Gestational Diabetes Mellitus and Risk of Childhood Overweight and Obesity in Offspring: A Systematic Review

We systematically reviewed research examining the association between gestational diabetes (GDM) and childhood overweight and obesity. We identified studies from three sources: (1) a PubMed search of articles published between January 1990–January 2011, (2) reference lists of publications from the PubMed search, and (3) reference lists of review articles. We included studies that examined GDM separately from pregestational diabetes and childhood overweight or obesity defined as BMI > 85th or 95th percentile. A total of 12 studies were included in the systematic review. Crude odds ratios for the relationship between GDM and childhood overweight or obesity ranged from 0.7 to 6.3; in 8 studies, the associations were not statistically significant. In only 3 studies were results adjusted for any confounders; in the 2 that adjusted for prepregnancy obesity, the GDM and childhood overweight or obesity associations were attenuated and not statistically significant after adjustment. This paper demonstrates inconsistent evidence of an association between GDM and offspring overweight and obesity due to the methodological limitations of existing studies. Recommendations for future research are presented, which address methodological challenges

Hormonal contraception among electronic cigarette users and cardiovascular risk: a systematic review

Background: Women who use combined hormonal contraceptives and cigarettes have an increased risk for cardiovascular (CV) events. We reviewed the literature to determine whether women who use hormonal contraceptives (HC) and electronic cigarettes (e-cigarettes) also have an increased risk. Study Design: Systematic review. Methods: We searched for articles reporting myocardial infarction (MI), stroke, venous thromboembolism, peripheral arterial disease or changes to CV markers in women using e-cigarettes and HC. We also searched for indirect evidence, such as CV outcomes among e-cigarette users in the general population and among HC users exposed to nicotine, propylene glycol or glycerol. Results: No articles reported on outcomes among e-cigarette users using HC. Among the general population, 13 articles reported on heart rate or blood pressure after e-cigarette use. These markers generally remained normal, even when significant changes were observed. In three studies, changes were less pronounced after e-cigarette use than cigarette use. One MI was reported among 1012 people exposed to ecigarettes in these studies. One article on nicotine and HC exposure found both exposures to be significantly associated with acute changes to heart rate, though mean heart rate remained normal. No articles on propylene glycol or glycerol and HC exposure were identified. Conclusion: We identified no evidence on CV outcomes among e-cigarette users using HC. Limited data reporting mostly acute outcomes suggested that CV events are rare among e-cigarette users in the general population and that e-cigarettes may affect heart rate and blood pressure less than conventional cigarettes. There is a need for research assessing joint HC and e-cigarette exposure on clinical CV outcomes

Estimation of the correlation coefficient using the Bayesian Approach and its applications for epidemiologic research

BACKGROUND: The Bayesian approach is one alternative for estimating correlation coefficients in which knowledge from previous studies is incorporated to improve estimation. The purpose of this paper is to illustrate the utility of the Bayesian approach for estimating correlations using prior knowledge. METHODS: The use of the hyperbolic tangent transformation (ρ = tanh ξ and r = tanh z) enables the investigator to take advantage of the conjugate properties of the normal distribution, which are expressed by combining correlation coefficients from different studies. CONCLUSIONS: One of the strengths of the proposed method is that the calculations are simple but the accuracy is maintained. Like meta-analysis, it can be seen as a method to combine different correlations from different studies

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio

Tobacco industry marketing to low socioeconomic status women in the USA

ObjectivesDescribe tobacco companies' marketing strategies targeting low socioeconomic status (SES) females in the U.S.A.MethodsAnalysis of previously secret tobacco industry documents.ResultsTobacco companies focused marketing on low SES women starting in the late 1970s, including military wives, low-income inner-city minority women, 'discount-susceptible' older female smokers and less-educated young white women. Strategies included distributing discount coupons with food stamps to reach the very poor, discount offers at point-of-sale and via direct mail to keep cigarette prices low, developing new brands for low SES females and promoting luxury images to low SES African-American women. More recently, companies integrated promotional strategies targeting low-income women into marketing plans for established brands.ConclusionsTobacco companies used numerous marketing strategies to reach low SES females in the U.S.A. for at least four decades. Strategies to counteract marketing to low SES women could include (1) counteracting price discounts and direct mail coupons that reduce the price of tobacco products, (2) instituting restrictions on point-of-sale advertising and retail display and (3) creating counteradvertising that builds resistance to psychosocial targeting of low SES women. To achieve health equity, tobacco control efforts are needed to counteract the influence of tobacco industry marketing to low-income women

Patterns and predictors of current cigarette smoking in women and men of reproductive age-Ecuador, El Salvador, Guatemala, and Honduras Patrones y factores predictivos del tabaquismo actual en mujeres y hombres en edad fértil en Ecuador, El Salvador, Guatemala y Honduras

OBJECTIVE: To estimate smoking prevalence by gender, describe patterns of cigarette use, and identify predictors of current smoking in reproductive-age adults in four Latin American countries. METHODS: Self-reported smoking was examined using data from Reproductive Health Surveys of women aged 15-49 years in Ecuador (2004), El Salvador (2002-2003), Guatemala (2002), and Honduras (2001), and of men aged 15-59 years in El Salvador, Guatemala, and Honduras for the same years. Current smoking was assessed by demographic characteristics, and independent associations were examined using logistic regression. Data were weighted to be nationally representative of households with reproductive-age women and men. RESULTS: Current smoking prevalence ranged from 2.6% (Guatemala) to 13.1% (Ecuador) for women and from 23.1% (Guatemala) to 34.9% (El Salvador) for men. In Ecuador, 67.6% of female smokers were non-daily users; in other countries, daily use was more prevalent than non-daily use for both men and women. In daily users, the median number of cigarettes smoked per day ranged from 1.9 (Ecuador, Honduras) to 2.3 (Guatemala) for women and from 2.1 (Guatemala) to 3.6 (Honduras) for men. In bivariate analysis, smoking prevalence in all countries was highest in women who lived in urban areas, were previously married, and/or had high socioeconomic status. Risk factors for smoking varied by country and gender. CONCLUSIONS: National tobacco control programs in these countries should aggressively target high-risk populations (reproductive-age men) and maintain low prevalence in low-risk populations (reproductive-age women). More research is needed to understand addiction patterns in non-daily smokers.OBJETIVO: Calcular la prevalencia del tabaquismo según el sexo, describir los patrones de consumo de cigarrillos y determinar los factores predictivos del tabaquismo actual en mujeres y hombres en edad fértil en cuatro países latinoamericanos. MÉTODOS: Se analizaron los datos sobre tabaquismo proporcionados por los participantes de las Encuestas de Salud Reproductiva efectuadas en mujeres de 15 a 49 años de edad en Ecuador (2004), El Salvador (2002-2003), Guatemala (2002) y Honduras (2001), y en hombres de 15 a 59 años en El Salvador, Guatemala y Honduras en los mismos años. Se evaluó el tabaquismo actual según las características demográficas y se examinaron las asociaciones independientes mediante regresión logística. Se ponderaron los datos a fin de que fuesen representativos de hogares con mujeres y hombres en edad fértil a escala nacional. RESULTADOS: La prevalencia del tabaquismo actual varió entre 2,6% (Guatemala) y 13,1% (Ecuador) en las mujeres y entre 23,1% (Guatemala) y 34,9% (El Salvador) en los hombres. En Ecuador, 67,6% de las mujeres eran fumadoras ocasionales; en otros países, el consumo diario fue más prevalente que el ocasional tanto en los hombres como en las mujeres. En los consumidores diarios, la mediana del número de cigarrillos fumados por día varió entre 1,9 (Ecuador y Honduras) y 2,3 (Guatemala) en las mujeres y entre 2,1 (Guatemala) y 3,6 (Honduras) en los hombres. En el análisis bivariado, la prevalencia del tabaquismo en todos los países fue más alta en las mujeres que vivían en zonas urbanas, habían estado casadas o tenían un nivel socioeconómico alto. Los factores de riesgo de tabaquismo variaron según el país y el sexo. CONCLUSIONES: Los programas nacionales de control del tabaquismo de estos países deben orientarse principalmente a los habitantes de alto riesgo (hombres en edad fértil) y a mantener una prevalencia baja en los habitantes de bajo riesgo (mujeres en edad fértil). Se requieren más investigaciones para comprender los patrones de adicción de los fumadores ocasionales

Clinicians' awareness of the Affordable Care Act mandate to provide comprehensive tobacco cessation treatment for pregnant women covered by Medicaid

The Affordable Care Act (ACA) requires states to provide tobacco-cessation services without cost-sharing for pregnant traditional Medicaid-beneficiaries effective October 2010. It is unknown the extent to which obstetricians–gynecologists are aware of the Medicaid tobacco-cessation benefit. We sought to examine the awareness of the Medicaid tobacco-cessation benefit in a national sample of obstetricians–gynecologists and assessed whether reimbursement would influence their tobacco cessation practice. In 2012, a survey was administered to a national stratified-random sample of obstetricians–gynecologists (n = 252) regarding awareness of the Medicaid tobacco-cessation benefit. Results were stratified by the percentage of pregnant Medicaid patients. Chi-squared tests (p < 0.05) were used to assess significant associations. Analyses were conducted in 2014. Eighty-three percent of respondents were unaware of the benefit. Lack of awareness increased as the percentage of pregnant Medicaid patients in their practices decreased (range = 71.9%–96.8%; P = 0.02). One-third (36.1%) of respondents serving pregnant Medicaid patients reported that reimbursement would influence them to increase their cessation services. Four out of five obstetricians–gynecologists surveyed in 2012 were unaware of the ACA provision that required states to provide tobacco cessation coverage for pregnant traditional Medicaid beneficiaries as of October 2010. Broad promotion of the Medicaid tobacco-cessation benefit could reduce treatment barriers

Prevalence of Adverse Pregnancy Outcomes, by Maternal Diabetes Status at First and Second Deliveries, Massachusetts, 1998–2007

Introduction: Understanding patterns of diabetes prevalence and diabetes-related complications across pregnancies could inform chronic disease prevention efforts. We examined adverse birth outcomes by diabetes status among women with sequential, live singleton deliveries. Methods: We used data from the 1998–2007 Massachusetts Pregnancy to Early Life Longitudinal Data System, a population-based cohort of deliveries. We restricted the sample to sets of parity 1 and 2 deliveries. We created 8 diabetes categories using gestational diabetes mellitus (GDM) and chronic diabetes mellitus (CDM) status for the 2 deliveries. Adverse outcomes included large for gestational age (LGA), macrosomia, preterm birth, and cesarean delivery. We computed prevalence estimates for each outcome by diabetes status. Results: We identified 133,633 women with both parity 1 and 2 deliveries. Compared with women who had no diabetes in either pregnancy, women with GDM or CDM during any pregnancy had increased risk for adverse birth outcomes; the prevalence of adverse outcomes was higher in parity 1 deliveries among women with no diabetes in parity 1 and GDM in parity 2 (for LGA [8.5% vs 15.1%], macrosomia [9.7% vs. 14.9%], cesarean delivery [24.7% vs 31.3%], and preterm birth [7.7% vs 12.9%]); and higher in parity 2 deliveries among those with GDM in parity 1 and no diabetes in parity 2 (for LGA [12.3% vs 18.2%], macrosomia [12.3% vs 17.2%], and cesarean delivery [27.0% vs 37.9%]). Conclusions: Women with GDM during one of 2 sequential pregnancies had elevated risk for adverse outcomes in the unaffected pregnancy, whether the diabetes-affected pregnancy preceded or followed it