Showing papers by "Anny H. Xiang published in 2023"
2 citations
TL;DR: In this paper , the authors assessed ASD associations with fine particulate matter tracers of tailpipe (elemental carbon [EC] and organic carbon [OC]) and non-tailpipe (copper [Cu]; iron [Fe] and manganese [Mn]) sources during pregnancy in a large cohort.
1 citations
TL;DR: In this article , the authors correct the article DOI: 10.1016/j.xhgg.2022.100099 and 10.10.2020.000.
Abstract: [This corrects the article DOI: 10.1016/j.xhgg.2022.100099.].
TL;DR: In this paper , the association between maternal labor epidural analgesia (LEA) and child autism spectrum disorders (ASD) was found, and the risk appeared to be further increased if oxytocin was also administered.
Abstract: Importance
Maternal labor epidural analgesia (LEA) and oxytocin use for labor and delivery have been reported to be associated with child autism spectrum disorders (ASD). However, it remains unclear whether these 2 common medications used during labor and delivery have synergistic associations with ASD risk in children.
Objective
To assess the independent associations of LEA and oxytocin during labor and delivery with ASD, as well as outcome modification associated with the concurrent use of both interventions.
Design, Setting, and Participants
Data for this cohort study included 205 994 singleton births with vaginal deliveries in a single integrated health care system in Southern California from calendar years 2008 to 2017. Children were followed up to December 31, 2021. Data on use of LEA and oxytocin, covariates, and ASD outcome in children were obtained from electronic medical records. Cox proportional hazards regression was used to estimate the hazard ratios (HRs) adjusting for covariates.
Exposures
Labor epidural analgesia and/or oxytocin use during labor and delivery.
Main Outcomes and Measures
A child's clinical diagnosis of ASD during follow-up and at age of diagnosis.
Results
Among the cohort, 153 880 children (74.7%) were exposed to maternal LEA and 117 808 children (57.2%) were exposed to oxytocin during labor and delivery. The population of children was approximately half boys and half girls. The median (IQR) age of the mothers was 30.8 (26.8-34.5) years for those not exposed to LEA, 30.0 (25.9-33.8) years for those exposed to LEA, 30.4 (26.5-34.1) years for those unexposed to oxytocin, and 30.0 (25.9-33.9) years for those exposed to oxytocin during labor and delivery. A total of 5146 children (2.5%) had ASD diagnosed during follow-up. Oxytocin exposure was higher among LEA-exposed (67.7%) than -unexposed (26.1%) children. The ASD risk associated with LEA was independent of oxytocin exposure (HR, 1.28; 95% CI, 1.18-1.38); however, the ASD risk associated with oxytocin was not significant after adjusting for LEA exposure (HR, 1.05; 95% CI, 0.99-1.12). A significant interaction of LEA and oxytocin on child ASD risk was found (P = .02 for interaction). Compared with no exposure, HRs were 1.20 (95% CI, 1.09-1.32) for LEA alone, 1.30 (95% CI, 1.20-1.42) for both LEA and oxytocin, and 0.90 (95% CI, 0.78-1.04) for oxytocin alone.
Conclusions and Relevance
The findings of this cohort study suggest an association between maternal LEA and ASD risk in children, and the risk appeared to be further increased if oxytocin was also administered. Oxytocin exposure without LEA exposure was not associated with ASD risk in children. These findings must be interpreted with caution. Further studies are needed to replicate or refute the study results and examine biological plausibility.
TL;DR: In this article , the authors assessed whether only one abnormal value from the OGTT screening during pregnancy, which qualify as GDM by the IADPSG criteria, was associated with risk of offspring autism spectrum disorders.
Abstract: We assessed whether only one abnormal value from the OGTT screening during pregnancy, which qualify as GDM by the IADPSG criteria (GDM_IADPSG), was associated with risk of offspring autism spectrum disorders (ASD). The cohort included 590,001 singletons from a large integrated healthcare system with electronic medical records. GDM was largely screened by two-steps and Carpenter-Coustan criteria (GDM_CC). We excluded those exposed to pre-existing diabetes or 1-hr 50g glucose challenge test ≥ 200mg/dl. OGTT glucose levels were used to define GDM_IADPSG. Cox models with hazard ratio (HR) were used to assess associations. Among the cohort, 7.6% were exposed to maternal GDM_CC, an additional 5.9% to GDM_IADPSG with only one abnormal OGTT value. Within GDM_CC, 41.3% had abnormal fasting, 30.5% were diagnosed at ≤ 26 wks and 30.7% prescribed medications. Within GDM_IADPSG, 28.4% had abnormal fasting alone, 27.0% at ≤ 26 wks and none received medications. Table 1 shows the HRs (95% CI). GDM_IADPSG was associated with increased risk of ASD, with risk slightly lower compared to GDM_CC. However, the risk appeared greater if abnormal fasting presented at diagnosis. The risk of ASD associated with GDM_IADPSG by abnormal fasting alone was comparable to GDM_CC treated with medications. Studies are needed to assess whether diabetes management for pregnancies with only elevated fasting will reduce adverse effect on offspring.
A.Xiang: None. S.A.Carter: None. J.C.Lin: None. T.Chow: None. M.P.Martinez: None. K.A.Page: None. R.Feldman: None.
TL;DR: In this paper , the variability and classification concordance for HbA1c, fasting and 2-hour glucose from OGTTs were compared in 66 youth (mean age 14.2 years) and 354 adults (52.7 years).
Abstract: AIMS
Previous work found poor reproducibility for measures of glycemia in individuals at risk for dysglycemia. Differences between youth and adults have not been assessed. Using youth and adults in the Restoring Insulin Secretion Study, we tested variability and classification concordance for HbA1c, fasting and 2-hour glucose from OGTTs.
METHODS
HbA1c and glucose on repeated samples obtained ∼six weeks apart were compared in 66 youth (mean age 14.2 years) and 354 adults (52.7 years). Changes, coefficient of variation (CV) and concordance of diagnostic categories between the two visits were compared.
RESULTS
Mean difference between the two visits in HbA1c was higher in youth than adults (p < 0.001), while fasting glucose was similar and 2-hour glucose was lower in youth (p = 0.051). CV was smallest for HbA1c compared to fasting and 2-hour glucose. For HbA1c, youth had higher CV (p < 0.001); whereas, CV for 2-hour glucose was lower for youth (p = 0.041). Classification concordance by HbA1c was lower in youth (p = 0.004). Using OGTT or HbA1c for classification, inter-visit variability produced discordant classification in 20% of youth and 28% of adults. Using both fasting glucose and HbA1c, inter-visit variability reduced discordant classification to 16% of adults while not improving classification in youth.
CONCLUSIONS
Poor reproducibility and lack of classification concordance highlight the limitations of one-time testing, with important implications for assessing eligibility in clinical trials. Consideration should be given to using more than a single parameter for screening and diagnosis, especially when classification category is important.
TL;DR: In this paper , exposure to intrapartum antibiotic prophylaxis to reduce perinatal group B streptococcal disease was associated with increased childhood body mass index (BMI) persisting to age 10 years compared to no exposure.
Abstract: Exposure to intrapartum antibiotic prophylaxis to reduce perinatal group B streptococcal disease was associated with increased childhood body mass index (BMI) persisting to age 10 years compared to no exposure (Δ BMI at 10 years: vaginal delivery 0.14 kg/m2, caesarean 0.40 kg/m2).
TL;DR: The authors provided an overview of the work that my colleagues and I have done to advance the knowledge base around diabetes and pregnancy in four areas: 1) diabetes risk after gestational diabetes mellitus (GDM), including racial and ethnic disparities; 2) the pathophysiology of GDM and subsequent diabetes in Hispanic women; 3) diabetes prevention and β-cell preservation following GDM; and 4) evidence for multiple potential developmental effects in offspring that vary according to the timing of exposure and severity of maternal diabetes during pregnancy.
Abstract: Hyperglycemia during pregnancy is a double-edged sword, affecting both mothers and their offspring and creating a vicious cycle that can affect multiple generations. Research in this field over the past 30 years has greatly improved our understanding of this disease and formed the basis of improved strategies to improve the health of mothers and their babies. Despite this progress, gestational and preexisting diabetes continue to have significant effects on both short- and long-term health of mothers and their offspring. In this article, I provide an overview of the work that my colleagues and I have done to advance the knowledge base around diabetes and pregnancy in four areas: 1) diabetes risk after gestational diabetes mellitus (GDM), including racial and ethnic disparities; 2) the pathophysiology of GDM and subsequent diabetes in Hispanic women; 3) diabetes prevention and β-cell preservation following GDM; and 4) evidence for multiple potential developmental effects in offspring that vary according to the timing of exposure and severity of maternal diabetes during pregnancy. This research continues the legacy of Norbert Freinkel and the concepts that he contributed to the field of diabetes and pregnancy. With the epidemic of obesity, increasing rates of type 1 and type 2 diabetes in youth, and rising prevalence of GDM across all racial and ethnic groups, we have a lot more work to do to combat this disease to break the vicious cycle.
TL;DR: In this article , risk of adverse birth outcomes (ABO) associated with GDM by Carpenter-Coustan (C&C) and International Association of the Diabetes and Pregnancy Study Groups (IADPSG) with and without abnormal fasting at OGTT screening was assessed.
Abstract: This study assessed risk of adverse birth outcomes (ABO) associated with GDM by Carpenter-Coustan (C&C) and International Association of the Diabetes and Pregnancy Study Groups (IADPSG) with and without abnormal fasting at OGTT screening. Data included 355,506 singletons born in a single healthcare system. Data on demographics, maternal GDM status with or without abnormal fasting, and six ABOs [caesarean section (CS), shoulder dystocia (SD), fetal distress (FD), neonatal hypoglycemia (NH), preterm birth (PTB), and large-for gestational age (LGA)] were extracted from electronic medical records. Logistic regression was used to assess associations adjusting for covariates. In this cohort, 27,990 (7.9%) were diagnosed by C&C and 21,464 (6.0%) by IADPSG. In the C&C group, 37.3% had abnormal fasting (C&C_AF); among IADPSG, 23.3% met OGTT fasting thresholds (IADPSG_AF). Table 1 shows odds ratios (OR) of ABOs associated with GDM diagnostic types relative to no GDM. GDM by C&C or IADPSG with or without abnormal fasting was associated with higher odds of CS, PTB (except IADPSG_AF), and LGA (except C&C without abnormal fasting). IADPSG without abnormal fasting was associated with higher odds of SD and NH, and C&C_AF was associated with higher odds of SD but lower odds FD and NH. These data suggest GDM by IADPSG was associated with risk of some ABOs; this group may benefit from diabetes care in pregnancy to reduce risk of ABOs.
S.A.Carter: None. J.C.Lin: None. T.Chow: None. M.P.Martinez: None. R.Feldman: None. K.A.Page: None. A.Xiang: None.
TL;DR: In this paper , the authors investigated changes in brain functional connectivity during a food cue reactivity task before and after a glucose ingestion in children with low and high insulin sensitivity, and found that viewing food images elicits heightened brain responses in regions involved in reward processing.
Abstract: Introduction In children with obesity, viewing of food images elicits heightened brain responses in regions involved in reward processing. This activation seems to facilitate weight gain and the development of diabetes. The current study investigates changes in brain functional connectivity (FC) during a food cue reactivity task before and after a glucose ingestion in children with low and high insulin sensitivity.
TL;DR: This paper identified 1,289 independent association signals at genome-wide significance (P <5x10-8) that map to 611 loci, of which 145 loci are previously unreported, and defined eight non-overlapping clusters of Type 2 diabetes signals characterised by distinct profiles of cardiometabolic trait associations.
Abstract: Type 2 diabetes (T2D) is a heterogeneous disease that develops through diverse pathophysiological processes. To characterise the genetic contribution to these processes across ancestry groups, we aggregate genome-wide association study (GWAS) data from 2,535,601 individuals (39.7% non-European ancestry), including 428,452 T2D cases. We identify 1,289 independent association signals at genome-wide significance (P<5x10-8) that map to 611 loci, of which 145 loci are previously unreported. We define eight non-overlapping clusters of T2D signals characterised by distinct profiles of cardiometabolic trait associations. These clusters are differentially enriched for cell-type specific regions of open chromatin, including pancreatic islets, adipocytes, endothelial, and enteroendocrine cells. We build cluster-specific partitioned genetic risk scores (GRS) in an additional 137,559 individuals of diverse ancestry, including 10,159 T2D cases, and test their association with T2D-related vascular outcomes. Cluster-specific partitioned GRS are more strongly associated with coronary artery disease and end-stage diabetic nephropathy than an overall T2D GRS across ancestry groups, highlighting the importance of obesity-related processes in the development of vascular outcomes. Our findings demonstrate the value of integrating multi-ancestry GWAS with single-cell epigenomics to disentangle the aetiological heterogeneity driving the development and progression of T2D, which may offer a route to optimise global access to genetically-informed diabetes care.