Recent developments in genetics and medically assisted reproduction : from research to clinical applications

Two leading European professional societies, the European Society of Human Genetics and the European Society for Human Reproduction and Embryology, have worked together since 2004 to evaluate the impact of fast research advances at the interface of assisted reproduction and genetics, including their application into clinical practice. In September 2016, the expert panel met for the third time. The topics discussed highlighted important issues covering the impacts of expanded carrier screening, direct-to-consumer genetic testing, voiding of the presumed anonymity of gamete donors by advanced genetic testing, advances in the research of genetic causes underlying male and female infertility, utilisation of massively parallel sequencing in preimplantation genetic testing and non-invasive prenatal screening, mitochondrial replacement in human oocytes, and additionally, issues related to cross-generational epigenetic inheritance following IVF and germline genome editing. The resulting paper represents a consensus of both professional societies involved.Peer reviewe

The effect of maternal diabetes on pre- and postnatal growth

Background and objective: The abnormal intrauterine environment in case of maternal diabetes results in impaired perinatal outcome. In this thesis we investigated factors that were related to altered fetal growth and growth during childhood. Methods: A cohort of women with pregnancies complicated by type 1 (DM1), type 2 (DM2) and gestational diabetes mellitus (GDM) who received prenatal care in the University Medical Center Utrecht and delivered there between 1990 and 2010 were included. Antenatal ultrasound data was retrieved from patient records; postnatal and height and weight for offspring of these mothers were retrieved from infant welfare centers after informed consent was received. Additionally, parents were invited to complete a questionnaire regarding lifestyle and eating habits of their children. Results: Screening for GDM around 24-28 weeks of gestation results in a better perinatal outcome than waiting for symptoms and should therefore be the method of choice. Disproportionate fetal growth (abdominal circumference larger than the fetal head (HC/AC ratio)) is found al all fetuses of mothers with all 3 types of diabetes; even in the ones with a normal birthweight, which illustrates the effect of the abnormal intrauterine environment on fetal growth. Disproportionate growth (HC/AC ratio) is correlated to the body mass index (BMI) in 4-5 year-old toddlers of women with DM1 only. In offspring from DM2 or GDM, birthweight is correlated to the BMI at these ages, but not disproportionate intra-uterine growth. Mothers with DM2 had the highest BMI, so did their toddlers. Apparently in DM2 maternal obesity is an important driving factor for childhood obesity, whereas specific effects of the altered intrauterine glucose homeostasis are only present in offspring from mothers with DM1 (ODM1). Growth trajectories of the infants until 14 years showed that being large-for-gestational age at birth or having an obese mother (mainly DM2) are related to childhood overgrowth. Offspring of mothers with DM2 (ODM2) had a BMI at 14 years that was almost 2 SD above that of the Dutch background population. Finally, lifestyle differences were found between offspring of the different types of maternal diabetes: ODM2 show a less healthy diet and lifestyle compared to ODM1 and OGDM. This may play an additional role in their higher incidence of obesity. Conclusion: Infants of women with diabetes have an altered intrauterine development, are frequently large-for-gestational age at birth and are more likely to become overweight/obese during childhood. The most important risk factors for childhood obesity were, maternal overweight, being born large-for-gestational age and inadequate diet/lifestyle during childhood. These findings enable targeted preventive strategies

Perinatal outcomes in type 2 diabetes

Over the past decade the prevalence of type 2 diabetes in pregnancy has continued to increase. It is vital that health care professionals recognize that preconception care is just as important for mothers with type 2 diabetes as it is in type 1 diabetes. All women with type 2 diabetes should be advised regarding safe effective contraception and the benefits of optimal glycemic control, folic acid supplementation, and avoidance of potentially harmful mediations before attempting pregnancy. Glycemic control is the most important modifiable risk factor for congenital anomaly in women with type 2 diabetes, whereas maternal obesity and social disadvantage are associated with large for gestational age neonates. This review aims to bring the reader up to date with the burden of perinatal outcomes and clinical interventions to improve maternal and infant health. It warns that the consequences of type 2 diabetes pregnancy do not end at birth

Influence of COVID-19 on lifestyle behaviors in the Middle East and North Africa Region: a survey of 5896 individuals

Background: Coronavirus disease (COVID-19) pandemic has affected health and lifestyle behaviors of people globally. This project aims to identify the impact of COVID-19 on lifestyle behavior of individuals in the Middle East and North Africa (MENA) region during confinement. Methods: We conducted an online survey in 17 countries (Egypt, Jordan, United Arab Emirates, Kuwait, Bahrain, Saudi Arabia, Oman, Qatar, Yemen, Syria, Palestine, Algeria, Morocco, Libya, Tunisia, Iraq, and Sudan) from the MENA region on August and September 2020. The questionnaire included self-reported information on lifestyle behaviors, including physical activity, eating habits, smoking, watching television, social media use and sleep before and during the pandemic. Logistic regression was performed to analyze the impact of COVID-19 on lifestyle behaviors. Results: A total of 5896 participants were included in the final analysis and 62.8% were females. The BMI of the participants was 25.4 ± 5.8 kg/m2. Around 38.4% of the participants stopped practicing any physical activities during the confinement (P < 0.001), and 57.1% reported spending more than 2 h on social media (P < 0.001). There were no significant changes in smoking habits. Also, 30.9% reported an improvement in their eating habits compared with 24.8% reported worsening of their eating habits. Fast-food consumption decreased significantly in 48.8% of the study population. This direct/indirect exposure to COVID-19 was associated with an increased consumption of carbohydrates (OR = 1.09; 95% CI = 1.02–1.17; P = 0.01), egg (OR = 1.08; 95% CI = 1.02–1.16; P = 0.01), sugar (OR = 1.09; 95% CI = 1.02–1.16; P = 0.02), meat, and poultry (OR = 1.13; 95% CI = 1.06–1.20; P < 0.01). There was also associated increase in hours spent on watching television (OR = 1.07; 95% CI = 1.02–1.12; P < 0.01) and social media (OR = 1.09; 95% CI = 1.01–1.18; P = 0.03). However, our results showed a reduction in sleeping hours among those exposed to COVID-19 infection (OR = 0.85; 95% CI = 0.77–0.94; P < 0.01). Conclusions: The COVID-19 pandemic was associated with an increase in food consumption and sedentary life. Being exposed to COVID-19 by direct infection or through an infected household is a significant predictor of amplifying these changes. Public health interventions are needed to address healthy lifestyle behaviors during and after the COVID-19 pandemic