scholarly journals 522Occupational chemical exposures in pregnancy and fetal growth: evidence from the Born in Bradford Study

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Adeleh Shirangi ◽  
John Wright ◽  
Eve M Blair ◽  
Rosemary RC McEachan ◽  
Mark J Nieuwenhuijsen
Keyword(s):  
Occupational Exposure ◽  
Fetal Growth ◽  
Endocrine Disrupting Chemicals ◽  
Fold Increase ◽  
Population Based ◽  
Birth Cohort Study ◽  
Adjusted Risk ◽  
Chemical Exposures ◽  
Born In Bradford ◽  
Increased Risk

Abstract Background Understanding the effect of occupational exposure to endocrine disrupting chemicals (EDC) during pregnancy on inadequate fetal growth as measured by small-for-gestational age (SGA) and as measured by percentage of optimal birth weight (POBW) is not well understood. Methods We studied 4142 pregnant women who were in paid employment during pregnancy and participated in a population-based, prospective 2007–2011 birth cohort study, the Born in Bradford Study, with an estimated participation of 80%. Job titles were coded at 26–28 weeks' gestation at a 4-digit level according to 353 unit groups in the 2000 UK Standard Occupational Classification. They were then linked to expert judgment on exposure to each of ten EDC groups as assessed through a job exposure matrix. A modified Poisson regression was used to assess the risk of POBW and SGA associated with an increased risk of chemical exposures. Results The frequency of POBW<85 significantly increased for mothers exposed to pesticides [adjusted risk ratio (RRadj) 3.72, 95% confidence interval (CI) 1.40–9.91] and phthalates (RRadj 3.71, 95% CI 1.62–8.51). There was a 5-fold increase risk of SGA for mothers exposed to pesticides (RRadj 5.45, 95% CI 1.59–18.62). Veterinary nurses and horticultural trades were most frequently associated with exposure to pesticides while hairdressers, beauticians, and printing machine minders were associated with phthalates. Conclusion Maternal occupational exposure to estimated concentrations of pesticides and phthalates is associated with impaired fetal growth. Key messages The POBW is useful in measuring inadequate fetal growth in study of occupational chemical exposures.

scholarly journals Combined Effect of Maternal Vitamin D Deficiency and Gestational Diabetes Mellitus on Trajectories of Ultrasound-Measured Fetal Growth: A Birth Cohort Study in Beijing, China

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Zheng Liu ◽  
Hui Liu ◽  
Xiangrong Xu ◽  
Shusheng Luo ◽  
Jue Liu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Birth Cohort ◽  
Fetal Growth ◽  
Reference Population ◽  
Abdominal Circumference ◽  
Birth Cohort Study ◽  
Increased Risk ◽  
Beijing China

Objective. Few studies have examined whether maternal 25(OH)D deficiency and gestational diabetes mellitus (GDM) jointly affect fetal growth. We aimed to examine the separate and combined effects of maternal 25(OH)D deficiency and GDM on trajectories of fetal growth. Methods. We established a birth cohort (2016-2017) with 10,913 singleton pregnancies in Tongzhou Maternal and Child Health Hospital of Beijing, China. Maternal 25(OH)D deficiency (serum 25OHD concentration<20.0 ng/mL) was detected, and GDM was diagnosed at 24~28 gestational weeks. Fetal growth was assessed by longitudinal ultrasound measurements of estimated fetal weight (EFW) and abdominal circumference (AC) from 28 gestational weeks to delivery, both of which were standardized as gestational-age-adjusted Z-score. A k-means algorithm was used to cluster the longitudinal measurements (trajectories) of fetal growth. Logistic regression models were used for estimating exposure-outcome associations and additive interactions. Results. We identified two distinct trajectories of fetal growth, and the faster one resembling the 90th centile curve in the reference population was classified as excessive fetal growth. Maternal 25(OH)D deficiency and GDM were independently associated with an increased risk of excessive fetal growth. The combination of maternal 25(OH)D deficiency and GDM was associated with an increased risk of excessive fetal growth assessed by EFW Z-score (odds ratio (OR): 1.36; 95% confidence interval (CI): 1.15~1.62) and AC Z-score (OR (95% CI): 1.32 (1.11~1.56)), but the relative excess risks attributable to interaction were nonsignificant (P>0.05). Conclusion. Maternal 25(OH)D deficiency and GDM may jointly increase the risk of excessive fetal growth. Interventions for pregnancies with GDM may be more beneficial for those with 25(OH)D deficiency than those without regarding risk of excessive fetal growth, if confirmed in a large sample.

scholarly journals Renin–angiotensin system blocker use and the risk of acute kidney injury after colorectal cancer surgery: a population-based cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032964
Author(s):  
Charlotte Slagelse ◽  
H Gammelager ◽  
Lene Hjerrild Iversen ◽  
Kathleen D Liu ◽  
Henrik T Toft Sørensen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Angiotensin Receptor Blockers ◽  
Kidney Injury ◽  
Population Based ◽  
Adjusted Risk ◽  
Increased Risk ◽  
The Impact ◽  
Postoperative Aki

ObjectivesIt is unknown whether preoperative use of ACE inhibitors (ACE-I) or angiotensin receptor blockers (ARBs) affects the risk of acute kidney injury (AKI) after colorectal cancer (CRC) surgery. We assessed the impact of preoperative ACE-I/ARB use on risk of AKI after CRC surgery.DesignObservational cohort study. Patients were divided into three exposure groups—current, former and non-users—through reimbursed prescriptions within 365 days before the surgery. AKI within 7 days after surgery was defined according to the current Kidney Disease Improving Global Outcome consensus criteria.SettingPopulation-based Danish medical databases.ParticipantsA total of 9932 patients undergoing incident CRC surgery during 2005–2014 in northern Denmark were included through the Danish Colorectal Cancer Group Database.Outcome measureWe computed cumulative incidence proportions (risk) of AKI with 95% CIs for current, former and non-users of ACE-I/ARB, including death as a competing risk. We compared current and former users with non-users by computing adjusted risk ratios (aRRs) using log-binomial regression adjusted for demographics, comorbidities and CRC-related characteristics. We stratified the analyses of ACE-I/ARB users to address any difference in impact within relevant subgroups.ResultsTwenty-one per cent were ACE-I/ARB current users, 6.4% former users and 72.3% non-users. The 7-day postoperative AKI risk for current, former and non-users was 26.4% (95% CI 24.6% to 28.3%), 25.2% (21.9% to 28.6%) and 17.8% (17.0% to 18.7%), respectively. The aRRs of AKI were 1.20 (1.09 to 1.32) and 1.16 (1.01 to 1.34) for current and former users, compared with non-users. The relative risk of AKI in current compared with non-users was consistent in all subgroups, except for higher aRR in patients with a history of hypertension.ConclusionsBeing a current or former user of ACE-I/ARBs is associated with an increased risk of postoperative AKI compared with non-users. Although it may not be a drug effect, users of ACE-I/ARBs should be considered a risk group for postoperative AKI.

Exposure to crystalline silica in Canadian workplaces and the risk of kidney cancer

2019 ◽  
Vol 76 (9) ◽  
pp. 668-671
Author(s):  
Cheryl E Peters ◽  
Laura Bogaert ◽  
Lidija Latifovic ◽  
Linda Kachuri ◽  
Shelley A Harris ◽  
...  
Keyword(s):  
Occupational Exposure ◽  
Kidney Cancer ◽  
Occupational Exposures ◽  
Population Based ◽  
Crystalline Silica ◽  
Three Dimensions ◽  
Cumulative Exposure ◽  
Increased Risk ◽  
Occupationally Exposed ◽  
Canadian Provinces

ObjectivesThe causes of kidney cancer are not well understood though occupational exposures are thought to play a role. Crystalline silica is a known human carcinogen, and despite previous links with kidney disease, there have been few studies investigating its association with kidney cancer. We addressed this research gap using a population-based case-control study of Canadian men.MethodsQuestionnaire data were obtained from individuals with histologically confirmed kidney cancer, and population-based controls recruited from eight Canadian provinces (1994–1997). An industrial hygienist characterised participants’ lifetime occupational exposure, and their confidence in the assessment (possibly, probably or definitely exposed) to silica on three dimensions (intensity, frequency and duration), and cumulative exposure was estimated. Logistic regression was used to estimate ORs and 95% CIs, adjusting for potential confounders.ResultsNearly half of the 689 kidney cancer cases (49%) and 2369 controls (44%) had ever been occupationally exposed to crystalline silica. In a fully adjusted model, workers ever-exposed to silica had a slightly increased risk of kidney cancer relative to those who were unexposed (OR 1.10, 95% CI 0.92 to 1.32). Odds were modestly (and generally not statistically significantly) increased for models with duration of exposure and cumulative exposure, though exposure-response relationships were not evident.ConclusionsOur findings do not provide evidence that occupational exposure to crystalline silica increases risk of kidney cancer in men.

scholarly journals Fetal growth and psychiatric and socioeconomic problems: population-based sibling comparison

2014 ◽  
Vol 205 (5) ◽  
pp. 355-361 ◽  
Author(s):  
Quetzal A. Class ◽  
Martin E. Rickert ◽  
Henrik Larsson ◽  
Paul Lichtenstein ◽  
Brian M. D'Onofrio
Keyword(s):  
Birth Weight ◽  
Fetal Growth ◽  
Population Based ◽  
Autism Spectrum ◽  
Swedish Population ◽  
Unmeasured Confounding ◽  
Lower Birth Weight ◽  
Sibling Comparison ◽  
Increased Risk ◽  
Socioeconomic Problems

BackgroundIt is unclear whether associations between fetal growth and psychiatric and socioeconomic problems are consistent with causal mechanisms.AimsTo estimate the extent to which associations are a result of unmeasured confounding factors using a sibling-comparison approach.MethodWe predicted outcomes from continuously measured birth weight in a Swedish population cohort (n = 3 291 773), while controlling for measured and unmeasured confounding.ResultsIn the population, lower birth weight (⩽2500 g) increased the risk of all outcomes. Sibling-comparison models indicated that lower birth weight independently predicted increased risk for autism spectrum disorder (hazard ratio for low birth weight = 2.44, 95% CI 1.99–2.97) and attention-deficit hyperactivity disorder. Although attenuated, associations remained for psychotic or bipolar disorder and educational problems. Associations with suicide attempt, substance use problems and social welfare receipt, however, were fully attenuated in sibling comparisons.ConclusionsResults suggest that fetal growth, and factors that influence it, contribute to psychiatric and socioeconomic problems.

scholarly journals Interpregnancy Interval and Subsequent Severe Maternal Morbidity: A Population-based Study from California over 16 years

2021 ◽  
Author(s):  
Can Liu ◽  
Jonathan M Snowden ◽  
Deirdre J Lyell ◽  
Elizabeth Wall-Wieler ◽  
Barbara Abrams ◽  
...  
Keyword(s):  
Maternal Age ◽  
Maternal Morbidity ◽  
Perinatal Outcomes ◽  
Population Based ◽  
Subsequent Pregnancy ◽  
Severe Maternal Morbidity ◽  
Interpregnancy Interval ◽  
Adjusted Risk ◽  
Index Pregnancy ◽  
Increased Risk

Abstract Interpregnancy interval (IPI) associates with adverse perinatal outcomes, but its contribution to severe maternal morbidity (SMM) remains unclear. We examined the association between IPI and SMM, using data linked across sequential pregnancies to women in California 1997-2012. Adjusting for confounders measured at the index pregnancy (i.e. the first in a pair of consecutive pregnancies), we estimated adjusted risk ratios (aRRs) of SMM related to the subsequent pregnancy. We further conducted within-mother comparisons and analyses stratified by parity and maternal age at the index pregnancy. Compared to 18-23 months, IPI&lt;6 months had same risk for SMM in between-mother comparison (aRR=0.96, 95%CI 0.91, 1.02) but lower risk in within-mother comparison (aRR=0.76, 95% confidence interval (CI) 0.67, 0.86). IPI 24-59 months and IPI≥60 months associated with increased risk of SMM in both between-mother (aRR=1.18, 95%CI 1.13, 1.23 and aRR=1.76, 95% CI 1.68, 1.85 respectively) and within-mother comparisons (aRR=1.22, 95%CI 1.11, 1.34 and aRR=1.88, 95% CI 1.66, 2.13 respectively). The association between IPI and SMM did not substantially differ by maternal age and parity. Longer IPI was associated with increased risk of SMM, which may be partly attributed to interpregnancy health.

scholarly journals Increased risk of monoclonal gammopathy in first-degree relatives of patients with multiple myeloma or monoclonal gammopathy of undetermined significance

Blood ◽  
2009 ◽  
Vol 114 (4) ◽  
pp. 785-790 ◽  
Author(s):  
Celine M. Vachon ◽  
Robert A. Kyle ◽  
Terry M. Therneau ◽  
Barbara J. Foreman ◽  
Dirk R. Larson ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Monoclonal Gammopathy ◽  
Population Based ◽  
Detection Methods ◽  
Shared Environment ◽  
Serum Samples ◽  
Adjusted Risk ◽  
First Degree Relatives ◽  
Increased Risk ◽  
Undetermined Significance

Abstract We examined whether monoclonal gammopathy of undetermined significance (MGUS) is increased in first-degree relatives of multiple myeloma (MM) or MGUS patients. Probands were recruited from a population-based prevalence study (MGUS) and the Mayo Clinic (MM). Serum samples were collected from first-degree relatives older than 40 years and subjected to electrophoresis and immunofixation. The prevalence of MGUS in relatives was compared with population-based rates. Nine-hundred eleven relatives of 232 MM and 97 MGUS probands were studied. By electrophoresis, MGUS was detected in 55 (6%) relatives, and immunofixation identified 28 additional relatives for an age- and sex-adjusted prevalence of 8.1% (95% CI, 6.3 to 9.8). The prevalence of MGUS in relatives increased with age (1.9%, 6.9%, 11.6%, 14.6%, 21.0% for ages 40-49, 50-59, 60-69, 70-79, ≥ 80 years, respectively; P < .001). Using similar MGUS detection methods, there was a higher risk of MGUS in relatives (age-adjusted risk ratio [RR], 2.6; 95% CI, 1.9 to 3.4) compared with the reference population. The increased risk was seen among relatives of MM (RR, 2.0; 95% CI, 1.4 to 2.8) and MGUS probands (RR, 3.3; 95% CI, 2.1 to 4.8). The increased risk of MGUS in first-degree relatives of MGUS or MM patients implies shared environment and/or genetics.

Adverse Prognostic Factors for Testicular Cancer–Specific Survival: A Population-Based Study of 27,948 Patients

2011 ◽  
Vol 29 (8) ◽  
pp. 963-970 ◽  
Author(s):  
Sophie D. Fosså ◽  
Milada Cvancarova ◽  
Linlin Chen ◽  
Annie L. Allan ◽  
Jan Oldenburg ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Marital Status ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Fold Increase ◽  
Population Based ◽  
Retroperitoneal Lymph Node Dissection ◽  
Cancer Specific Survival ◽  
Increased Risk ◽  
Specific Mortality

Purpose The prognostic significance of age at testicular cancer (TC) diagnosis, socioeconomic status (SES), race, and marital status on TC-specific mortality is not well-characterized. In a cancer that is so curable, it is important to identify any influence that confers an increased risk of TC-specific mortality. Patients and Methods Using multivariate cause-specific Cox regression models that accounted for competing risks, hazard ratios (HRs) were calculated for 10-year TC-specific mortality among 27,948 patients with TC reported to the Surveillance, Epidemiology and End Results program (1978 to 2006). Independent predictors were age at diagnosis, SES, race, marital status, extent of disease (EOD), calendar year of diagnosis, radiotherapy, and retroperitoneal lymph node dissection (RPLND). Results Compared with younger patients, diagnostic age 40+ was associated with increased mortality (seminoma, HR, 2.00, P < .001; nonseminoma, HR, 2.09; P < .001; most evident in metastatic disease, HR, 8.62; P < .001; HR, 6.35; P < .001, respectively). Unmarried men had two-to three-fold excess mortality compared to married men (HR, 2.97; P < .001; HR, 1.54; P < .001, respectively). Among nonseminoma patients, decreasing SES (P trend < .001) and nonwhite race (HR, 2.11; P < .001) increased mortality. Diagnosis after 1987 resulted in reduced mortality compared to earlier calendar years (HR, 0.58; P = .001; HR, 0.74; P = .001, respectively). Lack of RPLND was associated with seven-fold increase in death (P < .001). Conclusion TC-specific mortality is doubled among US patients diagnosed with seminoma or nonseminoma after age 40, even when initial treatment and EOD are taken into account. Among men with nonseminoma, nonwhite race and lower SES also significantly increase TC-specific mortality. Additional research is needed, enabling the development of interventional strategies and preventive approaches, as applicable.

scholarly journals Paternal Occupational Exposure to Endocrine-Disrupting Chemicals as a Risk Factor for Leukaemia in Children: A Case-Control Study from the North of England

2014 ◽  
Vol 2014 ◽  
pp. 1-7
Author(s):  
Mark S. Pearce ◽  
Lucy R. Baxter ◽  
Louise Parker
Keyword(s):  
Occupational Exposure ◽  
Case Control Study ◽  
Endocrine Disrupting Chemicals ◽  
Control Group ◽  
Live Births ◽  
The North ◽  
Increased Risk ◽  
Endocrine Disrupting ◽  
Control Study ◽  
Polychlorinated Organic Compounds

Occupations with exposures to a variety of chemicals, including those thought to be potential endocrine disruptors, have been associated with an increased risk of leukaemia in offspring. We investigated whether an association exists between paternal occupations at birth involving such exposures and risk of leukaemia in offspring. Cases (n=958) were matched, on sex and year of birth, to controls from two independent sources, one other cancers, one cancer-free live births. Paternal occupations at birth were classified, using an occupational exposure matrix, as having “very unlikely,” “possible,” or “likely” exposure to six groups of potential endocrine-disrupting chemicals. There was a significantly increased risk of acute nonlymphocytic leukaemia (ANLL) for polychlorinated organic compounds (OR 1.95, 95% CI 1.08–3.54) only in comparison with cancer-free controls, and for phthalates (OR 1.61, 95% CI 1.00–2.61) only with registry controls. A number of other, including inverse, associations were seen, but limited to one control group only. No associations were seen with likely paternal exposure to heavy metals. The associations identified in this study require further investigation, with better exposure and potential confounding (for example maternal variables) information, to evaluate the likelihood of true associations to assess whether they are real or due to chance.

scholarly journals Assessing the Ability of Hospital Diagnosis Codes to Detect Inpatient Exposure to Antibacterial Agents

2018 ◽  
Vol 39 (4) ◽  
pp. 377-382 ◽  
Author(s):  
Michael J. Ray ◽  
William E. Trick ◽  
Michael Y. Lin
Keyword(s):  
Broad Spectrum ◽  
Antibacterial Agents ◽  
Fold Increase ◽  
Medication Administration ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Hospital Inpatient ◽  
Adjusted Risk ◽  
Increased Risk ◽  
Patients At Risk

OBJECTIVEBecause antibacterial history is difficult to obtain, especially when the exposure occurred at an outside hospital, we assessed whether infection-related diagnostic billing codes, which are more readily available through hospital discharge databases, could infer prior antibacterial receipt.DESIGNRetrospective cohort study.PARTICIPANTSThis study included 121,916 hospitalizations representing 78,094 patients across the 3 hospitals.METHODSWe obtained hospital inpatient data from 3 Chicago-area hospitals. Encounters were categorized as “infection” if at least 1 International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) code indicated a bacterial infection. From medication administration records, we categorized antibacterial agents and calculated total therapy days using Centers for Disease Control and Prevention (CDC) definitions. We evaluated bivariate associations between infection encounters and 3 categories of antibacterial exposure: any, broad spectrum, or surgical prophylaxis. We constructed multivariable models to evaluate adjusted risk ratios for antibacterial receipt.RESULTSOf the 121,916 inpatient encounters (78,094 patients) across the 3 hospitals, 24% had an associated infection code, 47% received an antibacterial, and 13% received a broad-spectrum antibacterial. Infection-related ICD-9-CM codes were associated with a 2-fold increase in antibacterial administration compared to those lacking such codes (RR, 2.29; 95% confidence interval [CI], 2.27–2.31) and a 5-fold increased risk for broad-spectrum antibacterial administration (RR, 5.52; 95% CI, 5.37–5.67). Encounters with infection codes had 3 times the number of antibacterial days.CONCLUSIONSInfection diagnostic billing codes are strong surrogate markers for prior antibacterial exposure, especially to broad-spectrum antibacterial agents; such an association can be used to enhance early identification of patients at risk of multidrug-resistant organism (MDRO) carriage at the time of admission.Infect Control Hosp Epidemiol 2018;39:377–382

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