The relationship between body size and the risk of multiple sclerosis. The EnvIMS study

Introduction: Two recent studies from Canada and Sweden have shown that a large body size around 18-20 years may increase the risk of Multiple Sclerosis (MS), suggestive of a possible effect of reduced circulating levels of vitamin D in overweight individuals. We assessed this association in a large multinational case-control study (EnvIMS). Methods: A population based sample of 959 cases (286 men, 673 women) and 1718 controls (462 men, 1256 women) in Norway and 732 cases (261 men, 471 women) and 1439 controls (471 men, 968 women) in Italy reported their body size using body silhouettes ranging from 1 to 9 where 9 represents the largest. Body sizes at age (in years) 5, 10, 15, 25, 30 and current age (after onset of disease for MS cases) were reported. Self-report of body size was validated against current body mass index. We analyzed men and women separately and compared the cases to controls with independent samples t-test and logistic regression, using body size 3 as a reference group and smoking and education as co-variates. Results: In Norway cases reported a larger average body size between age 5 and 30, being significant from age 15 to 25 among men and age 10 to 25 among women. In Italy cases reported a slightly larger, non-significant, average body size up to 20 years among men and 25 years among women. Interestingly, at current age cases in general had a lower average body size compared with controls in both countries. In Norway we found that a large body size (silhouettes 6-9) at age 25 was associated with an increased risk for MS [men: OR=2.20 (95% CI: 1.14-4.24, p-trend=0.003), women: OR=1.62 (95% CI 1.04-2.53, p-trend=0.0005)]. The corresponding results at age 20 were OR=1.55 (95% CI: 0.71-3.36, p-trend=0.001) for men and OR=1.16 (95% CI: 0.72-1.88, p-trend=0.01) for women. No significant trend was found in Italy. Adjustment for smoking and education did not materially change the results. In both countries we found a protective effect for the slimmest body sizes (1-2) compared with body size 3 in all age groups (5-30). Conclusions: Our analyses show that factors related to a large body size, particularly around 20-25 years, seem to be a risk factor for MS in Norway, but less so in Italy. These results are compatible with low circulating vitamin D or a chronic inflammatory state in overweight individuals. The difference between the countries might be related to protection through higher sun exposure in Italy

Pregnancy in women with corrected aortic coarctation: Uteroplacental Doppler flow and pregnancy outcome

OBJECTIVE: Women with repaired coarctation of the aorta (rCoA) are at risk of hypertensive disorders and other complications during pregnancy. Hypertensive disorders in pregnant women are associated with inadequate uteroplacental flow, which is related to adverse offspring outcome. The aim of this study was to investigate the relationship of maternal cardiac function, placental function and pregnancy complications in women with rCoA. METHODS: We included 49 pregnant women with rCoA and 69 controls from the prospective ZAHARA-studies (Zwangerschap bij Aangeboren HARtAfwijkingen, pregnancy in congenital heart disease). Clinical evaluation, echocardiography and uteroplacental Doppler flow (UDF) measurements were performed at 20 and 32weeks gestation. Univariable regression analysis was performed. RESULTS: Comparison of rCoA and healthy women. In women with rCoA, tricuspid annular plane systolic excursion (TAPSE) decreased during pregnancy (25.7mm to 22.8mm, P=0.006). UDF indices and pregnancy complication rates were similar in both groups. Offspring of rCoA women had lower birth weight (3233g versus 3578g, P=0.001), which was associated with beta-blocker use during pregnancy (beta=-418.0, P=0.01). Association of cardiac function and UDF. Right ventricular (RV) function before pregnancy (TAPSE) and at 20weeks gestation (TAPSE and RV fractional area change) were associated with impaired UDF indices (umbilical artery pulsatility index at 20weeks beta=-0.02, P=0.01, resistance index at 20 and 32weeks beta=-0.01, P=0.02 and beta=-0.02, P=0.01 and uterine artery pulsatility and resistance index at 20weeks gestation beta=-0.02, P=0.05 and beta=-0.01, P=0.02). CONCLUSIONS: Women with rCoA tolerate pregnancy well. However, RV function is altered and is associated with impaired placentation

Engravings of the arteries; illustrating the second volume of the anatomy of the human body: serving as an introduction to the surgery of the arteries.

AIMS: In women with congenital heart disease (CHD), cardiovascular complications during pregnancy are common, but the risk assessment of these patients remains difficult. This study sought to determine the independent role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in addition to other parameters in predicting adverse cardiovascular events during pregnancy in women with CHD. METHODS AND RESULTS: We conducted a national, prospective multicentre cohort study. Follow-up with clinical evaluation and echocardiography and NT-proBNP measurement was performed at 20-week gestation. Adverse cardiovascular events occurred in 10.3% of 213 pregnancies. N-terminal pro-B-type natriuretic peptide levels >128 pg/mL at 20-week gestation, the presence of a mechanical valve, and subpulmonary ventricular dysfunction before conception were independently associated with events [odds ratio (OR) 10.6 (P = 0.039), OR 12.0 (P = 0.016), and OR 4.2 (P = 0.041), respectively]. The negative predictive value of NT-proBNP levels 128 pg/mL at 20 weeks of gestation had an additional value in predicting the occurrence of adverse cardiovascular events on the top of the other identified predictors (area under the curve 0.90 vs. 0.78, P = 0.035). CONCLUSION: Increased NT-proBNP levels at 20 weeks of gestation are an independent risk predictor of cardiovascular events during pregnancy in women with CHD

Doppler gradients, valve area and ventricular function in pregnant women with aortic or pulmonary valve disease: left versus right

Objective: Little is known about the course of echocardiographic parameters used for the evaluation of valvular heart disease (VHD) during pregnancy, hampering interpretation of possible changes (physiological vs. pathophysiological). Therefore we studied the course of these parameters and ventricular function in pregnant women with aortic and pulmonary VHD.Methods: The cohort comprised 66 pregnant women enrolled in the prospective ZAHARA studies or evaluated by an identical protocol who had pulmonary VHD or aortic VHD (stenosis/prosthetic valve). The control group comprised 46 healthy pregnant women. Echocardiography was performed preconception, during pregnancy and 1 year postpartum. Peak gradient, mean gradient, aortic valve area (AVA)/effective orifice area (EOA), left ventricular ejection fraction (LVEF) and right ventricular function (RVF; TAPSE) were assessed.Results: Peak and mean gradients increased during pregnancy compared to preconception inwomen with aortic VHD and controls (p = 23 mm; p < 0.001). In women with pulmonary VHD a decrease of TAPSE was observed during pregnancy (p = 0.005).Conclusion: Physiological changes during pregnancy lead to increased Doppler gradients in women with aortic VHD. This increase was not found inwomen with pulmonary VHD, probably caused by impaired RVF. Therefore, evaluation of RVF during pregnancy might be important to prevent underestimation of the degree of stenosis. (c) 2019 Elsevier B.V. All rights reserved