Lipid levels after childbirth and association with number of children: A population-based cohort study

Objective Low parity women are at increased risk of cardiovascular mortality. Unfavourable lipid profiles have been found in one-child mothers years before they conceive. However, it remains unclear whether unfavourable lipid profiles are evident in these women also after their first birth. The aim was to estimate post-pregnancy lipid levels in one-child mothers compared to mothers with two or more children and to assess these lipid’s associations with number of children. Methods We used data on 32 618 parous women (4 490 one-child mothers and 28 128 women with ≥2 children) examined after first childbirth as part of Cohort of Norway (1994–2003) with linked data on reproduction and number of children from the Medical Birth Registry of Norway (1967–2008). Odds ratios (ORs) with 95% confidence intervals (CIs) for one lifetime pregnancy (vs. ≥2 pregnancies) by lipid quintiles were obtained by logistic regression and adjusted for age at examination, year of first birth, body mass index, oral contraceptive use, smoking and educational level. Results Compared to women with the lowest quintiles, ORs for one lifetime pregnancy for the highest quintiles of LDL and total cholesterol were 1.30 (95%CI: 1.14–1.45) and 1.43 (95%CI: 1.27–1.61), respectively. Sensitivity analysis (women <40 years) showed no appreciable change in our results. In stratified analyses, estimates were slightly stronger in overweight/obese, physically inactive and women with self-perceived bad health. Conclusions Mean lipid levels measured after childbirth in women with one child were significantly higher compared to mothers with two or more children and were associated with higher probability of having only one child. These findings corroborate an association between serum lipid levels and one lifetime pregnancy (as a feature of subfecundity), emphasizing that these particular women may be a specific predetermined risk group for cardiovascular related disease and death.publishedVersio

Women's prepregnancy lipid levels and number of children: a Norwegian prospective population-based cohort study

Objective. To study prepregnancy serum lipid levels and the association with the number of children. Design. Prospective, population-based cohort. Setting. Linked data from the Cohort of Norway and the Medical Birth Registry of Norway. Participants. 2645 women giving birth to their first child during 1994–2003 (488 one-child mothers and 2157 women with ≥2 births) and 1677 nulliparous women. Main outcome measures. ORs for no and one lifetime pregnancy (relative to ≥2 pregnancies) obtained by multinomial logistic regression, adjusted for age at examination, education, body mass index (BMI), smoking, time since last meal and oral contraceptive use. Results. Assessed in quintiles, higher prepregnant triglyceride (TG) and TG to high-density lipoprotein (TG:HDL-c) ratio levels were associated with increased risk of one lifetime pregnancy compared with having ≥2 children. Compared with the highest quintile, women in the lowest quintile of HDL cholesterol levels had an increased risk of one lifetime pregnancy (OR 1.7, 95% CI 1.2 to 2.4), as were women with the highest low-density lipoprotein (LDL) cholesterol, TG and TG:HDL-c ratio quintiles (compared with the lowest) (OR 1.2, 95% CI 0.8 to 1.7; OR 2.2, 95% CI 1.5 to 3.2; and OR 2.2, 95% CI 1.5 to 3.2, respectively). Similar effects were found in women with BMI≥25 and the highest LDL and total cholesterol levels in risk of lifetime nulliparity. Conclusion. Women with unfavourable prepregnant lipid profile had higher risk of having no or only one child. These findings substantiate an association between prepregnant serum lipid levels and number of children. Previously observed associations between low parity and increased cardiovascular mortality may in part be due to pre-existing cardiovascular disease lipid risk factors.publishedVersio

Procena rizika po zdravlje dece na osnovu sadržaja toksičnih metala Pb, Cd, Cu i Zn u gradskom zemljištu na teritoriji Podgorice, Crna Gora

Background/Aim. Due to their low tolerance to pollutants and hand-to-mouth pathways the health risk is very high in children's population. The aim of this study was to evaluate risk to children's health based on the content of heavy metals in urban soil samples from Podgorica, Montenegro. This study included the investigation of several toxic metals such as Pb, Cd, Cu and Zn in soil samples from public parks and playgrounds. Methods. Sampling was conducted in a period October-November, 2012. Based on cluster analysis, soil samples were divided into two groups related to similarity of metal content at examinated locations: the group I - near by recreational or residential areas of the city, and the group II - near traffic roads. Concentration of toxic metals, in urban soil samples were determined by a graphite furnace atomic absorption spectrometry (Pb and Cd) and by inductively coupled plasma optical emission spectrometry technique after microwave digestion. Due to exposure to urban soil, non-cancerogenic index hazardous index (HI) for children was estimated using 95th percentile values of total metal concentration. The value of the total (ingestion, dermal and inhalation) HI is calculated for maximum, minimum and the average concentration of metals for children. Results. Mean concentrations of Pb, Cd, Cu and Zn in the surface layer of the studied urban soils were 85.91 mg/kg, 2.8 mg/kg and 52.9 mg/kg and 112.5 mg/kg, respectively. Samples from group II showed higher metal content compared to group I. Urbanization and traffic are the main sources of pollution of the urban soils of Podgorica. Most of the samples (93.5%) had a high Pb content, 12.9% of the samples had a higher content of Cd, while Cu and Zn were within the limits prescribed by national legislation. At one location the level of security for lead is HI = 0.8 and very closed to maximum acceptable value of 1. It is probably the result of intensive traffic near by. Conclusion. All metals investigated showed relatively higher concentrations at sites that were close to industrial places and high ways. The mean concentrations of Pb and Zn and maximum concentrations of Pb, Cd, and Zn were higher than presented values in the National Regulation.Uvod/Cilj. Zbog niske tolerancije na zagađivače i puta prenošenja ruke-usta, rizik od narušenja zdravlja je veoma visok u dečjoj populaciji. Cilj ovog rada bio je da se izvrši procena rizika po zdravlje dece na osnovu sadržaja teških metala u uzorcima gradskog zemljišta u Podgorici, Crna Gora. Ovo istraživanje je obuhvatilo određivanje koncentracija nekoliko toksičnih metala kao što su Pb, Cd, Cu i Zn u uzorcima zemljišta javnih parkova i dečijih igrališta. Metode. Uzorkovanje je sprovedeno tokom oktobra i novembra 2012. godine. Klaster analizom uzorci zemljišta podeljeni su u dve grupe na osnovu sličnosti sadržaja metala na ispitivanim lokacijama: grupa I - uzorci sa mesta u rekreativnim ili stambenim delovima grada i grupa II - uzorci iz parkova i igralište blizu saobraćajnice. Koncentracija metala u uzorcima urbanog zemljišta određena je primenom atomske apsorpcione spektrometrije pomoću grafitne kivete (Pb i Cd) i tehnike optičke emisione spektroskopije sa induktivno kuplovanom plazmom (Cu i Zn) nakon mikrotalasne digestije. Na osnovu stepena izloženosti uticaju gradskog zemljišta, nekancerogeni indeks opasnosti (hazard index - HI) za decu izračunat je na 95. procentu vrednosti ukupne koncentracije metala. Vrednost za ukupni (ingestioni, dermalni i inhalacioni) HI izračunata je za maksimalne, minimalne i srednje koncentracije ispitivanih metala za decu. Rezultati. Srednja koncentracija toksičnih metala u uzorcima površinskog sloja zemljišta iznosila je 85,91 mg Pb/kg tla, 2,8 mg Cd/kg tla, 52,9 mg Cu/kg tla i 112,5 mg Zn/kg tla. Sadržaj metala bio je značajno veći u uzorcima zemljišta iz grupe II nego u uzorcima grupe I. Ovo jasno ukazuje na izražen i uočljiv uticaj urbanizacije, a naročito saobraćaja, na zagađenje zemljišta. Većina uzoraka (93,5%) imala je povećan sadržaj Pb, 12,9% uzoraka imalo je povećan sadržaj Cd, dok je sadržaj Cu i Zn bio u granicama propisanim nacionalnom regulativom. Na jednoj lokaciji vrednost za nivo bezbednosti za olovo bio je HI = 0,8, vrlo blizu maksimalne prihvatljive vrednosti koja iznosi 1, što je verovatno posledica intenzivnog saobraćaja u neposrednoj blizini ispitivane lokacije. Zaključak. Ispitivani metali imali su više koncentracije na mestima u blizini industrijske zone i autoputa. Prosečne koncentracije Pb i Zn, kao i maksimalne koncentracije Pb, Cd i Zn bile su više od vrednosti propisanih nacionalnom regulativom

Number of children: pre- and post-pregnancy lipids, effect of pregnancy outcome and modification by perinatal loss

Background: Cardiovascular disease (CVD) is an important public health problem and remains the number one cause of death in women. Substantial increase in CVD mortality has been found in women with only one child, and lipid disorders are suggested to play a role in both subfertility and later CVD development. Objectives: To explore the extent to which pre-pregnant serum lipid levels of total, low density lipoprotein (LDL) and high density lipoprotein (HDL) cholesterol, triglyceride (TG) and triglycerides to high density lipoprotein (TG/HDL) ratio are associated with having no and one lifetime pregnancy; to estimate post-pregnancy lipid levels in one-child mothers compared to mothers with two or more children and to assess these lipid’s associations with number of children; to explore if preterm delivery (PTD), preeclampsia (PE), small for gestational age (SGA) and cesarean section (CS) at first birth are associated with having one lifetime pregnancy, and assess the modifying effect of perinatal loss. Material and Methods: In paper I we analysed prepregnant lipid levels in 2 645 women giving birth to their first child during 1994 - 2003 and in 1 677 nulliparous women with linked data from Cohort of Norway (CONOR) and The Medical Birth Registry of Norway (MBRN). In paper II we used data on 32 618 parous women examined after first childbirth as part of CONOR (1994-2003) with linked data on reproduction and number of children from the MBRN (1967-2008). Paper III was a population-based study of 882 803 mothers giving birth to their first singleton infant (≥22 gestational weeks) during 1967 to 2007 who were followed for the occurrence of second birth in the MBRN until 2014. Logistic regression (Papers I and II) and generalized linear models (Paper III) were used to calculate odds ratios (ORs) and relative risks (RRs) with 95% confidence intervals (CIs) and to adjust for confounders. Results: Assessed in quintiles, higher pre-pregnant TG and TG/HDL ratio levels were associated with increased risk of one lifetime pregnancy compared to having ≥ 2 children. Compared to the highest quintile, women in the lowest quintile of HDL cholesterol levels had an increased risk of one lifetime pregnancy (OR 1.7 95% CI 1.2-2.4), as were women with the highest LDL cholesterol, TG and TG/HDL ratio quintiles (compared to the lowest) (OR 1.2 95% CI 0.8-1.7; OR 2.2 95% CI 1.5-3.2; and OR 2.2 95% CI 1.5-3.2, respectively). X Similar effects were found in women with BMI ≥ 25 and the highest LDL and total cholesterol levels in risk of lifetime nulliparity. When examined after first childbirth in paper II, ORs for one lifetime pregnancy for the highest quintiles of LDL and total cholesterol (compared to lowest quintiles) were 1.30 (95%CI: 1.14-1.45) and 1.43 (95%CI: 1.27-1.61), respectively. In women with pregnancy complications where the infant survived the perinatal period, RRs for one lifetime pregnancy were increased (PTD: 1.21 [1.19-1.22], SGA: 1.13 [1.12-1.15], PE: 1.09 [1.07-1.11], CS: 1.24 [1.23-1.25]), but significantly reduced if the child was lost (PTD: 0.63 [0.59-0.68], SGA: 0.57 [0.51-0.63], PE: 0.69 [0.59-0.80], CS: 0.67 [0.56-0.79]), compared to women with no perinatal loss and no adverse outcome. Conclusions and implications: Unfavorable pre-pregnant lipid levels were associated with having no and one lifetime pregnancy. The association with unfavourable lipids was also present for one child mothers with lipids measured more than a decade after childbirth. These findings provide a possible biological underpinning for a joint mechanistic pathway for reduced fertility and cardiovascular conditions. Associations between adverse outcomes of pregnancy and the risk of having one lifetime pregnancy were strongly modified by child survival in the perinatal period

Women's prepregnancy lipid levels and number of children: a Norwegian prospective population-based cohort study

Objective. To study prepregnancy serum lipid levels and the association with the number of children. Design. Prospective, population-based cohort. Setting. Linked data from the Cohort of Norway and the Medical Birth Registry of Norway. Participants. 2645 women giving birth to their first child during 1994–2003 (488 one-child mothers and 2157 women with ≥2 births) and 1677 nulliparous women. Main outcome measures. ORs for no and one lifetime pregnancy (relative to ≥2 pregnancies) obtained by multinomial logistic regression, adjusted for age at examination, education, body mass index (BMI), smoking, time since last meal and oral contraceptive use. Results. Assessed in quintiles, higher prepregnant triglyceride (TG) and TG to high-density lipoprotein (TG:HDL-c) ratio levels were associated with increased risk of one lifetime pregnancy compared with having ≥2 children. Compared with the highest quintile, women in the lowest quintile of HDL cholesterol levels had an increased risk of one lifetime pregnancy (OR 1.7, 95% CI 1.2 to 2.4), as were women with the highest low-density lipoprotein (LDL) cholesterol, TG and TG:HDL-c ratio quintiles (compared with the lowest) (OR 1.2, 95% CI 0.8 to 1.7; OR 2.2, 95% CI 1.5 to 3.2; and OR 2.2, 95% CI 1.5 to 3.2, respectively). Similar effects were found in women with BMI≥25 and the highest LDL and total cholesterol levels in risk of lifetime nulliparity. Conclusion. Women with unfavourable prepregnant lipid profile had higher risk of having no or only one child. These findings substantiate an association between prepregnant serum lipid levels and number of children. Previously observed associations between low parity and increased cardiovascular mortality may in part be due to pre-existing cardiovascular disease lipid risk factors

Lipid levels after childbirth and association with number of children: A population-based cohort study

Objective Low parity women are at increased risk of cardiovascular mortality. Unfavourable lipid profiles have been found in one-child mothers years before they conceive. However, it remains unclear whether unfavourable lipid profiles are evident in these women also after their first birth. The aim was to estimate post-pregnancy lipid levels in one-child mothers compared to mothers with two or more children and to assess these lipid’s associations with number of children. Methods We used data on 32 618 parous women (4 490 one-child mothers and 28 128 women with ≥2 children) examined after first childbirth as part of Cohort of Norway (1994–2003) with linked data on reproduction and number of children from the Medical Birth Registry of Norway (1967–2008). Odds ratios (ORs) with 95% confidence intervals (CIs) for one lifetime pregnancy (vs. ≥2 pregnancies) by lipid quintiles were obtained by logistic regression and adjusted for age at examination, year of first birth, body mass index, oral contraceptive use, smoking and educational level. Results Compared to women with the lowest quintiles, ORs for one lifetime pregnancy for the highest quintiles of LDL and total cholesterol were 1.30 (95%CI: 1.14–1.45) and 1.43 (95%CI: 1.27–1.61), respectively. Sensitivity analysis (women <40 years) showed no appreciable change in our results. In stratified analyses, estimates were slightly stronger in overweight/obese, physically inactive and women with self-perceived bad health. Conclusions Mean lipid levels measured after childbirth in women with one child were significantly higher compared to mothers with two or more children and were associated with higher probability of having only one child. These findings corroborate an association between serum lipid levels and one lifetime pregnancy (as a feature of subfecundity), emphasizing that these particular women may be a specific predetermined risk group for cardiovascular related disease and death

Lipid levels after childbirth and association with number of children: A population-based cohort study

Objective Low parity women are at increased risk of cardiovascular mortality. Unfavourable lipid profiles have been found in one-child mothers years before they conceive. However, it remains unclear whether unfavourable lipid profiles are evident in these women also after their first birth. The aim was to estimate post-pregnancy lipid levels in one-child mothers compared to mothers with two or more children and to assess these lipid’s associations with number of children. Methods We used data on 32 618 parous women (4 490 one-child mothers and 28 128 women with ≥2 children) examined after first childbirth as part of Cohort of Norway (1994–2003) with linked data on reproduction and number of children from the Medical Birth Registry of Norway (1967–2008). Odds ratios (ORs) with 95% confidence intervals (CIs) for one lifetime pregnancy (vs. ≥2 pregnancies) by lipid quintiles were obtained by logistic regression and adjusted for age at examination, year of first birth, body mass index, oral contraceptive use, smoking and educational level. Results Compared to women with the lowest quintiles, ORs for one lifetime pregnancy for the highest quintiles of LDL and total cholesterol were 1.30 (95%CI: 1.14–1.45) and 1.43 (95%CI: 1.27–1.61), respectively. Sensitivity analysis (women <40 years) showed no appreciable change in our results. In stratified analyses, estimates were slightly stronger in overweight/obese, physically inactive and women with self-perceived bad health. Conclusions Mean lipid levels measured after childbirth in women with one child were significantly higher compared to mothers with two or more children and were associated with higher probability of having only one child. These findings corroborate an association between serum lipid levels and one lifetime pregnancy (as a feature of subfecundity), emphasizing that these particular women may be a specific predetermined risk group for cardiovascular related disease and death

Children’s health risk assessment based on the content of toxic metals Pb, Cd, Cu and Zn in urban soil samples of Podgorica, Montenegro

Background/Aim. Due to their low tolerance to pollutants and hand-to-mouth pathways the health risk is very high in children’s population. The aim of this study was to evaluate risk to children’s health based on the content of heavy metals in urban soil samples from Podgorica, Montenegro. This study included the investigation of several toxic metals such as Pb, Cd, Cu and Zn in soil samples from public parks and playgrounds. Methods. Sampling was conducted in a period October-November, 2012. Based on cluster analysis, soil samples were divided into two groups related to similarity of metal content at examinated locations: the group I - near by recreational or residential areas of the city, and the group II - near traffic roads. Concentration of toxic metals, in urban soil samples were determined by a graphite furnace atomic absorption spectrometry (Pb and Cd) and by inductively coupled plasma optical emission spectrometry technique after microwave digestion. Due to exposure to urban soil, non-cancerogenic index hazardous index (HI) for children was estimated using 95th percentile values of total metal concentration. The value of the total (ingestion, dermal and inhalation) HI is calculated for maximum, minimum and the average concentration of metals for children. Results. Mean concentrations of Pb, Cd, Cu and Zn in the surface layer of the studied urban soils were 85.91 mg/kg, 2.8 mg/kg and 52.9 mg/kg and 112.5 mg/kg, respectively. Samples from group II showed higher metal content compared to group I. Urbanization and traffic are the main sources of pollution of the urban soils of Podgorica. Most of the samples (93.5%) had a high Pb content, 12.9% of the samples had a higher content of Cd, while Cu and Zn were within the limits prescribed by national legislation. At one location the level of security for lead is HI = 0.8 and very closed to maximum acceptable value of 1. It is probably the result of intensive traffic near by. Conclusion. All metals investigated showed relatively higher concentrations at sites that were close to industrial places and high ways. The mean concentrations of Pb and Zn and maximum concentrations of Pb, Cd, and Zn were higher than presented values in the National Regulation