To evaluate state-level prevalence estimates of prenatal and early postnatal cannabis use in a state with legalized medical and recreational marijuana and the association with adverse neonatal ...outcomes.
We conducted a cross-sectional study on 3,207 respondents from the 2014-2015 Colorado Pregnancy Risk Assessment Monitoring System with state-developed questions on cannabis use. Differences in perinatal cannabis use were evaluated according to maternal characteristics, breastfeeding patterns, and pregnancy intendedness. Multiple logistic regression models evaluated the relationship between prenatal cannabis use and adverse neonatal outcomes including low birth weight, small for gestational age, preterm birth, and admission to the neonatal intensive care unit.
The self-reported prevalence of cannabis use at any time during pregnancy was 5.7 ± 0.5% and the prevalence of early postnatal cannabis use among women who breastfed was 5.0% (95% CI, 4.1%-6.2%). Prenatal cannabis use was associated with a 50% increased likelihood of low birth weight, independent of maternal age, race/ethnicity, level of education, and tobacco use during pregnancy (OR, 1.5; 95% CI, 1.1-2.1; P = .02). Small for gestational age, preterm birth, and neonatal intensive care unit admission were not associated with prenatal cannabis use, independent of prenatal tobacco use.
Our findings underscore the importance of screening for cannabis use during prenatal care and the need for provider counselling about the adverse health consequences of continued use during pregnancy and lactation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Abstract Background Consistent evidence of an influence of maternal dietary intake during pregnancy on infant body size and composition in human populations is lacking, despite robust evidence in ...animal models. Objective To evaluate the influence of maternal macronutrient intake and balance during pregnancy on neonatal body size and composition, including fat mass and fat free mass. Study Design The analysis was conducted among 1040 mother-offspring pairs enrolled in the prospective pre-birth observational cohort: The Healthy Start Study. Diet during pregnancy was collected using repeated 24 hour dietary recalls (up to 8). Direct measures of body composition were obtained using air displacement plethysmography. The National Cancer Institute measurement error model was used to estimate usual dietary intake during pregnancy. Multivariable partition (non-isocaloric) and nutrient density (isocaloric) linear regression models were used to test the associations between maternal dietary intake and neonatal body composition. Results The median macronutrient composition during pregnancy was 32.2% from fat, 15.0% from protein and 47.8% from carbohydrates. In the partition multivariate regression model, individual macronutrient intake values were not associated with birth weight or fat free mass, but were associated with fat mass. Respectively, 100 kilocalorie increases in total fat, saturated fat, unsaturated fat and total carbohydrates were associated with 4.2 gram (p=0.03), 11.1 gram (p=0.003), 5.9 gram (p=0.04) and 2.9 gram (p=0.02) increases in neonatal fat mass, independent of pre-pregnancy BMI. In the nutrient density multivariate regression model, macronutrient balance was not associated with fat mass, fat free mass or birth weight after adjustment for pre-pregnancy BMI. Conclusions Neonatal adiposity, but not birth weight, is independently associated with increased maternal intake of total fat, saturated fat, unsaturated fat, and total carbohydrates, but not protein, suggesting that most forms of increased caloric intake contribute to fetal fat accretion.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Context:
The impact of specific maternal fuels and metabolic measures during early and late gestation on neonatal body composition is not well defined.
Objective:
To determine how circulating ...maternal glucose, lipids, and insulin resistance in the first and second halves of pregnancy influence neonatal body composition.
Design:
A prospective pre-birth cohort enrolling pregnant women, the Healthy Start Study, was conducted, in which fasting maternal serum samples were collected twice during pregnancy to measure glucose, insulin, hemoglobin A1c, triglyceride, total cholesterol, high-density lipoprotein, and free fatty acids. Neonatal body composition was measured with air displacement plethysmography.
Setting:
An observational epidemiology study of pregnant women attending obstetric clinics at the University of Colorado, Anschutz Medical Center.
Participants:
This analysis includes 804 maternal-neonate pairs.
Results:
A strong positive linear relationship between maternal estimated insulin resistance (homeostasis model of assessment for insulin resistance) in the first half of pregnancy and neonatal fat mass (FM) and FM percentage (FM%) was detected, independent of prepregnancy body mass index (BMI). In the second half of pregnancy, positive linear relationships between maternal glucose levels and offspring FM and FM% were observed, independent of prepregnancy BMI. An inverse relationship was detected between high-density lipoprotein in the first half of pregnancy and FM, independent of prepregnancy BMI. Free fatty acid levels in the second half of pregnancy were positively associated with higher birth weight, independent of prepregnancy BMI.
Conclusion:
Maternal insulin resistance in the first half of pregnancy is highly predictive of neonatal FM%, whereas maternal glycemia, even within the normal range, is an important driver of neonatal adiposity in later pregnancy, independent of prepregnancy BMI. Our data provide additional insights on potential maternal factors responsible for fetal fat accretion and early development of adiposity.
The association of markers of body iron stores with kidney disease in type 1 diabetes (T1D) is complex, with both positive and inverse relationships observed. Little data are available on the ...relationship of dietary iron (DI) intake with markers of kidney function, prior to occult disease, in youth and young adults with T1D. We tested the association of DI with albumin-to-creatinine ratio (ACR), both measured at multiple time points over a 14-year period in youth and young adults with T1D. Study participants (n=629) were from the Colorado site of the SEARCH for Diabetes in Youth study who completed research visits at baseline and (<1yr diabetes duration) and at least one follow-up visit over 14 years. We applied linear mixed models (repeated measures analysis) to test the hypothesis that higher DI over time is longitudinally associated with a higher ACR, which was natural log-transformed prior to regression analysis. Results: Mean age and diabetes duration at study baseline were 10.2 (std 4.2) years and 10.4 (std 6.8) months, respectively. Older age at baseline (p=0.009), female sex (vs. male, p=0.002), and Black race (vs Non-Hispanic White, p<0.001) were each associated with higher ACR levels across follow-up. Contrary to our hypothesis, average DI intake was inversely associated with ACR levels in analyses adjusted for age, sex, and race (p<0.05). This inverse relationship persisted after further controlling for average body mass index (BMI) over time. However, controlling for average HbA1c levels over time, which were positively associated with ACR (p=0.001), attenuated the relationship between DI intake and ACR (p=0.12). In conclusion, total DI intake in children and young adults was associated with a lower ACR over 14 years, but the association was confounded by HbA1c, suggesting that DI may be a marker of total glycemic load. Whether this relationship varies by heme/non-heme content needs to be further explored. These data highlight the important role of diet in the early years after T1D onset.
Disclosure
R.B.Conway: None. T.L.Crume: None. W.Perng: None. D.A.Mcclain: None. D.Dabelea: None.
Objective
To explore the long‐term impact of intrauterine growth restriction (IUGR) among a diverse, contemporary cohort of US children.
Design and Methods
A retrospective cohort of 42 children ...exposed to IUGR and 464 unexposed who were members of Kaiser Permanente of Colorado. Height and weight measurements since birth and measures of abdominal adiposity and insulin‐resistance were measured at an average age of 10.6 (±1.3) years.
Results
Infants born IUGR experienced “catch‐up growth” in the first 12 months of life at a rate of 3.58 kg/m2 compared to 2.36 kg/m2 in unexposed infants (P = 0.01). However, after 1 year of age, no differences in BMI growth velocity were observed. Nevertheless children exposed to IUGR had higher waist circumference (67.0 vs. 65.3 cm, P = 0.03), higher insulin (15.2 vs. 11.0 μU/ml, P = 0.0002), higher HOMA‐IR (2.8 vs. 2.3, P = 0.03), and lower adiponectin levels (9.0 vs. 12.0 μg/ml, P = 0.003) in adolescence, independent of other childhood and maternal factors.
Conclusions
Our data from a contemporary US cohort suggests that children exposed to IUGR have increased abdominal fat and increased insulin resistance biomarkers despite no differences in BMI growth patterns beyond 12 months of age. These data provide further support for the fetal programming hypothesis.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Objective To examine associations between exposure to maternal diabetes in utero and body mass index (BMI) growth trajectories from birth through 13 years of age among a diverse cohort of youth. ...Study design Mixed linear effects models were constructed to assess differences in BMI and BMI growth velocity from birth through 13 years of age for 95 subjects exposed to diabetes in utero and 409 unexposed subjects enrolled in a retrospective cohort study. Results The overall BMI growth trajectory (adjusted for sex and race/ethnicity) was not significantly different for exposed and unexposed subjects from birth through 26 months of age ( P = .48). However, the overall growth trajectory from 27 months of age through 13 years differed by exposure status ( P = .008), adjusted for sex and race/ethnicity. The difference was primarily due to a significantly higher BMI growth velocity among exposed youth between 10 and 13 years, increasing by 4.56 kg/m2 compared with 3.51 kg/m2 in the unexposed ( P = .005). Control for demographic variables, socioeconomic factors, and maternal prepregnancy BMI did not alter the observed associations. Conclusions Exposure to maternal diabetes in utero accelerates BMI growth in late childhood, thus increasing long-term obesity risk.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Evidence remains equivocal regarding the association of inflammation, a precursor to cardiovascular disease, and acute exposures to ambient air pollution from traffic-related particulate matter. ...Though youth with type 1 diabetes are at higher risk for cardiovascular disease, the relationship of inflammation and ambient air pollution exposures in this population has received little attention.
Using five geographically diverse US sites from the racially- and ethnically-diverse SEARCH for Diabetes in Youth Cohort, we examined the relationship of acute exposures to PM2.5 mass, Atmospheric Dispersion Modeling System (ADMS)-Roads traffic-related PM concentrations near roadways, and elemental carbon (EC) with biomarkers of inflammation including interleukin-6 (IL-6), c-reactive protein (hs-CRP) and fibrinogen.
Baseline questionnaires and blood were obtained at a study visit. Using a spatio-temporal modeling approach, pollutant exposures for 7 days prior to blood draw were assigned to residential addresses. Linear mixed models for each outcome and exposure were adjusted for demographic and lifestyle factors identified a priori.
Among the 2566 participants with complete data, fully-adjusted models showed positive associations of EC average week exposures with IL-6 and hs-CRP, and PM2.5 mass exposures on lag day 3 with IL-6 levels. Comparing the 25th and 75th percentiles of average week EC exposures resulted in 8.3% higher IL-6 (95%CI: 2.7%,14.3%) and 9.8% higher hs-CRP (95%CI: 2.4%,17.7%). We observed some evidence of effect modification for the relationships of PM2.5 mass exposures with hs-CRP by gender and with IL-6 by race/ethnicity.
Indicators of inflammation were associated with estimated traffic-related air pollutant exposures in this study population of youth with type 1 diabetes. Thus youth with type 1 diabetes may be at increased risk of air pollution-related inflammation. These findings and the racial/ethnic and gender differences observed deserve further exploration.
•In youth with T1 diabetes, EC average week exposures were positively associated with IL-6 and hs-CRP.•Overall, fibrinogen was not associated with acute traffic-related air pollution exposures.•Potential effect modification by race/ethnicity and gender
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
To examine the associations of in utero exposure to maternal diabetes with surrogate measures of offspring pubertal timing (age at peak height velocity APHV) and speed of pubertal growth (peak height ...velocity PHV).
Data from 77 exposed and 340 unexposed youth followed from age 2 to 19 years (51% non-Hispanic white, 50% female) were analyzed using the Exploring Perinatal Outcomes among Children study, a historical prospective cohort. Maternal diabetes status was collected from obstetric records, and child heights from 2 years to current age from pediatric records. Other covariates were collected during research visits. The superimposition by translation and rotation method, using height measurements (4-52 per participant), modeled APHV and PHV. Accelerated failure time analyses were used to test whether exposure to maternal diabetes was associated with younger APHV and faster PHV.
Adjusting for child's sex, race/ethnicity, and socioeconomic status, median APHV was reached ~3 months earlier in youth exposed to maternal diabetes compared with unexposed youth (P < .03). Youth exposed to maternal diabetes had a faster PHV than unexposed youth: exposed girls had 10.5% greater median PHV compared with unexposed girls and exposed boys had a 4.0% greater median PHV compared with unexposed boys (P < .001 for exposure by sex interaction).
Our findings provide evidence that exposure to maternal diabetes in utero is associated with earlier pubertal timing and faster pubertal growth. Whether earlier puberty or faster speed of pubertal growth mediates the association between maternal diabetes exposure and later chronic disease risk remains to be studied.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract
Objective
The disjointed healthcare system and the nonexistence of a universal patient identifier across systems necessitates accurate record linkage (RL). We aim to describe the ...implementation and evaluation of a hybrid record linkage method in a statewide surveillance system for congenital heart disease.
Materials and Methods
Clear-text personally identifiable information on individuals in the Colorado Congenital Heart Disease surveillance system was obtained from 5 electronic health record and medical claims data sources. Two deterministic methods and 1 probabilistic RL method using first name, last name, social security number, date of birth, and house number were initially implemented independently and then sequentially in a hybrid approach to assess RL performance.
Results
16 480 nonunique individuals with congenital heart disease were ascertained. Deterministic linkage methods, when performed independently, yielded 4505 linked pairs (consisting of 2 records linked together within or across data sources). Probabilistic RL, using 3 initial characters of last name and gender for blocking, yielded 6294 linked pairs when executed independently. Using a hybrid linkage routine resulted in 6451 linkages and an additional 18%–24% correct linked pairs as compared to the independent methods. A hybrid linkage routine resulted in higher recall and F-measure scores compared to probabilistic and deterministic methods performed independently.
Discussion
The hybrid approach resulted in increased linkage accuracy and identified pairs of linked record that would have otherwise been missed when using any independent linkage technique.
Conclusion
When performing RL within and across disparate data sources, the hybrid RL routine outperformed independent deterministic and probabilistic methods.
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