Most of the women who smoke before pregnancy continue smoking during pregnancy, and some start to quit smoking after being pregnant, although existing guidelines for pregnancy recommend that women ...who smoke should quit smoking before pregnancy. Findings about the timing and intensity of maternal smoking, especially low-intensity smoking (1-9 cigarettes per day), and preterm birth are still inconsistent and ambiguous. This study aimed to examine the association of the timing of smoking and doses of smoking before pregnancy and during the first or second trimester of pregnancy with preterm birth in a large-scale population-based retrospective cohort study.
We used nationwide birth certificate data from singleton mother-infant pairs in the United States National Vital Statistics System, 2011-2018. All adult women with live singleton births, without preexisting hypertension or diabetes, and with complete data on smoking and gestational age at delivery were included. Participants reported their smoking status (yes or no) and daily number of cigarettes consumed before and during each trimester of pregnancy. The outcome of interest was preterm birth, defined as a birth before 37 weeks of gestation. Logistic regression models were used to estimate the odds ratio (OR) with 95% confidence intervals (CIs) of preterm birth associated with smoking status and the number of cigarettes consumed, adjusting for maternal age, race/ethnicity, parity, education levels, prepregnancy BMI, previous history of preterm birth, marital status, infant sex, and initiation of prenatal care. This study included 25,623,479 women, with a mean age of 29 years (range 20-50 years); 13,742,486 (53.6%) participants were of non-Hispanic white ancestry, 5,971,598 (23.3%) of Hispanic ancestry, and 3,417,456 (13.34%) of non-Hispanic black ancestry. The prevalence of preterm birth was 9.3% (n = 2,378,398). We found that maternal smoking during pregnancy, even at a very low level of intensity, was associated with an increased risk of preterm delivery. The adjusted ORs (95% CI) of preterm birth for mothers who smoked 1-2, 3-5, 6-9, 10-19, and ≥20 cigarettes per day during the first trimester compared with mothers who did not smoke were 1.31 (1.29-1.33), 1.31 (1.30-1.32), 1.33 (1.31-1.35), 1.44 (1.43-1.45), and 1.53 (1.52-1.55), respectively (all P values < 0.001), whereas for those who smoked during the second trimester, the corresponding ORs were 1.37 (1.35-1.39), 1.36 (1.35-1.38), 1.36 (1.34-1.38), 1.48 (1.47-1.49), and 1.59 (1.58-1.61), respectively (all P values < 0.001). Furthermore, smokers who quit before pregnancy, regardless of smoking intensity, had a comparable risk of preterm birth with nonsmokers, although this was not the case when cessation occurred in the first or second trimester of pregnancy. The major limitation of this study is the self-reported information about smoking, which may be subject to information bias. In addition, we cannot rule out the possibility of residual confounding caused by unmeasured factors in an observational research design.
In this study, we observed that low-intensity cigarette consumption during either the first or second trimester of pregnancy, even as low as 1-2 cigarettes per day, was associated with an increased risk of preterm birth. These findings suggest that there is no safe level or safe trimester for maternal smoking during pregnancy. Women of reproductive age who smoke should be strongly encouraged and supported to quit smoking before pregnancy.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
AbstractObjectiveTo examine the trends in obesity and adiposity measures, including body mass index, waist circumference, body fat percentage, and lean mass, by race or ethnicity among adults in the ...United States from 2011 to 2018.DesignPopulation based study.SettingNational Health and Nutrition Examination Survey (NHANES), 2011-18.ParticipantsA nationally representative sample of US adults aged 20 years or older.Main outcome measuresWeight, height, and waist circumference among adults aged 20 years or older were measured by trained technicians using standardized protocols. Obesity was defined as body mass index of 30 or higher for non-Asians and 27.5 or higher for Asians. Abdominal obesity was defined as a waist circumference of 102 cm or larger for men and 88 cm or larger for women. Body fat percentage and lean mass were measured among adults aged 20-59 years by using dual energy x ray absorptiometry.ResultsThis study included 21 399 adults from NHANES 2011-18. Body mass index was measured for 21 093 adults, waist circumference for 20 080 adults, and body fat percentage for 10 864 adults. For the overall population, age adjusted prevalence of general obesity increased from 35.4% (95% confidence interval 32.5% to 38.3%) in 2011-12 to 43.4% (39.8% to 47.0%) in 2017-18 (P for trend<0.001), and age adjusted prevalence of abdominal obesity increased from 54.5% (51.2% to 57.8%) in 2011-12 to 59.1% (55.6% to 62.7%) in 2017-18 (P for trend=0.02). Age adjusted mean body mass index increased from 28.7 (28.2 to 29.1) in 2011-12 to 29.8 (29.2 to 30.4) in 2017-18 (P for trend=0.001), and age adjusted mean waist circumference increased from 98.4 cm (97.4 to 99.5 cm) in 2011-12 to 100.5 cm (98.9 to 102.1 cm) in 2017-18 (P for trend=0.01). Significant increases were observed in body mass index and waist circumference among the Hispanic, non-Hispanic white, and non-Hispanic Asian groups (all P for trend<0.05), but not for the non-Hispanic black group. For body fat percentage, a significant increase was observed among non-Hispanic Asians (30.6%, 29.8% to 31.4% in 2011-12; 32.7%, 32.0% to 33.4% in 2017-18; P for trend=0.001), but not among other racial or ethnic groups. The age adjusted mean lean mass decreased in the non-Hispanic black group and increased in the non-Hispanic Asian group, but no statistically significant changes were found in other racial or ethnic groups.ConclusionsAmong US adults, an increasing trend was found in obesity and adiposity measures from 2011 to 2018, although disparities exist among racial or ethnic groups.
AbstractObjectiveTo estimate the prevalence of diagnosed total diabetes, type 1 diabetes, and type 2 diabetes in the US general population and the proportions of each among US adults with a diagnosis ...of diabetes.DesignNationwide, population based, cross sectional survey.SettingNational Health Interview Survey, 2016 and 2017.ParticipantsAdults aged 20 years or older (n=58 186), as a nationally representative sample of the civilian, non-institutionalized US population.Main outcome measuresPrevalence of diagnosed diabetes, type 1 diabetes, and type 2 diabetes in the US general population, and the proportions of each subtype in participants with a diagnosis of diabetes.ResultsAmong the 58 186 included adults, 6317 had received a diagnosis of diabetes. The weighted prevalence of diagnosed diabetes, type 1 diabetes, and type 2 diabetes among US adults was 9.7% (95% confidence interval 9.4% to 10.0%), 0.5% (0.5% to 0.6%), and 8.5% (8.2% to 8.8%), respectively. Type 1 diabetes was more prevalent among adults with lower education level, and type 2 diabetes was more prevalent among older adults, men, and those with lower educational level, lower family income level, and higher body mass index (BMI). Among adults with a diagnosis of diabetes, the weighted percentage of type 1 and type 2 diabetes was 5.6% (4.9% to 6.4%) and 91.2% (90.4% to 92.1%), respectively. The percentage of type 1 diabetes was higher among younger adults (age 20-44 years), non-Hispanic white people, those with higher education level, and those with lower BMI, whereas the percentage of type 2 diabetes was higher among older adults (age ≥65 years), non-Hispanic Asians, those with lower education level, and those with higher BMI.ConclusionThis study provided benchmark estimates on the national prevalence of diagnosed type 1 diabetes (0.5%) and type 2 diabetes (8.5%) among US adults. Among US adults with diagnosed diabetes, type 1 and type 2 diabetes accounted for 5.6% and 91.2%, respectively.
Electronic cigarette are widely marketed as a tool for smoking cessation and a safer alternative to conventional cigarettes. The efficacy of e-cigarettes for succesful smoking cessation is ...inconclusive. Studies have reported a rapid increase in the prevalence of e-cigarette use among US adults since 2010. Data analysis has been the presented base on the data of National Health Interview Survey (NHIS) to estimate the changes in e-cigarette use among US adults in 2014-2016.
IMPORTANCE: Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder. Previous surveys have reported a steady increase in ASD prevalence in US children over the past decades. Several ...behavioral therapies and medications have been developed to treat the symptoms of ASD; however, little is known about the current status of treatment usage for children diagnosed as having ASD. OBJECTIVE: To estimate the prevalence and treatment patterns of ASD among US children using nationally representative data. DESIGN, SETTING, AND PARTICIPANTS: This study used data from the 2016 National Survey of Children’s Health, a nationwide, population-based, cross-sectional survey. We included 43 032 children aged 3 to 17 years. Data were collected through questionnaires completed by a parent or guardian. Data were analyzed from February 2018 to March 2018. MAIN OUTCOMES AND MEASURES: Outcome variables included ASD diagnosed by a physician or health professional and the use of behavioral treatment or medication treatment among children with ASD. RESULTS: Of the 43 032 included participants, 22 072 (51.3%) were male, and the mean (SD) age was 10.7 (4.4) years. The weighted prevalence of ever-diagnosed ASD and current ASD were 2.79% (95% CI, 2.46-3.12) and 2.50% (95% CI, 2.21-2.79), respectively. The state-level prevalence of ever-diagnosed ASD varied from 1.54% (95% CI, 0.60-2.48) in Texas to 4.88% (95% CI, 2.72-7.05) in Florida. Nationally, about 70% of children with current ASD (70.5%; 95% CI, 65.1-75.8) were treated; 43.3% (95% CI, 37.4-49.2) received behavioral treatment only, 6.9% (95% CI, 3.7-10.1) received medication treatment only, and 20.3% (95% CI, 16.5-24.1) received both behavioral and medication treatments. The remaining 29.5% (95% CI, 24.2-34.9) of children with current ASD did not receive either behavioral or medication treatment. CONCLUSIONS AND RELEVANCE: This study showed that the prevalence of ASD in the United States was relatively high, and it varied substantially across US states. Almost 30% of US children with ASD did not receive behavioral or medication treatment, which calls for a critical need to understand and address the barriers for those children to receive appropriate treatments.
Skipping breakfast is common among U.S. adults. Limited evidence suggests that skipping breakfast is associated with atherosclerosis and cardiovascular disease.
The authors sought to examine the ...association of skipping breakfast with cardiovascular and all-cause mortality.
This is a prospective cohort study of a nationally representative sample of 6,550 adults 40 to 75 years of age who participated in the National Health and Nutrition Examination Survey III 1988 to 1994. Frequency of breakfast eating was reported during an in-house interview. Death and underlying causes of death were ascertained by linkage to death records through December 31, 2011. The associations between breakfast consumption frequency and cardiovascular and all-cause mortality were investigated by using weighted Cox proportional hazards regression models.
Among the 6,550 participants (mean age 53.2 years; 48.0% male) in this study, 5.1% never consumed breakfast, 10.9% rarely consumed breakfast, 25.0% consumed breakfast some days, and 59.0% consumed breakfast every day. During 112,148 person-years of follow-up, 2,318 deaths occurred including 619 deaths from cardiovascular disease. After adjustment for age, sex, race/ethnicity, socioeconomic status, dietary and lifestyle factors, body mass index, and cardiovascular risk factors, participants who never consumed breakfast compared with those consuming breakfast everyday had hazard ratios of 1.87 (95% confidence interval: 1.14 to 3.04) for cardiovascular mortality and 1.19 (95% confidence interval: 0.99 to 1.42) for all-cause mortality.
In a nationally representative cohort with 17 to 23 years of follow-up, skipping breakfast was associated with a significantly increased risk of mortality from cardiovascular disease. Our study supports the benefits of eating breakfast in promoting cardiovascular health.
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To examine the association of maternal prepregnancy diabetes, gestational diabetes mellitus (GDM), and 12 subtypes of congenital anomalies of the newborn.
We included 29,211,974 live births with ...maternal age ranging from 18 to 49 years old documented in the National Vital Statistics System in the U.S. from 2011 to 2018. Information on prepregnancy diabetes, GDM, and congenital anomalies was retrieved from birth certificates. Log-binomial regression was used to estimate risk ratios (RRs) and 95% CIs for congenital anomalies overall and by subtypes.
Of the 29,211,974 live births, there were 90,061 infants who had congenital anomalies identified at birth. The adjusted RRs of congenital anomalies at birth were 2.44 (95% CI 2.33-2.55) for prepregnancy diabetes and 1.28 (95% CI 1.24-1.31) for GDM. The associations were generally consistent across subgroups by maternal age, race/ethnicity, prepregnancy obesity status, and infant sex. For specific subtypes of congenital anomalies, maternal prepregnancy diabetes or GDM was associated with an increased risk of most subtypes. For example, the adjusted RRs of cyanotic congenital heart disease were 4.61 (95% CI 4.28-4.96) for prepregnancy diabetes and 1.50 (95% CI 1.43-1.58) for GDM; the adjusted RRs of hypospadias were 1.88 (95% CI 1.67-2.12) for prepregnancy diabetes and 1.29 (95% CI 1.21-1.36) for GDM.
Prepregnancy diabetes and, to a lesser extent, GDM were associated with several subtypes of congenital anomalies of the newborn. These findings suggest potential benefits of preconception counseling in women with preexisting diabetes or at risk for GDM for the prevention of congenital anomalies.
Objective: To examine the association between attention-deficit/hyperactivity disorder (ADHD) and cardiovascular disease (CVD) in a nationally representative population sample of adults in the United ...States. Method: We included adults aged 18 years or older who participated in the National Health Interview Survey 2007 and 2012, because information about ADHD diagnosis among adults was only available in these two cycles. Physician-diagnosed ADHD and CVD were defined based on an affirmative response in the questionnaire during a household interview. Logistic regression with survey sampling weights was used to estimate the odds ratio (OR) and 95% confidence intervals (CIs) of CVD. Results: This analysis included 57,728 adults (weighted mean age 46.20 years; 47.66% males). Among them, 1,790 reported physician-diagnosed ADHD, 7,906 had CVD, 4,061 had coronary heart disease (CHD), and 1,749 had stroke. The age-adjusted prevalence of CVD was 19.72% (95% CI 16.56%, 22.88%) among individuals with ADHD, and 12.09% (95% CI 11.75%, 12.43%) among those without ADHD. After adjustment for age, sex, race/ethnicity, education level, family income level, smoking, alcohol drinking, physical activity, and body mass index, the OR of CVD, CHD and stroke in association with ADHD was 2.06 (95% CI 1.58, 2.68), 1.88 (95% CI 1.31, 2.69), and 1.75 (95% CI 1.07, 2.86), respectively. Conclusions: In a nationally representative sample of U.S. adults, we found a significant, positive association between a history of ADHD diagnosis and CVD. Further investigation is needed to replicate our findings and determine the underlying mechanisms.
Background Food insecurity is a global leading public health challenge that affects not only developing countries but also developed countries, including the United States. About 50 million Americans ...are food insecure. In this study we examined the associations of the adult food insecurity with all-cause and cardiovascular disease mortality in a nationally representative sample of US adults. Methods and Results We included 27 188 US adults (age ≥40 years of age) who participated in the US National Health and Nutrition Examination Survey from 1999 to 2014. Food insecurity status was assessed using the Food Security Survey Module developed by the US Department of Agriculture. Mortality from all causes and cardovascular disease was ascertained through data linkage to the National Death Index through December 31, 2015. We used multivariable Cox proportional hazards regression with sampling weights to estimate hazard ratios (HRs) and 95% CIs of all-cause and cardiovascular disease mortality, according to food security status. During 205 389 person-years of the period, 5039 deaths occurred, including 1084 cardiovascular disease deaths. After adjustment for age, sex, race/ethnicity, education, income, and dietary and lifestyle factors, participants with very low food security had higher risk of all-cause and cardiovascular disease mortality, with multivariable-adjusted HRs of 1.32 (95% CI, 1.07-1.62), and 1.53 (95% CI, 1.04-2.26), respectively, compared with those with high food security. Conclusions Food insecurity is significantly associated with increased risk of excess death from cardiovascular disease and all causes in US adults.
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