Associations between maternal prenatal cortisol and fetal growth are specific to infant sex: findings from the Wirral Child Health and Development Study

Recent findings highlight that there are prenatal risks for affective disorders that are mediated by glucocorticoid mechanisms, and may be specific to females. There is also evidence of sex differences in prenatal programming mechanisms and developmental psychopathology, whereby effects are in opposite directions in males and females. As birth weight is a risk for affective disorders, we sought to investigate whether maternal prenatal cortisol may have sex-specific effects on fetal growth. Participants were 241 mothers selected from the Wirral Child Health and Development Study (WCHADS) cohort (n=1233) using a psychosocial risk stratifier, so that responses could be weighted back to the general population. Mothers provided saliva samples, which were assayed for cortisol, at home over 2 days at 32 weeks gestation (on waking, 30-min post-waking and during the evening). Measures of infant birth weight (corrected for gestational age) were taken from hospital records. General population estimates of associations between variables were obtained using inverse probability weights. Maternal log of the area under the curve cortisol predicted infant birth weight in a sex-dependent manner (interaction term P=0.029). There was a positive and statistically significant association between prenatal cortisol in males, and a negative association in females that was not statistically significant. A sex interaction in the same direction was evident when using the waking (P=0.015), and 30-min post-waking (P=0.013) cortisol, but not the evening measure. There was no interaction between prenatal cortisol and sex to predict gestational age. Our findings add to an emerging literature that suggests that there may be sex-specific mechanisms that underpin fetal programming

Management of hypertension in pregnancy — prevention, diagnosis, treatment and long-term prognosis. A position statement of the Polish Society of Hypertension, Polish Cardiac Society and Polish Society of Gynaecologists and Obstetricians

ADDITIONAL INFORMATION This article has been co‑published in Kardiologia Polska (doi:10.33963/KP.14904), Arterial Hypertension (doi:10.5603/AH.a2019.0011), and Ginekologia Polska (doi:10.5603/GP.2019.0074). The articles in Kardiologia Polska, Arterial Hypertension, and Ginekologia Polska are identical except for minor stylistic and spelling differences in keeping with each journal’s style. Any citation can be used when citing this article

Placental function, body composition and cardiovascular autonomic function

Hypertension is an important modifiable risk factor for cardiovascular disease. An important recent advancement in hypertension research is an understanding that hypertension often may have a developmental origin. Birthweight is associated with hypertension across the lifespan and adult cardiovascular disease, such that those at both ends of the spectrum are at increased risk. Nonetheless, birthweight is a crude surrogate of fetal growth and it may be that quantification of body composition, may more accurately identify the “at risk” individual. A causative mechanism linking birthweight and cardiovascular risk is yet to be identified but may involve changes to the structure and function of organs including the placenta which may impair development and predispose individuals to later cardiovascular disease. The aims of this thesis were to investigate the associations between placental function, body composition and cardiovascular autonomic function. Studies outlines in this thesis indicate different mechanism control fat mass and fat free mass in the newborn and that placental weight partly mediates the association of maternal factors with newborn body composition. While low birthweight has previously been shown to be associated altered autonomic function in the infant our studies suggests that body fatness may provide information beyond that obtained from birthweight assessment alone. Previous studies have shown altered blood pressure control in those born preterm, our studies found altered cardiovascular outcomes even in the late preterm newborn. Assessment of body composition in children and adolescents at rest and in response to an exercise test suggests worsening of autonomic control due to adiposity and may develop over time during childhood and adolescence. Collectively, these results emphasise the implications of altered in-utero and early life exposures on cardiovascular outcomes

Evaluating a Latent Measurement Model for Infant Sleep: From Intrinsic and Extrinsic Predictors to Cognitive Outcomes

The development of infant sleep is thought to be jointly guided by the dual processes of sleep consolidation and regulation. However, until now, there have been few empirical studies testing whether there is evidence for these latent processes. The current study uses structural equation modeling to test whether sleep consolidation and regulation can be modeled by two distinct latent variables. Using observed indicators from multiple sleep assessment methods, we found that a two factor model representing the processes of consolidation and regulation fit better than a one factor, undifferentiated model. These two latent factors were predicted by different intrinsic (i.e., infant) and extrinsic (i.e., parenting) factors, as well as interactions between the two classes of predictors. Specifically, we replicated the interaction of infant temperament and maternal emotional availability in predicting both consolidation and regulation. We also found that infant sleep regulation longitudinally predicted infant attention regulation, although this relationship was only true for children whose mothers held a college degree or higher. These findings contribute to the literature by providing a novel measurement model that appropriately accounts for measurement error. Further, our findings suggest that considering the interaction between child characteristics and parental input in promoting high quality sleep is a key avenue for future research. Finally, by partially replicating sleep-cognition linkages previously observed in adolescents and adults, we find support for the notion of hierarchically organized self-regulatory abilities, which motivates areas for future investigation and possible intervention.Doctor of Philosoph

Atrial Septal Defect

Atrial Septal Defects (ASDs) are relatively common both in children and adults. Recent reports of increase in the prevalence of ASD may be related use of color Doppler echocardiography. The etiology of the ASD is largely unknown. While the majority of the book addresses closure of ASDs, one chapter in particular focuses on creating atrial defects in the fetus with hypoplastic left heart syndrome. This book, I hope, will give the needed knowledge to the physician caring for infants, children, adults and elderly with ASD which may help them provide best possible care for their patients

Prenatal stress and vagal tone in infancy

Background: The fetal origins hypothesis poses that adverse intrauterine conditions predispose to cardiovascular and metabolic diseases in adulthood. Evidence is accumulating that similar mechanisms to those identified for physical disorders may also apply to psychiatric disorders. Focusing on the activity of neurophysiological systems thought to regulate emotions from very early in life may be key to understanding how maternal stress in pregnancy impacts on the developing baby with possible long-lasting consequences for behaviour and psychopathology. Respiratory Sinus Arrhythmia (RSA), "vagal tone", is thought to reflect autonomic regulatory capabilities that may underpin emotion regulation. However, little is known about possible fetal origins of vagal tone. Animal studies increasingly point to sex differences in the effects of prenatal stress, and this is supported by human studies of the prenatal origins of cardiovascular functioning and psychopathology. The current investigation examines whether prenatal depression and anxiety predict vagal tone in infancy, and whether the associations are modified by infant sex. Method: Two hundred mothers and infants from a high-risk consecutive community sample were examined prospectively from the first trimester of pregnancy until 29 weeks postnatal. Maternal self-reports of stress (EPDS and STAI) were collected in pregnancy (20 and 32 weeks) and postnatally (5 weeks and 29 weeks). Vagal tone was ascertained across five procedures, the "Helper-Hinderer" social evaluation task, toy exploration and the "Still Face" paradigm (2 minutes of social engagement, followed by 2 minutes of maternal unresponsiveness and concluded by 2 minutes of social reunion). Results: Principal Component Analysis of the RSA scores yielded a one-factor solution explaining over 70% of the variance, and so mean of RSA scores was used as the index of overall vagal tone, and the difference between overall and RSA during the Still Face as the estimate of vagal withdrawal. There were no main effects of prenatal maternal depression or anxiety on vagal tone or vagal withdrawal. However, there were significant prenatal stress by sex of infant interactions. Follow-up analyses revealed that increasing maternal depression and anxiety at 20 weeks gestation were associated with decreasing vagal tone in males and increasing vagal tone in females. Vagal withdrawal in response to the still face showed similar patterns i.e. decreased in males and increased in girls with elevated maternal anxiety at 32 weeks gestation. These associations were not explained by possible confounding variables assessed in pregnancy, nor by postnatal maternal depression and anxiety. Conclusions: The findings support the fetal origins hypothesis for vagal tone and vagal withdrawal, but only in interaction with sex of the infant. Longitudinal study is required to determine conditions under which increasing vagal tone and withdrawal in girls associated with prenatal depression and anxiety, and decreasing vagal tone and withdrawal in boys, are associated with later resilience or vulnerability to psychopathology.EThOS - Electronic Theses Online ServiceGBUnited Kingdo