Gestational Smoking Research Articles

125 Correlation between the updated chronic hypertension guidelines and cesarean delivery

To determine whether the newly defined stage 1 hypertension (HTN1) is an independent risk factor for Cesarean in nulliparous patients delivering at ≥ 39w. This is a retrospective cohort study of nulliparous patients delivering ≥39w at one academic medical center from 2016-2019. Exposure was defined as HTN1 (SBP 130-139mmHg and/or DBP 80-89mmHg prior to 20w) and compared to normotensive patients (NBP). Exclusion criteria included ≥ stage 2 HTN, multiple gestation, planned Cesarean, or known fetal anomalies. The primary outcome was Cesarean during labor. Secondary outcomes included hypertensive disorders of pregnancy, operative vaginal delivery, birth weight under 10th%, NICU admission, and a composite of adverse neonatal outcomes including 10 minute Apgar score < 7, assisted ventilation, surfactant use, antibiotics for suspected sepsis, neurologic dysfunction, and significant birth injury. Statistical analysis was performed using SPSS 27. A total of 500 patients were included, 250 with HTN1 and 250 with NBP. At baseline, the groups differed with respect to maternal race, smoking, BMI, and gestational diabetes. A total of 38% patients with HTN1 required Cesarean during labor as compared to 22% with NBP (RR 1.556, 95% CI 1.233 to 1.963, p<0.001). This association remained significant after controlling for gestational age, induction, BMI, age, birth weight, race/ethnicity, diabetes, aspirin, smoking, autoimmune conditions, and other comorbidities in a logistic regression model (OR 1.61, 95%CI 1.02 to 2.55, p<0.040). When stratified based on the indication for Cesarean being nonreassuring fetal status, there was a higher rate of Cesarean in patients with HTN1 (RR 1.347, 95%CI 1.035 to 1.753, p=0.015). Patients with HTN1 did have an increased rate of hypertensive disorders of pregnancy as compared to patients with NBP (RR 1.788, 95%CI 1.303 to 2.452, p<0.001), but there were no significant differences in the other secondary outcomes. In nulliparous patients, HTN1 is an independent risk factor for Cesarean during labor.

Variation of DNA Methylation in Newborns Associated with Exhaled Carbon Monoxide during Pregnancy.

Fetal exposure to tobacco smoke is an adverse risk factor for newborns. A plausible mechanism of how this exposure may negatively impact long term health is differential methylation of deoxyribonucleic acid (DNAm) and its relation to birth weight. We examined whether self-reported gestational smoking status and maternal exhaled carbon monoxide (eCO) during early pregnancy were associated with methylation of cytosine by guanines (CpG) sites that themselves predicted birth weight. We focused first on CpGs associated with maternal smoking, and secondly, among these, on CpGs related to birth weight found in another cohort. Then in 94 newborns from the Breathing for Life Trial (BLT) DNAm levels in cord blood were determined using Infinium Methylation EPIC BeadChip measuring >850K CpGs. We regressed CpGs on eCO and tested via mediation analysis whether CpGs link eCO to birth weight. Nine smoking related CpG sites were significantly associated with birth weight. Among these nine CpGs the methylation of cg02264407 on the LMO7 gene was statistically significant and linked with eCO measurements. eCO greater than six ppm showed a 2.3% decrease in infant DNAm (p = 0.035) on the LMO7 gene. A 1% decrease in methylation at this site resulted in decreased birth weight by 44.8 g (p = 0.003). None of the nine CpGs tested was associated with self-reported smoking. This is the first study to report potential mediation of DNA methylation, linking eCO measurements during early pregnancy with birth weight.

Fear, anxiety and depression among pregnant women during COVID-19 pandemic: impacts of healthy eating behaviour and health literacy

Introduction The COVID-19 pandemic has been influencing people’s psychological health, especially in pregnant women. We aimed to examine associated factors of fear of COVID-19, anxiety and depression among pregnant women during the pandemic where the impacts of healthy eating behaviour (HES) and health literacy (HL) were emphasized. Methods A cross-sectional study was conducted between 14 February 2020 and 31 May 2020 in 18 health centres and hospitals across Vietnam. Data of 518 pregnant women were analysed, including socio-demographics, pregnant-related factors, HES, HL, health-related behaviours, fear of COVID-19 scale (FCoV-19S), anxiety (using the generalized anxiety disorder (GAD-7)) and depression (using the patient health questionnaire with 9 items (PHQ-9)). Regression analysis was utilized to explore the associations. Results Pregnant women with higher scores of HES and HL had lower likelihood of anxiety (odds ratio, OR, 0.79; 95% confidence interval (95%CI), 0.73, 0.87; p < .001; and OR, 0.94; 95%CI, 0.90, 0.99; p = .018) and depression (OR, 0.84; 95%CI, 0.78, 0.91; p < .001; and OR, 0.96; 95%CI, 0.91, 0.99; p = .044), respectively. Pregnant women being employed had a lower FCoV-19S score (regression coefficient, B, −1.46; 95%CI, −2.51, −0.40; p = .007). Besides, other significant predictors of anxiety were eating healthier during the pandemic, unchanged or more physical activity, elevated gestational age and smoking. Other significant predictors of depression were eating healthier during the pandemic, elevated gestational age and smoking. Conclusions Among others, HES and HL had positive impacts on protecting pregnant women against anxiety and depression. Improving HES and HL should be addressed as a strategic approach to improve reproductive health during the pandemic. KEY MESSAGE The COVID-19 pandemic influences antenatal mental disorders with the higher level as opposed to that before the pandemic. Healthy eating behaviour and better health literacy (HL) had critical roles in lowering prenatal anxiety and depression during the COVID-19 crisis. Strategic approaches for improving healthy eating and HL should be recommended for protecting pregnant women from mental health problems during the pandemic.

PREGNANCY RELATED PLASMA PROTEIN–A AND PREMATURE BIRTH

Introduction: Children born prematurely are at higher risk of mortality, morbidity, and impaired motor and cognitive development in childhood than prematurely born babies. Aim: To establish the relationship between the corresponding levels of pregnancy-related plasma protein-A (PAPP-A) and the frequency of premature birth. Materials and methods: The study is prospective. The data was collected through monitoring patients through a questionnaire and sonographic examination at 11-13 gestational weeks. The study excluded all known risk factors for preterm birth, such as previous preterm births, pregnant women with gestational diabetes, preeclampsia, hypertension, placenta previa, hydramnion, multiple pregnancies, smoking, structural and chromosomal abnormalities of the fetus and planned preterm birth. The data from the measured values of PAPP-A and the frequency of premature birth in 636 pregnant women were analyzed. Conclusions: PAPP-A levels are a statistically significant factor for preterm birth. It is expected with a 95% probability in the population with PAPP-A values below 0,515 that the cases with premature birth will be from 7 to 14 times more. Pregnant women with PAPP-A level less than 10th per cent are significantly associated with an increased risk of preterm birth.

Pregnancy by Assisted Reproductive Technology Is Associated with Shorter Telomere Length in Neonates.

Telomere length (TL) influences the development of lifestyle-related diseases, and neonatal TL may influence their prevalence. Various factors have been reported to affect neonatal TL. Although the fetus is exposed to multiple conditions in utero, the main factors affecting the shortening of neonatal TL are still not known. In this study, we sought to identify factors that influence fetal TL. A total of 578 mother-newborn pairs were included for TL analysis. TL was measured in genomic DNA extracted from cord blood samples using quantitative PCR. The clinical factors examined at enrollment included the following intrauterine environmental factors: maternal age, assisted reproductive technology (ART) used, body mass index (BMI), gestational diabetes mellitus (GDM), maternal stress, smoking, alcohol consumption, preterm delivery, small-for-gestational-age, neonatal sex, and placental weight. Univariate and multivariate regression analyses were used to verify the relationship between neonatal TL and these clinical factors. The median neonatal TL to single-copy gene ratio was 1.0. Pregnancy with ART was among the 11 factors associated with shorter neonatal TL. From multiple regression analysis, we determined that neonatal TL was significantly shorter for pregnancies in the ART group than in the other groups. We conclude that pregnancy with ART is associated with shorter neonatal TL.

Effect of early determinants on adolescent fat-free mass: RPS cohort of São Luís - MA.

ABSTRACTOBJECTIVE:To analyze the effects of early determinants on adolescent fat-free mass.METHODS:A cohort study with 579 adolescents evaluated at birth and adolescence in a birth cohort in São Luís, Maranhão. In the proposed model, estimated by structural equation modeling, socioeconomic status (SES) at birth, maternal age, pregestational body mass index (BMI), gestational smoking, gestational weight gain, type of delivery, gestational age, sex of the newborn, length and weight at birth, adolescent socioeconomic status, “neither study/nor work” generation, adolescent physical activity level and alcohol consumption were tested as early determinants of adolescent fat-free mass (FFM).RESULTS:A higher pregestational BMI resulted in higher FFM in adolescence (Standardized Coefficient, SC = 0.152; p < 0.001). Being female implied a lower FFM in adolescence (SC = −0.633; p < 0.001). The negative effect of gender on FFM was direct (SC = −0.523; p < 0.001), but there was an indirect negative effect via physical activity level (SC = −0.085; p < 0.001). Women were less active (p < 0.001). An increase of 0.5 kg (1 Standard Deviation, SD) in birth weight led to a gain of 0.25 kg/m2 (0.106 SD) in adolescent FFM index (p = 0.034). Not studying or working had a negative effect on the adolescent's FFM (SC = −0.106; p = 0.015). Elevation of 1 SD in the adolescent's physical activity level represented an increase of 0.5 kg/m2 (0.207 SD) in FFM index (p < 0.001).CONCLUSIONS:The early determinants with the greatest effects on adolescent FFM are gender, adolescent physical activity level, pregestational BMI, birth weight and belonging to the “neither-nor” generation.

A Prudent dietary pattern is inversely associated with liver fat content among multi-ethnic youth.

To identify dietary patterns associated with hepatic fat fraction (HFF), a measure of liver fat content and risk factor for non-alcoholic fatty liver disease, in a prospective study of 397 multi-ethnic youth. We obtained information on habitual dietary intake via the Block Kids Food Frequency Questionnaire at age 6 to 15 years ('T1') and 12 to 19 years ('T2'), and measured HFF using magnetic resonance imaging at T2. We derived dietary patterns via principal components analysis and examined associations with ln-transformed HFF using linear regression models that accounted for maternal education, gestational diabetes exposure and smoking habits; and child pubertal status, BMI and physical activity. At T1, none of the dietary patterns identified were associated with HFF measured at T2. At T2, a Prudent dietary pattern characterized by high fruit and vegetable intake was inversely associated with HFF (-0.08 [95% CI: -0.16, -0.00]). Similarly, increased adherence to the Prudent pattern across T1 and T2 corresponded with lower ln-HFF (-0.11 [-0.18, -0.04] units). On the other hand, adherence to a Western pattern comprising fried foods and refined carbohydrates at T2 correlated with higher HFF among non-Hispanic White participants (0.16 [0.06, 0.26]). These findings persisted after accounting for child BMI. Even in healthy youth, a diet high in fruits and vegetables is associated with lower HFF, whereas a diet high in fried foods and refined carbohydrates is related to higher HFF. Dietary changes may serve as an early preventive measure to mitigate liver fat accrual.

Maternal obesity is associated with phenotypic alterations in fetal immune cells by single-cell mass cytometry.

Prenatal exposure to metabolic dysregulation arising from maternal obesity can have negative health consequences in post-natal life. To date, the specific effects of maternal obesity on fetal immunity at a cellular level have not been well characterized. Using cord blood mononuclear cells (CBMCs) and cord plasma (n=9/group) isolated from infants born to women with a high body mass index (BMI>25kg/m2 ) compared to women with a normal BMI (18-25kg/m2 ), we evaluated differences in immune cell populations using single-cell mass cytometry (CyTOF). CBMCs were matched according to potentially confounding variables, such as maternal and gestational age, ethnicity, smoking status, and gravidity. Statistical results were adjusted for fetal sex. Data were analyzed by viSNE and FlowSOM softwares in Cytobank™ . In newborn CBMCs from women with high BMI, we observed changes in frequency and phenotype of immune cell populations, including significant increases in CD4+ T cells and decreases in myeloid cell populations. IL-12p40 and MDC concentrations were significantly elevated in the high BMI group compared to control. This study demonstrates an association between maternal obesity and fetal immunity. Our results warrant following long-term immunologic outcomes and associated clinical risks in children born to women with a high pre-pregnancy BMI.

Ambient fine particulate matter and preterm birth in Temuco, Chile: effect modification by maternal morbidity

Background: Exposure to fine ambient particulate matter (PM2.5) during pregnancy has been related to increased risk of preterm birth (PTB), with some evidence for differential vulnerability by maternal morbidity. We evaluated whether selected maternal characteristics modified the effect of PM2.5 and risk of PTB (gestational age &lt;37 weeks) in Temuco, a city in southern Chile heavily impacted by residential wood-burning for heating. Methods: Between 2009-2015, information on all live births from the regional public hospital in Temuco was collected (n=15,510). Exposure to PM2.5 in each trimester of pregnancy was estimated using a land-use regression model. Survival analysis was used to estimate the effects of exposure to PM2.5 in each trimester for risk of PTB adjusting for potential confounders. We tested an interaction between exposure in each trimester and the following maternal characteristics: gestational diabetes, hypertension, heart disease, smoking, preeclampsia, anemia, nutritional status and level of education. Models were stratified when significant interactions were observed. Hazard ratios (HRs) are reported. Results: Median (IQR) of PM2.5 exposure in the first, second and third trimester was 32.3 (14.3-59.9), 34.5 (15.5-59.6) and 33.6 (13.9-59.9) µg/m3, respectively. A 10 µg/m3 increase in PM2.5 exposure in the first and third trimesters related to increased risks of PTB: HR=1.13 (1.07-1.20) and HR=1.14 (1.07-1.22), respectively. We did not observe significant interactions for: gestational diabetes, hypertension, heart disease, and smoking. Higher HRs of PTB, on the order of 12-38%, were observed for exposures during first and third trimester among women with preeclampsia, chronic anemia, overweight/obesity and lower education. In contrast, underweight women, seemed protected to the effects of PM2.5. Conclusions: In a city dominated by residential wood-burning, with PM2.5 levels exceeding WHO recommendations, we observed that women with comorbidities (preeclampsia, anemia, overweight/obese) and lower education were more vulnerable to present PTB when facing higher PM2.5 exposures.

Prenatal exposure to trichlorinated biphenyls (PCB 18 and 28) is associated with child hyperactivity 8 years later

Background: Polychlorinated biphenyl (PCB) exposure may be associated with neurodevelopmental problems, particularly hyperactivity and attention deficit/hyperactivity disorder (ADHD). In animal studies, exposure to PCBs increased hyperactivity, decreased dopamine in key brain regions, and PCB 28, 47, and 52 were found in those regions. Dopamine has also been implicated in the etiology of ADHD in humans. Most epidemiologic studies have relied on maternal blood rather than newborn blood to quantify prenatal PCB exposure, and neonatal levels might better reflect fetal exposure. Methods: Whole-blood concentrations of PCB congeners #8, 15, 18, 28, 52, 70, 95, 101, 138, and 153 were measured in the Upstate KIDS study, a population-based longitudinal study of children born in New York State between 2008-2010, using newborn dried blood spots (n=2610). PCBs were quantified (ng/mL) using gas chromatography-DFS high resolution mass spectrometry. Individual blood spots provided insufficient volume for assays, so pools of 5 were used, and individual values were derived from pools. Child hyperactivity symptoms (Mean=4.82, SD=5.13) were assessed by maternal report on the Vanderbilt ADHD Parent Rating Scale when children were 8 years of age. Models were adjusted for child age, sex, and plurality, and maternal age, education, race/ethnicity, insurance status, marital status, pre-pregnancy body mass index, gestational weight gain, parity, and pregnancy smoking. Results: Each 1 ng/mL increase in PCB 18 and PCB 28 was associated with 3.63 (95%CI=0.42-6.84) and 4.08 (95%CI=0.61-7.55) more points in hyperactive behavioral ratings, respectively. Except for PCB 15, other PCBs also had positive but imprecise relations with hyperactivity. Conclusions: Levels of PCBs in newborn blood spots were associated with less than 1 standard deviation higher hyperactivity 8 years later. Even low-level prenatal exposure may have long-term behavioral consequences.

Determinants of pre-eclampsia among pregnant women attending perinatal care in hospitals of the Omo district, Southern Ethiopia.

Pre‐eclampsia is estimated to cause 70 000 maternal death globally every year, with the majority of deaths in low‐ and middle‐income countries. In Ethiopia, pre‐eclampsia causes 16% of direct maternal deaths. Despite the high burden of disease, pre‐eclampsia remains poorly studied in low and middle‐income countries. In this study, we aimed to identify risk factors for pre‐eclampsia in pregnant women attending hospitals in the Omo district of Southern Ethiopia. Data were collected via face‐to‐face interviews. Logistic regression analysis was computed to examine the relationship between the independent variable and pre‐eclampsia. An adjusted odds ratio (AOR) with the corresponding 95% confidence interval (CI) excluding 1 in the multivariable analysis was considered to identify factors associated with pre‐eclampsia at a p‐value of <0.05. A total of 167 cases and 352 controls were included. Factors that were found to have a statistically significant association with pre‐eclampsia were primary relatives who had a history of chronic hypertension (AOR 2.1, 95% CI: 1.06‐4.21), family history of diabetes mellitus (AOR 2.35; 95% CI: 1.07‐5.20), preterm gestation (AOR = 1.56, 95% CI: 1.05‐2.32), and pre‐conception smoking exposure (AOR = 4.16, 95% CI: 1.1‐15.4). The study identified that a family history of chronic illnesses and diabetes mellitus, preterm gestation, and smoking exposure before conception were the risk factors for pre‐eclampsia. Presumably, addressing the identified risk factors may give further insight into where interventions and resources should be focused, as well as having an understanding of the burden of disease.

Gestational Smoking and Hypertension as Predictors of Working Memory Functioning in Childhood Attention-Deficit/Hyperactivity Disorder.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition affecting between 5 and 8% of all children and adolescents, characterized by impairing levels of inattention, hyperactivity, and impulsivity. Existing cognitive models of ADHD have placed working memory (WM) deficits at the core of ADHD and suggest that primary WM deficits may also underlie the additional deficits associated with the condition. Although not all children with ADHD show WM deficits, those with such deficits have been found to have worse functional outcomes when compared to their diagnosed peers with typical WM functioning. Even so, contributors to the variability of impaired WM functioning seen within this population remain unknown. In the present study, we examined the association between two known prenatal and perinatal risk factors for impaired cognitive functioning – gestational smoking and hypertension – in three independent samples of children and adolescents with ADHD (samples varied with respect to sample size and WM measurement procedures). Contrary to hypotheses and existing literature, presence of high blood pressure during pregnancy was unexpectedly found to be a positive predictor of offspring WM capacity in one of three samples (a sample of all girls with ADHD). Implications and considerations for future research are discussed.

Grand-maternal lifestyle during pregnancy and body mass index in adolescence and young adulthood: an intergenerational cohort study

To examine associations of healthy lifestyle during pregnancy with body mass index (BMI) and risk of overweight or obesity of grandchildren during adolescence and young adulthood. Our study population included 14,001 grandmother–mother–child triads comprised of participants of two ongoing prospective cohort studies of related individuals. We used self-reported grand-maternal gestational weight gain, diet, physical activity, and smoking during pregnancy to create a lifestyle score ranged from 0 to 12, with a higher score indicating healthier lifestyle. Grandchild BMI was self-assessed in follow-up questionnaires. Compared with individuals whose grandmothers had the least healthy lifestyle during pregnancy, individuals whose grandmothers had the most healthy lifestyle had 0.17 (95% CI 0.01, 0.33; P for trend = 0.05) kg/m2 lower BMI and 7% (95% CI 2%, 12%; P for trend = 0.001) lower risk of overweight or obesity during adolescence and young adulthood. The inverse associations between grand-maternal lifestyle and BMI in grandchildren were mainly mediated by maternal pre-pregnancy BMI (mediation effect: 64%; P value = 0.001). Overall, maternal BMI, along with maternal socioeconomic status and lifestyle factors in the second and third generations accounted for all of the inter-generational association (mediation effect: 99%; P value < 0.001). The inverse associations of grand-maternal lifestyle with BMI of offspring were not modified by grand-maternal pre-pregnancy BMI, grandchild age, or grandchild gender. Grandchildren of women who had the healthiest lifestyles during pregnancy defined by no excess gestational weight gain, no smoking, a healthy diet and being physically active, were less likely to be overweight or obese in adolescence and early adulthood.

Evaluating the long-term impact of an antenatal healthy lifestyle service: retrospective cohort study

Abstract Introduction Maternal obesity is associated with increased odds of obesity in the offspring. The antenatal period is considered a good opportunity to promote lifestyle improvements. The long-term impact of maternal characteristics and attending a maternal healthy lifestyle service (MHLS) on childhood risk of overweight was evaluated. Methods Women with a body mass index (BMI) ≥35kg/m² referred to one MHLS in England from 2009 were included in a retrospective cohort study. Pseudo-anonymised data from the National Child Measurement Programme were matched to data from women referred to this service. Children were classified as 'overweight' if their weight centile was ≥95th centile at 6-8 weeks or 9-12 months or their BMI was ≥95th centile at school entry (4-5 years). Univariate logistic regression determined the odds ratios (OR) and 95% confidence intervals (CI) of childhood overweight according to uptake of the MHLS, gestational weight gain (GWG) and other characteristics. Results The proportion of infants classified as overweight increased over time [2.8% at 6-8 weeks (20/713), 13.8% at 9-12 months (89/647) and 30.4% at school entry (206/677)]. The odds of overweight increased with each unit increase in birthweight (OR 39.9 95%CI 13.4-119.1 at 6-8 weeks, OR 3.7 95%CI 2.4-5.7 at 9-12 months and OR 1.9 95%CI 1.4-2.5 at school entry). GWG above Institute of Medicine recommendations increased the odds of overweight at 6-8 weeks (OR 2.9 95%CI 1.1-7.4). Women living in the most deprived quartile (OR 1.6 95%CI 1.1-2.2) or who smoked when booking for antenatal care (OR 1.5 95%CI 1.0-2.2) had increased odds of infant with BMI ≥95th centile at school entry. Attendance at a MHLS and maternal BMI did not significantly impact on child overweight at any time; however the sample only included women with a raised BMI. Conclusions Lifestyle during pregnancy, GWG and other wider health determinants such as deprivation have long lasting effects on infant health and childhood obesity. Key messages Overweight at school entry is high (&amp;gt;30%) for women with a raised BMI when booking for antenatal care. Addressing maternal socioeconomic conditions, gestational weight gain and smoking during pregnancy are key priorities for the long-term health of children.

Determinants of placental leptin receptor gene expression and association with measures at birth

IntroductionThe leptin signalling pathway is important in metabolic health during pregnancy. However, few studies have investigated the determinants and extent of leptin receptor gene (LEPR) expression in the placenta, nor the relationship with infant health in early life. Here, we investigate the genetic and maternal in utero determinants of placental LEPR expression, and whether this expression is linked to anthropometric and inflammatory measures at birth in healthy newborns in the Barwon Infant Study. MethodsPlacental LEPR expression was measured using RT-qPCR (n = 854 placentae). Associations between genetic variation in LEPR, maternal in utero factors, measures at birth and placental LEPR expression were assessed using multivariable linear regression modelling. ResultsWe found that the genotype at two intronic SNPs, rs9436301 and rs9436746, was independently associated with placental LEPR expression. Maternal pre-pregnancy body mass index, gestational diabetes mellitus, weight gain and smoking in pregnancy were not associated with LEPR expression. Placental LEPR expression was negatively associated with high sensitivity C-Reactive Protein in umbilical cord blood, which persisted after adjustment for potential confounders. DiscussionOverall, our findings suggest that genetic variation in LEPR plays a key role in regulating placental LEPR expression, which is in turn is associated with inflammatory markers in cord blood at birth. Further studies encompassing other aspects of leptin signalling are warranted to understand if these relationships are causal and have health implications.

Family history of chronic illness, preterm gestational age and smoking exposure before pregnancy increases the probability of preeclampsia in Omo district in southern Ethiopia: a case-control study

BackgroundPreeclampsia is a complex syndrome that is considered a disorder specific to pregnancy. However, research indicates that diffuse maternal endothelial damage may persist after childbirth. On the other hand, women who had a history of pre-eclampsia are at an increased risk of vascular disease. Considering that the multifactorial nature of pre-eclampsia in a remote health setting, knowledge of risk factors of preeclampsia gives epidemiological significance specific to the study area. Therefore, this study aimed to identify the determinants of preeclampsia among pregnant women attending perinatal service in Omo district Hospitals in southern Ethiopia.MethodsAn institution-based unmatched case-control study design was conducted among women visiting for perinatal service in Omo District public hospitals between February to August 2018. A total of 167 cases and 352 controls were included. Data were collected via face-to-face interviews. Bivariable and multivariable logistic regression analysis were computed to examine the effect of the independent variable on preeclampsia using Statistical Package for Social Sciences version 26 window compatible software. Variables with a p-value of less than 0.05 were considered statistically significant.ResultsFactors that were found to have a statistically significant association with pre-eclampsia were primary relatives who had history of chronic hypertension (AOR 2.1, 95% CI: 1.06–4.21), family history of diabetes mellitus (AOR 2.35; 95% CI: 1.07–5.20), preterm gestation(AOR = 1.56, 95%CI, 1.05–2.32), and pre-conception smoking exposure (AOR = 4.16, 95%CI, 1.1–15.4).ConclusionsThe study identified the risk factors for pre-eclampsia. Early detection and timely intervention to manage pre-eclampsia, and obstetric care providers need to emphasize women at preterm gestation and a history of smoking before pregnancy.

Gestational Exposure to Cigarette Smoke Suppresses the Gasotransmitter H2S Biogenesis and the Effects Are Transmitted Transgenerationally.

Rationale: Gestational cigarette smoke (CS) impairs lung angiogenesis and alveolarization, promoting transgenerational development of asthma and bronchopulmonary dysplasia (BPD). Hydrogen sulfide (H2S), a proangiogenic, pro-alveolarization, and anti-asthmatic gasotransmitter is synthesized by cystathionine-γ-lyase (CSE), cystathionine-β-synthase (CBS), and 3-mercaptopyruvate sulfur transferase (3MST).Objective: Determine if gestational CS exposure affected the expression of H2S synthesizing enzymes in the mouse lung and human placenta.Methods: Mice were exposed throughout gestational period to secondhand CS (SS) at approximating the dose of CS received by a pregnant woman sitting in a smoking bar for 3 h/days during pregnancy. Lungs from 7-days old control and SS-exposed pups and human placenta from mothers who were either non-smokers or smokers during pregnancy were analyzed for expression of the enzymes.Measurements: Mouse lungs and human placentas were examined for the expression of CSE, CBS, and 3MST by immunohistochemical staining, qRT-PCR and/or Western blot (WB) analyses.Results: Compared to controls, mouse lung exposed gestationally to SS had significantly lower levels of CSE, CBS, and 3MST. Moreover, the SS-induced suppression of CSE and CBS in F1 lungs was transmitted to the F2 generation without significant change in the magnitude of the suppression. These changes were associated with impaired epithelial-mesenchymal transition (EMT)—a process required for normal lung angiogenesis and alveolarization. Additionally, the placentas from mothers who smoked during pregnancy, expressed significantly lower levels of CSE, CBS, and 3MST, and the effects were partially moderated by quitting smoking during the first trimester.Conclusions: Lung H2S synthesizing enzymes are downregulated by gestational CS and the effects are transmitted to F2 progeny. Smoking during pregnancy decreases H2S synthesizing enzymes is human placentas, which may correlate with the increased risk of asthma/BPD in children.

Impact of smoking on gestational diabetes mellitus and offspring birthweight in primiparous women

Smoking has been shown to affect glucose homeostasis and increase the risk for type 2 diabetes mellitus. Further, gestational diabetes mellitus (GDM) and smoking are known to influence offspring birthweight. The effect of smoking on glucose homeostasis in pregnancy is less studied and the findings are inconsistent. The aim of this study was to evaluate the effect of smoking on risk for GDM and to evaluate the impact of smoking and GDM on offspring birthweight. This is an observational cohort study encompassing 4111 Finnish primiparous women from the city of Vantaa, Finland, who delivered a singleton child between 2009 and 2015. Data were obtained from Finnish national registers. Study participants had complete oral glucose tolerance test results and were divided into three groups according to smoking status: non-smokers (I), smokers who quit during first trimester (II), and smokers who continued after first trimester (III). Prevalence of GDM was 19.8%, 24.3%, and 26.6% in non-smokers, those who quit, and those who continued after the first trimester, respectively (P=.004 for differences between groups). The odds ratio for GDM in smokers who continued after the first trimester compared with non-smokers was 1.65 (95% CI 1.09-2.57) after adjustments for age, prepregnancy body mass index, education, and cohabitation. In women without GDM, offspring birthweight was lowest in those who continued smoking after the first trimester (P=.010 for differences between groups). In women with GDM, smoking status did not influence offspring birthweight. Smoking during pregnancy is associated with an increased risk for GDM. Offspring birthweight is lowest in women who continue smoking after the first trimester. If pregnancy is complicated by GDM, offspring birthweight is not influenced by smoking.

1245-P: Maternal HbA1c Is Related to Childhood Fat Mass and Only Partially Mediated by Neonatal Fat Mass

Maternal diabetes during pregnancy impacts offspring body composition and has been associated with greater offspring adiposity across the life course. However, the extent to which the relationship between maternal glycemia and offspring adiposity during later life is independent of neonatal adiposity is unclear. In a prospective study of 544 mother-child pairs in the Healthy Start Study, we estimated the total effect of maternal HbA1c on childhood fat mass (FM) %, and the direct effect independent of neonatal FM %. We measured maternal fasting HbA1c at a gestational age of 20-34 weeks, and offspring FM % using air displacement plethysmography at birth and during childhood (age 4-7 y). We used multivariable linear regression with HbA1c tertiles (T1 [reference], T2, T3) as the exposure, neonatal FM % as the mediator, and childhood FM % as the outcome. A counterfactual-based approach was used to estimate total and direct effects, while also accounting for exposure-mediator interaction. Covariates were maternal race, education, gestational weight gain and smoking, and offspring sex and age. The medians (interquartile ranges) of the HbA1c tertiles were T1: 4.80 (3.70, 4.90), T2: 5.05 (5.00, 5.10), and T3: 5.30 (5.20, 6.30). The estimated total effect on child FM % was 1.27 (95% CI: 0.00, 2.54) units higher for T2 vs. T1, and 1.53 (0.23, 2.82) units higher for T3 vs. T1 (P-trend=0.02). After adjusting for pre-pregnancy BMI, the total effect was 1.18 (-0.09, 2.44) and 1.31 (0.00, 2.62) units higher for T2 vs. T1 and T3 vs. T1, respectively (P-trend=0.04). The direct effect after accounting for neonatal FM % was slightly attenuated (T2 vs. T1: 1.14 [-0.11, 2.39], T3 vs. T1: 1.20 [-0.11, 2.51]; P-trend=0.07). Excluding women with gestational diabetes mellitus (n=27) did not substantially impact the results. Our data suggest that maternal glycemia during pregnancy, even within normal levels, may influence childhood adiposity through pathways that are in part mediated by programming of neonatal adiposity. Disclosure E.C. Francis: None. B. Ringham: None. D.H. Glueck: None. W. Perng: None. D. Dabelea: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (5R01DK076648-10)

A Prospective Investigation of Cesarean Birth with Total and Truncal Fat Mass in Early Adolescence

Abstract Objectives Nearly 1.3 million cesarean deliveries are performed each year in the United States, resulting in the birth of one third of all children nationwide. A higher risk of childhood obesity has been observed among children born by cesarean, but this literature is inconsistent. We investigated differences in total and truncal fat mass during early adolescence among offspring born by cesarean compared to those born by vaginal delivery. Methods This prospective study includes adolescents (median age 12.8 years) whose mothers enrolled in while pregnant in Project Viva between 1999 and 2002, and who have been followed since birth. A total of 740 adolescents had available total and truncal fat mass measured using Dual Energy X-Ray Absorptiometry (DXA) at the early adolescent in-person visit. We abstracted delivery mode from electronic medical records. We used multivariable linear regression models to estimate the difference in total and truncal fat mass indices (FMI, kg/m,2) among adolescents born by cesarean compared to those born by vaginal delivery while adjusting for confounders. We used stabilized inverse probability weights to account for censoring. Results Mean (SD) maternal age was 32.2 (5.4) years and pre-pregnancy BMI was 25.0 (5.3) kg/m,2. A total of 157 (21%) of the adolescents were born by cesarean delivery and 51%were female; mean (SD) total and truncal FMI were 6.3 (3.1) and 2.4 (1.5) kg/m,2 respectively. Adolescents born by cesarean vs. vaginal delivery had significantly higher total [β (95% CI) = 0.78 (0.23, 1.33) kg/m,2] and truncal [β (95% CI) = 0.35 (0.08, 0.61) kg/m,2] FMI than those born by vaginal delivery in models adjusted for child age and sex, and maternal age, education and race/ethnicity. These associations were attenuated and no longer statistically significant after further adjusting for maternal pre-pregnancy BMI [β (95% CI) = 0.45 (−0.06, 0.96) kg/m,2 for total and 0.19 (−0.05, 0.44) kg/m,2 for truncal FMI]. Additional adjustment for gestational weight gain, smoking and paternal BMI did not substantially change the results. Conclusions These data suggest that the association between birth by cesarean delivery and adolescent adiposity is largely explained by maternal pre-pregnancy BMI. Funding Sources NIH grants R01HD093761, R01HD034568, R01ES024765, and UH3 OD023286.