PREGNANCY/BIRTH COHORTS PAST-PRESENT-FUTURE

Transcription

1 PREGNANCY/BIRTH COHORTS PAST-PRESENT-FUTURE SALVE AND SKIDI-KIDS JØRN OLSEN FINLAND, MAY 11, 2011 præsen TATION 1

2 The beginning of life carries high risks, some of which are avoidable and can be identified and reduced/eliminated. Abortion stillbirth, % Infant mortality as in late middle aged life Congenital malformations Autism, ADHD, asthma 2

3 It has been recognized that this time is important, and we need to record data on exposures and endpoints. Medical birth registers data go back centuries. Computerized registers go back years. 3

4 At one week in March, 1946, all 16,695 babies born in the UK were followed as a cohort. They are now 65 years of age. They showed: High birth weight associated with breast cancer Low SES associated with obesity 8 books and 600 papers 4

5 More data rich cohorts probably started with the collaborative perinatal cohort in the US , pregnancies. Main aim = birth complications and cerebral palsy Low birth weight / hypoxia related cognitive functions and schizophrenia And much more 5

6 Similar less expensive studies in many other countries. Most of the knowledge we use in ANC comes from these cohorts and from use of data in medical birth registers, often linked to other registers. Advice on GWG, smoking, work, medicine often come from these data sources 6

7 Barker s ideas and findings of long-term health complications related to perinatal factors inspired a whole new interest in this field. This and new technologies placed in high throughput laboratories scaled up funding options to new levels. National Children Study in the US current budget exceeds 6 billion dollars 7

8 But it started in the Nordic area and was based on midwives decades of recording of birth characteristics. 8

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10 Many of the best studies came from the Helsinki Birth Cohort study 13,345 men born in Helsinki Kajantie E et al. Diabetes Care 2010; 33(12):

11 Barker DJP. Eur J Heart Failure 2010; 12:

12 It had also been recognized that reductions in early life mortality had played a major role in the increase in life expectancy seen over the last centuries. Perhaps the early life period also influences remaining life expectancy much later in life. 12

13 DEVELOPMENT IN LIFE EXPECTANCY FIGURE 2. MALE (BLUE SQUARES) AND FEMALE (RED CIRCLES) LIFE EXPECTANCY IN THE RECORD-HOLDING COUNTRY, BASED ON THE ANNUAL DATA SHOWN IN SUPPLEMENTARY TABLE 1. FOR MALES THE FITTED LINE HAS A SLOPE OF AND R 2 = Oeppen J, Vaupel JW. Science 2002; 296(5570): (Supplementary material.)

14 One of the exposures that have received much attention is early nutrition, which is important for fetal growth, diseases and mental health early in life but perhaps also for life expectancy. 14

15 Ozanne SE, et al. Nature 2004;427:

16 The Barker hypothesis received new support from studies showing that epigenetic changes are frequent; they happen over the life course, and they are highly modified by environmental exposures. 16

17 Epigenetics, environment, and development Copyright restrictions may apply. Foley, D. L. et al. Am. J. Epidemiol 2009;169: ; doi: /aje/kwn380

18 METHYLATION PROFILES ARE SET AARHUS DURING DEVELOPMENT Critical Period Jaenisch. Trends Genetics 1997

19 SPECIALIZED COHORTS/TIMING Highest priority: o Pre-and periconceptual exposures o Exposures around the time of rapid brain growth and development of Sertoli cells o Exposure during puberty Examples: o Cumulative exposures over a lifetime

20 Not only scientific journals accepted Barker s hypothesis, but the message also reached influencial public media. 20

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22 DEVELOPMENTAL ORIGINS OF HEALTH AND DISEASE: EPIGENETIC COMPONENT? Environment experienced inutero may predispose for diseases and disorders throughout life A critical period for exposures October 1999 January 2010 October 2010

23 A new generation of large-scale pregnancy cohorts started or was planned in the 1990s with attached biobanks and the aim to follow the offspring for decades or from conception to death and beyond. This happened in the Nordic countries should have been Nordic cohort with participants - China and the US (The National Children s Study budget 5-10 billion USD?)

24 Better Health for Mother and Child

25 BACKGROUND: Need for large population based studies, especially for gene/environment interaction perhaps epigenetic / environmental interactions. Should use our good possibility for tracing cohort members over time. Existence of health registers. A research register of exposures in intrauterine life and early childhood is needed.

26 Since many of the endpoints of interest are rare these studies have to be large. 26

27 IJE 2007;36:724-30

28 Many of the cohorts need to collaborate to provide sufficient power, and Biobank samples need to be used wisely; data collection has to be coordinated.

29 New hypotheses are not only related to nutrition but also to infections, hormones, stress. 29

30 TORCH (Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes simplex virus) Infections involving CNS with potential long-term consequences.

31 Molecular mimicry Antibodies to infectious agents with common epitopes of developing brain. Consequences of a brain lesion is expected to depend on timing of exposure.

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33 Risk for Schizophrenia for Years 1956 Through 1965 in Wuhu and Surrounding Counties Year Cases No. of births Adjusted RR (95 % CI) ( ) ( ) ( ) ( ) St. Clair D, et al. JAMA 2005; 294(5):

34 Bereavement before and during pregnancy as a model of stress exposure. Risk for type 1 diabetes in childhood among a cohort of 1,5 million with up to 25 years of follow-up time. Losing a father/child CI Traumatic death father/child CI Virk J., et al. PLoS One 2010;5:e11523.

35 And we have diseases with an alarming increase in incidences and causes that do operate early in life. Asthma, autism, ADHD and obesity. 35

36 CITATIONS BRFSS, Behavioral Risk Factor Surveillance System http: // Mokdad AH, et al. The spread of the obesity epidemic in the United States, JAMA 1999; 282:16: Mokdad AH, et al. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001; 286:10: Mokdad AH, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, JAMA 2003: 289:1: 76 9 CDC. State-Specific Prevalence of Obesity Among Adults United States, 2007; MMWR 2008; 57(36);765-8

37 OBESITY TRENDS AMONG U.S. ADULTS BETWEEN 1985 AND 2008 Definitions: Obesity: Body Mass Index (BMI) of 30 or higher. Body Mass Index (BMI): A measure of an adult s weight in relation to his or her height, specifically the adult s weight in kilograms divided by the square of his or her height in meters.

38 OBESITY TRENDS AMONG U.S. ADULTS BETWEEN 1985 AND 2008 Source of the data: The data shown in these maps were collected through CDC s Behavioral Risk Factor Surveillance System (BRFSS). Each year, state health departments use standard procedures to collect data through a series of telephone interviews with U.S. adults. Prevalence estimates generated for the maps may vary slightly from those generated for the states by BRFSS ( as slightly different analytic methods are used.

39 In 1990, among states participating in the Behavioral Risk Factor Surveillance System, ten states had a prevalence of obesity less than 10% and no states had prevalence equal to or greater than 15%. By 1999, no state had prevalence less than 10%, eighteen states had a prevalence of obesity between 20-24%, and no state had prevalence equal to or greater than 25%. In 2008, only one state (Colorado) had a prevalence of obesity less than 20%. Thirty-two states had a prevalence equal to or greater than 25%; six of these states (Alabama, Mississippi, Oklahoma, South Carolina, Tennessee, and West Virginia ) had a prevalence of obesity equal to or greater than 30%.

40 Obesity Trends* Among U.S. Adults BRFSS, 1990, 1999, 2008 (*BMI 30, or about 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%

41 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1985 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%

42 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1986 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%

43 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1987 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%

44 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1988 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%

45 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1989 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%

46 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1990 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%

47 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1991 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19%

48 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1992 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19%

49 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1993 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19%

50 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1994 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19%

51 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1995 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19%

52 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1996 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19%

53 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1997 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20%

54 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1998 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20%

55 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1999 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20%

56 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 2000 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20%

57 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 2001 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25%

58 Obesity Trends* Among U.S. Adults BRFSS, 2002 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25%

59 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 2003 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25%

60 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 2004 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25%

61 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 2005 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%

62 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 2006 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%

63 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 2007 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%

64 OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 2008 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%

65 For these reasons we need 1. An ongoing data collection related to early pregnancy or before that allows studies on gene expression and monitoring of environmental exposures with long-term follow-up. 2. And a very large-scale thin cohort with a biobank, limited information on life styles and links to all population registers complete follow-up. 65

66 CONCLUSION The Nordic countries have had a leading role in studying determinants of diseases occuring early in life. We have the infrastructure to maintain and strengthen this position. THANK YOU FOR YOUR ATTENTION 66