Cohort Profile: The Finnish Gestational Diabetes (FinnGeDi) Study

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Normal Gestational Weight Gain Protects From Large-for-Gestational-Age Birth Among Women With Obesity and Gestational Diabetes

Background: Pre-pregnancy obesity, excess gestational weight gain (GWG), and gestational diabetes (GDM) increase fetal growth. Our aim was to assess whether normal GWG is associated with lower risk for a large-for-gestational-age (LGA; over the 90th percentile of birth weight for sex and gestational age) infant and lower birth weight standard deviation (SD) score in the presence of GDM and maternal obesity. Methods: This multicenter case-control study is part of the Finnish Gestational Diabetes (FinnGeDi) Study and includes singleton pregnancies of 1,055 women with GDM and 1,032 non-diabetic controls. Women were divided into 12 subgroups according to their GDM status, pre-pregnancy body mass index (BMI; kg/m(2)), and GWG. Non-diabetic women with normal BMI and normal GWG (according to Institute of Medicine recommendations) served as a reference group. Results: The prevalence of LGA birth was 12.2% among women with GDM and 6.2% among non-diabetic women (p < 0.001). Among all women, normal GWG was associated with lower odds of LGA [odds ratio (OR) 0.57, 95% CI: 0.41-0.78]. Among women with both obesity and GDM, the odds for giving birth to a LGA infant was 2.25-fold (95% CI: 1.04-4.85) among those with normal GWG and 7.63-fold (95% CI: 4.25-13.7) among those with excess GWG compared with the reference group. Compared with excess GWG, normal GWG was associated with 0.71 SD (95% CI: 0.47-0.97) lower birth weight SD score among women with GDM and obesity. Newborns of normal weight women with GDM and normal GWG had 0.28 SD (95% CI: 0.05-0.51) lower birth weight SD scores compared with their counterparts with excess GWG. In addition, in the group of normal weight non-diabetic women, normal GWG was associated with 0.46 SD (95% CI: 0.30-0.61) lower birth weight SD scores compared with excess GWG. Conclusion: GDM, obesity, and excess GWG are associated with higher risk for LGA infants. Interventions aiming at normal GWG have the potential to lower LGA rate and birth weight SD scores even when GDM and obesity are present.Peer reviewe

A Pregnancy and Childhood Epigenetics Consortium (PACE) meta-analysis highlights potential relationships between birth order and neonatal blood DNA methylation

This is the final version. Available on open access from Nature Research via the DOI in this recordData availability: Blood samples and raw genetic data of neonatal subjects from each cohort are governed by their respective institutions and/or government agencies, and mostly could not be shared publicly without specific approvals. For example, for data from first author cohort, California Childhood Leukemia Study (CCLS), we respectfully are unable to share raw, individual genetic data freely with other investigators. Should we be contacted by other investigators who would like to use the data; we will direct them to the California Department of Public Health Institutional Review Board to establish their own approved protocol to utilize the data, which can then be shared peer-to-peer.Higher birth order is associated with altered risk of many disease states. Changes in placentation and exposures to in utero growth factors with successive pregnancies may impact later life disease risk via persistent DNA methylation alterations. We investigated birth order with Illumina DNA methylation array data in each of 16 birth cohorts (8164 newborns) with European, African, and Latino ancestries from the Pregnancy and Childhood Epigenetics Consortium. Meta-analyzed data demonstrated systematic DNA methylation variation in 341 CpGs (FDR adjusted P < 0.05) and 1107 regions. Forty CpGs were located within known quantitative trait loci for gene expression traits in blood, and trait enrichment analysis suggested a strong association with immune-related, transcriptional control, and blood pressure regulation phenotypes. Decreasing fertility rates worldwide with the concomitant increased proportion of first-born children highlights a potential reflection of birth order-related epigenomic states on changing disease incidence trends.National Institute of Environmental Health SciencesNational Cancer InstituteUS Environmental Protection Agenc

The roles of maternal characteristics and early-pregnancy serum parameters in gestational diabetes:the Finnish Gestational Diabetes study

Abstract Gestational diabetes (GDM) is defined as hyperglycaemia with onset or first recognition in pregnancy, affecting one of fifth of pregnancies in Finland. Besides its adverse perinatal outcomes, it predisposes both mother and child to long-term morbidity, such as type 2 diabetes, metabolic syndrome and cardiovascular disease. The major clinical risk factors for GDM, such as pre-pregnancy overweight and obesity, an advanced age and a family history of diabetes, are well established. However, the roles of other maternal clinical characteristics, such as polycystic ovary syndrome (PCOS), in the risk of developing GDM are controversial. The effect of an adequate gestational weight gain (GWG) on the prevention of fetal overgrowth also remain unclear. In addition to clinical risk factors, early-pregnancy serum parameters involved in the underlying pathophysiological mechanisms of GDM could improve the early detection of women with a high risk of GDM. The aim of this study was to evaluate the roles of maternal characteristics, especially PCOS and GWG, and serum parameters measured in early pregnancy, such as sex hormone-binding globulin (SHBG) and androgen excess, as well as of traditional lipids and ceramides (Cer), with subsequent GDM. The study was based on the Finnish Gestational Diabetes study, which included 1,146 women with GDM and 1,066 non-diabetic controls. The prevalence of PCOS was higher among women with GDM than in controls (10.7% vs. 7.4%), but PCOS was not an independent risk factor for GDM after considering pre-pregnancy BMI and age. Moderate GWG was an important factor in protecting against fetal overgrowth, especially in women with GDM and obesity. Lower early-pregnancy SHBG levels were associated with early-onset GDM, fasting hyperglycaemia and the need for insulin therapy, whereas androgen excess was associated with slightly higher post-prandial glucose values. Thus, low SHBG levels might reflect chronic insulin resistance, while androgen excess might impair post-prandial insulin secretion. Of the lipids measured in early pregnancy, higher levels of triglycerides, LDL and Cer(d18:1/24:0) were independent predictors of GDM. Along with clinical risk factors and triglycerides, ceramides did not markedly improve the prediction of GDM. Adverse alterations in hormonal and lipid parameters highlight the clustering of metabolic risk factors involved in GDM.Tiivistelmä Raskausdiabetes on raskausaikana ensimmäistä kertaa todettava sokeriaineenvaihdunnan häiriö, joka esiintyy Suomessa joka viidennellä synnyttäjällä. Siihen liittyy lisääntynyt raskausongelmien riski sekä myöhempi äidin ja lapsen suurentunut pitkäaikaissairauksien, kuten tyypin 2 diabeteksen, metabolisen oireyhtymän sekä sydän- ja verisuonisairauksien riski. Raskausdiabeteksen riskitekijöitä ovat ylipaino ja lihavuus, korkea ikä sekä lähisukulaisen diabetes. Muiden kliinisten tekijöiden, kuten munasarjojen monirakkulaoireyhtymän (PCOS) merkityksestä raskausdiabeteksen itsenäisenä riskitekijänä on kiistelty. Myös maltillisen raskauden aikaisen painonnousun roolista sikiön liikakasvulta suojaavana tekijänä tarvitaan lisätietoa. Lisäksi olisi tärkeää tunnistaa suuressa sairastumisriskissä olevat naiset jo varhaisraskaudessa. Yksi mahdollisuus on määrittää äidin alkuraskauden verinäytteistä merkkiaineita, jotka voivat olla yhteydessä raskausdiabeteksen kehittymiseen. Väitöskirjatutkimuksessa arvioitiin Suomalaisen raskausdiabetestutkimuksen (FinnGeDi) 1146 raskausdiabeetikkoa ja 1066 verrokkia sisältävässä aineistossa äidin kliinisten tekijöiden, erityisesti PCOS:n ja raskauden aikaisen painonnousun sekä alkuraskauden seerumin merkkiaineiden yhteyksiä raskausdiabetekseen. Työssä tarkasteltiin sukupuolihormoneja sitovan globuliinin (SHBG) ja androgeeniylimäärän sekä perinteisten rasva-arvojen ja keramidien (Cer) pitoisuuksia. PCOS oli raskausdiabetekseen sairastuneilla verrokkeja yleisempi (10,7 % vs. 7,4 %), mutta se ei ollut raskausdiabeteksen itsenäinen riskitekijä, vaan ero välittyi korkeamman iän ja ylipainon kautta. Suositusten mukainen raskauden aikainen painonnousu vähensi sikiön liikakasvua huolimatta raskausdiabeteksesta ja lihavuudesta. Matalampi alkuraskauden SHBG-taso oli yhteydessä varhaiseen raskausdiabetekseen, korkeaan paastoverensokeriin ja insuliinihoidon tarpeeseen. Androgeeniylimäärä oli yhteydessä hieman korkeampiin aterianjälkeisiin glukoosiarvoihin. Suuremmat triglyseridien, LDL-kolesterolin ja Cer(d18:1/24:0) pitoisuudet ennustivat itsenäisesti raskausdiabetesta, mutta keramidit eivät käytännössä parantaneet raskausdiabeteksen ennusteen tarkkuutta kliinisten riskitekijöiden ja triglyseridien rinnalla. Todetut hormonaaliset ja rasva-aineenvaihdunnan poikkeavuudet korostavat metabolisten häiriöiden laajuutta raskausdiabeteksen taustalla

Alkuraskauden verenvuoto säikäyttää:milloin on kiire?

Tiivistelmä Alkuraskauden verenvuoto on tavallisin gynekologisen päivystyskäynnin syy. Vuodon etiologia voi olla esimerkiksi uhkaava keskenmeno, keskenmeno tai ektooppinen (kohdunulkoinen) raskaus. Jatkohoidon tarpeen ja kiireellisyyden suunnittelussa keskeisiä ovat vuotomäärän, kivun ja hemodynamiikan arviointi sekä kaikukuvaus, jonka käyttö ja tulkinta vaativat kuitenkin harjoittelua. Ektooppisen raskauden mahdollisuus tulee pitää mielessä, jos alkuraskauteen liittyy poikkeavaa vuotoa tai kipua. Tällöin lähete erikoissairaanhoitoon on tarpeellinen. Kivulias tai runsaasti vuotava potilas lähetetään päivystyksenä. Tilanteen ollessa rauhallinen arvio voidaan tehdä seuraavana arkipäivänä. Kaikukuvauksen ohella seerumin istukkagonadotropiinin määritys on hyödyllinen ektooppisen raskauden diagnostiikassa. Anti-D-immunoglobuliinia suositellaan kahdeksannen raskausviikon jälkeen Rh-negatiivisille naisille.Abstract Bleeding in early pregnancy can frighten : when should on hurry? Vaginal bleeding in early pregnancy is the most common reason for gynecological on-call visits. The etiology can be for instance impending miscarriage, miscarriage or an ectopic pregnancy. Treatment strategy and urgency are based on the amount of bleeding, pain, hemodynamics, and transvaginal ultrasound scan (if available), which however requires some training and experience. In cases with abnormal bleeding and/or pain in early pregnancy and no visible intrauterine pregnancy, the possibility of ectopic pregnancy should be kept in mind. Patients with suspected ectopic pregnancy should be referred to a gynecological unit. Immediate evaluation by gynecologist is needed in cases with extensive pain, heavy bleeding and/or unstable hemodynamic status. Stable cases can be evaluated the next working day. Serum human chorionic gonadotropin measurement is useful in the diagnostics of ectopic pregnancy. Anti-D immunoglobulin is recommended for Rh-negative patients with vaginal bleeding after 8 weeks of pregnancy

LSD₂ – joint denoising and deblurring of short and long exposure images with CNNs

Abstract The paper addresses the problem of acquiring high-quality photographs with handheld smartphone cameras in low-light imaging conditions. We propose an approach based on capturing pairs of short and long exposure images in rapid succession and fusing them into a single high-quality photograph. Unlike existing methods, we take advantage of both images simultaneously and perform a joint denoising and deblurring using a convolutional neural network. A novel approach is introduced to generate realistic short-long exposure image pairs. The method produces good images in extremely challenging conditions and outperforms existing denoising and deblurring methods. It also enables exposure fusion in the presence of motion blur

Gyroscope-aided motion deblurring with deep networks

Abstract We propose a deblurring method that incorporates gyroscope measurements into a convolutional neural network (CNN). With the help of such measurements, it can handle extremely strong and spatially-variant motion blur. At the same time, the image data is used to overcome the limitations of gyro-based blur estimation. To train our network, we also introduce a novel way of generating realistic training data using the gyroscope. The evaluation shows a clear improvement in visual quality over the state-of-the-art while achieving real-time performance. Furthermore, the method is shown to improve the performance of existing feature detectors and descriptors against the motion blur