Associations among maternal socioeconomic status in childhood and pregnancy and hair cortisol in pregnancy.

Dysregulation of the maternal-fetal hypothalamic-pituitary-adrenal axis (HPAA) has been hypothesized to negatively influence various offspring physical and mental health outcomes. Limited data suggest that low maternal socioeconomic status (SES) in pregnancy may disrupt maternal HPAA functioning. Research is needed that examines how maternal SES in childhood may influence maternal HPAA functioning in pregnancy, given evidence that early life adversity can have persistent effects on physiological stress reactivity. In a sample of 343 sociodemographically diverse women, we tested whether indices of life course SES were associated with HPAA functioning across pregnancy reflected in hair cortisol collected within one week after delivery. Mothers were asked whether their parent(s) owned their home across three developmental periods, from birth through adolescence, as an indicator of their childhood SES. Measures of maternal SES in pregnancy included maternal educational attainment, annual household income, and current homeownership. Analyses revealed that indicators of lower maternal SES in childhood and in pregnancy were associated with higher cortisol levels during each trimester. In analyses adjusted for maternal race/ethnicity, pre-pregnancy body mass index, smoking in pregnancy, use of inhaled and topical corticosteroids, and mode of delivery, each indicator of maternal SES in pregnancy fully mediated maternal childhood SES effects on maternal hair cortisol levels in pregnancy. This is the first study to show an association between maternal life course SES and hair cortisol in pregnancy. The results suggest that maternal SES, starting in childhood, may have intergenerational consequences via disruption to the maternal-fetal HPAA in pregnancy. These findings have implications for elucidating mechanisms contributing to health disparities among socioeconomically disadvantaged populations.

Prenatal fine particulate exposure associated with reduced childhood lung function and nasal epithelia GSTP1 hypermethylation: Sex-specific effects.

BACKGROUND: In utero exposure to particulate matter with an aerodynamic diameter of less than 2.5 µm (PM2.5) has been linked to child lung function. Overlapping evidence suggests that child sex and exposure timing may modify effects and associations may be mediated through glutathione S-transferase P1 (GSTP1) methylation. METHODS: We prospectively examined associations among prenatal PM2.5 exposure and child lung function and GSTP1 methylation in an urban pregnancy cohort study. We employed a validated satellite-based spatiotemporally resolved prediction model to estimate daily prenatal PM2.5 exposure over gestation. We used Baysian distributed lag interaction models (BDLIMs) to identify sensitive windows for prenatal PM2.5 exposure on child lung function and nasal epithelia GSTP1 methylation at age 7 years, and to examine effect modification by child sex. RESULTS: BDLIMs identified a sensitive window for prenatal PM2.5 exposure at 35-40 weeks gestation [cumulative effect estimate (CEE) = - 0.10, 95%CI = - 0.19 to - 0.01, per µg/m3 increase in PM2.5] and at 36-40 weeks (CEE = - 0.12, 95%CI = - 0.20 to - 0.01) on FEV1 and FVC, respectively, in boys. BDLIMs also identified a sensitive window of exposure at 37-40 weeks gestation between higher prenatal PM2.5 exposure and increased GSTP1 percent methylation. The association between higher GSTP1 percent methylation and decreased FEV1 was borderline significant in the sample as a whole (ß = - 0.37, SE = 0.20, p = 0.06) and in boys in stratified analyses (ß = - 0.56, SE = 0.29, p = 0.05). CONCLUSIONS: Prenatal PM2.5 exposure in late pregnancy was associated with impaired early childhood lung function and hypermethylation of GSTPI in DNA isolated from nasal epithelial cells. There was a trend towards higher GSTP1 percent methylation being associated with reduced FEV1. All findings were most evident among boys.

Prone Percutaneous Nephrolithotomy: Does Bolster Orientation Matter?

OBJECTIVE: To assess whether horizontal vs vertical bolster orientation affects kidney position during prone percutaneous nephrolithotomy as this could impact the need for supracostal access and therefore the likelihood of pleural injury. MATERIALS AND METHODS: In a prospective trial, 10 subjects with 20 renal units underwent magnetic resonance imaging in prone position with standard cylindrical bolsters oriented vertically and then horizontally. Vertical bolsters were placed along the lateral aspect of the chest. Horizontal bolsters were placed at the xiphoid and symphysis pubis. The position of the kidney relative to the pleura was assessed by measuring distances from the kidney upper pole to diaphragm, to the top of the first lumbar vertebra, and inferior-most rib. Nephrostomy tract length and tract proximity to adjacent organs were also measured. RESULTS: Right and left kidney-to-diaphragm distance significantly increased with horizontal vs vertical bolsters by 3.44 cm and 1.86 cm, respectively (P = .02, P = .01). Right kidney-to-rib distance significantly increased by 2.4 cm (P = .025); left kidney-to-rib distance increased by 0.5 cm (P = .123). Right kidney-to-vertebral distance significantly increased by 2.16 cm (P = .007); left kidney-to-vertebral distance increased by 0.9 cm (P = .059). There was no significant difference in maximum access angle, overall tract length, or colon position between horizontal and vertical bolsters. CONCLUSION: Orienting bolsters horizontally results in caudal kidney displacement without affecting access angle, overall tract length, or colon position. In comparison with vertical orientation, this may improve safety of percutaneous nephrolithotomy by decreasing the need for supracostal access and increasing the safety of supracostal access when required.