IVF and risk of Type 1 diabetes mellitus: a population-based nested case-control study.

STUDY QUESTION: Is the mode of conception (natural, subfertility and non-IVF, and IVF) associated with the risk of Type 1 diabetes mellitus among offspring? SUMMARY ANSWER: The risk of Type 1 diabetes in offspring does not differ among natural, subfertility and non-IVF, and IVF conceptions. WHAT IS KNOWN ALREADY: Evidence has shown that children born through IVF have an increased risk of impaired metabolic function. STUDY DESIGN, SIZE, DURATION: A population-based, nested case-control study was carried out, including 769 children with and 3110 children without Type 1 diabetes mellitus within the prospective cohort of 2 228 073 eligible parent-child triads between 1 January 2004 and 31 December 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS: Using registry data from Taiwan, the mode of conception was divided into three categories: natural conception, subfertility, and non-IVF (indicating infertility diagnosis but no IVF-facilitated conception), and IVF conception. The diagnosis of Type 1 diabetes mellitus was determined according to the International Classification of Diseases, 9th or 10th Revision, Clinical Modification. Each case was matched to four controls randomly selected after matching for child age and sex, residential township, and calendar date of Type 1 diabetes mellitus occurrence. MAIN RESULTS AND THE ROLE OF CHANCE: Based on 14.3 million person-years of follow-up (median, 10 years), the incidence rates of Type 1 diabetes were 5.33, 5.61, and 4.74 per 100 000 person-years for natural, subfertility and non-IVF, and IVF conceptions, respectively. Compared with natural conception, no significant differences in the risk of Type 1 diabetes were observed for subfertility and non-IVF conception (adjusted odds ratio, 1.04 [95% CI, 0.85-1.27]) and IVF conception (adjusted odds ratio, 1.00 [95% CI, 0.50-2.03]). In addition, there were no significant differences in the risk of Type 1 diabetes according to infertility source (male/female/both) and embryo type (fresh/frozen). LIMITATIONS, REASONS FOR CAUTION: Although the population-level data from Taiwanese registries was used, a limited number of exposed cases was included. We showed risk of Type 1 diabetes was not associated with infertility source or embryo type; however, caution with interpretation is required owing to the limited number of exposed events after the stratification. The exclusion criterion regarding parents' history of diabetes mellitus was only applicable after 1997, and this might have caused residual confounding. WIDER IMPLICATIONS OF THE FINDINGS: It has been reported that children born to parents who conceived through IVF had worse metabolic profiles than those who conceived naturally. Considering the findings of the present and previous studies, poor metabolic profiles may not be sufficient to develop Type 1 diabetes mellitus during childhood. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by grants from Shin Kong Wu Ho-Su Memorial Hospital (No. 109GB006-1). The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication. The authors have no competing interests to disclose. TRIAL REGISTRATION NUMBER: N/A.

Physical activity, sitting time and sleep duration before and during pregnancy and pregnancy outcomes: A prospective panel study.

AIMS AND OBJECTIVES: To examine how changes in physical activity, sitting time and sleep duration through pre-, mid- and late pregnancy are in association with Caesarean section, medically indicated Caesarean section and small for gestational age. BACKGROUND: While circadian activities could change throughout pregnancy, studies exploring the effect of change in those activities on pregnancy outcomes remain limited. DESIGN: This study applied a prospective panel design. METHODS: A self-reported questionnaire was used to assess the three activities before and during pregnancy and was administered three times from August 2015-July 2017. Multiple logistic regression models were used. The analysis included 488, 477 and 455 participants in the models for Caesarean section, medically indicated Caesarean section and small for gestational age, respectively. This study followed the STROBE guidelines. RESULTS: The mean age of participants was 32.18 years, and more than half (54.90%) were primiparous. Sleep duration of >8 hr/day before pregnancy and experiencing a decrease in mid-pregnancy was a risk factor for Caesarean section and medically indicated Caesarean section. Sitting ≥8 hr/weekday in pre-, mid- and late pregnancy had a protective effect for Caesarean section and medically indicated Caesarean section. Sitting <8 hr in mid-pregnancy and experiencing a decrease in late pregnancy was a risk factor for small-for-gestational-age infants. Physical activity was not significantly related to pregnancy outcomes. CONCLUSION: Sleep duration of 7-8 hr and sitting time of more than 8 hr/day seem beneficial for women both before and during pregnancy. RELEVANCE TO CLINICAL PRACTICE: Health professionals could assess pregnant women or those intending to become pregnant regarding their sleep and sitting behaviour and provide relevant interventions.

[Using the Facebook Social Networking Website to Improve the Utilization of Weight Loss Programs by Community Obese Adults].

BACKGROUND: In light of the known impacts of obesity on well-being, we regularly work to promote weight loss programs in community settings. However, we found that a gap exists between the need for weight loss and the utilization of healthy weight loss programs among BMI (body mass index) ≥ 27 kg/m2adults. The low utilization of healthy weight loss programs may lower the overall benefit of these programs. PURPOSE: We reexamined access to health services and developed an accessible weight loss program for BMI ≥ 27 kg/m2adults that would improve the overall utilization of healthy weight loss programs. RESOLUTION: A telephone survey for obese adults was conducted to explore the reasons that discouraged persons in this group to not use our weight loss programs. The main reasons identified were: program schedules did not fit with respondent's daily schedule, the unsuitable services provided, and the overly long distance to the weight loss class. The social-cognitive-theory-based 1-year weight loss program that was developed provided immediate and accurate information about weight loss, inspiring words, weight management advice, and immediate and convenient consultation services. Moreover, this program established an incentives system on a social networking platform (Facebook) and was marketed under a creative slogan. RESULTS: The developed weight loss program increased not only program utilization (from 54.7% to 78.1%) but also reduced the average weight of obese adult participants by 3.4 kg. CONCLUSIONS: Conclusions: This program adjusted existing weight loss programs and improved the utilization of weight loss programs. These results may be applied elsewhere to increase weight-loss efficacy and to maximize health.

Psychological symptoms among hospital nurses in Taiwan: a cross sectional study.

BACKGROUND: A considerable number of studies have identified the risk factors attributable to job-related stress among nurses. However, studies investigating psychological symptoms among hospital nurses is still lacking, especially in Taiwan, where the average patient to nurse ratio is among the highest in the world. This study aimed to investigate the potential role of self-rated health status, self-reported diseases, and utilization of occupational health checks in psychological symptoms among Taiwanese nurses. METHODS: A cross-sectional design was conducted from September through December 2013. Data were collected through online self-administered questionnaire among 697 registered nurses in seven regional hospitals governed by the Taipei City Government. RESULTS: Nurses with fair or poor self-rated health, lower education, <30 years of age, and low back pain were more likely to suffer from psychological symptoms. A trend toward significance was also noticed for those aged 30-39. Importantly, low back pain was the most common disease among nurses in self-reported diseases and half of the nurses reported not utilizing the occupational health examination for the last 5 years. CONCLUSIONS: To alleviate or prevent the psychological symptoms, psychosocial support, and awareness program on prevention of occupational injuries should be offered to nurses younger than 39 years old and having lower educational levels. Moreover, underutilization of occupational health examination among nurses deserves more attention.

Differences between native and immigrant women in Taiwan in factors associated with caesarean section: A prospective observational study.

This study aimed to examine the association of social support, social factors, and maternal complications with caesarean deliveries in native and immigrant women, and to explore the association between acculturation and caesarean deliveries in immigrant women in Taiwan. This prospective panel study was conducted from August 2012 through April 2014 and included 222 native and 147 immigrant pregnant women in Taiwan. Caesarean rates did not differ significantly between native and immigrant women, including the overall caesarean rate (28.8%, 32.0%), medically indicated caesarean (22.5%, 24.5%), and caesarean without medical indications (6.3%, 7.5%). Results of multiple logistic regression models revealed that maternal complications and household activity support were positively associated with caesarean deliveries. Both native and immigrant women with high levels of informational support were less likely to receive caesareans. Immigrant women who were older than 35 years, had a middle level socioeconomic status, and perceived a high level of acceptance of caesarean in Taiwan were more likely to have caesarean deliveries. Informational support was a protective factor for caesarean delivery, whereas household activity support offered by the family was positively associated with caesarean delivery. Perceived acceptance level in mainstream society could affect immigrant women's use of caesarean delivery.

Assisted Reproductive Technology and Risk of Childhood Cancers.

Importance: The number of children born through the use of assisted reproductive technology (ART) has been increasing. These children may have higher risks for epigenetic alteration and adverse perinatal outcomes, which may be associated with childhood cancers. Objective: To determine the associations between different modes of conception and childhood cancers and potential mediation by preterm birth and low birth weight. Design, Setting, and Participants: This nationwide, population-based cohort study included registry data from 2 308 016 eligible parents-child triads in Taiwan from January 1, 2004, to December 31, 2017. A total of 1880 children with incident childhood cancer were identified. Data were analyzed between September 1, 2020, and June 30, 2022. Exposure: Mode of conception, defined as (1) natural conception, (2) subfertility and non-ART (ie, infertility diagnosis but no ART-facilitated conception), or (3) ART (ie, infertility diagnosis and ART-facilitated conception). Main Outcomes and Measures: Diagnosis of childhood cancer according to the International Classification of Childhood Cancers, Third Edition. Results: The mean (SD) paternal and maternal ages were 33.28 (5.07) and 30.83 (4.56) years, respectively. Of the 2 308 016 children, 52.06% were boys, 8.16% were born preterm, and 7.38% had low birth weight. During 14.9 million person-years of follow-up (median, 6 years [IQR, 3-10 years]), ART conception was associated with an increased risk of any type of childhood cancers compared with natural conception (hazard ratio, 1.58; 95% CI, 1.17-2.12) and subfertility with non-ART conception (hazard ratio, 1.42; 95% CI, 1.04-1.95). The increased cancer risk of children conceived with ART was mainly owing to leukemia and hepatic tumor. The increased cancer risk associated with ART conception was not mediated by preterm birth or low birth weight. Conclusions and Relevance: In this cohort study, children conceived via ART had a higher risk of childhood cancers than those conceived naturally and those born to parents with an infertility diagnosis did not use ART. The increased risk could not be explained by preterm birth or low birth weight.

Why does mode of conception affect early breastfeeding outcomes? A retrospective cohort study.

INTRODUCTION: It is uncertain whether Assisted Reproductive Technology (ART) is associated with an increased risk of poor breastfeeding outcomes and what could be possible mechanisms. This study aimed to examine the effect of mode of conception on breastfeeding outcomes during the first two months postpartum and identify the potential mediating pathways for this relationship. METHODS: A retrospective cohort study was conducted in a sample of 3,565 women with live births. Participants were classified by mode of conception as follows: fertile women who conceived naturally (fertile women; n = 2,857), women with infertility who conceived naturally (sub-fertile women; n = 483), and women with infertility who conceived through ART (women with infertility; n = 310). The infant-feeding patterns were assessed with four-time points before two months postpartum. Binary and multinomial logistic regression and causal mediation analyses were performed. RESULTS: The rates of breastfeeding initiation and discontinuation across modes of conception were similar. However, infertile and sub-fertile women had 37% (95% CI 1.02, 1.83) and 56% (95% CI 1.06, 2.27) increased risks of introducing formula before the first week postpartum, respectively, and 35% (95% CI 1.01, 1.82) and 52% (95% CI 1.04, 2.24) higher risks of exclusive breastfeeding for less than one week, respectively, compared to fertile women. The relationships were mainly mediated through multiple gestation and admission to neonatal/pediatric intensive care units (NICU/PICU; proportions of mediation were over 50%). The effects of mode of conception on breastfeeding outcomes became not significant in cases of singleton birth. CONCLUSIONS: Sub-fertile women and women with infertility intended to breastfeed but experienced higher perinatal risks in the early postpartum period. Multiple gestation and admission to NICU/PICU forced them to introduce formula earlier than preferred, thus leading to a shorter duration of exclusive breastfeeding. Single embryo transfer policy and breastfeeding support in NICU/PICU could help those women achieve positive early breastfeeding outcomes.

Neighbourhood Social Determinants of Health and Geographical Inequalities in Premature Mortality in Taiwan: A Spatiotemporal Approach.

Geographical inequalities in premature mortality and the role of neighbourhood social determinants of health (SDOH) have been less explored. This study aims to assess the geographical inequalities in premature mortality in Taiwan and how neighbourhood SDOH contribute to them and to examine the place-specific associations between neighbourhood SDOH and premature mortality. We used township-level nationwide data for the years 2015 to 2019, including age-standardized premature mortality rates and three upstream SDOH (ethnicity, education, and income). Space-time scan statistics were used to assess the geographical inequality in premature mortality. A geographical and temporal weighted regression was applied to assess spatial heterogeneity and how neighbourhood SDOH contribute to geographic variation in premature mortality. We found geographical inequality in premature mortality to be clearly clustered around mountainous rural and indigenous areas. The association between neighbourhood SDOH and premature mortality was shown to be area-specific. Ethnicity and education could explain nearly 84% variation in premature mortality. After adjusting for neighbourhood SDOH, only a handful of hotspots for premature mortality remained, mainly consisting of rural and indigenous areas in the central-south region of Taiwan. These findings provide empirical evidence for developing locally tailored public health programs for geographical priority areas.