Jia-Hu Hao

Maternal Thyroid Function in the First Twenty Weeks of Pregnancy and Subsequent Fetal and Infant Development: A Prospective Population-Based Cohort Study in China

CONTEXT There are a few prospective population-based cohort studies evaluating the effects of maternal thyroid dysfunctions on fetal and infant developments, but they are inconsistent. OBJECTIVE The objective of the study was to investigate the effects of maternal thyroid dysfunction on fetal and infant development. SETTING AND PARTICIPANTS The study was nested within a prospective population-based China-Anhui Birth Defects and Child Development study. A total of 1017 women with singleton pregnancies participated in this study. Maternal serum samples in the first 20 wk of pregnancy were tested for thyroid hormones (TSH and free T(4)). Pregnant women were classified by hormone status into percentile categories based on laboratory assay and were compared accordingly. MAIN OUTCOMES Outcomes included fetal loss, malformation, birth weight, preterm delivery, fetal stress, neonatal death, and infant development. RESULTS Clinical hypothyroidism was associated with increased fetal loss, low birth weight, and congenital circulation system malformations; the adjusted odds ratios [95% confidence interval (CI)] were 13.45 (2.54-71.20), 9.05 (1.01-80.90), and 10.44 (1.15-94.62), respectively. Subclinical hypothyroidism was associated with increased fetal distress, preterm delivery, poor vision development, and neurodevelopmental delay; the adjusted odds ratios (95% CI) were 3.65 (1.44-9.26), 3.32 (1.22-9.05), 5.34 (1.09-26.16), and 10.49 (1.01-119.19), respectively. Isolated hypothyroxinemia was related to fetal distress, small for gestational age, and musculoskeletal malformations; the adjusted odds ratios (95% CI) were 2.95 (1.08-8.05), 3.55 (1.01-12.83), and 9.12 (1.67-49.70), respectively. Isolated hyperthyroxinemia was associated with spontaneous abortion; the adjusted odds ratio (95% CI) was 6.02 (1.25-28.96). Clinical hyperthyroidism was associated with hearing dysplasia; the adjusted odds ratio (95% CI) was 12.14 (1.22-120.70). CONCLUSIONS Thyroid dysfunction in the first 20 wk of pregnancy may result in fetal loss and dysplasia and some congenital malformations.

Maternal anxiety during pregnancy and adverse birth outcomes: A systematic review and meta-analysis of prospective cohort studies

BACKGROUND Previous studies concerning the association between maternal anxiety during pregnancy and adverse birth outcomes have provided controversial findings. METHODS In this systematic review, a meta-analysis was utilized to investigate the association between maternal anxiety and preterm birth (PTB) and/or low birth weight (LBW). Literature was searched until June 2013. Only prospective cohort studies that reported data on maternal anxiety during pregnancy with PTB and/or LBW were included. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using fixed or random effects models depending on the size of heterogeneity. RESULTS Twelve studies totaling 17,304 pregnant women reported PTB data; and six studies totaling 4948 pregnant women reported LBW data. Maternal anxiety during pregnancy was associated with significant increased risk of PTB (pooled RR=1.50, 95% CI=1.33-1.70) and LBW (pooled RR=1.76, 95% CI=1.32-2.33). LIMITATIONS Potential moderators could not be adequately considered due to insufficient information. In addition, the effects of different types of anxiety disorder on the risk of these adverse birth outcomes could not be investigated. CONCLUSIONS The results suggested that maternal anxiety during pregnancy was positively related to an increased risk of PTB and LBW. Healthcare providers should give close attention to anxiety in pregnant women and provide appropriate mental health support in order to improve outcomes for both mothers and infants.

The role of preexisting diabetes mellitus on incidence and mortality of endometrial cancer: a meta-analysis of prospective cohort studies.

Objective The results of cohort studies are controversial regarding the association between preexisting diabetes mellitus (DM) and the risk of endometrial cancer (EC) incidence and mortality. The aim of this meta-analysis was to assess whether an association exists between them in prospective studies. Methods The PubMed and EMBASE database were searched for prospective cohort studies of preexisting DM on EC occurrence, mortality outcomes, updated up to June 2012. Data were independently extracted by 2 investigators using a standardized protocol. Summary relative risks (SRRs) with 95% confidence intervals (CIs) were estimated by the use of fixed-effect or random-effect models. Between-study heterogeneity was investigated using &khgr;2-based Cochran Q statistic test and I2 statistics. Results A total of 21 cohort studies (20 articles) involving 12,195 incident cases and 575 deaths caused by EC were included in the analysis. Among these, 15 studies reported the risk of EC incidence, and 6 studies reported risk of EC mortality. The meta-analysis showed that DM was associated with an increased incidence of EC (SRR, 1.81; 95% CI, 1.38–2.37; test for heterogeneity: Q = 280.96, P < 0.001, I2 = 95.4%), compared with individuals without diabetes or the general population. Subgroup analyses were conducted by geographical region, study design, year of publication, diabetes ascertainment, type of DM, and adjustments for some variables, and the positive association between DM and risk of EC was consistently observed in each subgroup. Sensitivity analyses also showed that no single study significantly influenced the pooled relative risk. No significant publication bias (P = 0.173) was found. Diabetes mellitus was not positively associated with EC mortality (SRR, 1.23; 95% CI, 0.80–1.90; test for heterogeneity: Q = 11.95, P = 0.035, I2 = 58.2%). Conclusions This meta-analysis of cohort studies suggests that there is a significant association between DM and increased risk of EC incidence but no increased risk of EC mortality.

Maternal vitamin D deficiency during pregnancy elevates the risks of small for gestational age and low birth weight infants in Chinese population.

CONTEXT Vitamin D deficiency is common in pregnant women. Nevertheless, the association between maternal vitamin D status during pregnancy and the risk of having small for gestational age (SGA) and low birth weight (LBW) infants is uncertain. OBJECTIVE The objective of this study was to investigate whether there is a correlation between maternal vitamin D deficiency during pregnancy and the risk of having SGA and LBW infants in a Chinese population. DESIGN AND PARTICIPANTS This was a population-based birth cohort study that recruited 3658 eligible mother-and-singleton-offspring pairs. MAIN OUTCOME MEASURES Serum 25-hydroxyvitamin D was measured by RIA. The rate and relative risk (RR) for SGA and LBW infants were calculated among subjects with vitamin D deficiency and insufficiency during pregnancy. RESULTS There was a positive correlation between maternal serum 25-hydroxyvitamin D level and offspring birth weight (r = 0.477; P < .001). Further analysis showed that 4.98% of neonates were LBW infants among the subjects with vitamin D deficiency (RR, 12.00; 95% confidence interval [CI], 4.37, 33.00) and 1.32% among the subjects with vitamin D insufficiency (RR, 3.18; 95% CI, 1.07, 9.48). After adjustment for confounders, the RR for LBW infants was 12.31 (95% CI, 4.47, 33.89) among subjects with vitamin D deficiency and 3.15 (95% CI, 1.06, 9.39) among subjects with vitamin D insufficiency. Moreover, 16.01% of neonates were SGA infants among subjects with vitamin D deficiency (RR, 5.72; 95% CI, 3.80, 8.59) and 5.59% among subjects with vitamin D insufficiency (RR, 1.99; 95% CI, 1.27, 3.13). After adjustment for confounders, the RR for SGA infants was 6.47 (95% CI, 4.30, 9.75) among subjects with vitamin D deficiency and 2.01 (95% CI, 1.28, 3.16) among subjects with vitamin D insufficiency. CONCLUSION Maternal vitamin D deficiency during pregnancy elevates the risk of SGA and LBW infants in a Chinese population.

Does prenatal maternal stress impair cognitive development and alter temperament characteristics in toddlers with healthy birth outcomes

The aim of this study was to assess the cognitive and behavioural development of children with healthy birth outcomes whose mothers were exposed to prenatal stress but did not experience pregnancy complications.

Pregnancy loss and anxiety and depression during subsequent pregnancies: data from the C-ABC study.

OBJECTIVE Previous studies have shown that pregnancy loss may affect the mental health of women in subsequent pregnancies. The China Anhui Birth Defects and Child Development cohort study therefore aimed to investigate the influence of pregnancy loss on anxiety and depression in subsequent pregnancies. STUDY DESIGN In total, 20,308 pregnant women provided written informed consent and completed the study questionnaire. The Self-rating Anxiety Scale and Center for Epidemiologic Studies-Depression Scale were used to evaluate anxiety and depression in pregnant women. Pearsons χ(2) test and binary logistic regression were used for statistical analyses. RESULTS Of 20,308 pregnant women, 1495 (7.36%) had a history of miscarriage and 7686 (37.85%) had a history of induced abortion. The binary logistic regression model found that pregnant women with a history of miscarriage had a significantly higher risk of anxiety and depression in the first trimester than primigravidae after stratified analysis according to the timing of the first prenatal visit (p<0.05). Compared with pregnant women with no history of miscarriage, women who had a history of miscarriage and an interpregnancy interval of less than 6 months had increased risk of anxiety symptoms (p<0.05) and depression symptoms (p<0.05) during the first trimester. Women with an interpregnancy interval of 7-12 months had a 2.511-fold higher risk of depression (p<0.05) than women with no history of miscarriage. These findings were not changed after adjustment for maternal age, maternal education, family income, place of residence and pre-pregnancy body mass index. CONCLUSIONS Women with a history of miscarriage experienced significant anxiety and depression during their next pregnancy. A short interpregnancy interval and the first trimester are risk factors for adverse mental health.

Early Menarche and Psychopathological Symptoms in Young Chinese Women

OBJECTIVE To evaluate the psychopathological symptoms, suicide, and self-harming behaviors among students with early, on-time, and late menarche in high school and college and the association of early menarche with these disorders. METHODS The design consisted of a cross-sectional study of 5597 high school students and 2768 college students. Menarche age, suboptimal mental health status, anxiety, depression, suicide, and self-harming behaviors were obtained by self-report questionnaire. RESULTS In high school students, all the disorders occurred at significantly higher frequency in those with early menarche than in those with on-time and late menarche. In college students, only suboptimal mental health status, depression, and suicidal ideation happened at significantly higher frequency in the early menarche group than in the other two groups. The college group had a lower frequency of all the disorders than the high school group for all three groups of girls, that is, with early, on-time, or late menarche. In a multivariate logistic regression model, early menarche persisted as a risk factor for all the disorders after other factors were controlled. CONCLUSIONS Psychopathological symptoms, suicide, and self-harming behaviors are more common in early menarche students than in on-time and late menarche students. The effects of early menarche on the disorders might dissipate over time. Early menarche might serve as a predictor for the disorders in Chinese girls.

Maternal zinc deficiency during pregnancy elevates the risks of fetal growth restriction: a population-based birth cohort study

We investigated the association between maternal zinc level during pregnancy and the risks of low birth weight (LBW) and small for gestational age (SGA) infants in a large population-based birth cohort study. In this study, 3187 pregnant women were recruited. For serum zinc level, 2940 pregnant women were sufficient (≥56 μg/dL) and 247 deficient (<56 μg/dL). Of interest, 7.3% newborns were with LBW among subjects with low zinc level (RR: 3.48; 95% CI: 2.03, 5.96; P < 0.001). Adjusted RR for LBW was 3.41 (95% CI: 1.97, 5.91; P < 0.001) among subjects with low zinc level. Moreover, 15.0% newborns were with SGA among subjects with low zinc level (RR: 1.98; 95% CI: 1.36, 2.88; P < 0.001). Adjusted RR for SGA was 1.93 (95% CI: 1.32, 2.82; P < 0.001) among subjects with low zinc level. A nested case-control study within above cohort showed that maternal serum zinc level was lower in SGA cases as compared with controls. By contrast, maternal serum C-reactive protein, TNF-α and IL-8 levels were significantly higher in SGA cases than that of controls. Moreover, nuclear NF-κB p65 was significantly up-regulated in placentas of SGA cases as compared with controls. Taken together, maternal zinc deficiency during pregnancy elevates the risks of LBW and SGA infants.

Cord Blood Vitamin D and Neurocognitive Development Are Nonlinearly Related in Toddlers

BACKGROUND Little is known about the relation between vitamin D status in early life and neurodevelopment outcomes. OBJECTIVE This study was designed to examine the association of cord blood 25-hydroxyvitamin D [25(OH)D] at birth with neurocognitive development in toddlers. METHODS As part of the China-Anhui Birth Cohort Study, 363 mother-infant pairs with complete data were selected. Concentrations of 25(OH)D in cord blood were measured by radioimmunoassay. Mental development index (MDI) and psychomotor development index (PDI) in toddlers were assessed at age 16-18 mo by using the Bayley Scales of Infant Development. The data on maternal sociodemographic characteristics and other confounding factors were also prospectively collected. RESULTS Toddlers in the lowest quintile of cord blood 25(OH)D exhibited a deficit of 7.60 (95% CI: -12.4, -2.82; P = 0.002) and 8.04 (95% CI: -12.9, -3.11; P = 0.001) points in the MDI and PDI scores, respectively, compared with the reference category. Unexpectedly, toddlers in the highest quintile of cord blood 25(OH)D also had a significant deficit of 12.3 (95% CI: -17.9, -6.67; P < 0.001) points in PDI scores compared with the reference category. CONCLUSIONS This prospective study suggested that there was an inverted-U-shaped relation between neonatal vitamin D status and neurocognitive development in toddlers. Additional studies on the optimal 25(OH)D concentrations in early life are needed.

Current Evidence on the Relationship Between Two Polymorphisms in the NBS1 Gene and Breast Cancer Risk: a Meta-analysis

INTRODUCTION Published studies on the association between Nijmegen breakage syndrome 1(NBS1) gene polymorphisms and breast cancer risk have been inconclusive, and a meta-analysis was therefore performed for clarification. METHODS Eligible articles were identified by a search of MEDLINE and EMBASE bibliographic databases for the period up to March 2012. The presence of between-study heterogeneity was investigated using the chi-square-based Cochrans Q statistic test. When there was statistical heterogeneity, the random effects model was chosen; otherwise, fixed effects estimates were reported as an alternative approach. RESULTS A total of 11 eligible articles (14 case-control studies) were identified, nine case-control studies were for the 657del5 mutation (7,534 breast cancer cases, 14,034 controls) and five case-control studies were for the I171V mutation (3,273 breast cancer cases, 4,004 controls). Our analysis results indicated that the 657del5 mutation was associated with breast cancer risk (carriers vs. non- carriers: pooled OR=2.63, 95% CI: 1.76-3.93), whereas the I171V mutation was not (carriers vs. non-carriers: pooled OR=1.52, 95% CI: 0.70-3.28). CONCLUSION The present meta-analysis suggests that the 657del5 gene mutation in the NBS1 gene plays a role in breast cancer risk, while the I171V mutation does not exert a significant influence.