Pharmacologic sex hormone use before and in early pregnancy in relation to birth and early childhood anthropometric outcomes

Objective: Possible adverse effects resulting from use of hormonal contraceptives have been studied extensively, yet few studies have been conducted evaluating the association between hormonal contraceptive use and offspring anthropometric indices and most studies have been unable to explore formulation-specific effects. Methods: Using data from a large, prospective pregnancy cohort study (n=44,734), with linkage to a national prescription registry, we evaluated the association between use of hormonal contraceptives (defined from dispensed prescription data) prior to and in early pregnancy (characterized by last date of use relative to conception, 12 - >4 months before, 4 - >1 months before, 1 - > 0 months before, and 0-12 weeks after) and preterm birth, small for gestational age, and overweight or obesity at age 3. We characterized use of a hormonal contraception by type (combination oral, progestin-only oral, vaginal ring, transdermal, and injectable) and specific progestin component. Results: We observed a positive association between use of a combination oral contraceptive and preterm birth for all exposure periods (adjusted OR: 1.21, 95% CI: 1.04, 1.41 for exposure within 12 months before conception). Generally, use of other types of hormonal contraception was not associated with preterm birth. Overall, use of a hormonal contraceptive was unrelated to small for gestational age. Evaluation of the association by progestin type identified variation by progestin formulation. We observed a weak, inverse association between early pregnancy use of a combination oral contraceptive and offspring overweight or obesity at age 3 (adjusted OR: 0.75, 95% CI: 0.53, 1.08) and a weak, positive association with use of a progestin-only oral contraceptive in early pregnancy (adjusted OR: 1.26, 95% CI: 0.79, 2.02). Observed associations were robust to sensitivity analyses. Conclusion: Hormonal contraceptive use prior to and in early pregnancy may be associated with preterm birth and offspring overweight. The association appears contingent upon the specific type or progestin component used. The potential for confounding by indication cannot be ruled out. Larger studies using population-based pregnancy cohort data with linkage to prescription registries may offer the potential to explore these questions further.Doctor of Philosoph

The Performance of Fertility Awareness-based Method Apps Marketed to Avoid Pregnancy

INTRODUCTION: In recent years there has been an explosion in the development of medical apps, with more than 40,000 apps now available. Nearly 100 apps allow women to track their fertility and menstrual cycles and can be used to avoid or achieve pregnancy. Apps offer a convenient way to track fertility biomarkers. However, only some use evidence-based fertility awareness-based methods (FABMs), which with ideal use have rates of effectiveness similar to those of commonly used forms of hormonal birth control. Since having a baby or preventing a pregnancy are important responsibilities, it is critical that women and couples have access to reliable, evidence-based apps that allow them to accurately track their fertility. METHODS: We developed a tool to evaluate and rate fertility apps. This tool is specifically designed to help couples avoid pregnancy. RESULTS: Results showed that the majority of fertility apps are not based on evidence-based FABMs or include a disclaimer discouraging use for avoiding pregnancy. However, at least 1 app in each FABM category (except symptohormonal methods) had a perfect score on accuracy. CONCLUSION: Relying solely on an app to use an FABM, without appropriate training in the method, may not be sufficient to prevent pregnancy

Prevalence of Eosinophilic Gastritis, Gastroenteritis, and Colitis: Estimates From a National Administrative Database

Eosinophilic esophagitis (EoE) is becoming increasingly more common, but the prevalence of other eosinophilic gastrointestinal disorders (EGIDs) is unknown. Our objective was to estimate the prevalence of eosinophilic gastritis, gastroenteritis, and colitis in the U.S.

Environmental and infectious factors in eosinophilic esophagitis

Identifying possible environmental or infectious etiologic factors for eosinophilic esophagitis (EoE) may offer insight into opportunities for disease prevention and treatment. We reviewed the current literature to assess environmental and infectious factors evaluated in EoE. Few studies have been conducted, however a consistent inverse association between EoE and H. pylori has been described. Several studies suggest a weak association between season and EoE diagnosis, but the evidence is inconclusive. EoE has also been associated with early life factors, including Cesarean delivery and antibiotic use. Larger studies are needed to evaluate these associations more thoroughly. Several papers have speculated the potential for anti-secretory agents to contribute to EoE. This has not been formerly evaluated. In summary, there is significant opportunity in the future to advance our understanding of possible environmental etiologic factors for EoE

Inflammatory responses to induced infectious endometritis in mares resistant or susceptible to persistent endometritis

BACKGROUND: The objective of the study was to evaluate the gene expression of inflammatory cytokines (interleukin [IL]-1β, IL-6, IL-8, IL-10, tumor necrosis factor [TNF]-α, IL-1 receptor antagonist [ra] and serum amyloid A (SAA) in endometrial tissue and circulating leukocytes in response to uterine inoculation of 105 colony forming units (CFU) Escherichia coli in mares. Before inoculation, mares were classified as resistant or susceptible to persistent endometritis based on their uterine inflammatory response to infusion of 109 killed spermatozoa and histological assessment of the endometrial quality. Endometrial biopsies were obtained 3, 12, 24 and 72 hours (h) after bacterial inoculation and blood samples were obtained during the 7 day period post bacterial inoculation. Expression levels of cytokines and SAA were determined by quantitative real-time reverse transcriptase PCR (qRT-PCR). RESULTS: Compared to levels in a control biopsy (obtained in the subsequent estrous), resistant mares showed an up-regulation of IL-1β, IL-6, IL-8 and TNF-α at 3 h after E. coli inoculation, while susceptible mares showed increased gene expression of IL-6 and IL-1ra. Susceptible mares had a significant lower gene expression of TNF-α,IL-6 and increased expression of IL-1ra 3 h after E. coli inoculation compared to resistant mares. Susceptible mares showed a sustained and prolonged inflammatory response with increased gene expression levels of IL-1β, IL-8, IL-1ra and IL-1β:IL-1ra ratio throughout the entire study period (72 h), whereas levels in resistant mares returned to estrous control levels by 12 hours. Endometrial mRNA transcripts of IL-1β and IL-1ra were significantly higher in mares with heavy uterine bacterial growth compared to mares with no/mild growth.All blood parameters were unaffected by intrauterine E. coli infusion, except for a lower gene expression of IL-10 at 168 h and an increased expression of IL-1ra at 48 h observed in susceptible mares compared to resistant mares. CONCLUSIONS: The current investigation suggests that endometrial mRNA transcripts of pro-inflammatory cytokines in response to endometritis are finely regulated in resistant mares, with initial high expression levels followed by normalization within a short period of time. Susceptible mares had a prolonged expression of pro-inflammatory cytokines, supporting the hypothesis that an unbalanced endometrial gene expression of inflammatory cytokines might play an important role in the pathogenesis of persistent endometritis

Direct Effects, Compensation, and Recovery in Female Fathead Minnows Exposed to a Model Aromatase Inhibitor

BackgroundSeveral chemicals in the environment have the potential to inhibit aromatase, an enzyme critical to estrogen synthesis.ObjectivesThe objective of this study was to provide a detailed characterization of molecular and biochemical responses of female fathead minnows to a model aromatase inhibitor, fadrozole (FAD).MethodsFish were exposed via water to 0, 3, or 30 microg FAD/L for 8 days and then held in clean water for 8 days, with samples collected at four time points during each 8-day period. We quantified ex vivo steroid production, plasma steroids, and plasma vitellogenin (Vtg) concentrations and analyzed relative transcript abundance of 10 key regulatory genes in ovaries and 3 in pituitary tissue by real-time polymerase chain reaction.ResultsEx vivo 17beta-estradiol (E2) production and plasma E2 and Vtg concentrations were significantly reduced after a single day of exposure to 3 microg or 30 microg FAD/L. However, plasma E2 concentrations recovered by the eighth day of exposure in the 3-microg/L group and within 1 day of cessation of exposure in the 30-microg/L group, indicating concentration- and time-dependent physiologic compensation and recovery. Concentration-dependent increases in transcripts coding for aromatase (A isoform), cytochrome P450 side-chain cleavage, steroidogenic acute regulatory protein, and follicle-stimulating hormone receptor all coincided with increased E2 production and recovery of plasma E2 concentrations.ConclusionsResults of this research highlight the need to consider compensation/adaptation and recovery when developing and interpreting short-term bioassays or biomarkers or when trying to predict the effects of chemical exposures based on mode of action

Capturing of organic carbon and nitrogen in eelgrass sediments of southern Scandinavia

The ability of seagrass meadows to filter nutrients and capture and store CO2 and nutrients in the form of organic carbon (OC) and nitrogen (N) in their sediments may help to mitigate local eutrophication as well as climate change via meadow restoration and protection. This study assesses OC and N sediment stocks (top 50 cm) and sequestration rates within Danish eelgrass meadows. At four locations, eelgrass-vegetated and nearby unvegetated plots were studied in protected and exposed areas. The average OC and N sediment 50 cm stocks were 2.6 ± 0.3 kg OC m − 2 and 0.23 ± 0.01 kg N m − 2, including vegetated and unvegetated plots. In general, OC and N stocks did not differ significantly between eelgrass meadows and unvegetated sediments. Lack of accumulation of excess 210Pb suggested sediment erosion or low rates of sediment accumulation at most sites. OC accumulation rates ranged from 6 to 134 g m − 2 yr − 1 and N from 0.7 to 14 g m − 2 yr − 1. Generalized additive models showed that ≥ 80 % of the variation in sediment OC and N stocks was explained by sediment grain size, organic matter source, and hydrodynamic exposure. Long cores, dated with 210Pb, showed declining OC and N densities toward present time, suggesting long-term declines in eelgrass OC and N pools. Estimates of potential nation-wide OC and N accumulation in eelgrass sediments show that they could annually capture up to 0.7 % ± 0.5 % of CO2 emissions and 6.9 % ± 5.2 % of the total terrestrial N load

Health-Care Utilization, Costs and the Burden of Disease Related to Eosinophilic Esophagitis in the United States

Eosinophilic esophagitis (EoE) has rapidly become a major cause of upper GI morbidity, but health care costs related to EoE have not been described. This study aimed to estimate EoE-related health care costs and utilization in the United States

Region-specific drivers cause low organic carbon stocks and sequestration rates in the saltmarsh soils of southern Scandinavia

Saltmarshes are known for their ability to act as effective sinks of organic carbon (OC) and their protection and restoration could potentially slow down the pace of global warming. However, regional estimates of saltmarsh OC storage are often missing, including for the Nordic region. To address this knowledge gap, we assessed OC storage and accumulation rates in 17 saltmarshes distributed along the Danish coasts and investigated the main drivers of soil OC storage. Danish saltmarshes store a median of 10 kg OC m−2 (interquartile range, IQR: 13.5–7.6) in the top meter and sequester 31.5 g OC m−2 yr−1 (IQR: 41.6–15.7). In a global context, these values are comparatively low. Soils with abundant clay (&gt; 20%), older and stable saltmarshes in mesohaline settings, and with low proportion of algal organic material showed higher OC densities, stocks, and accumulation rates. Grazing led to significantly higher OC stocks than neighboring ungrazed locations, likely due to trampling modifying soil abiotic conditions (higher erosion-resistance and higher clay content) that slow carbon decay. Scaling up, Danish saltmarsh soils, comprising about 1% of the country's area, have the potential to yearly capture up to 0.1% of Denmark's annual consumption-based CO2 emissions. Our research expands the baseline data needed to advance blue carbon research and management in the Nordic region while highlighting the need for a more comprehensive approach to saltmarsh management that considers the full range of services of these ecosystems and does not only focus on climate benefits.</p