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1.
MMWR Morb Mortal Wkly Rep ; 68(36): 777-783, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31513558

RESUMO

Since 1999, the rate of opioid use disorder (OUD) has more than quadrupled, from 1.5 per 1,000 delivery hospitalizations to 6.5 (1), with similar increases in incidence of neonatal abstinence syndrome (NAS) observed for infants (from 2.8 per 1,000 live births to 14.4) among Medicaid-insured deliveries (2). CDC's response to the opioid crisis involves strategies to prevent opioid overdoses and related harms by building state capacity and supporting providers, health systems, and payers.* Recognizing systems gaps in provision of perinatal care and services, CDC partnered with the Association of State and Territorial Health Officials (ASTHO) to launch the Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community (OMNI LC). OMNI LC supports systems change and capacity building in 12 states.† Qualitative data from participating states were analyzed to identify strategies, barriers, and facilitators for capacity building in state-defined focus areas. Most states focused on strategies to expand access to and coordination of quality services (10 of 12) or increase provider awareness and training (nine of 12). Fewer states focused on data, monitoring, and evaluation (four of 12); financing and coverage (three of 12); or ethical, legal, and social considerations (two of 12). By building capacity to strengthen health systems, state-identified strategies across all focus areas might improve the health trajectory of mothers, infants, and families affected by the U.S. opioid crisis.


Assuntos
Síndrome de Abstinência Neonatal/terapia , Transtornos Relacionados ao Uso de Opioides/terapia , Complicações na Gravidez/terapia , Efeitos Tardios da Exposição Pré-Natal/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Síndrome de Abstinência Neonatal/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Período Pós-Parto , Gravidez , Complicações na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Estados Unidos/epidemiologia
2.
Environ Res ; 177: 108630, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31421446

RESUMO

There is increasing evidence that several metals are endocrine disrupting chemicals (EDCs). In utero development and adolescence are critical windows of susceptibility to EDC exposure. With the exception of a few heavy metals, few human studies have evaluated the impact of metal exposure on pubertal development. Our aim was to investigate measures of in utero and peripubertal metal exposure in relation to reproductive hormone levels and sexual maturation and progression among girls from the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) cohorts. We measured urinary concentrations of aluminum (Al), arsenic (As), barium (Ba), cadmium (Cd), cobalt (Co), copper (Cu), iron (Fe), manganese (Mn), molybdenum (Mo), nickel (Ni), antimony (Sb), selenium (Se), and zinc (Zn) in samples collected from women during their third trimester of pregnancy and from their female children at 8-13 years (n = 132). We measured serum testosterone, estradiol, dehydroepiandrosterone sulfate (DHEA-S), inhibin B, and sex hormone-binding globulin (SHBG) at age 8-13, and assessed Tanner stages for sexual maturation (breast, pubic hair development, and menarche status), at two time points (8-13, 14-18 years). We used linear regression to independently examine in utero and peripubertal metal concentrations as predictors of peripubertal hormones. In a longitudinal analysis using generalized estimation equations, we evaluated Tanner stage and menarche progression in relation to individual in utero and peripubertal metal concentrations. We found that higher in utero Zn was associated with increased inhibin B. Several metals at 8-13 years were associated with higher DHEA-S and estradiol, while Ni was positively but Cu was negatively associated with testosterone. In utero Ni, Al, and Cd were associated with slower progression of breast development after adjustment for child age and BMI z-score. For example, an IQR increase in in utero Al exposure was associated with 0.82 times lower odds of progressing to a higher Tanner stage for breast development per year (95% CI: 0.68, 0.99). Peripubertal concentrations of Ba and Al were also associated with being at a higher pubic hair Tanner stage and menarche at 8-13, but lower odds of progressing to the next stage at 14-18 years. We used Bayesian kernel machine regression (BKMR) to model the joint effect of multiple metals while accounting for correlated exposures, as well as potential non-linear relationships between metals and outcomes of interest, which yielded results similar to individual analyses. These findings suggest that female reproductive development may be vulnerable to the effects of metal exposure, and using both Tanner stages and hormone levels may provide clues about underlying mechanisms in two sensitive periods of development.


Assuntos
Disruptores Endócrinos/efeitos adversos , Hormônios Esteroides Gonadais/sangue , Metais Pesados/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Maturidade Sexual , Adolescente , Teorema de Bayes , Criança , Cidades , Sulfato de Desidroepiandrosterona/sangue , Disruptores Endócrinos/urina , Estradiol/sangue , Feminino , Humanos , Inibinas/sangue , Metais Pesados/urina , México , Gravidez , Globulina de Ligação a Hormônio Sexual/análise , Testosterona/sangue
3.
Medicine (Baltimore) ; 98(31): e16665, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374040

RESUMO

BACKGROUND: The aim of this study was to summarize current evidence evaluating the association between antenatal infection and intraventricular hemorrhage (IVH) in preterm infants. MATERIALS AND METHODS: We searched for published articles on antenatal infection and IVH in 3 English (PubMed, the Cochrane Library, and EBSCO) and 3 Chinese (VEIPU, CNKI, and WANFANG) databases on May 19, 2019. In addition, the references of these articles were screened. The included studies had to meet all of the following criteria: preterm infants (<37 weeks); comparing antenatal infection with no infection; the outcomes included IVH (all grades), mild IVH, or sereve IVH; the type of study was randomized controlled trial or cohort study. RESULTS: A total of 23 cohort studies involving 13,605 preterm infants met our inclusion criteria. Antenatal infection increased the risk of IVH (odds ratios ([OR] 2.18, 95% confidence intervals [CI] 1.58-2.99), mild IVH (OR 1.95, 95% CI 1.09-3.49) and severe IVH (OR 2.65, 95% CI 1.52-4.61). For type of antenatal infection, the ORs and 95% CI were as follows: 2.21 (1.60-3.05) for chorioamnionitis, 2.26 (1.55-3.28) for histologic chorioamnionitis, 1.88 (1.22-2.92) for clinical chorioamnionitis, and 1.88 (1.14-3.10) for ureaplasma. CONCLUSIONS: Antenatal infection may increase the risk of developing IVH in the preterm infant. The evidence base is however of low quality and well-designed studies are needed.


Assuntos
Hemorragia Cerebral Intraventricular/epidemiologia , Recém-Nascido Prematuro , Infecção/epidemiologia , Resultado da Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Peso ao Nascer , Corioamnionite/epidemiologia , Feminino , Idade Gestacional , Humanos , Gravidez , Índice de Gravidade de Doença
4.
Lancet Psychiatry ; 6(7): 590-600, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31230684

RESUMO

BACKGROUND: Numerous studies have identified potential risk factors and biomarkers for autism spectrum disorder. We aimed to study the strength and validity of the suggested environmental risk factors or biomarkers of autism spectrum disorder. METHODS: We did an umbrella review and systematically appraised the relevant meta-analyses of observational studies. We searched PubMed, Embase, and the Cochrane Database of Systematic Reviews for papers published between database inception and Oct 17, 2018, and screened the reference list of relevant articles. We obtained the summary effect, 95% CI, heterogeneity, and 95% prediction intervals. We examined small study effects and excess significance. We did analyses under credibility ceilings. This review is registered with PROSPERO, number CRD42018091704. FINDINGS: 46 eligible articles yielded data on 67 environmental risk factors (544 212 cases, 81 708 787 individuals) and 52 biomarkers (15 614 cases, 15 433 controls). Evidence of association was convincing for maternal age of 35 years or over (relative risk [RR] 1·31, 95% CI 1·18-1·45), maternal chronic hypertension (odds ratio [OR] 1·48, 1·29-1·70), maternal gestational hypertension (OR 1·37, 1·21-1·54), maternal overweight before or during pregnancy (RR 1·28, 1·19-1·36), pre-eclampsia (RR 1·32, 1·20-1·45), prepregnancy maternal antidepressant use (RR 1·48, 1·29-1·71), and maternal selective serotonin reuptake inhibitor (SSRI) use during pregnancy (OR 1·84, 1·60-2·11). Only two associations, maternal overweight before or during pregnancy and SSRI use during pregnancy, retained their high level of evidence under subset sensitivity analyses. Evidence from biomarkers was scarce, being supported by p values close to the significance threshold and too few cases. INTERPRETATION: Convincing evidence suggests that maternal factors, such as age and features of metabolic syndrome, are associated with risk of autism spectrum disorder. Although SSRI use during pregnancy was also associated with such risk when exposed and non-exposed groups were compared, this association could be affected by other confounding factors, considering that prepregnancy maternal antidepressant use was also convincingly associated with higher risk of autism spectrum disorder. Findings from previous studies suggest that one possible confounding factor is underlying maternal psychiatric disorders. FUNDING: None.


Assuntos
Antidepressivos/efeitos adversos , Transtorno do Espectro Autista/epidemiologia , Idade Materna , Complicações na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Biomarcadores , Causalidade , Meio Ambiente , Feminino , Humanos , Gravidez , Fatores de Risco
5.
BMC Public Health ; 19(1): 845, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31253131

RESUMO

BACKGROUND: Fetal alcohol spectrum disorder (FASD) is one of the most disabling potential outcomes of prenatal alcohol exposure. The population-based prevalence of FASD among the general population of Canada was unknown. The objective of this study was to determine the population-based prevalence of FASD among elementary school students, aged 7 to 9 years, in the Greater Toronto Area (GTA) in Ontario, Canada. METHODS: This screening study used a cross-sectional, observational design utilizing active case ascertainment, along with retrospective collection of prenatal alcohol exposure information. Data collection involved two phases. Phase I consisted of taking growth measurements, a dysmorphology examination, and obtaining a history of behavioral and/or learning problems. Phase II consisted of a neurodevelopmental assessment, maternal interview, and behavioral observations/ratings by parents/guardians. Final diagnostic screening conclusions were made by consensus by a team of experienced multidisciplinary experts during case conferences, using the 2005 Canadian guidelines for FASD diagnosis. The prevalence of FASD was estimated, taking into consideration the selection rate, which was used to account for students who dropped out or were lost to follow-up during each phase. Monte Carlo simulations were employed to derive the confidence interval (CI) for the point estimates. RESULTS: A total of 2555 students participated. A total of 21 cases of suspected FASD were identified. The prevalence of FASD was estimated to be 18.1 per 1000, or about 1.8%. Using a less conservative approach (sensitivity analysis), the prevalence of FASD was estimated to be 29.3 per 1000, or about 2.9%. Therefore, the population-based prevalence of FASD is likely to range between 2 and 3% among elementary school students in the GTA in Ontario, Canada. CONCLUSIONS: This study provides the first population-based estimate of the prevalence of FASD in Canada. The estimate is approximately double or possibly even triple previous crude estimates. FASD prevalence exceeds that of other common birth defects such as Down's syndrome, spina bifida, trisomy 18, as well as autism spectrum disorder in Canada. More effective prevention strategies targeting alcohol use during pregnancy, surveillance of FASD, and timely interventions and support to individuals with FASD and their families are urgently needed.


Assuntos
Transtornos do Espectro Alcoólico Fetal/epidemiologia , Consumo de Bebidas Alcoólicas/efeitos adversos , Criança , Estudos Transversais , Feminino , Transtornos do Espectro Alcoólico Fetal/diagnóstico , Humanos , Masculino , Programas de Rastreamento , Ontário/epidemiologia , Gravidez , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Prevalência , Estudos Retrospectivos , Instituições Acadêmicas , Estudantes/estatística & dados numéricos
7.
Dev Neuropsychol ; 44(4): 339-356, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31059292

RESUMO

We examined the roles of maternal and child lifetime stress exposures, infant temperament (orienting/regulation, surgency/extraversion), and maternal caregiving during infancy and preschool on preschoolers' working memory and inhibitory control in a sociodemographically diverse pregnancy cohort. Working memory was predicted by infant orienting/regulation, with differential effects by the level of maternal cognitive support in infancy; maternal lifetime stress exposures exerted independent negative effects on working memory. Inhibitory control was positively associated with maternal emotionally supportive behaviors in infancy, which mediated the effects of maternal lifetime stress exposures on inhibitory control. These findings have implications for interventions designed to optimize child executive functioning.


Assuntos
Desenvolvimento Infantil , Inibição (Psicologia) , Exposição Materna/efeitos adversos , Memória de Curto Prazo , Relações Mãe-Filho/psicologia , Mães/psicologia , Orientação , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Autocontrole/psicologia , Estresse Psicológico , Temperamento , Criança , Pré-Escolar , Cognição , Função Executiva , Feminino , Seguimentos , Humanos , Lactente , Masculino , Gravidez , Estudos Prospectivos
8.
J Consult Clin Psychol ; 87(6): 551-562, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31120274

RESUMO

OBJECTIVE: This study examines the effect of a home visiting intervention on maternal alcohol use, problematic drinking, and the association of home visiting and alcohol use on children's behavioral, cognitive, and health outcomes at 5 time points over 5 years. METHOD: We analyzed 5,099 observations of 1,236 mothers and their children from pregnancy to 5 years postbirth, within a longitudinal cluster-randomized trial evaluating the effect of a home visiting intervention on mothers in Cape Town, South Africa. Paraprofessional home visitors coached mothers on coping with multiple risk factors, including a brief, 1-visit intervention on alcohol prevention in pregnancy. We assessed changes in maternal drinking over time in relation to the intervention, and then examined the impact of these drinking patterns on child outcomes over five years. RESULTS: Drinking increased over the 5 years postbirth, but it was significantly lower in the intervention condition. Compared with abstinence, mothers' problematic drinking was associated with decreased child weight (-0.21 z-units) at all assessments, increased child aggressive behavior (3 to 7 additional symptoms), and decreased child performance on an executive functioning measure (the silly sounds task; odds ratio = .34) at 3 and 5 years. The intervention's effect was associated with increased child aggression (0.25 to 0.75 of 1 additional symptom), but the intervention appeared to decrease the effect of problem drinking on children's aggressive acts and executive functioning. CONCLUSION: These findings support the need for sustained interventions to reduce alcohol use, especially for mothers who exhibit problematic drinking. Maternal drinking influences children's health and development over time. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/epidemiologia , Deficiências do Desenvolvimento/epidemiologia , Visita Domiciliar/estatística & dados numéricos , Mães/estatística & dados numéricos , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Adulto , Pré-Escolar , Análise por Conglomerados , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Gravidez , África do Sul/epidemiologia
9.
Eur J Epidemiol ; 34(7): 637-649, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31037572

RESUMO

Ecological observations suggest an inverse relationship between smoking in pregnancy and celiac disease (CD) in offspring. While individual-level analyses have been inconsistent, they have mostly lacked statistical power or refined assessments of exposure. To examine the association between pregnancy-related smoking and CD in the offspring, as well as its consistency across data sets, we analyzed: (1) The Norwegian Mother and Child Cohort (MoBa) of 94,019 children, followed from birth (2000-2009) through 2016, with 1035 developing CD; (2) a subsample from MoBa (381 with CD and 529 controls) with biomarkers; and (3) a register-based cohort of 536,861 Norwegian children, followed from birth (2004-2012) through 2014, with 1919 developing CD. Smoking behaviors were obtained from pregnancy questionnaires and antenatal visits, or, in the MoBa-subsample, defined by measurement of cord blood cotinine. CD and potential confounders were identified through nationwide registers and comprehensive parental questionnaires. Sustained smoking during pregnancy, both self-reported and cotinine-determined, was inversely associated with CD in MoBa (multivariable-adjusted [a] OR = 0.61 [95%CI, 0.46-0.82] and aOR = 0.55 [95%CI, 0.31-0.98], respectively); an inverse association was also found with the intensity of smoking. These findings differed from those of our register-based cohort, which revealed no association with sustained smoking during pregnancy (aOR = 0.97 [95%CI, 0.80-1.18]). In MoBa, neither maternal smoking before or after pregnancy, nor maternal or paternal smoking in only early pregnancy predicted CD. In a carefully followed pregnancy cohort, a more-detailed smoking assessment than oft-used register-based data, revealed that sustained smoking during pregnancy, rather than any smoking exposure, predicts decreased likelihood of childhood-diagnosed CD.


Assuntos
Doença Celíaca/epidemiologia , Cotinina/sangue , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Fumar/efeitos adversos , Poluição por Fumaça de Tabaco/efeitos adversos , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Doença Celíaca/induzido quimicamente , Feminino , Sangue Fetal , Antígenos HLA , Humanos , Masculino , Pessoa de Meia-Idade , Mães , Noruega/epidemiologia , Gravidez , Sistema de Registros , Fatores de Risco , Autorrelato , Fumar/sangue , Abandono do Hábito de Fumar
10.
Environ Pollut ; 251: 699-707, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31108303

RESUMO

We conducted a meta-analysis to evaluate the association between prenatal cadmium (Cd) exposure and birth weight. PubMed, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang databases were searched for studies published before March 2019. We used a model-based method, standardizing effect size from linear regression models to include a maximum number of studies during our quantitative evaluations. As a result, 11 articles from the general population, containing 10 birth cohorts and one cross-sectional study, were included. Our meta-analysis demonstrated that a 50% increase of maternal urine Cd (UCd) would be associated with a 6.15 g decrease in neonatal birth weight (ß = -6.15 g, 95% CI: -10.81, -1.49) as well as a 50% increase of maternal blood Cd (BCd) would be associated with an 11.57 g decrease (ß = -11.57 g; 95% CI: -18.85, -4.30). Stratified analysis of UCd data indicated that the results of female newborns were statistically significant (ß = -8.92 g, 95% CI: -17.51, -0.34), as was the first trimester (ß = -11.34 g, 95% CI: -19.54, -3.14). Furthermore, increased UCd levels were associated with a higher rate of low birth weight (LBW) risk (OR = 1.12, 95% CI: 1.03, 1.22). This meta-analysis demonstrated that elevated maternal Cd levels are associated with decreased birth weight and higher LBW risk.


Assuntos
Peso ao Nascer/efeitos dos fármacos , Cádmio/toxicidade , Exposição Materna/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal/etiologia , Cádmio/sangue , Cádmio/urina , China/epidemiologia , Feminino , Humanos , Recém-Nascido , Razão de Chances , Gravidez , Efeitos Tardios da Exposição Pré-Natal/epidemiologia
12.
Nord J Psychiatry ; 73(4-5): 257-263, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31070508

RESUMO

Background: Prenatal maternal stress increases the risk of offspring developmental and psychological difficulties. The biological mechanisms behind these associations are mostly unknown. One explanation suggests that exposure of the fetus to maternal stress may influence DNA methylation. However, this hypothesis is largely based on animal studies, and human studies of candidate genes from single timepoints. Aim: The aim of this study was to investigate if prenatal maternal stress, in the form of maternal depressive symptoms, was associated with variation in genome-wide DNA methylation at two timepoints. Methods: One-hundred and eighty-four mother-child dyads were selected from a population of pregnant women in the Little-in-Norway study. The Edinburgh Postnatal Depression Scale (EPDS) measured maternal depressive symptoms. It was completed by the pregnant mothers between weeks 17 and 32 of gestation. DNA was obtained from infant saliva cells at two timepoints (age 6 weeks and 12 months). DNA methylation was measured in 274 samples from 6 weeks (n = 146) and 12 months (n = 128) using the Illumina Infinium HumanMethylation 450 BeadChip. Linear regression analyses of prenatal maternal depressive symptoms and infant methylation were performed at 6 weeks and 12 months separately, and for both timepoints together using a mixed model. Results: The analyses revealed no significant genome-wide association between maternal depressive symptoms and infant DNA methylation in the separate analyses and for both timepoints together. Conclusions: This sample of pregnant women and their infants living in Norway did not reveal associations between maternal depressive symptoms and infant DNA methylation.


Assuntos
Metilação de DNA/fisiologia , Depressão/psicologia , Epigenômica/métodos , Complicações na Gravidez/psicologia , Efeitos Tardios da Exposição Pré-Natal/psicologia , Adulto , Animais , Depressão/epidemiologia , Depressão/genética , Feminino , Estudo de Associação Genômica Ampla/métodos , Humanos , Recém-Nascido , Estudos Longitudinais , Mães/psicologia , Noruega/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/genética , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/genética , Adulto Jovem
13.
Medicine (Baltimore) ; 98(18): e15352, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045777

RESUMO

BACKGROUND: Previous studies have investigated heavy metal exposure could increase the occurrence of congenital heart defects (CHDs). However, there are limited data regarding the relationship between exposure to nickel and CHDs occurrence in offspring. The aim of this study was to analyze the association between nickel exposure in mothers and the risk of CHDs in offspring. MATERIALS AND METHODS: To explore the association of nickel exposure and occurrence of CHD, a case-control study with 490 controls and 399 cases with CHDs in China were developed. The concentrations of nickel in hair of pregnant woman and fetal placental tissue were measured and used a logistic regression analysis to explore the relationship between nickel exposure and risk of CHD. RESULTS: The median concentrations of nickel were 0.629 ng/mg, P < .05 (adjusted odds ratio [aOR], 1.326; 95% CI, 1.003-1.757) and 0.178 ng/mg, P < .05 (aOR, 2.204; 95% CI, 0.783-6.206), in maternal hair and in fetal placental tissue in the CHD group, respectively. Significant differences in the level of nickel in hair were also found in the different CHD subtypes including septal defects (P < .05), conotruncal defects (P < .05), right ventricular outflow tract obstruction (P < .01), and left ventricular outflow tract obstruction (P < .05). Dramatically different nickel concentrations in fetal placenta tissue were found in cases with other heart defects (P < .05). CONCLUSIONS: The finding suggested that the occurrence of CHDs may be associated with nickel exposure.


Assuntos
Cardiopatias Congênitas/induzido quimicamente , Exposição Materna/efeitos adversos , Níquel/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Adulto , Estudos de Casos e Controles , China/epidemiologia , Feminino , Idade Gestacional , Cabelo/química , Humanos , Razão de Chances , Placenta/química , Gravidez , Análise de Regressão , Fatores de Risco , Adulto Jovem
14.
BMC Med ; 17(1): 77, 2019 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-30971237

RESUMO

BACKGROUND: The uterine environment may influence telomere length at birth, which is essential for cellular function, aging, and disease susceptibility over the lifespan. However, little is known about the impact of toxic chemicals on early-life telomeres. Therefore, we assessed the potential impact of multiple toxic metals on relative telomere length (rTL) in the maternal blood, cord blood, and placenta, as well as the potential modifying effects of pro-oxidants. METHOD: In a mother-child cohort in northern Argentina (n = 169), we measured multiple toxic metals in the maternal blood or urine collected during late pregnancy, as well as the placenta and cord blood collected at delivery, using inductively coupled plasma mass spectrometry (ICP-MS). We assessed associations of log2-transformed metal concentrations with rTL, measured in maternal and cord blood leukocytes and the placenta by real-time PCR, using multivariable-adjusted linear regression. Additionally, we tested for modifications by antioxidants (zinc, selenium, folate, and vitamin D3). RESULTS: Exposure to boron and antimony during pregnancy was associated with shorter maternal rTL, and lithium with longer maternal rTL; a doubling of exposure was associated with changes corresponding to 0.2-0.4 standard deviations (SD) of the rTL. Arsenic concentrations in the placenta (n = 98), blood, and urine were positively associated with placental rTL, about 0.2 SD by doubled arsenic. In the cord blood (n = 88), only lead was associated with rTL (inversely), particularly in boys (p for interaction 0.09). Stratifying by newborn sex showed ten times stronger association in boys (about 0.6 SD) than in girls. The studied antioxidants did not modify the associations, except that with antimony. CONCLUSIONS: Elevated exposure to boron, lithium, arsenic, and antimony was associated with maternal or newborn rTL in a tissue-specific, for lead also sex-specific, manner. Nutritional antioxidants did not generally influence the associations.


Assuntos
Antioxidantes/administração & dosagem , Exposição Ambiental/análise , Exposição Materna , Fenômenos Fisiológicos da Nutrição Materna , Metais Pesados/toxicidade , Homeostase do Telômero/fisiologia , Telômero/fisiologia , Adolescente , Adulto , Argentina/epidemiologia , Criança , Estudos de Coortes , Dieta , Exposição Ambiental/prevenção & controle , Feminino , Sangue Fetal/efeitos dos fármacos , Sangue Fetal/metabolismo , Humanos , Recém-Nascido , Masculino , Exposição Materna/estatística & dados numéricos , Fenômenos Fisiológicos da Nutrição Materna/efeitos dos fármacos , Troca Materno-Fetal/efeitos dos fármacos , Troca Materno-Fetal/genética , Metais Pesados/análise , Metais Pesados/sangue , Metais Pesados/urina , Mães , Placenta/efeitos dos fármacos , Placenta/metabolismo , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/genética , Efeitos Tardios da Exposição Pré-Natal/prevenção & controle , Telômero/efeitos dos fármacos , Homeostase do Telômero/efeitos dos fármacos , Adulto Jovem
16.
J Environ Radioact ; 204: 125-131, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31029986

RESUMO

Uranium and thorium are common radioactive elements that exist in the environment. However, few environmental epidemiological studies have focused on their possible effects on congenital malformations. Here, we explored the association between uranium and thorium concentrations in maternal scalp hair grown from 3 months before to 3 months after conception, namely during the periconceptional period and the risk of orofacial clefts (OFCs) in offspring. Our study included 153 women whose pregnancies were affected by OFCs (cases) and 601 women who delivered infants without birth defects (controls) from four provinces in China. Face-to-face interviews were used to collect sociodemographic characteristics with a structured questionnaire. Concentrations of uranium and thorium in maternal scalp hair grown during the periconceptional period were detected using inductively coupled plasma-mass spectrometry. The risk of OFCs in association with higher concentrations of the two radioactive elements was estimated using odds ratios (ORs) and 95% confidence intervals (CIs) while adjusting for potential confounding factors. The levels of uranium and thorium in maternal hair were in agreement with the published literature. After adjusting for several confounders, the ORs of thorium in the highest, upper, and lower quartile versus the lowest quartile were 2.63 (95% CI, 1.41-4.92), 1.98 (95% CI, 1.03-3.79), and 2.73 (95% CI, 1.46-5.12), respectively. No association was found between levels of uranium and the risk of OFCs. Maternal periconceptional exposure to thorium may be a risk factor for OFCs in offspring.


Assuntos
Fenda Labial/epidemiologia , Fissura Palatina/epidemiologia , Cabelo/química , Exposição Materna/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Tório/análise , Urânio/análise , Adulto , China/epidemiologia , Fenda Labial/induzido quimicamente , Fissura Palatina/induzido quimicamente , Feminino , Humanos , Recém-Nascido , Masculino , Razão de Chances , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Fatores de Risco , Couro Cabeludo/química , Adulto Jovem
17.
Artigo em Inglês | MEDLINE | ID: mdl-30875870

RESUMO

Objective: Investigate whether residential prenatal exposure to heavy metal hazardous air pollutants (HMHAPs) is associated with an increased risk of hypospadias. Methods: Data on non-syndromic hypospadias cases (n = 8981) and control patients delivered in Texas were obtained from the Texas Birth Defects Registry and matched 1:10 by birth year. Average exposure concentrations of HMHAPs were obtained from the 2005 U.S. Environmental Protection Agency National-Scale Air Toxics Assessment and categorized into quintiles. Odds ratios and 95% confidence intervals were estimated. STROBE reporting guidelines were followed. Results: We observed associations between hypospadias and prenatal HMHAP exposure. Manganese demonstrated significant increased risk of hypospadias at the medium, medium-high and high exposure quintiles; lead in the medium-high and high exposure quintiles. Cadmium, mercury and nickel demonstrated a significant inverted "U-shaped" association for exposures with significant associations in the medium and medium-high quintiles but not in the medium-low and high quintiles. Arsenic and chromium demonstrated a significant bivalent association for risk of hypospadias in a lower quintile as well as a higher quintile with non-significant intermediate quintiles. Conclusions: Using data from one of the world's largest active surveillance birth defects registries, we identified significant associations between hypospadias and HMHAP exposures. These results should be used in counseling for maternal demographic risk factors as well as avoidance of heavy metals and their sources.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar em Ambientes Fechados/efeitos adversos , Hipospadia/epidemiologia , Exposição Materna/efeitos adversos , Metais Pesados/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Adolescente , Adulto , Feminino , Substâncias Perigosas/efeitos adversos , Humanos , Hipospadia/induzido quimicamente , Masculino , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Fatores de Risco , Texas/epidemiologia , Adulto Jovem
18.
Environ Health Perspect ; 127(3): 37003, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30848671

RESUMO

BACKGROUND: Chronic cadmium exposure has been associated with osteotoxicity in adults, but little is known concerning its effects on early growth, which has been shown to be impaired by cadmium. OBJECTIVES: Our objective was to assess the impact of early-life cadmium exposure on bone-related biomarkers and anthropometry at 9 y of age. METHODS: For 504 children in a mother-child cohort in Bangladesh, cadmium exposure was assessed by concentrations in urine (U-Cd, long-term exposure) and erythrocytes (Ery-Cd, ongoing exposure) at 9 and 4.5 y of age, and in their mothers during pregnancy. Biomarkers of bone remodeling [urinary deoxypyridinoline (DPD), urinary calcium, plasma parathyroid hormone, osteocalcin, vitamin D3, insulin-like growth factor (IGF) 1, IGF binding protein 3, thyroid stimulating hormone] were measured at 9 y of age. RESULTS: In multivariable-adjusted linear models, a doubling of concurrent U-Cd was associated with a mean increase in osteocalcin of [Formula: see text] (95% CI: 0.042, 5.9) and in urinary DPD of [Formula: see text] (95% CI: 12, 32). In a combined exposure model, a doubling of maternal Ery-Cd was associated with a mean increase in urinary DPD of [Formula: see text] (95% CI: [Formula: see text], 30). Stratifying the osteocalcin model by gender ([Formula: see text] 0.001), a doubling of concurrent U-Cd was associated with a mean decrease in osteocalcin of [Formula: see text] (95% CI: [Formula: see text], [Formula: see text]) in boys and a mean increase of [Formula: see text] (95% CI: 5.4, 13) in girls. The same pattern was seen with U-Cd at 4.5 y of age ([Formula: see text] 0.016). Children's U-Cd and Ery-Cd, concurrent and at 4.5 y of age, were inversely associated with vitamin D3. CONCLUSIONS: Childhood cadmium exposure was associated with several bone-related biomarkers and some of the associations differed by gender. https://doi.org/10.1289/EHP3655.


Assuntos
Biomarcadores/análise , Osso e Ossos/química , Cádmio/efeitos adversos , Exposição Ambiental/efeitos adversos , Poluentes Ambientais/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Bangladesh , Criança , Feminino , Humanos , Estudos Longitudinais , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente
19.
Eur J Epidemiol ; 34(7): 651-660, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30868347

RESUMO

Recent studies have shown that certain pharmacological agents used by fathers before conception may increase the risk of adverse neonatal outcomes in offspring. However, little is known about the effect of paternal use of antiepileptic drugs (AEDs) on congenital anomalies in children. Based on Danish national registers, we conducted a cohort study of 733, 282 singletons born from 1997 to 2008, with follow-up throughout 2013. The children whose fathers used AEDs during the 3 months before conception were categorized as the exposed. Logistic regression model was used to examine association between paternal AEDs use before conception and the risk of congenital anomalies in offspring. Compared with unexposed children, the exposed had a 23% increased risk of congenital anomalies (odds ratios (OR) 1.23, 95% confidence interval [CI] 1.10-1.37) after adjusting for potential confounders. When extending the exposure window to 1 year before conception to the end of pregnancy, except for those using AEDs during 3 months before conception (the susceptible period of exposure), the increased risks were also observed in children whose fathers were former users (i.e., those using AEDs only from 1 year to 3 months before conception) (OR 1.29, 95%CI 1.03-1.61) and later users (i.e., those using AEDs only during pregnancy) (OR 1.35, 95%CI 1.12-1.65). This study suggested that the mildly increased risk of congenital anomalies in the offspring associated with paternal AEDs use before conception may be attributable to the underlying indications related to AEDs use.


Assuntos
Anticonvulsivantes/efeitos adversos , Epilepsia/tratamento farmacológico , Pai/psicologia , Exposição Paterna/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Adulto , Anticonvulsivantes/uso terapêutico , Carbamazepina/uso terapêutico , Criança , Pré-Escolar , Estudos de Coortes , Dinamarca/epidemiologia , Epilepsia/epidemiologia , Pai/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Vigilância da População , Cuidado Pré-Concepcional , Gravidez , Efeitos Tardios da Exposição Pré-Natal/epidemiologia
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