Publications by authors named "Edmond Shenassa"

60 Publications

Joint effects of ethnic enclave residence and ambient volatile organic compounds exposure on risk of gestational diabetes mellitus among Asian/Pacific Islander women in the United States.

Environ Health 2021 May 8;20(1):56. Epub 2021 May 8.

Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, MSC, Bethesda, MD, 7004, USA.

Background: Asian/Pacific Islander (API) communities in the United States often reside in metropolitan areas with distinct social and environmental attributes. Residence in an ethnic enclave, a socially distinct area, is associated with lower gestational diabetes mellitus (GDM) risk, yet exposure to high levels of air pollution, including volatile organic compounds (VOCS), is associated with increased GDM risk. We examined the joint effects of ethnic enclaves and VOCs to better understand GDM risk among API women, the group with the highest prevalence of GDM.

Methods: We examined 9069 API births in the Consortium on Safe Labor (19 hospitals, 2002-2008). API ethnic enclaves were defined as areas ≥66th percentile for percent API residents, dissimilarity (geographic dispersal of API and White residents), and isolation (degree that API individuals interact with another API individual). High levels of 14 volatile organic compounds (VOC) were defined as ≥75th percentile. Four joint categories were created for each VOC: Low VOC/Enclave (reference group), Low VOC/No Enclave, High VOC/Enclave, High VOC/No Enclave. GDM was reported in medical records. Hierarchical logistic regression estimated odds ratios (OR) and 95% confidence intervals (95%CI) between joint exposures and GDM, adjusted for maternal factors and area-level poverty. Risk was estimated for 3-months preconception and first trimester exposures.

Results: Enclave residence was associated with lower GDM risk regardless of VOC exposure. Preconception benzene exposure was associated with increased risk when women resided outside enclaves [High VOC/No Enclave (OR:3.45, 95%CI:1.77,6.72)], and the effect was somewhat mitigated within enclaves, [High VOC/Enclave (OR:2.07, 95%:1.09,3.94)]. Risks were similar for 12 of 14 VOCs during preconception and 10 of 14 during the first trimester.

Conclusions: API residence in non-enclave areas is associated with higher GDM risk, regardless of VOC level. Ethnic enclave residence may mitigate effects of VOC exposure, perhaps due to lower stress levels. The potential benefit of ethnic enclaves warrants further study.
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http://dx.doi.org/10.1186/s12940-021-00738-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8106843PMC
May 2021

Maternal smoking during pregnancy, offspring smoking, adverse childhood events, and risk of major depression: a sibling design study.

Psychol Med 2021 Apr 26:1-11. Epub 2021 Apr 26.

Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.

Background: Evidence of a biologically plausible association between maternal smoking during pregnancy (MSP) and the risk of depression is discounted by null findings from two sibling studies. However, valid causal inference from sibling studies is subject to challenges inherent to human studies of MSP and biases particular to this design. We addressed these challenges in the first sibling study of MSP and depression conducted among adults past the peak age for the onset of depression, utilizing a prospectively collected and biologically validated measure of MSP and accounting for non-shared as well as mediating factors.

Methods: We fit GEE binomial regression models to correct for dependence in the risk of depression across pregnancies of the same mother. We also fit marginal structural models (MSM) to estimate the controlled direct effect of MSP on depression that is not mediated by the offspring's smoking status. Both models allow the estimation of within- and between-sibling risk ratios.

Results: The adjusted within-sibling risk ratios (RRW) from both models (GEE: RRW = 1.97, CI 1.16-3.32; MSM: RRW = 2.08, CI 1.04-4.17) evinced an independent association between MSP and risk of depression. The overall effects from a standard model evinced lower associations (GEE: RRT = 1.12, CI 0.98-1.28; MSM: RRT = 1.18, CI 1.01-1.37).

Conclusions: Based on within-sibling information free of unmeasured shared confounders and accounting for a range of unshared factors, we found an effect of MSP on the offspring's risk of depression. Our findings, should they be replicated in future studies, highlight the importance of considering challenges inherent to human studies of MSP and affective disorders.
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http://dx.doi.org/10.1017/S0033291721001392DOI Listing
April 2021

Antepartum Depression and Preterm Birth: Pathophysiology, Epidemiology, and Disparities due to structural racism.

Curr Psychiatry Rep 2021 02 25;23(3):14. Epub 2021 Feb 25.

Maternal & Child Health Program, Department of Family Science; and Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA.

Purpose Of Review: Informed by the evidence of links between physiology of stress and parturition, we review recent epidemiologic evidence (2015-2020) of antenatal depression as a risk factor for preterm birth (PTB). We also explain racial/ethnic disparities in depression and preterm birth as a consequence of structural racism.

Recent Findings: Epidemiologic evidence is consistent in linking antepartum depression with an elevated risk of PTB. Antidepressant usage has been linked with an elevated risk of PTB. However, recent evidence suggests that severity of depression is the underlying driver of the elevated risk attributed to antidepressant usage. The number of depressive symptoms, as a proxy for severity of maternal stress, may be a more informative predictor of PTB than criterion based predictors. Across various study designs, measurement modalities, and populations, antenatal depression predicts an elevated risk of delivering preterm. The physiology of stress provides a plausible explanation for this observation. Excessive stress-induced elevations in maternal and then fetal HPA hormones can alter maternal and fetal homeostasis and hasten the timing of parturition. Antenatal depression and exposure to structural racism are two stressors that can trigger the maternal stress response. Chronically elevated levels of stress hormones among women of color in the USA provide a likely physiologic explanation for Black-White disparities in the risk of PTB. Focusing on the number of depressive symptoms as the more informative predictor of PTB raises several questions. We consider these questions as well as directions for future research in the context of recent advances in the field.
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http://dx.doi.org/10.1007/s11920-021-01223-1DOI Listing
February 2021

Concomitant exposure to area-level poverty, ambient air volatile organic compounds, and cardiometabolic dysfunction: a cross-sectional study of U.S. adolescents.

Ann Epidemiol 2020 08 5;48:15-22. Epub 2020 Jun 5.

Public Health Program, School of Medicine & Health Sciences, University of North Dakota, Grand Forks.

Purpose: A key to better understanding the influence of the place of residence on cardiometabolic function is the effect of concomitant exposure to both air pollution and residence in economically marginalized areas. We hypothesized that, among adolescents, the association between air pollution and cardiometabolic function is exacerbated among residents of economically marginalized areas.

Methods: In this cross-sectional study, individual-level data on cardiometabolic function collected from a representative sample of U.S. adolescents in the National Health and Nutrition Examination Survey (n = 10,415) were merged with data on area-level poverty (U.S. decennial survey and American Community Survey) and air pollution levels (National-Scale Air Toxics Assessment ) using contemporary census-tract identifiers. We excluded respondents who were pregnant, had hypertension or diabetes or using medication for hypertension or diabetes, or with missing data on outcome variables.

Results: We observed a significant interaction between area-level poverty and air pollution. Among residents of high-poverty areas, exposure to high levels of air pollution predicted a 30% elevated odds of cardiometabolic dysfunction (OR = 1.30; 95% CI: 1.04, 1.61), whereas in low-poverty areas, exposure to high levels of air pollution was not associated with elevated odds of cardiometabolic dysfunction (OR = 1.04; 95% CI: 0.85, 1.28).

Conclusions: Our findings suggest that the cardiometabolic consequences of air pollution are more readily realized among residents of economically marginalized areas. Structural remedies are discussed.
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http://dx.doi.org/10.1016/j.annepidem.2020.05.014DOI Listing
August 2020

Stressful life events, the incidence of infertility, and the moderating effect of maternal responsiveness: a longitudinal study.

J Dev Orig Health Dis 2021 Jun 3;12(3):465-473. Epub 2020 Aug 3.

Maternal & Child Health Program, Department of Family Science, School of Public Health, University of Maryland, 4200 Valley Dr., Suite 1142, College Park, MD20742, USA.

Although the association between stress and poor reproductive health is well established, this association has not been examined from a life course perspective. Using data from the National Longitudinal Survey of Youth 1997 cohort (N = 1652), we fit logistic regression models to test the association between stressful life events (SLEs) (e.g., death of a close relative, victim of a violent crime) during childhood, adolescence, and early adulthood and later experiences of infertility (inability to achieve pregnancy after 12 months of intercourse without contraception) reported by female respondents. Because reactions to SLEs may be moderated by different family life experiences, we stratified responses by maternal responsiveness (based on the Conger and Elder Parent-Youth Relationship scale) in adolescence. After adjusting for demographic and environmental factors, in comparison to respondents with one or zero SLEs, those with 3 SLEs and ≥ 4 SLEs had 1.68 (1.16, 2.42) and 1.88 (1.38, 2.57) times higher odds of infertility, respectively. Respondents with low maternal responsiveness had higher odds of infertility that increased in a dose-response manner. Among respondents with high maternal responsiveness, only those experiencing four or more SLEs had an elevated risk of infertility (aOR = 1.53; 1.05, 2.25). In this novel investigation, we demonstrate a temporal association between the experience of SLEs and self-reported infertility. This association varies by maternal responsiveness in adolescence, highlighting the importance of maternal behavior toward children in mitigating harms associated with stress over the life course.
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http://dx.doi.org/10.1017/S2040174420000690DOI Listing
June 2021

Sex-Specific Associations Between Area-Level Poverty and Cardiometabolic Dysfunction Among US Adolescents.

Public Health Rep 2020 01 14;135(1):47-55. Epub 2019 Nov 14.

Department of Family Science, Maternal and Child Health Program, University of Maryland College Park, College Park, MD, USA.

Objective: Cardiometabolic disease is the leading cause of mortality in the United States. Cardiometabolic function during adolescence predicts future cardiometabolic disease, yet few studies have examined early determinants of cardiometabolic function. Informed by evidence of sex differences in the prevalence and severity of cardiometabolic disorders and evidence of sexual dimorphism in the stress response, we examined sex differences in the association between living in poverty and cardiometabolic function during adolescence, a precursor of later cardiometabolic disorders.

Methods: We linked data from 10 415 adolescents aged 12-19 in the National Health and Nutrition Examination Survey (1999-2012) with US Census-tract data on area-level poverty (percentage of the population living in poverty, grouped into quartiles). We parameterized cardiometabolic dysfunction by summing the scores of 6 cardiometabolic biomarkers, grouped into quintiles. Hierarchical ordinal models estimated associations.

Results: Compared with residents in low-poverty areas, residents in high-poverty areas had elevated odds of cardiometabolic dysfunction (highest quartile of poverty odds ratio [OR] = 1.27; 95% confidence interval [CI], 1.08-1.50). This association was more pronounced among boys than girls (highest quartile of poverty for boys: OR = 1.36; 95% CI, 1.10-1.70; highest quartile of poverty for girls: OR = 1.17; 95% CI, 0.94-1.47).

Conclusion: Our study supports the existence of sex-specific associations. These results highlight the potential for community-based programs, such as housing assistance, to improve population health.
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http://dx.doi.org/10.1177/0033354919884303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7119245PMC
January 2020

Black-White Disparities in Preterm Birth: Geographic, Social, and Health Determinants.

Am J Prev Med 2019 11 25;57(5):675-686. Epub 2019 Sep 25.

Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland; Department of Epidemiology & Biostatistics, School of Public Health, University of Maryland, College Park, Maryland; Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island.

Introduction: Reducing racial/ethnic disparities in preterm birth is a priority for U.S. public health programs. The study objective was to quantify the relative contribution of geographic, sociodemographic, and health determinants to the black, non-Hispanic and white, non-Hispanic preterm birth disparity.

Methods: Cross-sectional 2016 U.S. birth certificate data (analyzed in 2018-2019) were used. Black-white differences in covariate distributions and preterm birth and very preterm birth rates were examined. Decomposition methods for nonlinear outcomes based on logistic regression were used to quantify the extent to which black-white differences in covariates contributed to preterm birth and very preterm birth disparities.

Results: Covariate differences between black and white women were found within each category of geographic, sociodemographic, and health characteristics. However, not all covariates contributed substantially to the disparity. Close to 38% of the preterm birth and 31% of the very preterm birth disparity could be explained by black-white covariate differences. The largest contributors to the disparity included maternal education (preterm birth, 11.3%; very preterm birth, 9.0%), marital status/paternity acknowledgment (preterm birth, 13.8%; very preterm birth, 14.7%), source of payment for delivery (preterm birth, 6.2%; very preterm birth, 3.2%), and hypertension in pregnancy (preterm birth, 9.9%; very preterm birth, 8.3%). Interpregnancy interval contributed a more sizable contribution to the disparity (preterm birth, 6.2%, very preterm birth, 6.0%) in sensitivity analyses restricted to all nonfirstborn births.

Conclusions: These findings demonstrate that the known portion of the disparity in preterm birth is driven by sociodemographic and preconception/prenatal health factors. Public health programs to enhance social support and preconception care, specifically focused on hypertension, may provide an efficient approach for reducing the racial gap in preterm birth.
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http://dx.doi.org/10.1016/j.amepre.2019.07.007DOI Listing
November 2019

Self-reported infertility, metabolic dysfunction, and cardiovascular events: a cross-sectional analysis among U.S. women.

Fertil Steril 2019 01 17;111(1):138-146. Epub 2018 Nov 17.

Maternal & Child Health Program, Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland.

Objective: To explore associations between infertility and metabolic syndrome, and cardiovascular events. Infertility is increasingly a public health issue, with emerging links to chronic disease. Existing literature on infertility focuses primarily on known causes, which likely excludes a substantial number of women for whom there is no known cause or formal diagnosis.

Design/setting: We conducted a cross-sectional analysis examining the association between self-reported infertility (i.e., ever experiencing inability to conceive after 12 months of trying to become pregnant) and metabolic syndrome and cardiovascular events (i.e., congestive heart failure, coronary heart disease, heart attack, or stroke). Data were analyzed using multivariate logistic regression.

Patient(s): A total of 744 U.S. women, 20-59 years of age, from the National Health and Nutrition Examination Survey (2013-2014), participated in the study. Among them, 15.7% reported ever experiencing infertility, 27.6% met the definition of metabolic syndrome, and 2.84% reported ever having a cardiovascular event.

Intervention(s): N/A.

Main Outcome Measure(s): Metabolic syndrome and cardiovascular events.

Results: Compared to women who had never experienced infertility, women who reported infertility had a 1.79 (95% confidence interval [CI] 1.04, 3.08) higher odds of reporting symptoms of metabolic syndrome and 1.83 (95% CI 1.15, 2.89) times higher odds of having experienced a cardiovascular event. Furthermore, women with self-reported infertility had a 71% higher odds of reporting a cardiovascular event after controlling for metabolic syndrome (95% CI 1.01, 3.00).

Conclusions: Our results suggest that among U.S. women, the experience of infertility at any point in a woman's reproductive window may be associated with later-life cardiovascular health.
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http://dx.doi.org/10.1016/j.fertnstert.2018.10.009DOI Listing
January 2019

Cardiometabolic Dysfunction Among U.S. Adolescents and Area-Level Poverty: Race/Ethnicity-Specific Associations.

J Adolesc Health 2018 11;63(5):546-553

National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland.

Purpose: To examine race/ethnicity-specific associations between area-level poverty and cardiometabolic dysfunction among U.S. adolescents.

Methods: Data were from 10,415 adolescents aged 12-19 in the National Health and Nutrition Examination Survey (1999-2012), linked with census tract data on area-level poverty (the percent population living in poverty, grouped into race/ethnicity-specific quartiles). Cardiometabolic dysfunction was parameterized by summing z-scores of six cardiometabolic biomarkers, grouped into quintiles. Hierarchical ordinal models estimated overall and race/ethnicity specific associations. Posthoc analysis explored associations between area-level poverty and family poverty-to-income ratio.

Results: Overall, compared to adolescents residing in areas with the lowest area-level poverty (i.e., first quartile), residents in third (OR 1.32, 95% CI 1.13, 1.53) and fourth (OR 1.27, 95% CI 1.08, 1.50) quartiles of area-level poverty experienced elevated odds of cardiometabolic dysfunction. Area-level poverty predicted cardiometabolic dysfunction between non-Hispanic white and Mexican American adolescents, but not between non-Hispanic black adolescents.

Conclusions: We found race/ethnicity-specific associations between area-level poverty and cardiometabolic dysfunction among U.S. adolescents, highlighting the moderating effect of race-ethnicity. Among non-Hispanic black adolescents, neither higher area-level nor family-level socioeconomic status is associated with cardiometabolic health, in contrast to non-Hispanic white adolescents. Similar associations among non-Hispanic white and Mexican American groups aligns with evidence of the Hispanic Paradox. Future studies of effect of area-level determinants of cardiometabolic dysfunction may consider race/ethnicity-specific associations.
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http://dx.doi.org/10.1016/j.jadohealth.2018.07.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6318802PMC
November 2018

Maternal Smoking during Pregnancy and Offspring Weight Gain: a Consideration of Competing Explanations.

Paediatr Perinat Epidemiol 2017 09 4;31(5):409-411. Epub 2017 Sep 4.

Maternal & Child Health Program, School of Public Health, University of Maryland, College Park, MD.

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http://dx.doi.org/10.1111/ppe.12405DOI Listing
September 2017

Gestational Weight Gain: Historical Evolution of a Contested Health Outcome.

Obstet Gynecol Surv 2017 Jul;72(7):445-453

Associate Professor, Maternal & Child Health Program; Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of Maryland, Baltimore, MD.

The history of research on gestational weight gain (GWG) in the United States and United Kingdom provides a context for current clinical practice. We trace the evolution of research on GWG in scientific literature from the 19th century to the present and examine its implications for contemporary clinical and public health practice. Obstetricians, beginning in the late 1800s, recommended dieting during pregnancy in order to limit GWG to 20 lb or less, driven by a belief that excessive weight gain was a cause of toxemia. Beginning in the 1930s, a burgeoning focus on nutrition and health allowed a better understanding of the effect of GWG on the health of the fetus and the newborn. Increased awareness of disparities in infant mortality in the 1960s, followed by systematic review of the literature, produced further refinements in GWG recommendations in the 1970s, which continue today. Current research focuses on epigenetic influences over the life course and has emphasized individualized recommendations. The complex historical perspective that this article provides serves as a reminder of both the interplay and the gaps between research and practice. These gaps result from the fact that clinical guidelines often reflect a specific point in a perpetually evolving state of knowledge that is influenced not only by advances in bench research, but also by refinements in statistical and epidemiologic methods, as well as by the political realities of the time in which they are drafted.

Importance: Gestational weight gain and its relationship to maternal, fetal, and infant health are areas of active inquiry.

Objective: We critically review evolution of scientific understanding of GWG from the 19th century to the present, and examine its implications for contemporary obstetric practice.

Evidence Acquisition: We reviewed all English-language medical studies related to GWG published through 1930s as well as widely cited influential works from 1940s through present time.

Results: During the past century, recommendations for GWG have reversed from emphasizing dieting during pregnancy to the importance of proper nutrition during pregnancy. Obstetricians' focus has also evolved from being exclusively on the newborn to include the health of mothers. Contemporary obstetric practice seeks to achieve a balance between mothers' and infants' risk of adverse outcomes.

Conclusions: Historical and social contexts of the United States and the United Kingdom led to distinct GWG policies in the 2 countries. Changes in GWG recommendations over the past century reflect developments in the allied fields, such as epidemiology and nutrition, as much as progress in obstetrics and gynecology.

Relevance: The complex historical perspective that this article provides serves as a reminder of both the interplay and the gaps between research and practice. These gaps result from the fact that clinical guidelines often reflect a specific point in a perpetually evolving state of knowledge that is influenced not only by advances in bench research, but also by refinements in statistical and epidemiologic methods, as well as by the political realities of the time in which they are drafted.
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http://dx.doi.org/10.1097/OGX.0000000000000459DOI Listing
July 2017

Maternal smoking during pregnancy and offspring antisocial behaviour: findings from a longitudinal investigation of discordant siblings.

J Epidemiol Community Health 2017 09 10;71(9):889-896. Epub 2017 Jul 10.

Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.

Background: Although many observational studies have found a strong association between maternal smoking during pregnancy (MSP) and offspring antisocial behaviour, the likelihood that this relationship is causal remains unclear. To comment on the potential causality of this association, the current investigation used a between-within decomposition approach to examine the association between MSP and multiple indices of adolescent and adult antisocial behaviour.

Methods: Study participants were offspring of women enrolled in the Providence and Boston sites of the Collaborative Perinatal Project. Information on MSP was collected prospectively. Antisocial behaviour was assessed via self-report and through official records searches. A subset of the adult offspring (average age: 39.6 years) were enrolled in a follow-up study oversampling families with multiple siblings. Participants in this follow-up study self-reported on juvenile and adult antisocial behaviours during a structured interview (n=1684). Official records of juvenile (n=3447) and adult (n=3433) criminal behaviour were obtained for participants in the Providence cohort. Statistical models allowed between-family effects of MSP exposure to differ from within-family effects. In the absence of heterogeneity in between-family versus within-family estimates, a combined estimate was calculated.

Results: MSP was associated with a range of antisocial behaviours, measured by self-report and official records. For example, MSP was associated with increased odds of elevated levels of antisocial behaviours during adolescence and adulthood, as well as violent and non-violent outcomes during both developmental periods.

Conclusions: Findings are consistent with a small-to-moderate causal effect of MSP on adolescent and adult antisocial behaviour.
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http://dx.doi.org/10.1136/jech-2016-208511DOI Listing
September 2017

Neonatal Outcomes Associated With Placental Abruption.

Am J Epidemiol 2017 Dec;186(12):1319-1328

Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.

Placental abruption (early separation of the placenta) is associated with preterm birth and perinatal mortality, but associations with other neonatal morbidities remain understudied. We examined the association between abruption and newborn outcomes. We analyzed 223,341 singleton deliveries from the Consortium on Safe Labor study, a retrospective, multisite, observational study (2002-2008) of electronic medical records in the United States. Adjusted relative risks, incidence rate ratios, and 99% confidence intervals were estimated. Direct effects attributable to abruption were examined by conditioning on intermediates (preterm birth and small for gestational age) with sensitivity analyses. Incidence of abruption was 1.6% (n = 3,619). Abruption was associated with an elevated risk of newborn resuscitation (relative risk (RR) = 1.5, 99% confidence interval (CI): 1.5, 1.6), apnea (RR = 5.8, 99% CI: 5.1, 6.5), asphyxia (RR = 8.5, 99% CI: 5.7, 11.3), respiratory distress syndrome (RR = 6.5, 99% CI: 5.9, 7.1), neonatal intensive care unit admission (RR = 3.4, 99% CI: 3.2, 3.6), longer intensive care length of stay (incidence rate ratio = 2.0, 99% CI: 1.9, 2.2), stillbirth (RR = 6.3, 99% CI: 4.7, 7.9), and neonatal mortality (RR = 7.6, 99% CI: 5.2, 10.1). In sensitivity analyses, there was a direct effect of abruption associated with increased neonatal risks. These findings expand our knowledge of the association between abruption and perinatal and neonatal outcomes.
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http://dx.doi.org/10.1093/aje/kwx202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5860509PMC
December 2017

Maternal, Labor, Delivery, and Perinatal Outcomes Associated with Placental Abruption: A Systematic Review.

Am J Perinatol 2017 08 22;34(10):935-957. Epub 2017 Mar 22.

Maternal and Child Health Program, University of Maryland, College Park, Maryland.

 Risk factors for placental abruption have changed, but there has not been an updated systematic review investigating outcomes.  We searched PubMed, EMBASE, Web of Science, SCOPUS, and CINAHL for publications from January 1, 2005 through December 31, 2016. We reviewed English-language publications reporting estimated incidence and/or risk factors for maternal, labor, delivery, and perinatal outcomes associated with abruption. We excluded case studies, conference abstracts, and studies that lacked a referent/comparison group or did not clearly characterize placental abruption.  A total of 123 studies were included. Abruption was associated with elevated risk of cesarean delivery, postpartum hemorrhage and transfusion, preterm birth, intrauterine growth restriction or low birth weight, perinatal mortality, and cerebral palsy. Additional maternal outcomes included relaparotomy, hysterectomy, sepsis, amniotic fluid embolism, venous thromboembolism, acute kidney injury, and maternal intensive care unit admission. Additional perinatal outcomes included acidosis, encephalopathy, severe respiratory disorders, necrotizing enterocolitis, acute kidney injury, need for resuscitation, chronic lung disease, infant death, and epilepsy.  Few studies examined outcomes beyond the initial birth period, but there is evidence that both mother and child are at risk of additional adverse outcomes. There was also considerable variation in, or absence of, the reporting of abruption definitions.
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http://dx.doi.org/10.1055/s-0037-1599149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683164PMC
August 2017

Income Inequality and US Children's Secondhand Smoke Exposure: Distinct Associations by Race-Ethnicity.

Nicotine Tob Res 2017 Nov;19(11):1292-1299

School of Public Health, Maryland Institute for Applied Environmental Health, University of Maryland, College Park, MD.

Introduction: Prior studies have found considerable racial and ethnic disparities in secondhand smoke (SHS) exposure. Although a number of individual-level determinants of this disparity have been identified, contextual determinants of racial and ethnic disparities in SHS exposure remain unexamined. The objective of this study was to examine disparities in serum cotinine in relation to area-level income inequality among 14 649 children from the National Health and Nutrition Examination Survey.

Methods: We fit log-normal regression models to examine disparities in serum cotinine in relation to Metropolitan Statistical Areas level income inequality among 14 649 nonsmoking children aged 3-15 from the National Health and Nutrition Examination Survey (1999-2012).

Result: Non-Hispanic black children had significantly lower serum cotinine than non-Hispanic white children (-0.26; 95% CI: -0.38, -0.15) in low income inequality areas, but this difference was attenuated in areas with high income inequality (0.01; 95% CI: -0.16, 0.18). Serum cotinine declined for non-Hispanic white and Mexican American children with increasing income inequality. Serum cotinine did not change as a function of the level of income inequality among non-Hispanic black children.

Conclusions: We have found evidence of differential associations between SHS exposure and income inequality by race and ethnicity. Further examination of environments which engender SHS exposure among children across various racial/ethnic subgroups can foster a better understanding of how area-level income inequality relates to health outcomes such as levels of SHS exposure and how those associations differ by race/ethnicity.

Implications: In the United States, the association between children's risk of SHS exposure and income inequality is modified by race/ethnicity in a manner that is inconsistent with theories of income inequality. In overall analysis this association appears to be as predicted by theory. However, race-specific analyses reveal that higher levels of income inequality are associated with lower levels of SHS exposure among white children, while levels of SHS exposure among non-Hispanic black children are largely invariant to area-level income inequality. Future examination of the link between income inequality and smoking-related health outcomes should consider differential associations across racial and ethnic subpopulations.
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http://dx.doi.org/10.1093/ntr/ntw293DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415442PMC
November 2017

Parenting and cognitive and psychomotor delay due to small-for-gestational-age birth.

J Child Psychol Psychiatry 2017 02 28;58(2):169-179. Epub 2016 Sep 28.

Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo, State University of New York, Buffalo, NY, USA.

Background: To examine whether different dimensions of parenting at different ages help small-for-gestational-age (SGA) children 'catch-up' the normal children in cognition and psychomotor.

Methods: We analyzed data of 800 children born SGA and 3,000 children born appropriate-for-gestational-age (AGA) from the Early Childhood Longitudinal Study-Birth cohort. The Two Bag Task was used to measure 2-year or 4-year parenting dimensions. Children's reading, math, gross motor, and fine motor scores were assessed at 5 years. Multivariable linear regression models were fitted to test the interactions between SGA and 2-year or 4-year parenting dimensions on 5-year cognitive and psychomotor outcomes (dependent variables).

Results: There were significant interactions between SGA and early parenting on 5-year reading, math, and fine motor scores. The gap between SGA and AGA children in 5-year fine motor score was attenuated to null [-0.25 (95% confidence interval, -0.41, -0.09) vs. 0.03 (-0.13, 0.20)] when 2-year parental sensitivity score increased from 1 standard deviation (SD) below mean (Mean - SD) to 1 SD above mean (Mean + SD). The gap between SGA and AGA children in 5-year fine motor [-0.28 (-0.44, -0.13) vs. 0.06 (-0.09, 0.22)] and math [-1.32 (-2.27, -0.37) vs. 0.20 (-0.77, 1.17)] scores was also attenuated to null when 4-year parental emotional support score increased from Mean - SD to Mean + SD. In contrast, the gap between SGA and AGA children in 5-year reading score increased from 0.49 (-0.90, 1.88) to -1.31 (-2.55, -0.07) when 4-year parental intrusiveness score increased from Mean - SD to Mean + SD. Similarly, the gap between SGA and AGA children in fine motor score increased with 4-year parental negative regard from 0.02 (-0.14, 0.18) to -0.23 (-0.38, -0.08).

Conclusions: Early high-quality parenting may buffer some adversity in long-term reading, math, and fine motor skills related to SGA birth, whereas low-quality parenting can amplify the adversity.
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http://dx.doi.org/10.1111/jcpp.12644DOI Listing
February 2017

Etiological Subgroups of Small-for-Gestational-Age: Differential Neurodevelopmental Outcomes.

PLoS One 2016 8;11(8):e0160677. Epub 2016 Aug 8.

Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo, State University of New York, Buffalo, NY, 14214, United States of America.

Objectives: It remains unclear why substantial variations in neurodevelopmental outcomes exist within small-for-gestational-age (SGA) children. We prospectively compared 5-y neurodevelopmental outcomes across SGA etiological subgroups.

Methods: Children born SGA (N = 1050) from U.S. Early Childhood Longitudinal Study-Birth Cohort (2001-2007) was divided into etiological subgroups by each of 7 well-established prenatal risk factors. We fit linear regression models to compare 5-y reading, math, gross motor and fine motor scores across SGA subgroups, adjusting for socio-demographic confounders.

Results: Compared to singleton SGA subgroup, multiple-birth SGA subgroup had lower mean reading (adjusted mean difference, -4.08 [95% confidence interval, -6.10, -2.06]) and math (-2.22 [-3.61, -0.84]) scores. These disadvantages in reading and math existed only among multiple-birth SGA subgroup without ovulation stimulation (reading, -4.50 [-6.64, -2.36]; math, -2.91 [-4.37, -1.44]), but not among those with ovulation stimulation (reading, -2.33 [-6.24, 1.57]; math 0.63 [-1.86, 3.12]). Compared to singleton SGA subgroup without maternal smoking and inadequate gestational weight gain, singleton SGA subgroup with co-occurrence of maternal smoking and inadequate gestational weight gain (GWG) had lower mean reading (-4.81 [-8.50, -1.12]) and math (-2.95 [-5.51, -0.38]) scores. These differences were not mediated by Apgar score.

Conclusions: Multiple-birth SGA subgroups (vs. singleton SGA) or singleton SGA subgroup with co-occurrence of smoking and inadequate GWG (vs. singleton SGA subgroup without maternal smoking and inadequate gestational weight gain) have poorer cognitive development up to 5 y.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0160677PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976943PMC
August 2017

Maternal postpartum depressive symptoms and infant externalizing and internalizing behaviors.

Infant Behav Dev 2016 Feb 19;42:119-27. Epub 2016 Jan 19.

Maternal and Child Health Program, Department of Family Science, School of Public Health, University of Maryland College Park, College Park, MD, USA; Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA; Department of Epidemiology, School of Medicine, University of Maryland, Baltimore, MD, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.

Maternal postpartum depression has been shown to be one of the main predictors of externalizing and internalizing behaviors in toddlers and adolescents. Research suggests that presence of such behaviors can be observed as early as infancy. The current study uses longitudinal data from 247 mothers to examine the relationship between postpartum depressive symptoms at 8 weeks and the infant's externalizing and internalizing behaviors at 12 months. In unadjusted linear regression models, there were associations between postpartum depressive symptoms and infant externalizing behaviors (β=0.082, SE=0.032, p=0.012) and internalizing behaviors (β=0.111, SE=0.037, p=0.003). After controlling for potential confounding factors, including maternal age, race, education, home ownership, smoking status in the postpartum period, marital status, parenting stress, and happiness from becoming a parent, the associations between postpartum depressive symptoms and infant externalizing (β=0.051, SE=0.034, p=0.138) and internalizing behaviors (β=0.077, SE=0.040, p=0.057) were reduced and became non-significant. Furthermore, in these models the total amount of variance explained was 17.2% (p<0.0001) for externalizing behaviors and 10.5% (p<0.01) for internalizing behaviors; the only significant predictor of externalizing behaviors was maternal age (β=-0.074, SE=0.030, p=0.014), and of internalizing behaviors was white non-Hispanic ethnicity (β=-1.33, SE=0.378, p=0.0005). A combined effect of the confounding factors seems to explain the finding of no significant independent association between postpartum depressive symptoms and infant externalizing and internalizing behaviors.
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http://dx.doi.org/10.1016/j.infbeh.2015.12.002DOI Listing
February 2016

Stunting at 5 Years Among SGA Newborns.

Pediatrics 2016 Feb 15;137(2):e20152636. Epub 2016 Jan 15.

Division of Behavioral Medicine, Department of Pediatrics, School of Medicine and Biomedical Sciences, and

Objective: To compare risk of stunting at 5 years across etiological subgroups of small for gestational age (SGA) newborns.

Methods: We analyzed data of a subsample (N = 1100) of the Early Childhood Longitudinal Study-Birth Cohort. We defined SGA as birth weight <10th percentile, then classified subjects into etiological subgroups by each of 8 risk factors (ie, maternal prepregnancy underweight, short stature, smoking during pregnancy, alcohol use during pregnancy, inadequate gestational weight gain [GWG], hypertension, genital herpes infection, and multiple births) or by cooccurrence of 2 often intertwined risk factors (smoking and inadequate GWG). We defined stunting as 5 years height-for-age z score below -2. We fitted logistic regression models to test whether the risk of stunting differed across SGA subgroups, adjusting for confounders.

Results: SGA subgroup with maternal short stature (odds ratio [OR] = 3.88; 95% confidence interval [CI] = 2.16-6.96) or inadequate GWG (OR = 2.18; 95% CI = 1.23-3.84) had higher risk of stunting at 5 years, compared with the SGA subgroup without the corresponding risk factor. SGA newborns with both maternal smoking and inadequate GWG during pregnancy had much higher risk of stunting at 5 years (OR = 3.10; 95% CI = 1.21-7.91), compared with SGA newborns without any of these 2 SGA risk factors.

Conclusions: Etiological subgroups of SGA differed in risk of stunting at 5 years. SGA newborns of inadequate GWG mothers who smoke and SGA newborns of short mothers were at particularly high risk of stunting.
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http://dx.doi.org/10.1542/peds.2015-2636DOI Listing
February 2016

Exposure to Tobacco Metabolites via Breast Milk and Infant Weight Gain: A Population-Based Study.

J Hum Lact 2016 Aug 7;32(3):462-71. Epub 2015 Dec 7.

Department of Family and Community Health, University of Maryland, Baltimore, MD, USA.

Background: Although the immutable benefits of breastfeeding are well documented, information on the potential consequences of exposure to tobacco metabolites specifically via breastfeeding is sparse.

Objective: The aim was to conduct the first study of the association between exposure to tobacco metabolites specifically through breastfeeding and infant weight gain.

Methods: We used historical data from the US Collaborative Perinatal Project. Mothers were classified as nonsmokers, light smokers (1-19 cigarettes/day), and heavy (20+ cigarettes/day) smokers. In-hospital feeding type was observed during a nursery stay after delivery. We conducted stratified analyses among average-for-gestational-age (AGA; N = 23 571) and small-for-gestational-age (SGA; N = 2552) infants. We isolated the effect of exposure to tobacco metabolites specifically through breastfeeding.

Results: Overall, maternal smoking was associated with change in weight-for-length z-score in a dose-response manner. Change in weight z-score was most pronounced among SGA infants of heavy smokers (breastfed: 0.53; 95% confidence interval [CI], 0.12-0.94; formula fed: 0.17; 95% CI, 0.03-0.30). Exposure to tobacco metabolites specifically through breastfeeding was not associated with additional weight gain among AGA infants. Among the much smaller sample of SGA infants, exposure specifically through breastfeeding was associated with marginally significant additional weight gain (0.46; 95% CI, 0.00-0.91) among infants of heavy smokers.

Conclusion: Our findings are in accord with recommendations by health agencies for smokers to breastfeed. However, SGA infants exposed to tobacco metabolites via breastfeeding by heavy smokers appear to gain weight more rapidly than other infants. Practical implications of our findings are discussed.
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http://dx.doi.org/10.1177/0890334415619154DOI Listing
August 2016

Telomere length and age-at-menopause in the US.

Maturitas 2015 Oct 22;82(2):215-21. Epub 2015 Jul 22.

Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention,United States.

Objectives: Age-at-menopause and leukocyte telomere length (LTL) are both associated with biologic aging. Therefore, it would be reasonable to hypothesize that LTL may also serve as a marker for reproductive aging as shorter LTL may be associated with earlier age-at-menopause.

Methods: We analyzed data from 799 post-menopausal (ages 41-85) participants in the National Health and Nutrition Examination Survey (1999-2002), a nationally representative sample of U.S. women.

Results: Controlling for behavioral, socio-demographic, and health-related determinants of menopause, we found that among non-Hispanic white women, an increase of one standard deviation in LTL was associated with a 0.43 year higher reported age-at-menopause. Among Mexican-Americans, an increase of one standard deviation in LTL was associated with a 1.56 year earlier menopause. There was no significant association between LTL and age-at-menopause among non-Hispanic black women.

Conclusions: Our main finding is evidence of a strong interaction by race/ethnicity in the association between LTL and age-at-menopause. This evidence does not support the hypothesis that shorter LTL is a predictor of earlier age-at-menopause, as the magnitude and direction of the associations between LTL and age-at-menopause varied across racial/ethnic groups.
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http://dx.doi.org/10.1016/j.maturitas.2015.07.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4669569PMC
October 2015

Elevated risk of nicotine dependence among sib-pairs discordant for maternal smoking during pregnancy: evidence from a 40-year longitudinal study.

Epidemiology 2015 May;26(3):441-7

From the aMaternal and Child Health Program, bDepartment of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD; cDepartment of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; and dDepartment of Epidemiology, eDepartment of Biostatistics, Brown University School of Public Health, Providence, RI.

Background: Compelling evidence links maternal smoking during pregnancy with elevated risk of nicotine dependence among the offspring. However, no study to date has examined the maternal smoking during pregnancy-nicotine dependence link among sibling-pairs discordant for maternal smoking during pregnancy. We tested two hypotheses that, if supported, suggest that the maternal smoking during pregnancy-nicotine dependence link may be physiologically mediated.

Methods: Study participants were adult offspring of women enrolled in the Providence and Boston sites of the Collaborative Perinatal Project (1959-1966). Approximately 10% of these adult offspring (average age: 39.6 years) were enrolled in the New England Family Study (n = 1,783), a follow-up study that oversampled families with multiple siblings. Logistic regression models predicting maternal smoking during pregnancy risk on various prospectively collected smoking and marijuana use outcomes, including nicotine dependence, were fit using models that allowed between-mother effects of maternal smoking during pregnancy exposure to differ from within-mother effects. In the absence of significant effect heterogeneity, we calculated a combined estimate.

Results: Maternal smoking during pregnancy predicted progression from weekly smoking to nicotine dependence (odds ratio = 1.4 [95% confidence interval = 1.2, 1.8]), but not weekly smoking or progression to marijuana dependence.

Conclusions: Current evidence from sibling-pairs discordant for maternal smoking during pregnancy is consistent with previous reports of a dose-response association between maternal smoking during pregnancy and nicotine dependence, as well as of up-regulation of nicotine receptors among animals exposed to maternal smoking during pregnancy. Together, they provide support for the existence of a physiologically mediated link between maternal smoking during pregnancy and nicotine dependence.
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http://dx.doi.org/10.1097/EDE.0000000000000270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455876PMC
May 2015

Davis et al. respond.

Am J Public Health 2014 Sep 17;104(9):e2. Epub 2014 Jul 17.

Regina R. Davis, Sandra L. Hofferth, and Edmond D. Shenassa are with the Department of Family Science, Maternal and Child Health Program, University of Maryland School of Public Health, College Park. Regina R. Davis is also with the American Public Health Association, Washington, DC.

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http://dx.doi.org/10.2105/AJPH.2014.302073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4151949PMC
September 2014

Gestational weight gain and risk of infant death in the United States.

Am J Public Health 2014 Feb 19;104 Suppl 1:S90-5. Epub 2013 Dec 19.

Regina R. Davis, Sandra L. Hofferth, and Edmond D. Shenassa are with the Maternal and Child Health Program, Department of Family Science, University of Maryland, College Park. Regina R. Davis is also with the American Public Health Association, Washington, DC. Edmond D. Shenassa is also with the Department of Epidemiology, University of Maryland, College Park.

Objectives: We examined the association of prepregnancy body mass index (BMI) and gestational weight gain (GWG) with risk of death during infancy using the Institute of Medicine's (IOM's) Pregnancy Weight Gain Guidelines.

Methods: We obtained maternal and infant data for 2004-2008 from 159,244 women with a singleton, full-term, live birth in the 41 states that participated in phase 5 of the Pregnancy Risk Assessment Monitoring System. We fit logistic regression models to estimate the association between prepregnancy BMI, GWG, and risk of death during infancy, controlling for confounders.

Results: Only 34% of women gained the IOM-recommended amount of weight during pregnancy. Infants born to underweight, normal-weight, and overweight women with inadequate GWG had odds of mortality during infancy that were 6.18, 1.47, and 2.11 times higher, respectively, than those of infants born to women with adequate GWG. Infants born to obese women with excessive weight gain had a 49% decreased likelihood of mortality.

Conclusions: A significant association exists between inadequate GWG and infant death that weakens with increasing prepregnancy BMI; weight gain beyond the recommended amount appears to be protective against infant mortality.
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http://dx.doi.org/10.2105/AJPH.2013.301425DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011101PMC
February 2014

Understanding and meeting the needs of women in the postpartum period: the Perinatal Maternal Health Promotion Model.

J Midwifery Womens Health 2013 Nov-Dec;58(6):613-21. Epub 2013 Dec 9.

A new model for the care of women in the postpartum focuses on the development of life skills that promote complete well-being. The year following childbirth is a time of significant transition for women. In addition to the physiologic changes associated with the postpartum period, a woman undergoes marked psychosocial changes as she transitions into a motherhood role, reestablishes relationships, and works to meet the physical and emotional needs of her infant and other family members. It is a time when women are vulnerable to health problems directly related to childbirth and to compromised self-care, which can manifest in the development or reestablishment of unhealthy behaviors such as smoking and a sedentary lifestyle. In addition to long-term implications for women, compromised maternal health in the postpartum period is associated with suboptimal health and developmental outcomes for infants. Maternal health experts have called for a change in how care is provided for women in the postpartum period. This article presents the rationale for a health promotion approach to meeting the needs of women in the postpartum period and introduces the Perinatal Maternal Health Promotion Model. This conceptual framework is built around a definition of maternal well-being that asserts that health goes beyond merely the absence of medical complications. In the model, the core elements of a healthy postpartum are identified and include not only physical recovery but also the ability to meet individual needs and successfully transition into motherhood. These goals can best be achieved by helping women develop or strengthen 4 key individual health-promoting skills: the ability to mobilize social support, self-efficacy, positive coping strategies, and realistic expectations. While the model focuses on the woman, the health promotion approach takes into account that maternal health in this critical period affects and is affected by her family, social network, and community. Clinical implications of the model are addressed, including specific health promotion strategies that clinicians can readily incorporate into antepartum and postpartum care.
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http://dx.doi.org/10.1111/jmwh.12139DOI Listing
April 2015

Prenatal glucocorticoids and maternal smoking during pregnancy independently program adult nicotine dependence in daughters: a 40-year prospective study.

Biol Psychiatry 2014 Jan 10;75(1):47-55. Epub 2013 Sep 10.

Department of Psychiatry and Human Behavior, Alpert Medical School, School of Public Health, Brown University, Providence, Rhode Island. Electronic address:

Background: Maternal smoking during pregnancy (MSDP) is an independent risk factor for offspring nicotine dependence (ND), but mechanisms remain unknown. We investigated prenatal glucocorticoid (cortisol) and androgen (testosterone) associations with offspring ND over 40 years and the possibility that prenatal glucocorticoids and androgens would mediate links between MSDP and offspring ND.

Methods: Participants were 1086 mother-adult offspring pairs (59% female) from the New England Family Study, a 40-year longitudinal follow-up of the Collaborative Perinatal Project. MSDP was assessed prospectively at each prenatal visit. Maternal cortisol, testosterone, and cotinine (nicotine metabolite) were assayed from third trimester maternal sera. Offspring lifetime ND was assessed via structured interview.

Results: Significant bivariate associations emerged for: 1) MSDP/cotinine and lifetime ND; and 2) maternal cortisol and lifetime ND, for daughters only. In multivariate models, maternal cortisol and MSDP/cotinine remained significantly and independently associated with increased odds of lifetime ND of daughters. However, cortisol did not mediate the MSDP-lifetime ND relation. No associations emerged between maternal testosterone and offspring ND.

Conclusions: Results provide the first evidence in support of prenatal glucocorticoid programming of adult ND over 40 years in daughters only. Our study highlights two independent prenatal pathways leading to increased risk for ND in daughters: elevated prenatal glucocorticoids and MSDP/nicotine exposure. Daughter-specific effects of glucocorticoid and MSDP programming over 40 years highlight the breadth and persistence of sexually dimorphic programming effects in humans. Results do not support androgen programming of offspring ND.
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http://dx.doi.org/10.1016/j.biopsych.2013.07.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858529PMC
January 2014

Allostatic load amplifies the effect of blood lead levels on elevated blood pressure among middle-aged U.S. adults: a cross-sectional study.

Environ Health 2013 Aug 16;12(1):64. Epub 2013 Aug 16.

Department of Environmental Science, Policy and Management and School of Public Health, University of California, Berkeley, California, USA.

Background: Scientists and regulators have sought to understand whether and how physiologic dysregulation due to chronic stress exposure may enhance vulnerability to the adverse health effects of toxicant exposures. We conducted a cross-sectional study to determine whether allostatic load (AL), a composite measure of physiologic response to chronic exposure to stress, amplifies the effect of lead exposure on blood pressure among middle-aged adults.

Methods: We analyzed associations between blood lead levels and blood pressure in a nationally representative sample of 8,194 U.S. adults (aged 40-65 years) participating in the National Health and Nutritional Examination Survey, 1999--2008. Outcomes were elevated systolic (≥ 140 mm Hg) and diastolic (≥ 90 mm Hg) blood pressure. AL was defined as the aggregate score of seven components, reflecting dysregulation of the cardiovascular, inflammatory, and endocrine systems.

Results: Logistic regression models showed a linear dose-response relationship for quintiles of blood lead and elevated systolic blood pressure in the high AL group (p = 0.03) but not the low AL group (p = 0.24). Similarly, the relationship between lead exposure and elevated diastolic blood pressure was stronger among the high AL group than the low AL group. Within the high AL group, the fourth and fifth quintiles had significantly elevated odds of elevated blood pressure compared to lowest quintile [OR = 1.92, (95% CI, 1.07, 3.47) and OR =2.28 (95% CI, 1.33, 3.91), respectively]. In the low AL group, none of the quintile effects were significantly different than the referent group although there was evidence of a linear trend (p =0.03). The lead by AL interaction term was not statistically significant for either systolic or diastolic blood pressure models.

Conclusions: Results suggest that higher AL may amplify the adverse effects of lead on blood pressure. Future research should assess the implications of cumulative exposures to environmental and social stressors for regulatory decision-making.
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http://dx.doi.org/10.1186/1476-069X-12-64DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3847858PMC
August 2013

Allostatic load may not be associated with chronic stress in pregnant women, NHANES 1999-2006.

Ann Epidemiol 2013 May;23(5):294-7

Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA.

Purpose: Pregnant women are generally excluded from studies that measure allostatic load (AL) because there is concern that the changing levels of AL-related biomarkers during pregnancy do not reflect a woman's true AL. The goal of this study was to determine whether AL can be measured in a meaningful way during pregnancy.

Methods: The National Health and Nutrition Examination Survey (NHANES) is a nationally representative, cross-sectional survey of the U.S. civilian population. AL was based on the distributions of 10 biomarkers in pregnant (n = 1138) and nonpregnant (n = 4993) women aged 15 to 44 from NHANES (1999-2006).

Results: The distribution of each AL-related biomarker differed significantly between pregnant and nonpregnant women (P < .01). Among nonpregnant women, high AL findings were consistent with previous studies (e.g., higher AL in women who are black, are older, and who have lower incomes). However, these associations were not seen in pregnant women.

Conclusions: Our results suggest that the various biomarkers that comprise AL may reflect proximal factors in pregnancy more strongly than they represent exposure to chronic stress over a woman's lifetime. Therefore, our approach to measuring AL may not provide meaningful information about chronic stress in pregnant women without further consideration of pregnancy-related factors.
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http://dx.doi.org/10.1016/j.annepidem.2013.03.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4132932PMC
May 2013

Menopause and lead body burden among US women aged 45-55, NHANES 1999-2010.

Environ Res 2013 Feb 24;121:110-3. Epub 2013 Jan 24.

Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd, Rockville, MD 20852, USA.

Background: Environmental factors in menopause have received limited attention. Lead is a known reproductive toxicant associated with delayed puberty in girls that may also affect menopause.

Methods: The odds of menopause among US women aged 45-55 were estimated in the National Health and Nutrition Examination Survey, 1999-2010, in relation to quartiles of blood lead. Women still menstruating (n=2158) were compared to women with natural menopause (n=1063). Logistic regression models included age, race/ethnicity, current hormone use, poverty, smoking and where available, bone density or bone alkaline phosphatase.

Results: Lead levels (ug/dL) were higher in menopausal women, geometric mean (standard error)=1.71 (0.04) vs. 1.23 (0.02). Adjusted odds of menopause and 95% confidence intervals for lead quartiles (lowest quartile referent) were 1.7 (1.0-2.8), 2.1 (1.2-3.6), and 4.2 (2.5-7.0) respectively. Results adjusting for bone markers were generally similar but had less precision.

Conclusions: Blood lead was associated with natural menopause in US women even after adjustment for bone turnover. This raises concern that lead exposure, even at low levels, may shorten women's reproductive lifespan.
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http://dx.doi.org/10.1016/j.envres.2012.12.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3578085PMC
February 2013

Reading disability and adult attained education and income: evidence from a 30-year longitudinal study of a population-based sample.

J Learn Disabil 2014 Jul-Aug;47(4):374-86. Epub 2012 Sep 14.

University of Maryland, College Park, MD, USA.

This study examined the impact of childhood reading disability (RD) on adult educational attainment and income. Participants' (N = 1,344) RD was assessed at age 7, and adult educational attainment and income were assessed in midlife using categorical variables. Participants with RD at age 7 were 74% (95% CI: 0.18, 0.37) less likely to attain a higher level of education and 56% (95% CI: 0.32, 0.61) less likely to attain a higher level of income as an adult than participants with average or above reading achievement at age 7. Attained education was found to mediate the relationship between RD and attained income.
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http://dx.doi.org/10.1177/0022219412458323DOI Listing
October 2015