The impact of prenatal parental tobacco smoking on risk of diabetes mellitus in middle-aged women

Growing evidence indicates that parental smoking is associated with risk of offspring obesity. The purpose of this study was to identify whether parental tobacco smoking during gestation was associated with risk of diabetes mellitus. This is a prospective study of 44- to 54-year-old daughters (n=1801) born in the Child Health and Development Studies pregnancy cohort between 1959 and 1967. Their mothers resided near Oakland California, were members of the Kaiser Foundation Health Plan and reported parental tobacco smoking during an early pregnancy interview. Daughters reported physician diagnoses of diabetes mellitus and provided blood samples for hemoglobin A1C measurement. Prenatal maternal smoking had a stronger association with daughters’ diabetes mellitus risk than prenatal paternal smoking, and the former persisted after adjustment for parental race, diabetes and employment (aRR=2.4 [95% confidence intervals 1.4–4.1] P<0.01 and aRR=1.7 [95% confidence intervals 1.0–3.0] P=0.05, respectively). Estimates of the effect of parental smoking were unchanged when further adjusted by daughters’ birth weight or current body mass index (BMI). Maternal smoking was also significantly associated with self-reported type 2 diabetes diagnosis (2.3 [95% confidence intervals 1.0–5.0] P<0.05). Having parents who smoked during pregnancy was associated with an increased risk of diabetes mellitus among adult daughters, independent of known risk factors, providing further evidence that prenatal environmental chemical exposures independent of birth weight and current BMI may contribute to adult diabetes mellitus. While other studies seek to confirm our results, caution toward tobacco smoking by or proximal to pregnant women is warranted in diabetes mellitus prevention efforts.

Download Full-text

Impact of the UK COVID-19 pandemic on HbA1c testing and its implications for diabetes diagnosis and management

10.22541/au.160770263.30907582/v1 ◽

2020 ◽

Author(s):

David Holland ◽

Adrian Heald ◽

Mike Stedman ◽

Lewis Green ◽

Jonathan Scargill ◽

...

Keyword(s):

Diabetes Mellitus ◽

Diabetes Diagnosis ◽

Long Term Conditions ◽

Diagnosis And Management ◽

Increased Risk ◽

Poor Outcomes ◽

The Uk ◽

The Impact

Our findings illustrate the widespread collateral impact of implementing measures to mitigate the impact of COVID-19 in people with, or being investigated for diabetes mellitus (DM). Ironically, failure to focus of the wider implications for people with DM and other groups with long-term conditions, may place them at increased risk of poor outcomes from SARS-CoV-2 infection itself, irrespective of the implications for their longer-term health prospects.

Download Full-text

Gestational Diabetes Mellitus and Infant Adiposity at Birth: A Systematic Review and Meta-Analysis of Therapeutic Interventions

Journal of Clinical Medicine ◽

10.3390/jcm10040835 ◽

2021 ◽

Vol 10 (4) ◽

pp. 835

Author(s):

Manoja P. Herath ◽

Jeffrey M. Beckett ◽

Andrew P. Hills ◽

Nuala M. Byrne ◽

Kiran D. K. Ahuja

Keyword(s):

Diabetes Mellitus ◽

Adipose Tissue ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Fat Mass ◽

Metabolic Disorders ◽

Later Life ◽

Therapeutic Interventions ◽

Increased Risk ◽

The Impact

Exposure to untreated gestational diabetes mellitus (GDM) in utero increases the risk of obesity and type 2 diabetes in adulthood, and increased adiposity in GDM-exposed infants is suggested as a plausible mediator of this increased risk of later-life metabolic disorders. Evidence is equivocal regarding the impact of good glycaemic control in GDM mothers on infant adiposity at birth. We systematically reviewed studies reporting fat mass (FM), percent fat mass (%FM) and skinfold thicknesses (SFT) at birth in infants of mothers with GDM controlled with therapeutic interventions (IGDMtr). While treating GDM lowered FM in newborns compared to no treatment, there was no difference in FM and SFT according to the type of treatment (insulin, metformin, glyburide). IGDMtr had higher overall adiposity (mean difference, 95% confidence interval) measured with FM (68.46 g, 29.91 to 107.01) and %FM (1.98%, 0.54 to 3.42) but similar subcutaneous adiposity measured with SFT, compared to infants exposed to normal glucose tolerance (INGT). This suggests that IGDMtr may be characterised by excess fat accrual in internal adipose tissue. Given that intra-abdominal adiposity is a major risk factor for metabolic disorders, future studies should distinguish adipose tissue distribution of IGDMtr and INGT.

Download Full-text

Pregnancy After Simultaneous Pancreas-Kidney Transplantation in Treatment of End-Stage Diabetes Mellitus: a Review

Zeitschrift für Geburtshilfe und Neonatologie ◽

10.1055/a-1710-4097 ◽

2021 ◽

Author(s):

Zana Stanic ◽

Marko Vulic ◽

Zlatko Hrgovic ◽

Rajko Fureš ◽

Milvija Plazibat ◽

...

Keyword(s):

Diabetes Mellitus ◽

Kidney Transplantation ◽

Graft Function ◽

Insulin Dependent Diabetes Mellitus ◽

Organ Damage ◽

Multiple Organ ◽

Dependent Diabetes Mellitus ◽

Increased Risk ◽

Simultaneous Pancreas Kidney ◽

The Impact

AbstractThe majority of patients with simultaneous pancreas and kidney transplant (SPKT) required transplantation owing to a long-standing history of insulin-dependent diabetes mellitus (IDDM). The disease causes multiple organ damage, impairs fertility, and affects quality of life. A successful kidney and pancreas transplant can improve health, ameliorate the consequences of pre-existent diabetes, and restore fertility. Good graft function, without any sign of rejection, and stable doses of immunosuppressant drugs are of utmost importance prior to the planned pregnancy. SPKT recipients who become pregnant may be at an increased risk for an adverse outcome and require meticulous multidisciplinary surveillance. We present experiences with SPKT pregnancies, traditional approaches, and recent considerations. In light of complex interactions between new anatomic relations and the impact of developing pregnancy and immunosuppressive medications, special stress is put on the risk of graft rejection, development of pregnancy complications, and potential harmful effects on fetal development. Recent recommendations in management of SPKT recipients who wish to commence pregnancy are presented as well. Key words: transplantation, pregnancy, pancreas, kidney, simultaneous pancreas and kidney transplantation (SPKT)

Download Full-text

Maternal education and offspring birth weight for gestational age: the mediating effect of smoking during pregnancy

European Journal of Public Health ◽

10.1093/eurpub/ckaa076 ◽

2020 ◽

Vol 30 (5) ◽

pp. 1001-1006 ◽

Cited By ~ 1

Author(s):

Aurélie Nakamura ◽

Laura Pryor ◽

Morgane Ballon ◽

Sandrine Lioret ◽

Barbara Heude ◽

...

Keyword(s):

Birth Weight ◽

Educational Attainment ◽

Gestational Age ◽

Tobacco Smoking ◽

Mediation Analysis ◽

Maternal Smoking ◽

Maternal Education ◽

Mediating Effect ◽

Smoking During Pregnancy ◽

Child Birth

Abstract Background Small for gestational age (SGA) birth weight, a risk factor for infant mortality and delayed child development, is associated with maternal educational attainment. Maternal tobacco smoking during pregnancy could contribute to this association. We aimed to quantify the contribution of maternal smoking during pregnancy to social inequalities in child birth weight for gestational age (GA). Methods Data come from the French nation-wide ELFE cohort study, which included 17 155 singletons. Birth weights for GA were calculated using z-scores. Associations between maternal educational attainment, tobacco smoking during pregnancy and child birth weight for GA were ascertained using mediation analysis. Mediation analyses were also stratified by maternal pre-pregnancy body mass index. Results Low maternal educational attainment was associated with an increased odd of tobacco smoking during pregnancy [adjusted OR (ORa) = 2.58 (95% CI 2.34–2.84)] as well as a decrease in child birth weight for GA [RRa = 0.94 (95% CI 0.91–0.98)]. Tobacco smoking during pregnancy was associated with a decrease in offspring birth weight for GA [RRa = 0.73 (95% CI 0.70–0.76)]. Mediation analysis suggests that 39% of the effect of low maternal educational attainment on offspring birth weight for GA was mediated by smoking during pregnancy. A more important direct effect of maternal educational attainment on child birth weight for GA was observed among underweight women [RRa = 0.82 (95% CI 0.72–0.93)]. Conclusions The relationship between maternal educational attainment and child birth weight for GA is strongly mediated by smoking during pregnancy. Reducing maternal smoking could lessen the occurrence of infant SGA and decrease socioeconomic inequalities in birth weight for GA.

Download Full-text

A switch toward angiostatic gene expression impairs the angiogenic properties of endothelial progenitor cells in low birth weight preterm infants

Blood ◽

10.1182/blood-2010-12-325142 ◽

2011 ◽

Vol 118 (6) ◽

pp. 1699-1709 ◽

Cited By ~ 57

Author(s):

Isabelle Ligi ◽

Stéphanie Simoncini ◽

Edwige Tellier ◽

Paula Frizera Vassallo ◽

Florence Sabatier ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Profile Analysis ◽

Preterm Neonates ◽

Akt Phosphorylation ◽

Protein Levels ◽

Increased Risk ◽

The Impact

Abstract Low birth weight (LBW) is associated with increased risk of cardiovascular diseases at adulthood. Nevertheless, the impact of LBW on the endothelium is not clearly established. We investigate whether LBW alters the angiogenic properties of cord blood endothelial colony forming cells (LBW-ECFCs) in 25 preterm neonates compared with 25 term neonates (CT-ECFCs). We observed that LBW decreased the number of colonies formed by ECFCs and delayed the time of appearance of their clonal progeny. LBW dramatically reduced LBW-ECFC capacity to form sprouts and tubes, to migrate and to proliferate in vitro. The angiogenic defect of LBW-ECFCs was confirmed in vivo by their inability to form robust capillary networks in Matrigel plugs injected in nu/nu mice. Gene profile analysis of LBW-ECFCs demonstrated an increased expression of antiangiogenic genes. Among them, thrombospondin 1 (THBS1) was highly expressed at RNA and protein levels in LBW-ECFCs. Silencing THBS1 restored the angiogenic properties of LBW-ECFCs by increasing AKT phosphorylation. The imbalance toward an angiostatic state provide a mechanistic link between LBW and the impaired angiogenic properties of ECFCs and allows the identification of THBS1 as a novel player in LBW-ECFC defect, opening new perspectives for novel deprogramming agents.

Download Full-text

Impact of Birth Weight and Length on Primary Hypertension in Children

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16234649 ◽

2019 ◽

Vol 16 (23) ◽

pp. 4649

Author(s):

Aneta Weres ◽

Joanna Baran ◽

Ewelina Czenczek-Lewandowska ◽

Justyna Leszczak ◽

Artur Mazur

Keyword(s):

Body Weight ◽

Birth Weight ◽

Gestational Age ◽

Primary Schools ◽

Body Height ◽

Primary Hypertension ◽

Increased Risk ◽

Appropriate For Gestational Age ◽

The Impact ◽

Hypertension In Children

Background: A child’s birth parameters not only enable assessment of intrauterine growth but are also helpful in identifying children at risk of developmental defects or diseases occurring in adulthood. Studies show that children born with a body weight that is small for their gestational age (SGA) are at a greater risk of hypertension though the inverse relation between excessive birth weight and the risk of primary hypertension in children is discussed less frequently. Purpose: To assess the impact of both birth weight and length on hypertension occurring in children aged 3–15 years. Methods: A total of 1000 children attending randomly selected primary schools and kindergartens were examined. Ultimately, the analyses took into account n = 747 children aged 4–15; 52.6% boys and 47.4% girls. The children’s body height and weight were measured; their blood pressure was examined using the oscillometric method. Information on perinatal measurements was retrieved from the children’s personal health records. Results: Compared to the children with small for gestational age (SGA) birth weight, the children with appropriate for gestational age birth weight (AGA) (odds ratio (OR) 1.31; 95% confidence interval (CI) 0.64–2.65) present greater risk for primary hypertension. Infants born with excessive body weight >4000 g irrespective of gestational age, compared to infants born with normal body weight, show increased risk of primary hypertension (OR 1.19; 95% CI 0.68–2.06). Higher risk of hypertension is observed in infants born with greater body length (OR 1.03; 95% CI 0.97–1.08). Conclusions: The problem of hypertension may also affect children with birth weight appropriate for gestational age. The prevalence of hypertension in children with AGA birth weight decreases with age. Birth length can be a potential risk factor for hypertension in children and adolescents.

Download Full-text

342. The Impact of Glycemic Control on CD4 Cell Count in Persons Living with HIV and Diabetes Mellitus—Washington, DC

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.415 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S182-S182

Author(s):

Lindsey J Powers Happ ◽

Anne K Monroe ◽

Heather A Young ◽

Yan Ma ◽

Alan E Greenberg ◽

...

Keyword(s):

Diabetes Mellitus ◽

Cd4 Count ◽

Diabetes Diagnosis ◽

Washington Dc ◽

Cd4 Counts ◽

Persons Living With Hiv ◽

Hba1c Control ◽

Living With Hiv ◽

The Impact

Abstract Background Among persons living with HIV (PLWH) with type 2 diabetes mellitus (DM) there is limited research on the effect of DM control on CD4 count. Current guidelines recommend that PLWH with DM maintain a hemoglobin A1c (HbA1c) <7%. This analysis examined the impact of HbA1c on trends in CD4 count among PLWH receiving care in Washington, DC. Methods We used data from the DC Cohort, a longitudinal observational cohort of patients receiving HIV care at 14 clinics between 2011–2018. Participants with DM on an ongoing antiretroviral regimen with ≥1 year of follow-up, ≥2 HbA1c results, and ≥2 CD4 count results were included. Participants were compared based on the most recent HbA1c result categorized into one of three control levels control: strict, HbA1c < 7.5%; moderate, HbA1c between 7.5–9.0%; and uncontrolled, HbA1c >9.0%. All statistical tests were performed within the framework of the linear mixed-effects (LME) model. The rates of increase in CD4 count by DM control were compared using an LME model with random slopes and random intercepts, adjusted for sex, BMI, nadir CD4, a history of AIDS, or cancer diagnosis. Results Among 554 participants (median age 53.5; 70.8% male; 82.7% Black), there were 5,138 total CD4 count measurements. In unadjusted analysis, participants with moderate or uncontrolled HbA1c had higher mean CD4 counts over the follow-up period than those with strict HbA1c control (strict: 690 cells/μL, moderate: 712 cells/μL uncontrolled: 711 cells/μL; P = 0.0156 strict vs. moderate, 0.049 strict vs. uncontrolled). All DM control groups had a similar temporal increase over time in CD4 count (P = 0.46). In multivariate analysis, only moderate vs. strict control showed a significant difference in CD4 count (mean difference=18.1; P = 0.02). Results showed CD4 count change was not affected by the duration of HIV diagnosis or diabetes diagnosis. See Table 1 for additional results. Conclusion PLWH and DM with moderate HbA1c control had higher CD4 counts than those with strict HbA1c control and similar CD4 counts compared with those with uncontrolled HbA1c levels, while the rate of increase in CD4 count was similar in the three groups. These results show that moderate DM control may benefit CD4 count, which should be considered when revising DM control guidelines for PLWH. Disclosures All authors: No reported disclosures.

Download Full-text

Risk of diabetes mellitus associated with disease-modifying antirheumatic drugs and statins in rheumatoid arthritis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2016-209954 ◽

2016 ◽

Vol 76 (5) ◽

pp. 848-854 ◽

Cited By ~ 31

Author(s):

Gulsen Ozen ◽

Sofia Pedro ◽

Marie E Holmqvist ◽

Michael Avery ◽

Frederick Wolfe ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Diabetes Mellitus ◽

Adult Population ◽

Data Bank ◽

Self Report ◽

Increased Risk ◽

Cox Proportional Hazard Models ◽

Synthetic Dmards ◽

Disease Modifying ◽

The Impact

ObjectiveTo investigate the rate of incident diabetes mellitus (DM) in patients with rheumatoid arthritis (RA) and the impact of disease-modifying antirheumatic drug (DMARD) and statin treatments.MethodsWe studied patients with RA and ≥1 year participation in the National Data Bank for Rheumatic Diseases without baseline DM from 2000 through 2014. DM was determined by self-report or initiating DM medication. DMARDs were categorised into four mutually exclusive groups: (1) methotrexate monotherapy (reference); (2) any abatacept with or without synthetic DMARDs (3) any other DMARDs with methotrexate; (4) all other DMARDs without methotrexate; along with separate statin, glucocorticoid and hydroxychloroquine (yes/no) variables. Time-varying Cox proportional hazard models were used to adjust for age, sex, socioeconomic status, comorbidities, body mass index and RA severity measures.ResultsDuring a median (IQR) 4.6 (2.5–8.8) years of follow-up in 13 669 patients with RA, 1139 incident DM cases were observed. The standardised incidence ratio (95% CI) of DM in patients with RA (1.37, (1.29 to 1.45)) was increased compared with US adult population. Adjusted HR (95% CI) for DM were 0.67 (0.57 to 0.80) for hydroxychloroquine, 0.52 (0.31 to 0.89) for abatacept (compared with methotrexate monotherapy), 1.31 (1.15 to 1.49) for glucocorticoids and 1.56 (1.36 to 1.78) for statins. Other synthetic/biological DMARDs were not associated with any risk change. Concomitant use of glucocorticoids did not alter DM risk reduction with hydroxychloroquine (HR 0.69 (0.51 to 0.93)).ConclusionsIn RA, incidence of DM is increased. Hydroxychloroquine and abatacept were associated with decreased risk of DM, and glucocorticoids and statins with increased risk.

Download Full-text

Gestational Weight Gain Influences Neonatal Outcomes in Women With Obesity and Gestational Diabetes

10.21203/rs.3.rs-607107/v1 ◽

2021 ◽

Author(s):

Ana M Ramos-Levi ◽

Gemma Rodriguez-Carnero ◽

Cristina Garcia-Fontao ◽

Antia Fernandez-Pombo ◽

Paula Andújar-Plata ◽

...

Keyword(s):

Weight Gain ◽

Birth Weight ◽

Gestational Diabetes ◽

Gestational Weight Gain ◽

Gestational Age ◽

Perinatal Outcomes ◽

Large For Gestational Age ◽

Gestational Weight ◽

Increased Risk ◽

The Impact

Abstract Background. Obesity and gestational diabetes mellitus (GDM) are associated to increased risk of perinatal complications and obesity in the offspring. However, the impact of gestational weight gain (GWG) on maternal and fetal outcomes has led to controversial results. Research design and methods. Retrospective study of 220 women with GDM and pre-pregnancy body mass index (BMI) ≥ 30 kg/m2. Pregnant women were classified according to the Institute of Medicine (IOM) recommendations regarding prior BMI and GWG. We evaluated the impact of GWG on birth weight and perinatal outcomes. Results. Mean maternal age was 34.7±5.3 years. Pre-pregnancy obesity was classified as grade I in 55.3% of cases, grade II in 32.0%, and grade III in 12.7%. GWG was adequate (5-9kg) in 24.2%, insufficient (< 5kg) in 41.8% and excessive (> 9kg) in 34.2%. Birthweight was within normal range in 81.9%, 3.6% were small for gestational age (SGA) and 14.4% were large for gestational age (LGA). Insufficient GWG was associated to a higher rate of SGA offspring, excessive GWG was associated to LGA and adequate GWG to normal birth weight. Conclusion. GWG in women with pre-pregnancy obesity and GDM impacts neonatal birthweight. Insufficient GWG is associated to SGA and excessive GWG is associated to LGA. Women with adequate GWG according to IOM guidelines obtained better perinatal outcomes.

Download Full-text

Abstract P029: Vendor Specific Differences in the Sprague Dawley Rat Strain Alter Baseline Blood Pressure and Body Composition and Influence the Impact of Slow Fetal Growth on Later Cardiovascular Risk

Hypertension ◽

10.1161/hyp.66.suppl_1.p029 ◽

2015 ◽

Vol 66 (suppl_1) ◽

Author(s):

John Henry H Dasinger ◽

Suttira Intapad ◽

Miles A Backstrom ◽

Anthony J Carter ◽

Barbara T Alexander

Keyword(s):

Blood Pressure ◽

Birth Weight ◽

Fetal Growth ◽

Male Rats ◽

Ang Ii ◽

Sprague Dawley ◽

Male Control ◽

Increased Risk ◽

Rat Strain ◽

The Impact

Low birth weight is associated with increased risk for cardiovascular (CV) disease including hypertension in later life. We previously reported that reduced uterine perfusion (RUP) in timed pregnant Sprague Dawley (SD) dams purchased from Harlan induced intrauterine growth restriction (IUGR) associated with hypertension and enhanced sensitivity to angiotensin II (Ang II) in male rats at 4 months of age. In addition, male IUGR exhibited a two-fold increase in testosterone relative to control. Upon castration, hypertension and sensitivity to Ang II were abolished suggesting that programmed CV risk is testosterone dependent in the male IUGR. The aim of this study was to determine if vendor differences in the SD strain impact CV risk following a developmental insult. Timed pregnant SD rats were purchased from Charles River and underwent either RUP or sham surgery at day 14 of gestation. Birth weight was significantly reduced in IUGR relative to control (P<0.05). At 4 months of age, body weight remained significantly decreased in male IUGR relative to control, blood pressure did not differ when measured in conscious, chronically instrumented animals, and male control and IUGR from Charles River also exhibited a similar blood pressure response to acute Ang II. However, baseline blood pressures were higher in male control from Charles River versus blood pressure previously noted for male control from Harlan. Thus, these results suggest that vendor specific differences in the SD rat strain influence baseline CV risk and effect the developmental programming of CV risk following slow fetal growth.

Download Full-text