The role of prenatal maternal sex steroid hormones in weight and adiposity at birth and growth trajectories during infancy.

Objective: Intrauterine factors can impact fetal and child growth and may underlie the developmental origins of childhood obesity. Sex steroid hormone exposure during pregnancy is a plausible target because of the impact on placental vascularization, nutrient transportation, bone growth, adipogenesis, and epigenetic modifications. In this study we assessed maternal sex steroid hormones in each trimester in relation to birthweight, neonatal adiposity, and infant growth trajectories, and evaluate sensitive windows of development. Methods: Participants from a prospective pregnancy cohort who delivered at term were included in the analysis (n=252). Estrone, estradiol, and estriol, as well as total and free testosterone throughout gestation were assessed using high-performance liquid chromatography and tandem mass spectrometry. Path analyses were used to assess the direct associations of sex steroid hormones in each trimester with birth outcomes and infant growth trajectories (birth to 12 months) adjusting for covariates and considering moderation by sex. Results: The associations between prenatal sex steroid hormones and fetal/infant growth varied by sex and hormone assessment timing. First trimester estrone were associated with higher birthweight z-scores (ß=0.37, 95%CI: 0.02, 0.73) and truncal skinfold thickness (TST) at birth (ß=0.94, 95%CI: 0.34, 1.54) in female infants. Third trimester total testosterone was associated with higher TST at birth (ß=0.61, 95%CI: 0.02, 1.21) in male infants. First trimester estrone/estradiol and first and third trimesters testosterone were associated with lower probabilities of high stable weight trajectory compared to low stable weight trajectory (Estrone: ß=-3.87, 95%CI: -6.59, -1.16; First trimester testosterone: ß=-3.53, 95%CI: -6.63, -0.43; Third trimester testosterone: ß=-3.67, 95%CI: -6.66, -0.69) during infancy in male infants. Conclusions: We observed associations between prenatal sex steroid hormone exposure and birthweight, neonatal adiposity and infant growth that were sex and gestational timing dependent. Our findings suggest further investigation on additional mechanisms linking prenatal sex steroid exposure and fetal/postnatal growth is needed.

Association between sex steroid hormones and subsequent hyperglycemia during pregnancy.

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 (ß=5.24, 95% CI: 0.01, 10.46, p=0.05) and free testosterone (ß=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 (ß=-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.

Longitudinal trends in produce purchasing behavior: a descriptive study of transaction level data from loyalty card households.

BACKGROUND: Household food purchases (HFP) are in the pathway between the community food environment and the foods available in households for consumption. As such, HFP data have emerged as alternatives to monitor population dietary trends over-time. In this paper, we investigate the use of loyalty card datasets as unexplored sources of continuously collected HFP data to describe temporal trends in household produce purchases. METHODS: We partnered with a grocery store chain to obtain a loyalty card database with grocery transactions by household from January 2016-October 2018. We included households in an urban county with complete observations for head of household age group, household income group, and family size. Data were summarized as weighted averages (95% CI) of percent produce purchased out of all foods purchased by household per month. We modeled seasonal and linear trends in the proportion of produce purchases by age group and income while accounting for repeated observations per household using generalized estimating equations. RESULTS: There are 290,098 households in the database (88% of all county households). At baseline, the smallest and largest percent produce purchases are observed among the youngest and lowest income (12.2%, CI 11.1; 13.3) and the oldest and highest income households (19.3, CI 18.9; 19.6); respectively. The seasonal variations are consistent in all age and income groups with an April-June peak gradually descending until December. However, the average linear change in percent produce purchased per household per year varies by age and income being the steepest among the youngest households at each income level (from 1.42%, CI 0.98;1.8 to 0.69%, CI 0.42;0.95) while the oldest households experience almost no annual change. CONCLUSIONS: We explored the potential of a collaboration with a food retailer to use continuously collected loyalty card data for public health nutrition purposes. Our findings suggest a trend towards a healthier pattern in long-term food purchases and household food availability among the youngest households that may lessen the population chronic disease burden if sustained. Understanding the foods available for consumption within households allows public health advocates to develop and evaluate policies and programs promoting foods and nutrients along the life course.

An evidence review of the association of immune and inflammatory markers with obesity-related eating behaviors.

Background: Eating behaviors contribute to disproportionate energy intake and are linked to the development of obesity. Animal studies support the role of inflammatory cytokines and chemokines in the regulation of obesity-related eating behaviors and offer a potential target to combat obesity through the modulation of inflammation. However, more complex eating behaviors are present in humans, and their relationships with immune/inflammation markers are unclear. The present study reviewed current literature to synthesize the evidence on the association of immune/inflammation markers with obesity-related eating behaviors in humans. Methods: A systematic search of three electronic databases yielded 811 articles, of which 11 met the inclusion criteria. Results: The majority of the included studies (91%) were either case-control or cross-sectional studies. A variety of immune/inflammation markers and obesity-related eating behaviors have been assessed in the chosen studies. Three out of four studies identified a positive relationship between C-reactive protein (CRP)/high-sensitivity CRP and loss of control eating. Other inflammatory markers that potentially have a positive relationship with obesity-related eating behaviors include fractalkine and fibrinogen. Additionally, immune molecules, including interferon gamma (INF-γ), interleukin (IL)-7, IL-10, and α-melanocyte-stimulating hormone-reactive immunoglobulin G (α-MSH/IgG) immune complex, may have negative associations with obesity-related eating behaviors. However, most findings were identified by single studies. Conclusion: Limited studies have been conducted in humans. Current evidence indicates a potential bi-directional relationship between inflammatory/immune markers and obesity-related eating behaviors. Additional studies with sophisticated research design and comprehensive theoretical models are warranted to further delineate the relationship between immune/inflammation markers and obesity-related eating behaviors.

Associations between Dietary Patterns and Inflammatory Markers during Pregnancy: A Systematic Review.

Elevated inflammation in pregnancy has been associated with multiple adverse pregnancy outcomes and potentially an increased susceptibility to future chronic disease. How maternal dietary patterns influence systemic inflammation during pregnancy requires further investigation. The purpose of this review was to comprehensively evaluate studies that assessed dietary patterns and inflammatory markers during pregnancy. This review was guided by the Preferred Reporting Items for Systematic Review and Meta-Analyses. Included studies were sourced from EMBASE, PubMed, Web of Science, and Scopus and evaluated using The Quality Assessment Tool for Quantitative Studies. Inclusion criteria consisted of human studies published in English between January 2007 and May 2020 that addressed associations between dietary patterns and inflammatory markers during pregnancy. Studies focused on a single nutrient, supplementation, or combined interventions were excluded. A total of 17 studies were included. Despite some inconsistent findings, maternal diets characterized by a higher intake of animal protein and cholesterol and/or a lower intake of fiber were shown to be associated with certain pro-inflammatory markers (C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF- α), IL-8, serum amyloid A (SAA), and glycoprotein acetylation (GlycA)). Future studies that explore a broader range of inflammatory markers in the pregnant population, reduce measurement errors, and ensure adequate statistical adjustment are warranted.

Cohort profile: Understanding Pregnancy Signals and Infant Development (UPSIDE): a pregnancy cohort study on prenatal exposure mechanisms for child health.

PURPOSE: Extensive research suggests that maternal prenatal distress is reliably related to perinatal and child health outcomes-which may persist into adulthood. However, basic questions remain regarding mechanisms involved. To better understand these mechanisms, we developed the Understanding Pregnancy Signals and Infant Development (UPSIDE) cohort study, which has several distinguishing features, including repeated assessments across trimesters, analysis of multiple biological pathways of interest, and incorporation of placental structure and function as mediators of child health outcomes. PARTICIPANTS: Women with normal risk pregnancies were recruited at <14 weeks gestation. Study visits occurred in each trimester and included extensive psychological, sociodemographic, health behaviour and biospecimen collection. Placenta and cord blood were collected at birth. Child visits (ongoing) occur at birth and 1, 6, 12, 24, 36 and 48 months of age and use standard anthropometric, clinical, behavioural, biological and neuroimaging methods to assess child physical and neurodevelopment. FINDINGS TO DATE: We recruited 326 pregnancies; 294 (90%) were retained through birth. Success rates for prenatal biospecimen collection were high across all trimesters (96%-99% for blood, 94%-97% for urine, 96%-99% for saliva, 96% of placentas, 88% for cord blood and 93% for buccal swab). Ninety-four per cent of eligible babies (n=277) participated in a birth examination; postnatal visits are ongoing. FUTURE PLANS: The current phase of the study follows children through age 4 to examine child neurodevelopment and physical development. In addition, the cohort participates in the National Institutes of Health's Environmental influences on Child Health Outcomes programme, a national study of 50 000 families examining early environmental influences on perinatal outcomes, neurodevelopment, obesity and airway disease. Future research will leverage the rich repository of biological samples and clinical data to expand research on the mechanisms of child health outcomes in relation to environmental chemical exposures, genetics and the microbiome.