Sexual dimorphism in adverse pregnancy outcomes - A retrospective Australian population study 1981-2011

Published: July 11, 2016Objectives: Sexual inequality starts in utero. The contribution of biological sex to the developmental origins of health and disease is increasingly recognized. The aim of this study was to assess and interpret sexual dimorphisms for three major adverse pregnancy outcomes which affect the health of the neonate, child and potentially adult. Methods: Retrospective population-based study of 574,358 South Australian singleton live births during 1981–2011. The incidence of three major adverse pregnancy outcomes [preterm birth (PTB), pregnancy induced hypertensive disorders (PIHD) and gestational diabetes mellitus (GDM)] in relation to fetal sex was compared according to traditional and fetus-at-risk (FAR) approaches. Results: The traditional approach showed male predominance for PTB [20–24 weeks: Relative Risk (RR) M/F 1.351, 95%-CI 1.274–1.445], spontaneous PTB [25–29 weeks: RR M/F 1.118, 95%-CI 1.044–1.197%], GDM [RR M/F 1.042, 95%-CI 1.011–1.074], overall PIHD [RR M/F 1.053, 95%-CI 1.034–1.072] and PIHD with term birth [RR M/F 1.074, 95%-CI 1.044–1.105]. The FAR approach showed that males were at increased risk for PTB [20–24 weeks: RR M/F 1.273, 95%-CI 1.087–1.490], for spontaneous PTB [25–29 weeks: RR M/F 1.269, 95%-CI 1.143–1.410] and PIHD with term birth [RR M/F 1.074, 95%-CI 1.044–1.105%]. The traditional approach demonstrated female predominance for iatrogenic PTB [25–29 weeks: RR M/F 0.857, 95%-CI 0.780–0.941] and PIHD associated with PTB [25–29 weeks: RR M/F 0.686, 95%-CI 0.581–0.811]. The FAR approach showed that females were at increased risk for PIHD with PTB [25–29 weeks: RR M/F 0.779, 95%-CI 0.648–0.937]. Conclusions: This study confirms the presence of sexual dimorphisms and presents a coherent framework based on two analytical approaches to assess and interpret the sexual dimorphisms for major adverse pregnancy outcomes. The mechanisms by which these occur remain elusive, but sex differences in placental gene expression and function are likely to play a key role. Further research on sex differences in placental function and maternal adaptation to pregnancy is required to delineate the causal molecular mechanisms in sex-specific pregnancy outcome. Identifying these mechanisms may inform fetal sex specific tailored antenatal and neonatal care.Petra E. Verburg, Graeme Tucker, Wendy Scheil, Jan Jaap H. M. Erwich, Gus A. Dekker, Claire Trelford Robert

Seasonality of gestational diabetes mellitus: a South Australian population study

Objective: To investigate whether there is a seasonal variation in the incidence of gestational diabetes mellitus (GDM). Research design and methods: This retrospective cohort study of 60 306 eligible South Australian live-born singletons during 2007-2011 recorded in the South Australian Perinatal Statistics Collection (SAPSC) examined the incidence of GDM in relation to estimated date of conception (eDoC). Fourier series analysis was used to model seasonal trends. Results: During the study period, 3632 (6.0%) women were diagnosed with GDM. Seasonal modeling showed a strong relation between GDM and eDoC (p<0.001). Unadjusted and adjusted models (adjusted for maternal age, body mass index (BMI), parity, ethnicity, socioeconomic status, and chronic hypertension) demonstrated the presence of a peak incidence occurring among pregnancies with eDoC in winter (June/July/August), with a trough for eDoc in summer (December/January/February). As this was a retrospective study, we could only use variables that had been collected as part of the routine registration system, the SAPSC. CONCLUSIONS: This study is the first population-based study to demonstrate a seasonal variation for GDM. Several maternal lifestyle and psychosocial factors associated with seasonality and GDM may be influential in the pathophysiologic mechanisms of GDM. Ambient temperature, physical activity, nutrient intake, and vitamin D levels may affect maternal physiology, and fetal and placental development at the cellular level and contribute to the development of GDM. The mechanisms underlying these possible associations are not fully understood and warrant further investigation.Petra E Verburg, Graeme Tucker, Wendy Scheil, Jan Jaap H M Erwich, Gus A Dekker, Claire T Robert

Modelling regional land change scenarios to assess land abandonment and reforestation dynamics in the Pyrenees (France)

International audienceOver the last decades and centuries, European mountain landscapes have experienced substantial transformations. Natural and anthropogenic LULC changes (land use and land cover changes), especially agro-pastoral activities, have directed influenced the spatial organization and composition of European mountain landscapes. For the past 60 years, natural reforestation has been occurring due to a decline in both agricultural production activities and rural population. Stakeholders, to better anticipate future changes, need spatially and temporally explicit models to identiy areas at risk of land change and possible abandonment. This paper presents an integrated approach combining forecasting scenarios and a LULC changes simulation model to assess where LULC changes may occur in the Pyrenees Mountains, based on historical LULC trands and a range of future socio-economic drivers. The proposed methodology considers local specificities of Pyrenan valleys, sub-regional climate and topographical properties, and regional economic policies. Results indicate that some regions are projected to face strong abandonment, regardless of scenario conditions. Overall, high rates of change are associated with administrative regions where land productivity is highly dependent on socio-economic drivers and climatic and environmental conditions limit intensive (agricultural and/or pastoral) production and profitability. The combination of the results for the four scenarios allows assessements of where encroachment (e.g. colonization by shrublands) and reforestation are the most probable. This assessment intends to provide insight into the potential future development of the Pyrenees to help identify areas that are the most sensitive to change and to guide decision makers to help their management decisions

Lake-size dependency of wind shear and convection as controls on gas exchange

High-frequency physical observations from 40 temperate lakes were used to examine the relative contributions of wind shear (u*) and convection (w*) to turbulence in the surface mixed layer. Seasonal patterns of u* and w* were dissimilar; u* was often highest in the spring, while w * increased throughout the summer to a maximum in early fall. Convection was a larger mixed-layer turbulence source than wind shear (u */w*-1 for lakes* and w* differ in temporal pattern and magnitude across lakes, both convection and wind shear should be considered in future formulations of lake-air gas exchange, especially for small lakes. © 2012 by the American Geophysical Union.Jordan S. Read, David P. Hamilton, Ankur R. Desai, Kevin C. Rose, Sally MacIntyre, John D. Lenters, Robyn L. Smyth, Paul C. Hanson, Jonathan J. Cole, Peter A. Staehr, James A. Rusak, Donald C. Pierson, Justin D. Brookes, Alo Laas, and Chin H. W

Clinical considerations for the treatment of secondary differentiated thyroid carcinoma in childhood cancer survivors

The incidence of differentiated thyroid carcinoma (DTC) has increased rapidly over the past several years. Thus far, the only conclusively established risk factor for developing DTC is exposure to ionizing radiation, especially when the exposure occurs in childhood. Since the number of childhood cancer survivors (CCS) is increasing due to improvements in treatment and supportive care, the number of patients who will develop DTC after surviving childhood cancer (secondary thyroid cancer) is also expected to rise. Currently, there are no recommendations for management of thyroid cancer specifically for patients who develop DTC as a consequence of cancer therapy during childhood. Since complications or late effects from prior cancer treatment may elevate the risk of toxicity from DTC therapy, the medical history of CCS should be considered carefully in choosing DTC treatment. In this paper, we emphasize how the occurrence and treatment of the initial childhood malignancy affects the medical and psychosocial factors that will play a role in the diagnosis and treatment of a secondary DTC. We present considerations for clinicians to use in the management of patients with secondary DTC, based on the available evidence combined with experience -based opinions of the authors

Description of the linked modelling system of sector models and multi-sector assessments

Deliverable D.7.1 Description of a coupled macroeconomic, multi-sector analysis at global scale with first simulation results and D.7.2 Description of the linked modelling system of sector models and multi-sector assessments are now available. These deliverables should be seen and read in together. D.7.1 describes results for 4 marker scenarios from the global models in the topdown analysis in WP7, which provide the boundary conditions for in-depth analysis at the level of EU-27, individual member countries as well as sub-national levels while D7.2 presents selected results from the linked modelling system. The 4 marker scenarios will also provide a starting point for a larger number of policy scenarios to be analyzed in the next steps of the VOLANTE project. The VOLANTE top-down modelling framework has been developed to serve the stakeholder discussions and roadmapping in module Visions by adequate information that can fuel discussions and provide quantitative assessments to support the final roadmapping exercise. Selected scenario results have already been used in 4 visions workshops which have been conducted by Module Visions in June and September 2012