Pre-pregnancy maternal fasting plasma glucose levels in relation to time to pregnancy among the couples attempting first pregnancy
Permanent link to this recordhttp://hdl.handle.net/20.500.12613/4585
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Abstract© 2019 The Author(s). STUDY QUESTION: What is the relationship between pre-pregnancy maternal glucose levels and fecundability in Chinese couples? SUMMARY ANSWER: Elevated pre-pregnancy maternal glucose levels were associated with fecundability, as reflected by prolonged time to pregnancy (TTP) among the couples with no prior gravidity. STUDY DESIGN, SIZE, DURATION: Based on the National Free Pre-conception Check-up Projects supported by the Chinese government, 2 226 048 eligible couples attempting first pregnancy and participating in the project from 2015 to 2016 were included. They were followed-up for 1 year or until they reported pregnancy. PARTICIPANTS/MATERIALS, SETTINGS, METHODS: The Kaplan-Meier method was used to estimate the cumulative pregnancy rate in each menstrual cycle, and the discrete-time analogue of the Cox models was used to estimate the fecundability odds ratios (FORs) and 95% CIs by different pre-pregnancy maternal glucose levels (impaired fasting glucose (IFG) or diabetes as compared to normal). MAIN RESULTS AND THE ROLE OF CHANCE: The cumulative pregnancy rate for 12 cycles of the normal fasting plasma glucose (FPG) level group was 42.29%, significantly higher than that of the IFG (35.52%) and diabetes groups (31.52%). After adjusting for confounding factors, the FORs were 0.82 (95% CI: 0.81-0.83) and 0.74 (95% CI: 0.72-0.76) for the IFG and diabetes groups, respectively, as compared to the normal group. The association between pre-pregnancy maternal FPG levels and the FORs was non-linear, and the optimal FPG level for greatest fecundability (shortest TTP) was 3.90-4.89 mmol/L. LIMITATIONS, REASONS FOR CAUTION: The findings from this register-based cohort study require cautious interpretation given that information bias would be inevitable for single FPG measurements and for TTP calculations that were based on telephone follow-up information. Additionally, because couples who achieved pregnancy during their first menstrual cycle in the study were excluded, the pregnancy rates reported were low and possibly biased. WIDER IMPLICATIONS OF THE FINDINGS: The current report suggests that elevated pre-pregnancy maternal glucose levels were associated with prolonged TTP. Early evaluation and preventive treatment for female partners with IFG or diabetes in a pre-pregnancy examination are necessary. STUDY FUNDING/COMPETING INTEREST(S): Funding was provided by the National Key Research and Development Program of China (grants No. 2016YFC1000300 and 2016YFC1000307), the National Natural Science Foundation of China (grant No. 81872634), the CAMS Innovation Fund for Medical Sciences (grant No. 2018-I2M-1-004), the National Human Genetic Resources Sharing Service Platform (grant No. 2005DKA21300) and the National Population and Reproductive Health Science Data Center (grant No. 2005DKA32408), People's Republic of China. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER: N/A
Citation to related workOxford University Press (OUP)
Has partHuman Reproduction
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One-year postpartum anthropometric outcomes in mothers and children in the LIFE-Moms lifestyle intervention clinical trialsPhelan, Suzanne; Clifton, Rebecca G; Haire-Joshu, Debra; Redman, Leanne M; Van Horn, Linda; Evans, Mary; Joshipura, Kaumudi; Couch, Kimberly A; Arteaga, S Sonia; Cahill, Alison G; Drews, Kimberly L; Franks, Paul W; Gallagher, Dympna; Josefson, Jami L; Klein, Samuel; Knowler, William C; Martin, Corby K; Peaceman, Alan M; Thom, Elizabeth A; Wing, Rena R; Yanovski, Susan Z; Pi-Sunyer, Xavier; Phelan, S; Wing, RR; Hagobian, TA; Schaffner, A; Hart, C; Yin, EK; Phipps, MG; Abrams, B; Scholl, TO; Savitz, DA; Gallagher, D; Pi-Sunyer, X; Thornton, J; Rosenn, B; Paley, C; Gidwani, S; Horowitz, M; Joshipura, K; Franks, PW; Palacios, C; Campos, M; Rivera, J; Willett, WC; Zorrilla, C; Soltero, S; Hu, F; Cordero, J; Trak, MA; Melendez, M; Cahill, AG; Klein, S; Haire-Joshu, D; Stein, R; Mathur, A; Cade, WT; Moley, K; Peaceman, AM; Van Horn, L; Kwasny, M; Josefson, JL; Neff, L; Spring, B; Redman, LM; Martin, CK; Elkind-Hirsh, K; Breaux, J; Johnson, W; Frost, EA; Knowler, WC; Couch, KA; Curtis, JM; Dunnigan, DL; Hanson, RL; Hoskin, M; Kavena, K; Kishi, GY; Moffett, C; Murphy, S; Nelson, RG; Pomeroy, J; Shovestull, L; Williams, Rachel; Clifton, RG; Thom, EA; Drews, K; Boekhoudt, T; Evans, M; Yanovski, SZ; Arteaga, S; Alekel, DL; Grp, LIFE-Moms Res (2020-01)BACKGROUND/OBJECTIVES: Excess gestational weight gain (GWG) is a risk factor for maternal postpartum weight retention and excessive neonatal adiposity, especially in women with overweight or obesity. Whether lifestyle interventions to reduce excess GWG also reduce 12-month maternal postpartum weight retention and infant weight-for-length z score is unknown. Randomized controlled trials from the LIFE-Moms consortium investigated lifestyle interventions that began in pregnancy and tested whether there was benefit through 12 months on maternal postpartum weight retention (i.e., the difference in weight from early pregnancy to 12 months) and infant-weight-for-length z scores. SUBJECTS/METHODS: In LIFE-Moms, women (N = 1150; 14.1 weeks gestation at enrollment) with overweight or obesity were randomized within each of seven trials to lifestyle intervention or standard care. Individual participant data were combined and analyzed using generalized linear mixed models with trial entered as a random effect. The 12-month assessment was completed by 83% (959/1150) of women and 84% (961/1150) of infants. RESULTS: Compared with standard care, lifestyle intervention reduced postpartum weight retention (2.2 ± 7.0 vs. 0.7 ± 6.2 kg, respectively; difference of -1.6 kg (95% CI -2.5, -0.7; p = 0.0003); the intervention effect was mediated by reduction in excess GWG, which explained 22% of the effect on postpartum weight retention. Lifestyle intervention also significantly increased the odds (OR = 1.68 (95% CI, 1.26, 2.24)) and percentage of mothers (48.2% vs. 36.2%) at or below baseline weight at 12 months postpartum (yes/no) compared with standard care. There was no statistically significant treatment group effect on infant anthropometric outcomes at 12 months. CONCLUSIONS: Compared with standard care, lifestyle interventions initiated in pregnancy and focused on healthy eating, increased physical activity, and other behavioral strategies resulted in significantly less weight retention but similar infant anthropometric outcomes at 12 months postpartum in a large, diverse US population of women with overweight and obesity.
CONTRIBUTIONS OF PRENATAL INFECTION AND ANTIBIOTIC EXPOSURE TO OFFSPRING INFECTION AND ASTHMA RISKEllman, Lauren M.; Olino, Thomas; Alloy, Lauren B.; Bangasser, Debra A.; Weinraub, Marsha; Wimmer, Mathieu (Temple University. Libraries, 2020)Increasing evidence from both animal and human research implicates prenatal infection in the development of long-lasting disruptions in immune function of offspring, including an increased risk of infection and allergic disorders, such as asthma. Infection, specifically during early life, also has been repeatedly associated with subsequent risk of asthma in childhood. Moreover, antibiotic exposure, during both the pre- and post-natal period, has been linked with several of these immune-related health outcomes. The aim of the current study was to investigate the role of maternal infection during pregnancy in relation to the development of offspring infection and subsequent asthma risk. Further, we considered the confounding factors of pre- and postnatal antibiotic exposure in the context of offspring infection and asthma inception. Participants (N=2062) were pregnant women and their offspring prospectively enrolled in a longitudinal birth cohort study with follow-up data through childhood. Extensive health information, including data on illness episodes and antibiotic exposures, was obtained from medical records for both mothers and their offspring. Results indicated that second trimester prenatal infection was associated with an increased risk of offspring infection from birth through age five. Both offspring infection and antibiotic exposure from birth through age five were significantly associated with a diagnosis of asthma in children at age five. Offspring infection was found to mediate the relationship between mothers’ second trimester infection and offspring asthma. Sensitivity analyses suggested that our results primarily were due to infections and not antibiotic use, given that findings were replicated when restricting analyses to samples of mothers and offspring without antibiotic exposure. These findings suggest fetal origins of offspring infection and asthma risk.
Deconstructing the Teenage Pregnancy "Epidemic:" An Informed Approach to Caring for Marginalized Adolescents While Respecting Reproductive AutonomyJones, Nora L.; Rocco, Providenza Loera (Temple University. Libraries, 2017)Teenage childbearing is considered a societal ill, despite the evidence failing to demonstrate a causative link between teenage childbearing and negative consequences for teens or their children. This thesis argues that the strongly held assertion that teenage childbearing is detrimental to teens and society is rooted in racist eugenics theories and histories of reproductive coercion. Today, social scientists, health care providers, and public health professionals develop and celebrate programs that reduce rates of teen pregnancy, particularly programs that provide Long Acting Reversible Contraceptives (LARCs) to teens in marginalized communities. While these efforts are well-intentioned, they fail to recognize their perpetuation of histories of reproductive coercion of young women of color. This paper recommends ways in which the medical community can be better informed and respect reproductive autonomy in caring for teens from marginalized communities.