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Pubmed: Obstetrics and Gynecology »

  • Obstetric mode of delivery and attention-deficit/hyperactivity disorder: a sibling-matched study.

    Posted 2017-09-23 21:00:32 by: Mahammad A. Tafida

    Related Articles Obstetric mode of delivery and attention-deficit/hyperactivity disorder: a sibling-matched study. Int J Epidemiol. 2016 Apr;45(2):532-42 Authors: Curran EA, Khashan AS, Dalman C, Kenny LC, Cryan JF, Dinan TG, Kearney PM Abstract BACKGROUND: It has been suggested that birth by caesarean section (CS) may affect psychological development through changes in microbiota or stress response. We assessed the impact of mode of delivery, specifically CS, on the development of attention-deficit/hyperactivity disorder (ADHD), using a large, population-based cohort. METHODS: The study cohort consisted of all singleton live births in Sweden from 1990 to 2008 using data from Swedish national registers. Mode of delivery included: unassisted vaginal delivery(VD), assisted VD, elective CS or emergency CS. ADHD was determined using International Classification of Diseases version 10 (F90 or F98.8), or prescription for ADHD medication. We used Cox regression to assess the association between birth by CS and ADHD in the total study population, adjusting for perinatal and sociodemographic factors, then stratified Cox regression analysis on maternal identification number to assess the association among siblings. RESULTS: Our cohort consisted of 1 722 548 children, and among these 47 778 cases of ADHD. The hazard ratio (HR) of the association between elective CS, compared with unassisted VD, and ADHD was 1.15 [95% confidence interval (CI): 1.11-1.20] in the cohort, and 1.05 (95% CI: 0.93-1.18) in the stratified analysis. The HR of the association between emergency CS and ADHD was 1.16 (95% CI: 1.12-1.20])in the cohort and 1.13 (95% CI: 1.01-1.26) in the stratified analysis. CONCLUSION: Birth by CS is associated with a small increased risk of ADHD. However among siblings the association only remained for emergency CS. If this were a causal effect by CS, the association would be expected to ...

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  • Neonatal encephalopathy in New Zealand: Demographics and clinical outcome.

    Posted 2017-09-23 21:00:32 by: Mahammad A. Tafida

    Related Articles Neonatal encephalopathy in New Zealand: Demographics and clinical outcome. J Paediatr Child Health. 2016 Jun;52(6):632-6 Authors: Battin M, Sadler L, Masson V, Farquhar C, Neonatal Encephalopathy Working Group of the PMMRC Abstract AIM: To establish the incidence of moderate to severe neonatal encephalopathy (NE) in term infants from New Zealand and to document demographic characteristics and neonatal outcomes. METHODS: Cases were reported monthly via the New Zealand Paediatric Surveillance Unit (NZPSU). Data were collected from paediatricians for neonatal items and lead maternity carers for pregnancy and birth details. Term neonatal deaths in the Perinatal and Maternal Mortality Review Committee dataset that were because of hypoxia and/or neonatal deaths from hypoxic ischaemic encephalopathy were added to the cases identified via the NZPSU, if they had not previously been ascertained. RESULTS: For the period January 2010 to December 2012, there were 227 cases, equivalent to a rate of 1.30/1000 term births (95% CI 1.14-1.48). Rates of NE were high in babies of Pacific and Indian mothers but only reached statistical significance for the comparison between Pacific and NZ European. There was also a significant increase in NE rates with increasing deprivation. Resuscitation at birth was initiated for 209 (92.1%) infants with NE. Mechanical ventilation was required, following neonatal unit admission, in 171 (75.3%) infants. Anticonvulsants were used in 157 (69.2%) infants with phenobarbitone (65.6%), phenytoin (14.5%) and benzodiazapines (21.1%), the most common. Cooling was induced in 168 infants (74%) with 145 (86.3%) reported as commenced within a 6-h window. CONCLUSIONS: The rate of NE in New Zealand is consistent with reported international rates. Establishing antecedent factors for NE is an important part of improving care, which may inform strategic efforts to decrease ...

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  • Maternal total T4 during the first half of pregnancy: physiologic aspects and the risk of adverse outcomes in comparison with free T4.

    Posted 2017-09-23 21:00:32 by: Mahammad A. Tafida

    Related Articles Maternal total T4 during the first half of pregnancy: physiologic aspects and the risk of adverse outcomes in comparison with free T4. Clin Endocrinol (Oxf). 2016 Nov;85(5):757-763 Authors: Korevaar TI, Chaker L, Medici M, de Rijke YB, Jaddoe VW, Steegers EA, Tiemeier H, Visser TJ, Peeters RP Abstract AIM: We aimed to investigate TT4 physiological aspects and associations with clinical end-points. BACKGROUND: Total T4 (TT4) has been suggested as a marker for maternal thyroid function during pregnancy because as compared to FT4 (i) TT4 measurement is not affected by binding protein interference, (ii) TT4 is considered to be more stable from the second trimester onwards, and (iii) TT4 better reflects changes in the hypothalamic-pituitary-thyroid axis. However, this is based on data from small studies, and, more importantly, it is unknown whether TT4 is associated with adverse pregnancy or child outcomes. METHODS: We selected 5647 mother-child pairs from a large population-based prospective cohort with data on maternal TSH, FT4 and TT4 during early pregnancy (median 13·2 weeks, 95% range 9·8-17·6). We used multivariable (non)linear and logistic regression models to study the association of maternal TT4 with pre-eclampsia, premature delivery, birthweight and offspring IQ and compare the results with previously obtained results for FT4. RESULTS: The change of mean TT4 levels was 27·5% compared to 20·2% for FT4. There was a log-linear association of TT4 and FT4 with TSH, but the explained variability of TSH was much lower for TT4 than for FT4 (R-squared TT4: 2·5% vs 8·0% for FT4). In contrast to FT4, there was no independent association of maternal TT4 with pre-eclampsia, premature delivery, birthweight or offspring IQ. CONCLUSION: Maternal TT4 levels are highly variable in the first half of pregnancy and are poorly related to maternal TSH. This study shows that ...

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  • Diffusion Tensor Tractography of the Cerebellar Peduncles in Prematurely Born 7-Year-Old Children.

    Posted 2017-09-23 21:00:32 by: Mahammad A. Tafida

    Related Articles Diffusion Tensor Tractography of the Cerebellar Peduncles in Prematurely Born 7-Year-Old Children. Cerebellum. 2017 Apr;16(2):314-325 Authors: Shany E, Inder TE, Goshen S, Lee I, Neil JJ, Smyser CD, Doyle LW, Anderson PJ, Shimony JS Abstract The objective of this study was to correlate neurodevelopmental outcome of preterm-born children and their perinatal clinical and imaging characteristics with diffusion magnetic resonance imaging (MRI) measures of the three cerebellar peduncles at age 7. Included in this prospective longitudinal study were 140 preterm-born children (<30 weeks gestation) who underwent neurodevelopmental assessment (IQ, motor, language, working memory) and diffusion-weighted imaging (DWI) at age 7 years. White matter tracts in the superior, middle, and inferior cerebellar peduncles were delineated using regions of interest drawn on T2-weighted images and fractional anisotropy (FA) maps. Diffusion measures (mean diffusivity (MD) and FA) and tract volumes were calculated. Linear regression was used to assess relationships with outcome. The severity of white matter injury in the neonatal period was associated with lower FA in the right superior cerebellar peduncle (SCP) and lower tract volumes of both SCPs and middle cerebellar peduncles (MCPs). In the MCP, higher IQ was associated with lower MD in the whole group and higher FA in right-handed children. In the SCP, lower motor scores were associated with higher MD and higher language scores were associated with higher FA. These associations remained significant in multivariable models. This study adds to the body of literature detailing the importance of cerebellar involvement in cognitive function related to reciprocal connections with supratentorial structures. PMID: 27255706 [PubMed - indexed for ...

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  • Natural history, risk factors and clinical features of primary hypogonadism in ageing men: Longitudinal Data from the European Male Ageing Study.

    Posted 2017-09-23 21:00:32 by: Mahammad A. Tafida

    Related Articles Natural history, risk factors and clinical features of primary hypogonadism in ageing men: Longitudinal Data from the European Male Ageing Study. Clin Endocrinol (Oxf). 2016 Dec;85(6):891-901 Authors: Ahern T, Swiecicka A, Eendebak RJ, Carter EL, Finn JD, Pye SR, O'Neill TW, Antonio L, Keevil B, Bartfai G, Casanueva FF, Forti G, Giwercman A, Han TS, Kula K, Lean ME, Pendleton N, Punab M, Rastrelli G, Rutter MK, Vanderschueren D, Huhtaniemi IT, Wu FC, EMAS study group Abstract OBJECTIVE: In ageing men, the incidence and clinical significance of testosterone (T) decline accompanied by elevated luteinizing hormone (LH) are unclear. We describe the natural history, risk factors and clinical features associated with the development of biochemical primary hypogonadism (PHG, T < 10·5 nmol/l and LH>9·4U/l) in ageing men. DESIGN, PATIENTS AND MEASUREMENTS: A prospective observational cohort survey of 3,369 community-dwelling men aged 40-79 years, followed up for 4·3 years. Men were classified as incident (i) PHG (eugonadal [EUG, T ≥ 10·5 nmol/l] at baseline, PHG at follow-up), persistent (p) PHG (PHG at baseline and follow-up), pEUG (EUG at baseline and follow-up) and reversed (r) PHG (PHG at baseline, EUG at follow-up). Predictors and changes in clinical features associated with the development of PHG were analysed by regression models. RESULTS: Of 1,991 men comprising the analytical sample, 97·5% had pEUG, 1·1% iPHG, 1·1% pPHG and 0·3% rPHG. The incidence of PHG was 0·2%/year. Higher age (>70 years) [OR 12·48 (1·27-122·13), P = 0·030] and chronic illnesses [OR 4·24 (1·08-16·56); P = 0·038] predicted iPHG. Upon transition from EUG to PHG, erectile function, physical vigour and haemoglobin worsened significantly. Men with pPHG had decreased morning erections, sexual thoughts and haemoglobin with increased insulin resistance. CONCLUSIONS: Primary ...

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  • MicroRNA-146a rs2910164 is associated with severe preeclampsia in Black South African women on HAART.

    Posted 2017-09-23 21:00:32 by: Mahammad A. Tafida

    Related Articles MicroRNA-146a rs2910164 is associated with severe preeclampsia in Black South African women on HAART. BMC Genet. 2017 Jan 19;18(1):5 Authors: Maharaj NR, Ramkaran P, Pillay S, Chuturgoon AA Abstract BACKGROUND: South African (SA) Black women have a high prevalence of preeclampsia and HIV, both conditions associated with increased inflammation. miR-146a is an inflammatory-associated miR and a common single nucleotide polymorphism (rs2910164) has been associated with several disease conditions. To date, this SNP has not been investigated in SA Black women. We therefore aimed to investigate the miR-146a G > C SNP in SA Blacks with preeclampsia, and further examine possible association among preeclamptic (PE) women with HIV infection on HAART. METHODS: This hospital-based, case-control study included 95 normotensive and 98 PE Black SA women (aged 16-46 years old). Patients and controls were genotyped by PCR-RFLP. Using a Cytometric Bead Array assay, serum cytokine levels (including Th1- and Th2-related cytokines) were determined in 4 groups of pregnant women, viz: normotensive, HIV infected, PE + HIV infected, and PE women. RESULTS: There was no significant association between the miR-146a polymorphism and PE susceptibility in our data. However, in the subgroup analyses, the variant genotypes (GC/CC) were significantly associated with lower severe PE risk (p = 0.0497), more especially in the presence of HIV and HAART (p = 0.017). In the normotensive group, the variant genotypes were associated with lower IL-2 in both the total normotensive group (269 ± 1.26 (36) vs 273 ± 1.31 (23); p = 0.035) and the PE HIV+ sub-group 265 ± 1.54 (19) vs 271 ± 1.38 (11); p = 0.008). CONCLUSIONS: Our study suggests that miR-146a rs2910164 polymorphism might not be associated with PE susceptibility, cytokines or related features. However, the ...

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  • Maternal fat and fatty acid intake and birth outcomes in a South Indian population.

    Posted 2017-09-23 21:00:32 by: Mahammad A. Tafida

    Related Articles Maternal fat and fatty acid intake and birth outcomes in a South Indian population. Int J Epidemiol. 2016 Apr;45(2):523-31 Authors: Mani I, Dwarkanath P, Thomas T, Thomas A, Kurpad AV Abstract BACKGROUND: The quantity and quality of dietary fat during pregnancy play a key role in the growth and development of the fetus. The aim of this study was to examine the association between fat and fatty acid intakes in early pregnancy and birth outcomes in an apparent healthy normal South Indian population. METHODS: The study was a prospective observational cohort of 1838 pregnant women, conducted in South India. Intakes of total fat, saturated fatty acids (SFA) and polyunsaturated fats (PUFA) were assessed by a validated food-frequency questionnaire, and correlated with birthweight and incidence of small for gestational age (SGA) infants. RESULTS: This is a population that traditionally consumes diets that are low in SFA and n-3 PUFA, but high in linoleic acid (LA, 18:2 n-6). The data show that consumption of low SFA was associated with decreased birthweight and an increased risk of SGA [adjusted odds ratio (AOR) 1.45; 95% confidence interval (CI): 1.1, 2.1). Similar results were seen with n-3 PUFA: low intakes of alpha linolenic acid (ALNA, 18:3 n-3) as well as low intakes of long-chain (LC) n-3 PUFA were associated with increased risk of SGA (AOR 1.70; 95% CI: 1.1, 2.6, and AOR 1.27; 95% CI: 1.1, 2.1, respectively). Increased intakes of SFA and ALNA were predominantly associated with lower intakes of cereals and higher intakes of milk and milk products. CONCLUSIONS: These findings show that higher intakes of SFA and n-3 PUFA in early stages of pregnancy are associated with increased birthweight and reduced incidence of SGA in a South Indian population. PMID: 27013336 [PubMed - indexed for ...

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