BMI Trajectories from Birth to 23 Years by Cardiometabolic Risks in Young Adulthood

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154617/1/oby22754_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154617/2/oby22754-sup-0001-FigS1-S2.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154617/3/oby22754.pd

Preconception Cardiometabolic Health and Risk of Adverse Birth Outcomes among US Women

Background: Cardiovascular disease (CVD) is the leading cause of mortality among US women. CVD risk factors emerge well before onset of clinical disease, requiring a life course approach to prevention. Women of reproductive age are a targeted demographic due to growing burden of CVD risk in this group, and because poor preconception cardiovascular health may cause worse pregnancy outcomes. Few studies have evaluated associations between prospectively measured preconception cardiometabolic risk factors and birth outcomes. Methods: This dissertation includes three studies. Study 1 leverages data from the National Health and Nutrition Examination Surveys administered between 1988 and 2016 to describe trends in the burden of metabolic syndrome-- a clustering of CVD risk factors---among US women ages 18 to 44. Studies 2 and 3 use data from Add Health, a cohort study that recruited and followed US adolescents through adulthood, to evaluate effects of preconception blood pressure (Study 2) and preconception glycemia (Study 3) on two birth outcomes: preterm birth and birthweight. Study 3 additionally examines healthcare and racial and ethnic disparities in preconception hyperglycemia and preterm birth. Results: The prevalence of metabolic syndrome among US women ages 18-44 increased between 1988-94 (14%) and 1999-2004 (21%) and has since plateaued. The prevalence of two metabolic syndrome components, elevated waist circumference and elevated fasting glucose, have increased dramatically with persistent disparities by race/ethnicity (Study 1). Higher preconception blood pressure and higher preconception glycemia were associated with increased risk of preterm birth, even at levels below clinical cutoffs for hypertension and diabetes (Study 2, 3). Women with limited access and utilization of healthcare experienced a disproportionate burden of preconception hyperglycemia and preterm birth (Study 3). Conclusions: The proportion of women entering pregnancy with existing cardiometabolic risk factors like hypertension and diabetes is rising. Interventions to optimize maternal health prior to pregnancy, and to better manage these conditions during pregnancy, could greatly improve health outcomes for women and children

Preconception Cardiometabolic Health and Risk of Adverse Birth Outcomes among US Women

Background: Cardiovascular disease (CVD) is the leading cause of mortality among US women. CVD risk factors emerge well before onset of clinical disease, requiring a life course approach to prevention. Women of reproductive age are a targeted demographic due to growing burden of CVD risk in this group, and because poor preconception cardiovascular health may cause worse pregnancy outcomes. Few studies have evaluated associations between prospectively measured preconception cardiometabolic risk factors and birth outcomes. Methods: This dissertation includes three studies. Study 1 leverages data from the National Health and Nutrition Examination Surveys administered between 1988 and 2016 to describe trends in the burden of metabolic syndrome-- a clustering of CVD risk factors---among US women ages 18 to 44. Studies 2 and 3 use data from Add Health, a cohort study that recruited and followed US adolescents through adulthood, to evaluate effects of preconception blood pressure (Study 2) and preconception glycemia (Study 3) on two birth outcomes: preterm birth and birthweight. Study 3 additionally examines healthcare and racial and ethnic disparities in preconception hyperglycemia and preterm birth. Results: The prevalence of metabolic syndrome among US women ages 18-44 increased between 1988-94 (14%) and 1999-2004 (21%) and has since plateaued. The prevalence of two metabolic syndrome components, elevated waist circumference and elevated fasting glucose, have increased dramatically with persistent disparities by race/ethnicity (Study 1). Higher preconception blood pressure and higher preconception glycemia were associated with increased risk of preterm birth, even at levels below clinical cutoffs for hypertension and diabetes (Study 2, 3). Women with limited access and utilization of healthcare experienced a disproportionate burden of preconception hyperglycemia and preterm birth (Study 3). Conclusions: The proportion of women entering pregnancy with existing cardiometabolic risk factors like hypertension and diabetes is rising. Interventions to optimize maternal health prior to pregnancy, and to better manage these conditions during pregnancy, could greatly improve health outcomes for women and children

Low to Moderate Prenatal Alcohol Exposure and Neurodevelopmental Outcomes: A Narrative Review and Methodological Considerations.

PURPOSE: Although abstinence is recommended in pregnancy, many pregnancies are exposed to alcohol. Observational studies of the effects of low to moderate prenatal alcohol exposure (PAE) and neurodevelopmental outcomes have yielded inconsistent results, with some studies finding an increased risk of adverse neurobehavioral and cognitive outcomes, and other studies finding no changes or reduced risk of the same outcomes. The purpose of this narrative review is to summarize these inconsistencies and apply a methodological framework to discuss how different parameters contribute to the findings. The authors also provide recommendations on how to advance future research in this area. SEARCH METHODS: The PubMed, Web of Science, and Embase databases were searched, along with reference lists of selected systematic reviews and meta-analyses. Search terms used were (infant or child or children or adolescent or offspring) AND (low or light or mild or moderate or low-to-moderate) AND (drinking or alcohol or drinks) AND (pregnancy or prenatal or fetal) AND (neurodevelopment or behavioral or psychological or cognitive or developmental) NOT (mice or rat or fish or animal) NOT (meta-analysis or review). Peer-reviewed original research studies were included if they analyzed associations between an exposure defined and characterized as low/light or moderate PAE with offspring neurodevelopmental outcomes. Animal studies, studies that did not provide clear cutoff points to classify PAE categories, studies lacking an abstinence control group, and studies that did not present a multivariable-adjusted measure of association were excluded. SEARCH RESULTS: The searches identified 2,422 papers, with 36 papers meeting eligibility criteria. These studies were carried out across nine countries and included samples ranging from approximately 500 to 40,000 participants. Cognitive, academic, socioemotional, and behavioral outcomes were assessed from infancy through age 19. DISCUSSION AND CONCLUSION: When the findings from the selected articles were summarized by geographic region, exposure definition, or neurodevelopmental outcome, no consistent observations or patterns emerged between low to moderate PAE and offspring outcomes. Although some studies found positive (i.e., beneficial) associations between low to moderate PAE and outcomes (primarily outcomes related to cognition) and others found negative (i.e., detrimental) associations (primarily for behavioral outcomes), most findings were null (i.e., showed no effect of PAE). The heterogeneity in study results is likely due to methodological issues, including residual confounding, effect measure modification, and exposure misclassification that make synthesis of studies difficult. Alternative study designs, including longitudinal trajectory analysis, sibling design, negative controls, and instrumental variable analyses, may reduce biases and are discussed. To date, the consequences of light to moderate levels of PAE on neurodevelopment remain unresolved; studies that advance methodological rigor will be important contributions to the field

Sodium and Health Outcomes: Ascertaining Valid Estimates in Research Studies.

Purpose of reviewThe dietary reference intake (DRI) for sodium has been highly debated with persuasive and elegant arguments made for both population sodium reduction and for maintenance of the status quo. After the 2015 Dietary Guidelines Advisory Committee (DGAC) report was published, controversy ensued, and by Congressional mandate, the sodium DRIs were updated in 2019. The 2019 DRIs defined adequate intake (AI) levels by age-sex groups that are largely consistent with the DRIs for sodium that were published in 2005. Given the overall similarities between the 2005 and 2019 DRIs, one may wonder how the recently published research on sodium and health outcomes was considered in determining the DRIs, particularly, the recent studies from very large observational cohort studies. We aim to address this concern and outline the major threats to ascertaining valid estimates of the relationship between dietary sodium and health outcomes in observational cohort studies. We use tools from modern epidemiology to demonstrate how unexpected and inconsistent findings in these relationships may emerge. We use directed acyclic graphs to illustrate specific examples in which biases may occur.Recent findingsWe identified the following key threats to internal validity: poorly defined target intervention, poorly measured sodium exposure, unmeasured or residual confounding, reverse causality, and selection bias. Researchers should consider these threats to internal validity while developing research questions and throughout the research process. For the DRIs to inform real-world interventions relating to sodium reduction, it is recommended that more specific research questions be asked that can clearly define potential interventions of interest

Randomized Controlled Trial of Iron-Fortified versus Low-Iron Infant Formula: Developmental Outcomes at 16 Years

Objectives: To test differences in cognitive outcomes among adolescents randomly assigned previously as infants to iron-fortified formula or low-iron formula as part of an iron deficiency anemia prevention trial. Study design: Infants were recruited from community clinics in low- to middle-income neighborhoods in Santiago, Chile. Entrance criteria included term, singleton infants; birth weight of ≥3.0 kg; and no major congenital anomalies, perinatal complications, phototherapy, hospitalization >5 days, chronic illness, or iron deficiency anemia at 6 months. Six-month-old infants were randomized to iron-fortified (12 mg/L) or low-iron (2.3 mg/L) formula for 6 months. At 16 years of age, cognitive ability, visual perceptual ability, visual memory, and achievement in math, vocabulary, and comprehension were assessed, using standardized measures. We compared differences in developmental test scores according to randomization group. Results: At the follow-up assessment, the 405 participants averaged 16.2 years of age and 46% were male. Those randomized to iron-fortified formula had lower scores than those randomized to low-iron formula for visual memory, arithmetic achievement, and reading comprehension achievement. For visual motor integration, there was an interaction with baseline infancy hemoglobin, such that the iron-fortified group outperformed the low-iron group when 6-month hemoglobin was low and underperformed when 6-month hemoglobin was high. Conclusions: Adolescents who received iron-fortified formula as infants from 6 to 12 months of age at levels recommended in the US had poorer cognitive outcomes compared with those who received a low-iron formula. The prevention of iron deficiency anemia in infancy is important for brain development. However, the optimal level of iron supplementation in infancy is unclear