Race/Ethnicity, Educational Attainment, and Pregnancy Complications in New York City Women with Pre-existing Diabetes

Background: More women are entering pregnancy with pre-existing diabetes. Disease severity, glycaemic control, and predictors of pregnancy complications may differ by race/ethnicity or educational attainment, leading to differences in adverse pregnancy outcomes. Methods: We used linked New York City hospital record and birth certificate data for 6291 singleton births among women with pre-existing diabetes between 1995 and 2003. We defined maternal race/ethnicity as non-Hispanic white, non-Hispanic black, Hispanic, South Asian, and East Asian, and education level as 12 years. Our outcomes were pre-eclampsia, preterm birth (PTB) (<37 weeks gestation and categorised as spontaneous or medically indicated), as well as small-for-gestational age (SGA) and large-for-gestational age (LGA). Using multivariable binomial regression, we estimated the risk ratios for pre-eclampsia, SGA, and LGA. We used multivariable multinomial regression to estimate odds ratios (OR) for PTB. Results: Compared with non-Hispanic white women with pre-existing diabetes, non-Hispanic black and Hispanic women with pre-existing diabetes had a 1.50-fold increased risk of pre-eclampsia compared with non-Hispanic whites with pre-existing diabetes, after full adjustment. Non-Hispanic black and Hispanic women with pre-existing diabetes had adjusted ORs of 1.72 [adj. 95% confidence interval (CI) 1.38, 2.15] and 1.65 [adj.95% CI 1.32, 2.05], respectively, for medically indicated PTB. South Asian women with pre-existing diabetes had the highest risk for having an SGA infant [adj. OR: 2.29; adj. 95% CI 1.73, 3.03]. East Asian ethnicity was not associated with these pregnancy complications. Conclusions: Non-Hispanic black, Hispanic, and South Asian women with pre-existing diabetes may benefit from targeted interventions to improve pregnancy outcomes

Exposure to perfluoroalkyl acids and markers of kidney function among children and adolescents living near a chemical plant.

BACKGROUND: Serum levels of perfluorooctanoic acid (PFOA) have been associated with decreased renal function in cross-sectional analyses, but the direction of the association is unclear. OBJECTIVES: We examined the association of measured and model-predicted serum PFOA concentrations with estimated glomerular filtration rate (eGFR), a marker of kidney function, in a highly exposed population (median serum PFOA, 28.3 ng/mL). METHODS: We measured serum creatinine, PFOA, perfluorooctane sulfonate (PFOS), perfluorononanoic acid (PFNA), and perfluorohexane sulfonate (PFHxS) and calculated eGFR in 9,660 children 1 to < 18 years of age at study enrollment. We predicted concurrent and historical serum PFOA concentrations using a validated environmental, exposure, and pharmacokinetic model based on individual residential histories, and used linear regression to estimate the association between eGFR and measured and predicted serum PFOA concentrations. We hypothesized that predicted serum PFOA levels would be less susceptible to reverse causation than measured levels. RESULTS: An interquartile range increase in measured serum PFOA concentrations [IQR ln(PFOA) = 1.63] was associated with a decrease in eGFR of 0.75 mL/min/1.73 m(2) (95% CI: -1.41, -0.10; p = 0.02). Measured serum levels of PFOS, PFNA, and PFHxS were also cross-sectionally associated with decreased eGFR. In contrast, predicted serum PFOA concentrations at the time of enrollment were not associated with eGFR (-0.10; 95% CI: -0.80, 0.60; p = 0.78). Additionally, predicted serum PFOA levels at birth and during the first ten years of life were not related to eGFR. CONCLUSIONS: Our findings suggest that the cross-sectional association between eGFR and serum PFOA observed in this and prior studies may be a consequence of, rather than a cause of, decreased kidney function

Health effects of electric and magnetic fields: overview of research recommendations

We developed a series of articles concerning epidemiologic research on potential health effects of electric and magnetic fields. Our goal was to identify methodological issues that have arisen through past studies of cancer, reproduction, and neurobehavioral outcomes in order to suggest strategies to extend knowledge. Following an overview of relevant physics and engineering principles, cancer epidemiology of electric and magnetic fields is discussed separately with a focus on epidemiologic methods and cancer biology, respectively. Reproductive health studies, many of which focus on exposure from video display terminals are then summarized, followed by an evaluation of the limited literature on neurobehavioral outcomes, including suicide and depression. Methodological issues in exposure assessment are discussed, focusing on the challenges in residential exposure assessment and interpretation of wire configuration codes. An overview offers recommendations for priorities across these topic areas, emphasizing the importance of resolving the question of wire codes and childhood cancer. Collectively, these articles provide an array of observations and suggestions regarding the epidemiologic literature, recognizing the potential benefits to science and public policy

A Time Series Analysis of Air Pollution and Preterm Birth in Pennsylvania, 1997–2001

Preterm delivery can lead to serious infant health outcomes, including death and lifelong disability. Small increases in preterm delivery risk in relation to spatial gradients of air pollution have been reported, but previous studies may have controlled inadequately for individual factors. Using a time-series analysis, which eliminates potential confounding by individual risk factors that do not change over short periods of time, we investigated the effect of ambient outdoor particulate matter with diameter ≤10 μm (PM(10)) and sulfur dioxide on risk for preterm delivery. Daily counts of preterm births were obtained from birth records in four Pennsylvania counties from 1997 through 2001. We observed increased risk for preterm delivery with exposure to average PM(10) and SO(2) in the 6 weeks before birth [respectively, relative risk (RR) = 1.07; 95% confidence interval (CI), 0.98–1.18 per 50 μg/m(3) increase; RR = 1.15; 95% CI, 1.00–1. 32 per 15 ppb increase], adjusting for long-term preterm delivery trends, co-pollutants, and offsetting by the number of gestations at risk. We also examined lags up to 7 days before the birth and found an acute effect of exposure to PM(10) 2 days and 5 days before birth (respectively, RR = 1.10; 95% CI, 1.00–1.21; RR = 1.07; 95% CI, 0.98–1.18) and SO(2) 3 days before birth (RR = 1.07; 95% CI, 0.99–1.15), adjusting for covariates, including temperature, dew point temperature, and day of the week. The results from this time-series analysis, which provides evidence of an increase in preterm birth risk with exposure to PM(10) and SO(2), are consistent with prior investigations of spatial contrasts

Environmental exposures and childhood cancer: our best may not be good enough

Childhood cancer ranks high among public concerns, evoking the public’s fear of cancer as well as the special emotional attention that is focused on children. Although it is rare, its priority is elevated on the basis of years of life lost and its prominence among life-threatening diseases of children. Despite great success in the treatment of childhood cancers such as Wilms’tumor and leukemia, cancer continues to be life threatening in children

Diagnosis of bacterial vaginosis from self-obtained vaginal swabs.

OBJECTIVE: To determine the concordance between vaginal fluid Gram stains and pH obtained at speculum exam with similar stains and pH prepared from self-obtained vaginal swabs. METHODS: Using vaginal fluid Gram stain, 129 pregnant women were screened for bacterial vaginosis at 24 to 29 weeks' gestation. Two smears were collected from each woman during the same prenatal visit: the first was prepared from a self-obtained vaginal swab and the second from a physician-obtained speculum examination. Vaginal pH was recorded for each swab. Kappa coefficient was used to quantify agreement between the two sets of results. RESULTS: When compared with the physician-obtained smear, the ability of the self-obtained Gram stain to diagnose bacterial vaginosis had a sensitivity of 77%, specificity of 97%, positive predictive value of 71% and negative predictive value of 97%. There was substantial agreement (weighted kappa=0.82) between the two techniques in the ability to determine the grade of vaginal flora. CONCLUSION: When compared with physician-obtained vaginal smears, self-obtained smears have substantial agreement in the diagnosis of bacterial vaginosis

Association of childhood cancer with residential traffic density.

Data from a recently completed case-referent study of childhood cancer were used to explore a possible role of environmental exposures from traffic exhaust. The street addresses of 328 cancer patients and 262 population-based referents were used to assign traffic density (vehicles per day) as a marker of potential exposure to motor vehicle exhaust. An odds ratio of 1.7 [95 % confidence interval (95 % CI) 1.0— 2.8] was found for the total number of childhood cancers and 2.1 (95 % CI 1.1— 4.0) for leukemias in a contrast of high and low traffic density addresses (≥ 500 versus < 500 vehicles per day). Stronger associations were found with a traffic density cutoff score of ~ 10 000 vehicles per day, with imprecise odds ratios of 3.1 (95% CI 1.2-8.0) and 4.7 (95% CI 1.6---13.5) for the total number of cancers and leukemias, respectively. Adjustment for suspected risk factors for childhood cancer did not substantially change these results. Though the results are inconclusive, the identified association warrants further evaluation