Physical activity and the incidence of depression during the COVID-19 pandemic in Brazil: Findings from the PAMPA cohort

We examined the longitudinal association between physical activity (PA) and the incidence of self-reported diagnosed depression in adults in southern Brazil during the COVID-19 pandemic. Data from the PAMPA (Prospective Study About Mental and Physical Health) cohort was used. Data collection for baseline was carried out on June–July 2020, with two follow-up assessments taking place six months apart. An online, self-reported questionnaire assessed depression and PA. Depression was assessed by asking participants whether they were ever diagnosed with depression. We included 441 participants (women: 75.9%; mean age [SD]: 38.0 [13.5]) in southern Brazil. Over the follow-up, 21.8% (95% confidence interval [CI]: 18.1%–25.9%) were diagnosed with depression. Insufficiently active (<150 min per week of physical activity) (Incidence rate [IR]: 61.9; 95%CI: 39.5–102.4; p = 0.047) and active (≥150 min per week of physical activity) (IR: 50.4; 95%CI: 31.9–84.0; p = 0.015) participants had reduced IR of depression per 1000 persons-year at risk compared to inactive ones (0 min per week of physical activity) (IR: 99.9; 95%CI: 79.7–126.8). In the adjusted analyses, participants in the insufficient active (hazard ratio [HR]: 0.58; 95%CI: 0.34–0.98) and active (HR: 0.53; 95%CI: 0.31–0.93) group had a lower risk of developing depression than the inactive group. PA both at and out of home reduced the risk of incident depression (HR: 0.49; 95%CI: 0.25–0.98) compared to no physical activity. Endurance (HR: 0.52; 95%CI: 0.28–0.97) and endurance plus strengthening (HR: 0.40; 95%CI: 0.17–0.95) PA reduced the risk of incident depression compared to none. Being physically active during pandemic, regardless of the amount of PA practiced, reduced the incidence of depression in adults in southern Brazil.     

Correlates of Pre-Pregnancy Physical Inactivity: Results from the Pregnancy Risk Assessment Monitoring System

Objectives Evaluate the prevalence of physical inactivity (no physical activity or exercise for 30 min or more at least one day per week) in the 3 months prior to pregnancy in a population-based sample of women and identify individual socio-demographic, personal, health, and behavioral factors predictive of pre-pregnancy physical inactivity. Methods In this cross-sectional study, we used data from the Centers for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System to assess the prevalence of self-reported pre-pregnancy physical activity among 4,069 women who delivered a live birth in 2004 in Maine, North Carolina, or Washington State. We developed a predictive model by using a backward selection approach to building logistic regression models to identify independent predictors of physical inactivity in the 3 months prior to pregnancy among those women who did not meet national recommendations for physical activity (activity more than 5 days per week). Results Overall, the prevalence of pre-pregnancy physical inactivity was 39.2%. Predictors of physical inactivity prior to pregnancy included higher or lower than normal pre-pregnancy body mass index, lower maternal education level, and a history of previous live births. Women with 12 years of education were particularly likely to be inactive prior to pregnancy (prevalence odds ratio 1.81, 95% confidence interval 1.42, 2.32; compared to women with more than 12 years of education). Conclusions Physical inactivity is common among women prior to pregnancy. Information on factors predictive of physical inactivity can be used in the development of clinical activities and public health interventions that aim to reduce the level of physical inactivity among women of reproductive age.     

Postpartum Care Utilization Among Women with Medicaid-Funded Live Births in Oregon

Introduction

Postpartum care is an important strategy for preventing and managing chronic disease in women with pregnancy complications (i.e., gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP)).

Methods

Using a population-based, cohort study among Oregon women with Medicaid-financed deliveries (2009–2012), we examined Medicaid-financed postpartum care (postpartum visits, contraceptive services, and routine preventive health services) among women who retained Medicaid coverage for at least 90 days after delivery (n?=?74,933). We estimated postpartum care overall and among women with and without GDM and/or HDP using two different definitions: 1) excluding care provided on the day of delivery, and 2) including care on the day of delivery. Pearson chi-square tests were used to assess differential distributions in postpartum care by pregnancy complications (p?<?.05), and generalized estimating equations were used to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs).

Results

Of Oregon women who retained coverage through 90 days after delivery, 56.6–78.1% (based on the two definitions) received any postpartum care, including postpartum visits (26.5%-71.8%), contraceptive services (30.7–35.6%), or other routine preventive health services (38.5–39.1%). Excluding day of delivery services, the odds of receiving any postpartum care (aOR 1.26, 95% CI 1.08–1.47) or routine preventive services (aOR 1.32, 95% CI 1.14–1.53) were meaningfully higher among women with GDM and HDP (reference?=?neither).

Discussion

Medicaid-financed postpartum care in Oregon was underutilized, it varied by pregnancy complications, and needs improvement. Postpartum care is important for all women and especially those with GDM or HDP, who may require chronic disease risk assessment, management, and referrals.

     

Association Between Birth Weight and Risk of Pregnancy-Induced Hypertension and Gestational Diabetes in Japanese Women: JPHC-NEXT Study

BackgroundAlthough prevalence of low birth weight has increased in the last 3 decades in Japan, no studies in Japanese women have investigated whether birth weight is associated with the risk of pregnancy complications, such as pregnancy-induced hypertension (PIH) and gestational diabetes mellitus (GDM).MethodsWe used data from the Japan Public Health Center-based Prospective Study for the Next Generation (JPHC-NEXT), a population-based cohort study in Japan that launched in 2011. In the main analysis, we included 46,365 women who had been pregnant at least once, for whom information on birth weight and events during their pregnancy was obtained using a self-administered questionnaire. Women were divided into five categories according to their birth weight, and the relationship between birth weight and risk of PIH and GDM was examined using multilevel logistic regression analyses with place of residence as a random effect.ResultsCompared to women born with birth weight of 3,000–3,999 grams, the risk of PIH was significantly higher among women born <1,500 grams (adjusted odd ratio [aOR] 1.60; 95% confidence interval [CI], 1.17–2.21), 1,500–2,499 grams (aOR 1.16; 95% CI, 1.03–1.30), and 2,500–2,999 grams (aOR 1.13; 95% CI, 1.04–1.22). The risk of GDM was significantly higher among women born 1,500–2,499 grams (aOR 1.20; 95% CI, 1.02–1.42), albeit non-significant association among women in other birthweight categories.ConclusionsWe observed an increased risk of PIH among women born with lower birth weight albeit non-significant increased risk of GDM among Japanese women.Key words: gestational diabetes mellitus, lower birth weight, pregnancy induce hypertension, transgenerational effect     

Predictors of change in physical activity during and after pregnancy: Project Viva

BACKGROUND: Few studies document longitudinal changes in physical activity from prepregnancy to the postpartum period. METHODS: This study estimated change in self-reported leisure-time physical activity in 1442 women before pregnancy, during the second trimester, and at 6 months postpartum. In addition, it also examined predictors of becoming insufficiently active during or after pregnancy. RESULTS: The mean (SD) age was 32.5 (4.5) years, 34% of the women were overweight or obese prepregnancy (body mass index equal to or greater than 25 kg/m(2)), and 76% were white. Before pregnancy, the mean total leisure physical activity was 9.6 hours per week. The reported decrease in total activity between prepregnancy and 6 months postpartum was -1.4 (95% CI=-1.0 to -1.9) hours per week, accounted for by decreases in moderate and vigorous physical activity but not walking. Prevalence of insufficiently active lifestyle (less than 150 minutes per week of total activity) increased from 12.6% before pregnancy to 21.7% during the postpartum period. The OR for becoming insufficiently active during pregnancy was 1.58 (95% CI=1.07-2.32) in women with at least one child compared with no children. Predictors of becoming insufficiently active postpartum included postpartum weight retention (OR=1.31; 95% CI=1.05-1.58 for each 5-kg increment); working longer hours in the first trimester (e.g., OR=5.12; 95% CI=1.96-13.4 for 45+ vs 0 hours); and reporting that lack of child care was a barrier to physical activity (OR=1.73; 95% CI=0.99-3.02). CONCLUSIONS: Women reported decreases in moderate and vigorous physical activity during pregnancy that persisted at 6 months postpartum. Levels of walking did not decline. Children in the home, longer work hours, and lack of child care were predictors of becoming insufficiently active during or after pregnancy.     

Association of pneumococcal vaccination with cardiovascular diseases in older adults: The vaccine effectiveness,networking, and universal safety (VENUS) study

The protective effect of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) against cardiovascular disease has been investigated in the United States and Europe; however, its effect has not been fully established. This study aimed to investigate the protective effect of PPSV23 on cardiovascular events in adults aged ≥ 65 years. This population-based nested case-control study was conducted using the claims data and vaccine records between April 2015 and March 2020 from the Vaccine Effectiveness, Networking, and Universal Safety (VENUS) Study. PPSV23 vaccination was identified using vaccination records in each municipality. The primary outcome was acute myocardial infarction (AMI) or stroke. The adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for PPSV23 vaccination were calculated using conditional logistic regression. Among 383,781 individuals aged ≥ 65 years, 5,356 and 25,730 individuals with AMI or stroke were matched with 26,753 and 128,397 event-free controls, respectively. Individuals who were PPSV23 vaccinated, compared with the unvaccinated individuals, had significantly lower odds of AMI or stroke events (aOR, 0.70 [95% CI, 0.62–0.80] and aOR, 0.81 [95% CI, 0.77–0.86], respectively). More recent PPSV23 vaccination was associated with lower odds ratios (AMI, aOR 0.55 [95% CI, 0.42–0.72] for 1–180 days and aOR 1.11 [95% CI, 0.84–1.47] for 720 days or longer; stroke, aOR 0.83 [95% CI, 0.74–0.93] for 1–180 days and aOR 0.90 [95% CI, 0.78–1.03] for 720 days or longer). Among Japanese older adults, individuals who were PPSV23 vaccinated, compared with unvaccinated individuals, had significantly lower odds of AMI or stroke events.     

Limitación auditiva y fragilidad social en hombres y mujeres mayores

ObjectiveTo explore the association between hearing loss and social frailty in a sample of Spanish older adults recruited from primary health care network.MethodCross-sectional study on a sample of 445 non-institutionalized adults aged 65 or more years (190 men and 255 women), recruited from primary care centers in Spain. Three self-reported hearing impairment questions were used to assess hearing loss. Social frailty was deemed to exist when the person presented two or more of the following conditions: living alone, absence of a person to provide help, infrequent contact with family, infrequent contact with friends, lack of confident and lack of help for daily activities in the last 3 months. To study the association between hearing loss and social frailty we used logistic regression models adjusted for potential confounders, including physical frailty.ResultsThe mean age of participants was 76.2 years (77.5 years for women). More than half of the participants (54.4%) reported hearing loss and the frequency of social frailty was 23.2%. Hearing loss was associated with social frailty (adjusted odds ratio [aOR] = 1.78; 95% confidence interval [95%CI]: 1.04-3.06). However, the association was sex-dependent (p for interaction = 0.041). In stratified analysis, the association was only found in women (aOR = 3.21; 95%CI: 1.44-7.17).ConclusionsHearing loss was associated with social frailty in women, but not in men. Longitudinal studies are needed to confirm this association and to understand the differential effect of gender.     

The Influence of Maternal Vitamin E Concentrations in Different Trimesters on Gestational Diabetes and Large-for-Gestational-Age: A Retrospective Study in China

Vitamin E can protect pregnant women from oxidative stress and further affect pregnancy outcomes. This study aimed to investigate maternal vitamin E concentration in each trimester and its associations with gestational diabetes (GDM) and large-for-gestational-age (LGA). The data were derived from Peking University Retrospective Birth Cohort in Tongzhou, collected from 2015 to 2018 (n = 19,647). Maternal serum vitamin E were measured from blood samples collected in each trimester. Logistic regressions were performed to analyze the association between maternal vitamin E levels and outcomes. The median levels of maternal vitamin E increased from the first (10.00 mg/L) to the third (16.00 mg/L) trimester. Among mothers who had inadequate vitamin E levels, most of them had excessive amounts. Excessive vitamin E level in the second trimester was a risk factor for GDM (aOR = 1.640, 95% CI: 1.316–2.044) and LGA (aOR = 1.334, 95% CI: 1.022–1.742). Maternal vitamin E concentrations in the first and second trimesters were positively associated with GDM (first: aOR = 1.056, 95% CI: 1.038–1.073; second: aOR = 1.062, 95% CI: 1.043–1.082) and LGA (first: aOR = 1.030, 95% CI: 1.009–1.051; second: aOR = 1.040, 95% CI: 1.017–1.064). Avoiding an excess of vitamin E during pregnancy might be an effective measure to reduce GDM and LGA. Studies to explore the potential mechanisms are warranted.     

2013-2017年北京市通州区34637例孕妇妊娠期糖尿病流行情况及其影响因素研究

  目的  了解北京市通州区孕妇妊娠期糖尿病（gestational diabetes mellitus,GDM）的流行情况及其相关影响因素。  方法  收集2013年1月1日至2017年12月31日期间在北京市通州区妇幼保健院住院分娩的34 637例单胎孕妇的社会人口学特征、既往史、糖尿病家族史及本次妊娠情况等资料,分析孕妇GDM患病率,利用多因素Logistic回归分析GDM相关影响因素。  结果  34 637例单胎孕妇的GDM患病率为23.19%（8 034/34 637）。多因素分析显示,高龄（aOR=1.87,95%CI:1.71~2.05）、高文化程度（aOR=1.19~1.23）、2016-2017年分娩（aOR=1.46,95%CI:1.38~1.55）、巨大儿分娩史（aOR=1.27,95%CI:1.02~1.59）、剖宫产史（aOR=1.18,95%CI:1.08~1.30）、自然流产史（aOR=1.23,95%CI:1.10~1.37）、药物及人工流产史（aOR=1.08,95%CI:1.01~1.14）、糖尿病家族史（aOR=1.51,95%CI:1.26~1.83）、经产妇（aOR=1.24,95%CI:1.15~1.34）、孕前超重（aOR=2.02,95%CI:1.89~2.15）、孕前肥胖（aOR=3.11,95%CI:2.81~3.43）、采用辅助生殖技术怀孕者（aOR=1.47,95%CI:1.03~2.10）是GDM的独立危险因素。  结论  北京市通州区住院分娩的孕妇中GDM处于较高的流行水平。应针对影响GDM发病的相关危险因素,开展孕前及孕期健康教育,及时监测及预防GDM的发生,以促进母婴健康。     

Early Resumption of Sexual Intercourse after First Childbirth and Unintended Pregnancy within Six Months

ObjectiveWe aimed to evaluate factors associated with early resumption of sexual intercourse after first childbirth and assess whether early intercourse is associated with unprotected intercourse, subsequent pregnancy, and unintended pregnancy over 6 months.MethodsThis secondary analysis used data from the First Baby Study, a prospective study of women aged 18–35 years with singleton pregnancies who delivered at 76 hospitals in Pennsylvania. At 1 and 6 months postpartum, women were asked about intercourse and the use of birth control since childbirth. We compared women who resumed intercourse in the first month after childbirth (early resumption) with those who resumed intercourse later, via multivariable logistic regression models.ResultsIn our cohort, 261 of 2,643 women (9.9%) reported first intercourse within the first postpartum month (7–31 days). Women who resumed intercourse early were less educated, younger, and less likely to breastfeed, have had a perineal laceration, or have had an episiotomy than those who resumed intercourse later. In addition, they were more likely to have unprotected intercourse in at least one of the first 6 months after first childbirth (adjusted odds ratio [aOR], 2.33; 95% confidence interval [CI], 1.76–3.09); to be pregnant by 6 months postpartum (aOR, 3.03; 95% CI, 1.48–6.20); and to report that pregnancy as unintended (aOR, 3.32; 95% CI, 1.50–7.36).ConclusionsNearly 10% of women resumed intercourse in the first month after childbirth. Because early resumption of intercourse was associated with a greater likelihood of unprotected intercourse and unintended pregnancy within 6 months of first childbirth, clinicians should focus efforts on comprehensive family planning and contraception counseling beginning in the prenatal period.     

Impact of Ready-Meal Consumption during Pregnancy on Birth Outcomes: The Japan Environment and Children’s Study

Ready-meal consumption is increasing worldwide; however, its impact on human health remains unclear. We aimed to examine the association between processed food and beverage consumption during pregnancy and pregnancy outcomes. Pregnant women were recruited for the Japan Environment and Children’s Study (JECS), a nationwide, large-scale, prospective cohort study. This study included 104,102 registered children (including fetuses or embryos) and collected questionnaire-based data during the first and second/third trimester of pregnancy. Participants’ medical records were transcribed at pregnancy registration, immediately after delivery, and 1 month after delivery. Logistic regression analysis was used to estimate the association between processed food consumption and pregnancy outcomes. The incidence of stillbirth was higher in the group that consumed moderate (1–2 times per week) and high (≥3–7 times per week) amounts of ready-meals (adjusted odds ratio (aOR) = 2.054, 95% confidence interval (CI): 1.442–2.926, q = 0.002; aOR = 2.632, 95% CI: 1.507–4.597, q = 0.007, respectively) or frozen meals (aOR = 2.225, 95% CI: 1.679–2.949, q < 0.001; aOR = 2.170, 95% CI: 1.418–3.322, q = 0.005, respectively) than in the group that rarely consumed such foods. Processed food consumption during pregnancy should be carefully considered.     

Exercise during Pregnancy and Risk of Late Preterm Birth,Cesarean Delivery,and Hospitalizations

BackgroundFederal physical activity guidelines recommend at least 150 minutes of moderate-intensity exercise per week during pregnancy. We studied whether regular exercise during pregnancy is associated with preterm birth, cesarean delivery, and hospitalization during pregnancy.MethodsSelf-reported weekly exercise was ascertained in 3,006 women during the third trimester of pregnancy. Using multivariable logistic regression, we report the relationship between regular exercise (≥150 min/wk) and late preterm birth, cesarean delivery, and hospitalization during pregnancy, controlling for age, race, marital status, education, poverty status, prepregnancy body mass index weight category, gestational weight gain, and prepregnancy diabetes or hypertension.ResultsNearly one third of women reported meeting current federal physical activity recommendations during pregnancy. Five percent had late preterm birth, 29% had cesarean deliveries, and 20% reported hospitalization during pregnancy. In multivariable analysis, regular exercise during pregnancy was not associated with late preterm birth or hospitalization during pregnancy. Physical activity of 150 or more minutes per week was associated with reduced odds of cesarean delivery compared with less than 60 minutes per week, but the finding was not significant (adjusted odds ratio, 0.86; 95% confidence interval, 0.69–1.07).ConclusionIn the First Baby Study, physical activity was not associated with late preterm birth or hospitalizations, and may be associated with decreased odds of cesarean delivery.     

Relationship of parity and prior cesarean delivery to levonorgestrel 52 mg intrauterine system expulsion over 6 years

ObjectiveAssess the relationship between parity and prior route of delivery to levonorgestrel 52 mg intrauterine system (IUS) expulsion during the first 72 months of use.Study DesignWe evaluated women enrolled in the ACCESS IUS multicenter, Phase 3, open-label clinical trial of the Liletta levonorgestrel 52 mg IUS. Investigators evaluated IUS presence at 3 and 6 months after placement and then every 6 months and during unscheduled visits. We included women with successful placement and at least one follow-up assessment. We evaluated expulsion rates based on obstetric history; for prior delivery method subanalyses, we excluded 12 participants with missing delivery data. We determined predictors of expulsion using multivariable regression analyses.ResultsOf 1714 women with IUS placement, 1710 had at least one follow-up assessment. The total population included 986 (57.7%) nulliparous women. Sixty-five (3.8%) women experienced expulsion within 72 months, 50 (76.9%) within the first 12 months. Expulsion rates among nulliparous women (22/986 [2.2%]) or parous women with any pregnancy ending with a Cesarean delivery (6/195 [3.1%]) differed from parous women who only experienced vaginal deliveries (37/517 [7.2%]) (p < 0.001). In multivariable regression, obesity (adjusted odds ratio [aOR] 2.2, 95% confidence interval [CI] 1.3–3.7), parity (aOR 2.2, 95% CI 1.2–4.1), and non-white race (aOR 1.8, 95% CI 1.1–3.2) predicted expulsion. Among parous women, obesity (aOR 2.2, 95% CI 1.2–4.2) increased the odds and having ever had a cesarean delivery (aOR 0.4, 95% CI 0.1–0.9) decreased the odds of expulsion.ConclusionIUS expulsion occurs in less than 4% of users over the first 6 years of use and occurs mostly during the first year. Expulsion is more likely among obese and parous women.ImplicationsLevonorgestrel 52 mg intrauterine system expulsion occured more commonly in parous than nulliparous women; the increase in parous women is primarily in women who had vaginal deliveries only. The association between obesity, delivery route, and IUS expulsion needs further elucidation.     

Social class and self-reported health status among men and women: what is the role of work organisation, household material standards and household labour?

Social class understood as social relations of ownership and control over productive assets taps into parts of the social variation in health that are not captured by conventional measures of social stratification. The objectives of this study are to analyse the association between self-reported health status and social class and to examine the role of work organisation, material standards and household labour as potential mediating factors in explaining this association. We used the Barcelona Health Interview Survey, a cross-sectional survey of 10,000 residents of the city's non-institutionalised population in 2000. This was a stratified sample, strata being the 10 districts of the city. The present study was conducted on the working population, aged 16-64 years (2345 men and 1874 women). Social class position was measured with Erik Olin Wright's indicators according to ownership and control over productive assets. The dependent variable was self-reported health status. The independent variables were social class, age, psychosocial and physical working conditions, job insecurity, type of labour contract, number of hours worked per week, possession of appliances at home, as well as household labour (number of hours per week, doing the housework alone and having children, elderly or disabled at home). Several hierarchical logistic regression models were performed by adding different blocks of independent variables. Among men the prevalence of poor reported health was higher among small employers and petit bourgeois, supervisors, semi-skilled (adjusted odds ratio-aOR: 4.92; 95% CI: 1.88-12.88) and unskilled workers (aOR: 7.69; 95%CI: 3.01-19.64). Work organisation and household material standards were associated with poor health status with the exception of number of hours worked per week. Work organisation variables were the main explanatory variables of social class inequalities in health, although material standards also contributed. Among women, only unskilled workers had poorer health status than the referent category of manager and skilled supervisors (aOR: 3.25; 95%CI: 1.37-7.74). All indicators of work organisation and household material standards reached statistical significance, excepting the number of hours worked per week. In contrast to men, among women the number of hours per week of household labour was associated with poor health status (aOR: 1.02; 95% CI: 1.01-1.03). Showing a different pattern from men in the full model, household material deprivation and hours of household labour per week were associated with poor health status among women. Our findings suggest that among men, part of the association between social class positions and poor health can be accounted for psychosocial and physical working conditions and job insecurity. Among women, the association between the worker (non-owner, non-managerial, and un-credentiated) class positions and health is substantially explained by working conditions, material well being at home and amount of household labour.     

Association of Prenatal Physical Activity and Gestational Weight Gain: Results from the First Baby Study

BackgroundIn response to increasing rates of excessive gestational weight gain (GWG) and evidence of postpartum weight retention and long-term overweight and obesity, the Institute of Medicine (IOM) revised their guidelines for GWG in 2009. Prenatal physical activity is recommended, although its role in preventing excessive GWG is unclear. We sought to understand the association between prenatal physical activity and GWG in a longitudinal cohort.MethodsDuring a baseline survey at 34 weeks, women (n = 3,006) reported their height, prepregnancy weight, and physical activity during pregnancy. GWG was self-reported at 1-month postpartum. Multivariable logistic regression adjusting for age, race/ethnicity, education, poverty status, marital status, gestational age at the time of delivery, and smoking was used to model the association between adequate physical activity during pregnancy and exceeding the IOM recommendations for GWG.FindingsOverweight women were most likely to exceed the IOM recommendations for GWG (78.7%), followed by obese women and normal weight women (65.0% and 42.4%, respectively). The majority of women participated in some physical activity during pregnancy, with 41.2% engaging in 60 to 149 minutes and 32.1% engaging in at least 150 minutes of physical activity per week. In adjusted analysis, meeting the physical activity guidelines was associated with a 29% (confidence interval, 0.57–0.88) lower odds of exceeding the IOM recommendations for GWG compared with inactive women.ConclusionsFindings of high rates of excessive GWG, especially among women with overweight and obesity, are concerning given the associated health burdens. The association of guideline-concordant physical activity with appropriate GWG suggests this is an important target for future interventions.     

Association of spontaneous abortion with receipt of inactivated influenza vaccine containing H1N1pdm09 in 2010–11 and 2011–12

IntroductionInactivated influenza vaccine is recommended in any stage of pregnancy, but evidence of safety in early pregnancy is limited, including for vaccines containing A/H1N1pdm2009 (pH1N1) antigen. We sought to determine if receipt of vaccine containing pH1N1 was associated with spontaneous abortion (SAB).MethodsWe conducted a case-control study over two influenza seasons (2010–11, 2011–12) in the Vaccine Safety Datalink. Cases had SAB and controls had live births or stillbirths and were matched on site, date of last menstrual period, and age. Of 919 potential cases identified using diagnosis codes, 485 were eligible and confirmed by medical record review. Exposure was defined as vaccination with inactivated influenza vaccine before the SAB date; the primary exposure window was the 1–28 days before the SAB.ResultsThe overall adjusted odds ratio (aOR) was 2.0 (95% CI, 1.1–3.6) for vaccine receipt in the 28-day exposure window; there was no association in other exposure windows. In season-specific analyses, the aOR in the 1–28 days was 3.7 (95% CI 1.4–9.4) in 2010–11 and 1.4 (95% CI 0.6–3.3) in 2011–12. The association was modified by influenza vaccination in the prior season (post hoc analysis). Among women who received pH1N1-containing vaccine in the previous influenza season, the aOR in the 1–28 days was 7.7 (95% CI 2.2–27.3); the aOR was 1.3 (95% CI 0.7–2.7) among women not vaccinated in the previous season. This effect modification was observed in each season.ConclusionSAB was associated with influenza vaccination in the preceding 28 days. The association was significant only among women vaccinated in the previous influenza season with pH1N1-containing vaccine. This study does not and cannot establish a causal relationship between repeated influenza vaccination and SAB, but further research is warranted.     

Chocolate consumption in pregnancy and reduced likelihood of preeclampsia

BACKGROUND: Preeclampsia is a major pregnancy complication with cardiovascular manifestations. Recent studies suggest that chocolate consumption may benefit cardiovascular health. METHODS: We studied the association of chocolate consumption with risk of preeclampsia in a prospective cohort study of 2291 pregnant women who delivered a singleton livebirth between September 1996 and January 2000. Chocolate consumption was measured by self report in the first and third trimesters, and by umbilical cord serum concentrations of theobromine, the major methylxanthine component of chocolate. Preeclampsia was assessed by detailed medical record review for 1943 of the women. We derived adjusted odds ratios (aOR) and 95% confidence intervals (CIs) from logistic regression models controlling for potential confounders. RESULTS: Preeclampsia developed in 3.7% (n = 63) of 1681 women. Cord serum theobromine concentrations were negatively associated with preeclampsia (aOR = 0.31; CI = 0.11-0.87 for highest compared with lowest quartile). Self-reported chocolate consumption estimates also were inversely associated with preeclampsia. Compared with women consuming under 1 serving of chocolate weekly, women consuming 5+ servings per week had decreased risk: aOR = 0.81 with consumption in the first 3 months of pregnancy (CI = 0.37-1.79) and 0.60 in the last 3 months (0.30-1.24). CONCLUSIONS: Our results suggest that chocolate consumption during pregnancy may lower risk of preeclampsia. However, reverse causality may also contribute to these findings.     

Vitamin D Status and Gestational Diabetes in Russian Pregnant Women in the Period between 2012 and 2021: A Nested Case–Control Study

Several meta-analyses found an association between low maternal serum 25-hydroxyvitamin D (25(OH)D) level and gestational diabetes mellitus (GDM). However, some of them reported significant heterogeneity. We examined the association of serum 25(OH)D concentration measured in the first and in the second halves of pregnancy with the development of GDM in Russian women surveyed in the periods of 2012–2014 and 2018–2021. We conducted a case–control study (including 318 pregnant women) nested on two previous studies. In 2012–2014, a total of 214 women (83 GDM and 131 controls) were enrolled before 15 weeks of gestation and maternal serum 25(OH)D concentrations were measured twice: at 8th–14th week of gestation and simultaneously with two-hour 75 g oral glucose tolerance test (OGTT) at 24th–32nd week of gestation. In the period of 2018–2021, 104 women (56 GDM and 48 controls) were included after OGTT and 25(OH)D concentrations were measured at 24th–32nd week of gestation. Median 25(OH)D levels were 20.0 [15.1–25.7] vs. 20.5 [14.5–27.5] ng/mL (p = 0.565) in GDM and control group in the first half of pregnancy and 25.3 [19.8–33.0] vs. 26.7 [20.8–36.8] ng/mL (p = 0.471) in the second half of pregnancy, respectively. The prevalence rates for vitamin D deficiency (25(OH)D levels < 20 ng/mL) were 49.4% and 45.8% (p = 0.608) in the first half of pregnancy and 26.2% vs. 22.1% (p = 0.516) in the second half of pregnancy in women who developed GDM and in women without GDM, respectively. The frequency of vitamin D supplements intake during pregnancy increased in 2018–2021 compared to 2012–2014 (p = 0.001). However, the third trimester 25(OH)D levels and prevalence of vitamin D deficiency (25.5 vs. 23.1, p = 0.744) did not differ in women examined in the periods of 2012–2014 and 2018–2021. To conclude, there was no association between gestational diabetes risk and maternal 25(OH)D measured both in the first and in the second halves of pregnancy. The increased prevalence of vitamin D supplements intake during pregnancy by 2018–2021 did not lead to higher levels of 25(OH)D.     

Physical activity and hip fracture: a population-based case-control study. Swedish Hip Fracture Study Group

BACKGROUND: A growing body of literature suggests that physical activity may be a protective factor against hip fracture. METHODS: To study the association between hip fracture risk and recreational physical activity at various ages, changes in activity during adult life, occupational physical activity and how risks vary by adult weight change, we performed a population-based case-control study among postmenopausal women aged 50-81 years residing in six counties in Sweden in 1993-1995. The analysis consisted of 1327 women with hip fracture and 3262 randomly selected controls. Information on leisure physical activity before age 18, at 18-30 years and during recent years was based on a questionnaire. Data on occupational physical activity were collected through an independent classification of job titles obtained from record linkage with census data from 1960, 1970 and 1980. RESULTS: There was a protective effect of recent leisure physical activity. Compared to women who reported no leisure activity, the odds ratios (OR) were 0.79 (95% CI: 0.62-1.00), 0.67 (95% CI: 0.54-0.84) and 0.48 (95% CI: 0.39-0.60) for women who exercised <1 h per week, 1-2 h per week, and 3+ h per week, respectively. These decreased OR were more pronounced in women who had lost weight after 18 years of age than in those who had gained weight. Women with high physical activity at both 18-30 years and during recent years did not have a stronger protection than those with isolated high activity late in life, after accounting for recent activity. Occupational physical activity was not associated with hip fracture risk in this study. CONCLUSIONS: Recent physical activity is protective against hip fracture. The protective effect is most pronounced in women who had lost weight after age 18.