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Adoption of diagnostic technology and variation in caesarean section rates: a test of the practice style hypothesis in Norway.

https://arctichealth.org/en/permalink/ahliterature124304
Source
Health Serv Res. 2012 Dec;47(6):2169-89
Publication Type
Article
Date
Dec-2012
Author
Jostein Grytten
Lars Monkerud
Rune Sørensen
Author Affiliation
Section of Community Dentistry, University of Oslo and Akershus University Hospital, Blindern, Oslo, Norway. josteing@odont.uio.no
Source
Health Serv Res. 2012 Dec;47(6):2169-89
Date
Dec-2012
Language
English
Publication Type
Article
Keywords
Cardiotocography
Cesarean Section - statistics & numerical data - trends
Diagnostic Techniques and Procedures - statistics & numerical data
Electrocardiography
Female
Fetal Blood - chemistry
Humans
Norway
Physician's Practice Patterns - statistics & numerical data - trends
Pregnancy
Ultrasonography
Uncertainty
Abstract
To examine whether the introduction of advanced diagnostic technology in maternity care has led to less variation in type of delivery between hospitals in Norway.
The Medical Birth Registry of Norway provided detailed medical information for 1.7 million deliveries from 1967 to 2005. Information about diagnostic technology was collected directly from the maternity units.
The data were analyzed using a two-level binary logistic model with Caesarean section as the outcome measure. Level one contained variables that characterized the health status of the mother and child. Hospitals are level two. A heterogeneous variance structure was specified for the hospital level, where the error variance was allowed to vary according to the following types of diagnostic technology: two-dimensional ultrasound, cardiotocography, ST waveform analysis, and fetal blood analyses.
There was a marked variation in Caesarean section rates between hospitals up to 1973. After this the variation diminished markedly. This was due to the introduction of ultrasound and cardiotocography.
Diagnostic technology reduced clinical uncertainty about the diagnosis of risk factors of the mother and child during delivery, and variation in type of delivery between hospitals was reduced accordingly. The results support the practice style hypothesis.
PubMed ID
22594486 View in PubMed
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The All Our Babies pregnancy cohort: design, methods, and participant characteristics.

https://arctichealth.org/en/permalink/ahliterature115873
Source
BMC Pregnancy Childbirth. 2013;13 Suppl 1:S2
Publication Type
Article
Date
2013
Author
Sheila W McDonald
Andrew W Lyon
Karen M Benzies
Deborah A McNeil
Stephen J Lye
Siobhan M Dolan
Craig E Pennell
Alan D Bocking
Suzanne C Tough
Author Affiliation
Department of Paediatrics, University of Calgary, Calgary, AB, Canada. sheilaw.mcdonald@albertahealthservices.ca
Source
BMC Pregnancy Childbirth. 2013;13 Suppl 1:S2
Date
2013
Language
English
Publication Type
Article
Keywords
Adult
Alberta
Child
Female
Fetal Blood - chemistry
Gene-Environment Interaction
Health Services - utilization
Health Services Accessibility
Humans
Infant
Longitudinal Studies
Pregnancy - blood
Pregnancy Complications - epidemiology
Pregnancy Outcome - epidemiology
Prospective Studies
Questionnaires
Research Design
Socioeconomic Factors
Abstract
The prospective cohort study design is ideal for examining diseases of public health importance, as its inherent temporal nature renders it advantageous for studying early life influences on health outcomes and research questions of aetiological significance. This paper will describe the development and characteristics of the All Our Babies (AOB) study, a prospective pregnancy cohort in Calgary, Alberta, Canada designed to examine determinants of maternal, infant, and child outcomes and identify barriers and facilitators in health care utilization.
Women were recruited from health care offices, communities, and through Calgary Laboratory Services before 25 weeks gestation from May 2008 to December 2010. Participants completed two questionnaires during pregnancy, a third at 4 months postpartum, and are currently being followed-up with questionnaires at 12, 24, and 36 months. Data was collected on pregnancy history, demographics, lifestyle, health care utilization, physical and mental health, parenting, and child developmental outcomes and milestones. In addition, biological/serological and genetic markers can be extracted from collected maternal and cord blood samples.
A total of 4011 pregnant women were eligible for recruitment into the AOB study. Of this, 3388 women completed at least one survey. The majority of participants were less than 35 years of age, Caucasian, Canadian born, married or in a common-law relationship, well-educated, and reported household incomes above the Calgary median. Women who discontinued after the first survey (n=123) were typically younger, non-Caucasian, foreign-born, had lower education and household income levels, were less likely to be married or in a common-law relationship, and had poor psychosocial health in early pregnancy. In general, AOB participants reflect the pregnant and parenting population at local and provincial levels, and perinatal indicators from the study are comparable to perinatal surveillance data.
The extensive and rich data collected in the AOB cohort provides the opportunity to answer complex questions about the relationships between biology, early experiences, and developmental outcomes. This cohort will contribute to the understanding of the biologic mechanisms and social/environmental pathways underlying associations between early and later life outcomes, gene-environment interactions, and developmental trajectories among children.
Notes
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PubMed ID
23445747 View in PubMed
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Analysis of hemoglobin adducts from acrylamide, glycidamide, and ethylene oxide in paired mother/cord blood samples from Denmark.

https://arctichealth.org/en/permalink/ahliterature131736
Source
Chem Res Toxicol. 2011 Nov 21;24(11):1957-65
Publication Type
Article
Date
Nov-21-2011
Author
Hans von Stedingk
Anna C Vikström
Per Rydberg
Marie Pedersen
Jeanette K S Nielsen
Dan Segerbäck
Lisbeth E Knudsen
Margareta Törnqvist
Author Affiliation
Department of Materials and Environmental Chemistry, Environmental Chemistry Unit, Arrhenius Laboratory, Stockholm University, SE-106 91 Stockholm, Sweden.
Source
Chem Res Toxicol. 2011 Nov 21;24(11):1957-65
Date
Nov-21-2011
Language
English
Publication Type
Article
Keywords
Acrylamide - blood
Adult
Case-Control Studies
Chromatography, Liquid
Denmark
Epoxy Compounds - blood
Ethylene Oxide - blood
Female
Fetal Blood - chemistry
Fetus
Hemoglobins - metabolism
Humans
Mass Spectrometry
Maternal Exposure
Placenta - physiology
Pregnancy
Smoking - adverse effects - blood
Abstract
The knowledge about fetal exposure to acrylamide/glycidamide from the maternal exposure through food is limited. Acrylamide, glycidamide, and ethylene oxide are electrophiles and form adducts with hemoglobin (Hb), which could be used for in vivo dose measurement. In this study, a method for analysis of Hb adducts by liquid chromatography-mass spectrometry, the adduct FIRE procedure, was applied to measurements of adducts from these compounds in maternal blood samples (n = 87) and umbilical cord blood samples (n = 219). The adduct levels from the three compounds, acrylamide, glycidamide, and ethylene oxide, were increased in tobacco smokers. Highly significant correlations were found between cord and maternal blood with regard to measured adduct levels of the three compounds. The mean cord/maternal hemoglobin adduct level ratios were 0.48 (range 0.27-0.86) for acrylamide, 0.38 (range 0.20-0.73) for glycidamide, and 0.43 (range 0.17-1.34) for ethylene oxide. In vitro studies with acrylamide and glycidamide showed a lower (0.38-0.48) rate of adduct formation with Hb in cord blood than with Hb in maternal blood, which is compatible with the structural differences in fetal and adult Hb. Together, these results indicate a similar life span of fetal and maternal erythrocytes. The results showed that the in vivo dose in fetal and maternal blood is about the same and that the placenta gives negligible protection of the fetus to exposure from the investigated compounds. A trend of higher levels of the measured adducts in cord blood with gestational age was observed, which may reflect the gestational age-related change of the cord blood Hb composition toward a higher content of adult Hb. The results suggest that the Hb adduct levels measured in cord blood reflect the exposure to the fetus during the third trimester. The evaluation of the new analytical method showed that it is suitable for monitoring of background exposures of the investigated electrophilic compounds in large population studies.
PubMed ID
21882862 View in PubMed
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Anti-Müllerian hormone in pregnant women in relation to other hormones, fetal sex and in circulation of second trimester fetuses.

https://arctichealth.org/en/permalink/ahliterature150115
Source
Reprod Biomed Online. 2009 May;18(5):694-9
Publication Type
Article
Date
May-2009
Author
Melissa Lutterodt
Anne Grete Byskov
Sven Oluf Skouby
Ann Tabor
Claus Yding Andersen
Author Affiliation
The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, Denmark.
Source
Reprod Biomed Online. 2009 May;18(5):694-9
Date
May-2009
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Anti-Mullerian Hormone - blood
Denmark
Female
Fetal Blood - chemistry
Humans
Immunohistochemistry
Male
Pregnancy
Pregnancy Trimesters - blood
Sex Determination Analysis
Sex Factors
Abstract
The aim of this study was to investigate the regulation of anti-Müllerian hormone (AMH) blood concentrations in mother and fetus during pregnancy. Serum concentrations of AMH, gonadotrophins, oestradiol and progesterone were measured in pregnant women in the first trimester and AMH concentrations in second-trimester fetuses, and these were compared in relation to the sex of the fetus. A total of 153 women undergoing elective termination of a first-trimester pregnancy and seven second-trimester pregnant women undergoing cordocentesis were included. Concentrations of AMH in the serum of first-trimester pregnant women were similar to non-pregnant women and were unrelated to the very high concentrations of human chorionic gonadotrophin and the undetectable concentrations of FSH and LH. Serum concentrations of oestradiol and progesterone were unrelated to the concentrations of AMH and the sex of the fetus. Serum concentrations of AMH of four, second trimester, male fetuses ranged from 64 to 92 ng/ml, whereas it was undetectable in female fetuses. It appears that AMH serum concentrations in first-trimester pregnant women seem to be independent of gonadotrophin concentrations and fetal sex. The concentration of AMH in the circulation of male fetuses is higher than previously reported and is a highly sensitive marker for fetal sex.
PubMed ID
19549450 View in PubMed
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Apolipoprotein E phenotypes and serum lipids in newborns and 3-year-old children: the Cardiovascular Risk in Young Finns Study.

https://arctichealth.org/en/permalink/ahliterature217182
Source
Pediatrics. 1994 Oct;94(4 Pt 1):489-93
Publication Type
Article
Date
Oct-1994
Author
T. Lehtimäki
K. Porkka
J. Viikari
C. Ehnholm
H K Akerblom
T. Nikkari
Author Affiliation
Department of Biomedical Sciences, University of Tampere, Finland.
Source
Pediatrics. 1994 Oct;94(4 Pt 1):489-93
Date
Oct-1994
Language
English
Publication Type
Article
Keywords
Adolescent
Age Factors
Alleles
Analysis of Variance
Apolipoprotein E2
Apolipoprotein E3
Apolipoprotein E4
Apolipoproteins E - genetics
Arteriosclerosis - epidemiology - etiology
Child
Child, Preschool
Cholesterol - blood
Cholesterol, LDL - blood
Enteral Nutrition
Female
Fetal Blood - chemistry
Finland - epidemiology
Follow-Up Studies
Humans
Infant, Newborn - blood
Male
Phenotype
Risk factors
Abstract
Apolipoprotein E (apoE) phenotype is a genetic determinant of plasma total cholesterol and low density lipoprotein (LDL) cholesterol concentrations, that are classical coronary heart disease risk factors. ApoE appears in three major isoforms E2, E3, and E4, coded by corresponding alleles epsilon 2, epsilon 3, and epsilon 4. These give rise to six different phenotypes.
To study the associations of apoE phenotype with cord serum lipids (during minimal enteral nutrition), and with serum lipids of 3-year-old children.
We determined serum lipid levels and apoE phenotypes in 206 newborns and 259 3-year-old children in connection with a larger follow-up study of atherosclerosis precursors in children and young adults. ApoE phenotyping was done directly from plasma by isoelectric focusing followed by immunoblotting.
The effect of apoE phenotype on serum total and LDL cholesterol was significantly different in newborns and 3-year-old children (two-way ANOVA, interaction between apoE phenotype and age group: P .05) either in males or in females. The mean serum levels of triglycerides and high density lipoprotein cholesterol did not differ between apoE phenotypes either in 3-year-old children or newborns.
The results show that the differences in serum total and LDL cholesterol levels between apoE phenotypes are formed after birth by the influence of environmental factors and suggest that both genetic and external factors influence the levels of serum cholesterol concentrations during the first years of life.
PubMed ID
7936857 View in PubMed
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[Application of a standardized-human biomonitoring methodology to assess prenatal exposure to mercury].

https://arctichealth.org/en/permalink/ahliterature263391
Source
Gig Sanit. 2014 Sep-Oct;(5):10-8
Publication Type
Article
Author
A I Egorov
I N Ilchenko
S M Lyapunov
E V Marochkina
O I Okina
B V Ermolaev
T V Karamysheva
Source
Gig Sanit. 2014 Sep-Oct;(5):10-8
Language
Russian
Publication Type
Article
Keywords
Environmental Monitoring - methods - standards
Female
Fetal Blood - chemistry
Food Habits
Hair - chemistry
Humans
Maternal Exposure - adverse effects
Mercury - analysis - blood - pharmacokinetics - urine
Pregnancy
Pregnancy Trimester, Third
Questionnaires
Russia
Seafood
Water Pollutants, Chemical - analysis - blood - pharmacokinetics - urine
World Health Organization
Abstract
World Health Organization (WHO), in cooperation with the Consortium to Perform Human Biomonitoring on a European Scale (COPHES), has developed a standardized methodology for human biomonitoring (HBM) surveys in maternities in order to assess prenatal exposure to mercury. To test this standard methodology and adapt it to Russian settings, a cross-sectional HBM survey involving 120 parturient women was conducted in six maternities of the Moscow Region. Levels of total mercury in maternal hair (geometric mean: 0.21 µg/g, 95th percentile: 0.54 µg/g), cord blood (0.89 µg/L and 2.38 µg/L, respectively) and maternal urine (0.27 µg/L and 0.94 µg/L) in this population were similar to those in other European countries with relatively low fish consumption. Consumption of all types of fish at least once per week during the third trimester of pregnancy compared to fish consumption less than once per month was associated with the increase of geometric mean level of total mercury: in hair by 31% (95% confidence interval: 4%, 66%) higher, in cord blood--by 38% (9%, 74%) and in maternal urine--by 36% (2%, 81%). No biomarker values exceeded levels recommended by WHO or national agencies in the USA and Germany. However; at the population level, adverse effects of prenatal exposures to mercury can still be substantial.
PubMed ID
25831921 View in PubMed
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Arachidonic acid status during pregnancy is associated with polychlorinated biphenyl exposure.

https://arctichealth.org/en/permalink/ahliterature58428
Source
Am J Clin Nutr. 2003 Mar;77(3):715-9
Publication Type
Article
Date
Mar-2003
Author
Grandjean P
Weihe P
Author Affiliation
Institute of Public Health, University of Southern Denmark, Odense. pgrandjean@health.sdu.dk
Source
Am J Clin Nutr. 2003 Mar;77(3):715-9
Date
Mar-2003
Language
English
Publication Type
Article
Keywords
Animals
Arachidonic Acid - blood
Cohort Studies
Denmark
Fatty Acid Desaturases - antagonists & inhibitors
Fatty Acids, Unsaturated - blood
Female
Fetal Blood - chemistry
Food Contamination
Humans
Infant, Newborn - growth & development
Maternal-Fetal Exchange
Polychlorinated Biphenyls - administration & dosage - adverse effects
Pregnancy - blood - drug effects
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Seafood
Whales
Abstract
BACKGROUND: Seafood is an important source of long-chain polyunsaturated fatty acids (LCPs), which are essential for normal growth and development. However, the nutritional benefits could be limited by polychlorinated biphenyl (PCB) contamination. In particular, inhibition of desaturase activities by PCBs may affect the maintenance of arachidonic acid (AA) status during development. OBJECTIVE: The aim was to evaluate AA status in a birth cohort from a fishing community with a high seafood intake and a wide range of PCB exposures. DESIGN: We measured LCP concentrations in paired mother and umbilical cord serum samples obtained from 182 consecutive births in the Faroe Islands, where PCB-contaminated whale blubber forms part of the diet. PCB exposure was determined from maternal concentrations. RESULTS: Serum phospholipid AA concentrations averaged 9.14% and 16.5% (by wt) in maternal and cord serum, respectively. After adjustment for gestational age and concentrations of linoleic, alpha-linolenic, and eicosapentaenoic acids, a decrease in AA concentrations of 0.17% (by wt) (95% CI: 0.03%, 0.31%) and 0.31% (by wt) (95% CI: 0.10%, 0.52%) was seen in maternal and cord serum, respectively, for each doubling of PCB exposure. CONCLUSIONS: Increased PCB exposure was associated with a modest decrease in serum AA concentrations, which is in accordance with the experimental evidence of desaturase inhibition by PCBs. Such interference with LCP utilization could attenuate the beneficial effects of the essential lipids contained in seafood. Because AA is of key importance for growth and development, these results suggest that this possible mechanism for PCB toxicity deserves to be explored.
PubMed ID
12600866 View in PubMed
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Assessment of pre- and postnatal exposure to polychlorinated biphenyls: lessons from the Inuit Cohort Study.

https://arctichealth.org/en/permalink/ahliterature4473
Source
Environ Health Perspect. 2003 Jul;111(9):1253-8
Publication Type
Article
Date
Jul-2003
Author
Pierre Ayotte
Gina Muckle
Joseph L Jacobson
Sandra W Jacobson
Eric Dewailly
Author Affiliation
Department of Social and Preventive Medicine, Laval University and Public Health Research Unit, CHUQ-Laval University Medical Centre, Québec, Québec, Canada. pierre.ayotte@inspq.qc.ca
Source
Environ Health Perspect. 2003 Jul;111(9):1253-8
Date
Jul-2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Biological Markers - analysis
Breast Feeding
Chromatography, Gas
Cohort Studies
Environmental Exposure
Environmental Pollutants - analysis - blood
Epidemiologic Studies
Female
Fetal Blood - chemistry
Forecasting
Humans
Indians, North American
Infant
Infant, Newborn
Maternal-Fetal Exchange
Milk, human - chemistry
Models, Theoretical
Polychlorinated Biphenyls - analysis - blood
Pregnancy
Quebec - epidemiology
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Abstract
Polychlorinated biphenyls (PCBs) are food-chain contaminants that have been shown to induce adverse developmental effects in humans. In the course of an epidemiologic study established to investigate neurodevelopmental deficits induced by environmental PCB exposure in the Inuit population of northern Québec (Nunavik, Canada), we compared three biomarkers of prenatal exposure and models to predict PCB plasma concentration at 6 months postpartum. Concentrations of 14 PCB congeners were measured by high-resolution gas chromatography with electron capture detection in lipids extracted from maternal plasma, cord plasma, breast milk (collected at approximately 1 month postpartum), and 6-month-old infant plasma samples. Similar congener profiles were observed in all biologic samples, and PCB-153, the most abundant and persistent PCB congener, was strongly correlated with other frequently detected PCB congeners in all biologic media. When expressed on a lipid basis, maternal plasma, cord plasma, and milk concentrations of this congener were strongly intercorrelated, indicating that PCB concentration in any of these biologic media is a good indicator of prenatal exposure to PCBs. A multivariate model that included maternal PCB-153 plasma lipid concentration, breast-feeding duration, and the sum of two skin-fold thicknesses (an index of infant body fat mass) explained 72% of PCB-153 plasma concentration variance at 6 months postpartum (p
PubMed ID
12842782 View in PubMed
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Associations between prenatal cigarette smoke exposure and externalized behaviors at school age among Inuit children exposed to environmental contaminants.

https://arctichealth.org/en/permalink/ahliterature258359
Source
Neurotoxicol Teratol. 2013 Sep-Oct;39:84-90
Publication Type
Article
  1 document  
Author
Caroline Desrosiers
Olivier Boucher
Nadine Forget-Dubois
Eric Dewailly
Pierre Ayotte
Sandra W Jacobson
Joseph L Jacobson
Gina Muckle
Author Affiliation
Université Laval, Québec City, Québec, Canada; Centre de recherche du Centre Hospitalier Universitaire de Québec, Québec City, Québec, Canada.
Source
Neurotoxicol Teratol. 2013 Sep-Oct;39:84-90
Language
English
Publication Type
Article
File Size
63846
Keywords
Attention - drug effects
Attention Deficit Disorder with Hyperactivity - chemically induced - epidemiology - psychology
Attention Deficit and Disruptive Behavior Disorders - chemically induced - psychology
Child
Drug Interactions
Environmental Pollutants - analysis - toxicity
Female
Fetal Blood - chemistry
Humans
Inuits - psychology
Lead Poisoning, Nervous System, Childhood - blood - psychology
Male
Mercury Poisoning, Nervous System - blood - psychology
Pregnancy
Prenatal Exposure Delayed Effects - chemically induced - psychology
Prevalence
Quebec - epidemiology
Tobacco Smoke Pollution - adverse effects
Abstract
Smoking during pregnancy is common among Inuit women from the Canadian Arctic. Yet prenatal cigarette smoke exposure (PCSE) is seen as a major risk factor for childhood behavior problems. Recent data also suggest that co-exposure to neurotoxic environmental contaminants can exacerbate the effects of PCSE on behavior. This study examined the association between PCSE and behavior at school age in a sample of Inuit children from Nunavik, Qu?bec, where co-exposure to environmental contaminants is also an important issue. Interactions with lead (Pb) and mercury (Hg), two contaminants associated with behavioral problems, were also explored.
Participants were 271 children (mean age=11.3years) involved in a prospective birth-cohort study. PCSE was assessed through maternal recall. Assessment of child behavior was obtained from the child's classroom teacher on the Teacher Report Form (TRF) and the Disruptive Behavior Disorders Rating Scale (DBD). Exposure to contaminants was assessed from umbilical cord and child blood samples. Other confounders were documented by maternal interview.
After control for contaminants and confounders, PCSE was associated with increased externalizing behaviors and attention problems on the TRF and higher prevalence of attention deficit hyperactivity disorder (ADHD) assessed on the DBD. No interactions were found with contaminants.
This study extends the existing empirical evidence linking PCSE to behavioral problems in school-aged children by reporting these effects in a population where tobacco use is normative rather than marginal. Co-exposure to Pb and Hg do not appear to exacerbate tobacco effects, suggesting that these substances act independently.
Notes
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PubMed ID
23916943 View in PubMed
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