple linear regression analyses were performed to examine the relationships between eating rate in early childhood and BMI at 30 and 42 months. There were strong positive associations between eating rate and BMI at 30 and 42 months of age that were robust to adjustment for confounders including maternal BMI, socioeconomic status, health behaviors, and child's nutrient intake. In comparison with children in the "slow" rate of eating group, the size of the difference in BMI (95% confidence interval) at 42 months of age was 0.49 (0.17-0.80) and 0.67 (0.24-1.10) kg/m² greater among children in the "medium" and "fast" groups, respectively. In conclusion, a higher rate of eating in early childhood was positively associated with not only current BMI but also BMI measured 1 year later in young Japanese children.

Early sugar-sweetened beverage consumption frequency is associated with poor quality of later food and nutrient intake patterns among Japanese young children: the Osaka Maternal and Child Health Study

Evidence from Western countries shows that higher consumption of sugar-sweetened beverages (SSBs) is associated with lower quality of young children's diets, but little is known about these relations in non-Western countries with relatively low consumption levels of SSBs. We hypothesized that SSB consumption in infancy would be associated with poor quality of later food and nutrient intake patterns among Japanese young children. The study subjects were 493 Japanese mother-child pairs from a prospective birth cohort study. Dietary data on children were collected from the mothers using self-administered questionnaires when the children were aged 16-24 months and 41-49 months. Multiple linear regression analyses were used to examine the relationships between SSB consumption frequency in infancy and later intake of foods and nutrients. At 16-24 months of age, more than half of the children (56.4%) consumed SSBs less than once a week, whereas 11.6% consumed SSBs at least once daily. More frequent consumption of SSBs in infancy was associated with higher intake of confectionaries and SSBs and lower intake of fruits and vegetables at 41-49 months of age. These associations were still evident after adjustment for maternal SSB consumption and socioeconomic status. At the nutrient level, SSB consumption frequency was positively associated with energy intake and inversely associated with intake of many nutrients, such as protein, dietary fiber, and most of the micronutrients examined. In conclusion, higher consumption frequency of SSBs at an early age is associated with poor quality of overall dietary intake among young Japanese children 1.5-2.5 years later.

Higher B-cell activating factor levels at birth are positively associated with maternal dairy farm exposure and negatively related to allergy development

BACKGROUND

A high proportion of circulating immature/naive CD5(+) B cells during early infancy is a risk factor for allergy development. B-cell activating factor (BAFF) is an important cytokine for B-cell maturation.

OBJECTIVE

We sought to investigate whether BAFF levels are related to environmental exposures during pregnancy and early childhood and whether BAFF levels are associated with postnatal B-cell maturation and allergic disease.

METHODS

In the FARMFLORA study, including both farming and nonfarming families, we measured BAFF levels in plasma from mothers and their children at birth and at 1, 4, 18, and 36 months of age. Infants' blood samples were also analyzed for B-cell numbers and proportions of CD5(+) and CD27(+) B cells. Allergic disease was clinically evaluated at 18 and 36 months of age.

RESULTS

Circulating BAFF levels were maximal at birth, and farmers' children had higher BAFF levels than nonfarmers' children. Higher BAFF levels at birth were positively associated with proportions of CD27(+) memory B cells among farmers' children and inversely related to proportions of CD5(+) immature/naive B cells among nonfarmers' children. Children with allergic disease at 18 months of age had lower cord blood BAFF levels than nonallergic children. At birth, girls had higher BAFF levels and lower proportions of CD5(+) B cells than boys.

CONCLUSIONS

Farm exposure during pregnancy appears to induce BAFF production in the newborn child, and high neonatal BAFF levels were associated with more accelerated postnatal B-cell maturation, which lend further strength to the role of B cells in the hygiene hypothesis.

Associations between self-reported symptoms of prenatal maternal infection and post-traumatic stress disorder in offspring: evidence from a prospective birth cohort study

OBJECTIVE

Consistent evidence has linked a range of prenatal maternal infections with psychotic disorders in later life. However, the potential for this exposure to impact more common disorders requires further investigation.

METHODS

Participants came from the Mater University Study of pregnancy, a longitudinal, pre-birth cohort study which recruited pregnant mothers from a Brisbane hospital between 1981 and 1984. At age 21, 2439 offspring completed the CIDI-Auto. Multivariate logistic regression was used to investigate associations of self-reported symptoms of prenatal infection with a range of DSM-IV anxiety and affective diagnoses, while also testing for gender interactions.

RESULTS

In multivariate analyses, self-reported symptoms of prenatal genital infection predicted Post-traumatic stress disorders (OR=2.38, 95% CI: 1.14, 4.95) and social phobias (OR=1.93, 95% CI: 1.03, 3.61), in addition to evidence for a gender interaction by which males (OR=6.04, 95% CI: 2.00, 18.30) but not females were at greater risk for PTSD. Further analyses among those with PTSD revealed the relationship to be stronger when excluding those not exposed to trauma (OR=3.21, 95% CI: 1.53, 6.72).

LIMITATIONS

We were unable to clinically or serologically verify the presence and the type of prenatal genital infection.

CONCLUSION

This is the first study to show an association between self-reported symptoms of prenatal genital infections and two highly prevalent anxiety disorders among adult offspring. The relationship with PTSD was particularly strong and suggested that the exposure may primarily impact PTSD in males. Further research with the capacity to assess a fuller-range of specific prenatal infections is warranted to evaluate the potential of reducing the prevalence of these disorders.

Maternal total caffeine intake, mainly from Japanese and Chinese tea, during pregnancy was associated with risk of preterm birth: the Osaka Maternal and Child Health Study

The relation of maternal caffeine intake with birth outcomes is still inconclusive and has not been examined in Japan, where the sources of caffeine intake are different from those in Western countries. We hypothesized that maternal consumption of total caffeine and culture-specific major sources of caffeine would be associated with birth outcomes among Japanese pregnant. The study subjects were 858 Japanese women who delivered singleton infants. Maternal diet during pregnancy was assessed using a validated, self-administered diet history questionnaire. Birth outcomes considered were low birth weight (LBW; <2500 g), preterm birth (PTB; <37 weeks of gestation), and small for gestational age (SGA; <10th percentile). The main caffeine sources were Japanese and Chinese tea (73.5%), coffee (14.3%), black tea (6.6%), and soft drinks (3.5%). After controlling for confounders, maternal total caffeine intake during pregnancy was significantly associated with an increased risk of PTB (odds ratio per 100 mg/d caffeine increase, 1.28; 95% confidence interval, 1.03-1.58; P for trend = .03). However, no evident relationships were observed between total caffeine intake and risk of LBW or SGA. As for caffeine sources, higher Japanese and Chinese tea consumption was associated with an increased risk of PTB (odds ratio per 1 cup/d increase, 1.14; 95% confidence interval, 1.00-1.30; P for trend = .04), but not LBW or SGA. There were no associations between consumption of the other beverages examined and birth outcomes. In conclusion, this prospective birth cohort in Japan suggests that higher maternal total caffeine intake, mainly in the form of Japanese and Chinese tea, during pregnancy is associated with a greater risk of PTB.