Association of Antepartum Suicidal Ideation during the Third Trimester with Infant Birth Weight and Gestational Age at Delivery

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1 Assocition of Anteprtum Suicidl Idetion during the Third Trimester with Infnt Birth Weight nd Gesttionl Age t Delivery Amber Domingue 1 ; Bizu Gelye 1 ; Fernnd Rebelo 2 ; Chunfng Qiu 3 ; Miguel Angel Luque Fernndez 1, Sixto E. Snchez 4, 5 ; Glori Lrrbure-Torrelv 6,7 ; Michelle A. Willims 1 1. Deprtment of Epidemiology, Hrvrd T. H. Chn School of Public Helth, Boston, MA, USA; 2. Ntionl School of Public Helth, Fiocruz, Brzil; 3. Center for Perintl Studies, Swedish Medicl Center, Settle, WA, US; 4. Asocición Civil Proyectos en Slud, AC.PROESA, Lim, Perú; 5. Universidd Perun de Ciencis Aplicds, Lim, Perú; 6. Instituto Ncionl Mterno Perintl de Lim, Lim, Perú; 7. Deprtmentos de Medicin y Ginecologí y Obstetrici Universidd Ncionl Universidd Ncionl Myor de Sn Mrcos, Lim, Perú Anteprtum suicidl behviors including suicidl The prevlence of nteprtum suicidl idetion ws 8.7. Women with suicidl idetion were more likely to hve infnts with lower birth weight (3,267 ± 511 grms vs. 3,417 ± 492 idetion nd ttempts re the leding cuses of injury nd mternl deth worldwide. One of the strongest risk fctors, suicidl idetion, is considered hrbinger nd distl predictor of lter suicide ttempt nd completion, nd lso presents n grms; p=0.005) compred with women without suicidl idetion. Anteprtum suicidl idetion ws independently nd negtively ssocited with infnt birth weight (β=-94.2g, P=0.037) fter djusting for confounders including depression (Tble 1). No sttisticlly significnt ssocition ws noted between suicidl idetion nd men gesttionl ge t delivery. Women who endorsed suicidl idetion were 3.73-fold times s likely to deliver smll-for-gesttionl ge newborn (OR: 3.73; 95CI: ) (Figure 1). opportunity for interventions prior to physicl selfhrm. Few investigtors hve exmined the dverse mternl nd infnt outcomes ssocited with nteprtum suicidl idetion. To evlute the reltionship of nteprtum suicidl idetion with infnt birth weight (BW) nd gesttionl Tble 1. Multivrite regression of ssocition of mternl suicidl idetion during middle pregnncy with gesttionl ge t delivery nd birth weight, with robust vrince. Suicidl idetion N Adjusted β* (95 CI) Gesttionl ge t delivery (wks) Adjusted β** (95 CI) Gesttionl ge t delivery (wks) No 1004 Yes (-0.39, 0.22) (-0.40, 0.27) Infnt birthweight (grms) Infnt birthweight (grms) No 1012 Yes (-181.7, -11.4) (-183.0, -5.5) *Model is djusted for mternl nulliprity (Y/N), ccess to bsic food (Y/N), plnned pregnncy (Y/N), nd lcohol intke during pregnncy (Y/N), nd self-reported helth sttus (good/poor). **Further djustment for nteprtum depression (PHQ-8). 1 model * + infnt gender nd gesttionl ge t delivery 2 model ** + infnt gender nd gesttionl ge t delivery Conclusions ge t delivery (GA). The study popultion consisted of cohort of 1,183 Figure 1. The odds rtio (OR) nd 95 confidence intervls (CI) of pre-term delivery (PTD), low infnt birthweight (LBW) or smll for gesttionl ge (SGA) bby risk in reltion to mternl suicidl idetion during middle pregnncy. Anteprtum suicidl idetion, even fter djusting for depression, ws ssocited with reductions in infnt BW nd incresed SGA risk. Future studies should continue to exmine the pregnnt Peruvin women who were interviewed t consequences of nteprtum suicidl idetion weeks of gesttion. N o P T D ( ) Y e s P T D ( 6 3 ) ( ) * with nd without concomitnt psychitric Antentl depression nd suicidl idetion were ( ) * * disorders so tht improved preventive nd ssessed using the Ptient Helth Questionnire 9 N o S G A ( ) therpeutic pproches cn be developed nd (PHQ-9). Y e s S G A ( 3 8 ) ( ) * implemented in the cre of t-risk pregnnt Gesttionl ge nd birth weight were obtined from medicl records. Multivrible liner nd logistic regression procedures were used to estimte djusted mesures of ssocition (β coefficients nd odds rtios) nd 95 confidence intervls (CI). N o L B W ( ) Y e s L B W ( 4 9 ) ( ) * ( ) * * O d d s R tio (9 5 C I) ( ) * * *Model is djusted for mternl nulliprity (Y/N), ccess to bsic food (Y/N), plnned pregnncy (Y/N), nd lcohol intke during pregnncy (Y/N), nd self-reported helth sttus (good/poor). ** Further djustment for nteprtum depression (PHQ-8) --for LBW models further djusted for infnt gender nd gesttionl ge t delivery women. This reserch ws supported by wrds from the Ntionl Institutes of Helth (NIH), Ntionl Institute of Minority Helth nd Helth Disprities (T37-MD ), nd the Eunice Kenney Shriver Ntionl Institute of Child Helth nd Humn Development (R01-HD ). The uthors wish to thnk the dedicted stff members of Asocicion Civil Proyectos en Slud (PROESA), Peru, nd Instituto Especilizdo Mterno Perintl, Peru, for their expert technicl ssistnce with this reserch.

2 Vitl Exhustion in Reltion to Migrine: Findings from n Occuptionl Cohort in Ethiopi LQueishi Cummins 1, Bizu Gelye 1, Hnn Y. Berhne 2, Yemne Berhne 2, Qiu-Yue Zhong 1, Michelle A. Willims 1 1 Deprtment of Epidemiology, Hrvrd T.H. Chn School of Public Helth, Boston, MA, USA; 2 Addis Continentl Institute of Public Helth, Addis Abb, Ethiopi Vitl exhustion, physicl nd mentl stte of exhustion, is chrcterized by feelings of excess ftigue, lck of energy, demorliztion, nd irritbility. Vitl exhustion is ssocited with n incresed risk of depression nd hedche disorders. Among men, the djusted odds rtio for probble migrine incresed with higher qurtiles of vitl exhustion [Qurtile 1: 1.45 (0.88, 2.38); Qurtile 3: 2.06 (1.35, 3.14); Qurtile 4: 2.20 (1.42, 3.40)] (Tble 2). Lrger mgnitudes of ssocitions were seen between vitl exhustion qurtiles nd strict migrine [Qurtile 1: 0.95 (0.37, 2.46); Qurtile 3: 2.77 (1.40, 5.47); Qurtile 4: 3.06 (1.54, 6.09)]. Among women, similr ssocitions were seen between vitl exhustion nd probble migrine or strict migrine (Tble 2). Few investigtors hve exmined vitl exhustion in sub- Tble 1. Associtions between vitl exhustion qurtiles nd migrine mong mle nd femle prticipnts Shrn Afric. Although the dverse helth effects of vitl exhustion Vitl exhustion No migrine Any migrine OR (95 CI) Adjusted OR (95 CI) Adjusted OR (95 CI) b re well estblished, its reltionship with migrine hs not been studied. To exmine the ssocition between vitl exhustion nd migrine mong working Ethiopin dults. This ws cross-sectionl study of 1,890 Ethiopin working dults. Vitl exhustion ws mesured using the Mstricht Questionnire. Migrine ws clssified bsed on Interntionl Clssifiction of Hedche Disorders-II criteri. Probble migrine ws dignosed s 4 of 5 migrine criteri. Multivrible logistic regressions were used to estimte odds rtios (ORs) nd 95 confidence intervls (CIs) of vitl exhustion nd migrine. Migrine prevlence ws 24.8 mong men nd 43.0 mong women. Among men, the djusted ORs (95 CI) for successive qurtiles (lowest to highest) of vitl exhustion ssocited with ny migrine were 1.30 ( ), Mle (N = 1142) Qurtile 1 [0, 2] Qurtile 2 [3, 5] (0.86, 2.11) 1.33 (0.85, 2.10) 1.30 (0.82, 2.05) Qurtile 3 [6, 10] (1.61, 3.38) 2.23 (1.53, 3.25) 2.09 (1.41, 3.10) Qurtile 4 [11, 40] (1.81, 3.84) 2.41 (1.64, 3.55) 2.11 (1.34, 3.31) P-trend < < Femle (N = 748) Qurtile 1 [0, 3] Qurtile 2 [4, 7] (0.85, 2.08) 1.29 (0.82, 2.03) 1.24 (0.79, 1.96) Qurtile 3 [8, 13] (1.53, 3.58) 2.24 (1.45, 3.45) 2.04 (1.30, 3.22) Qurtile 4 [14, 40] (3.12, 7.47) 4.50 (2.88, 7.04) 3.66 (2.14, 6.27) P-trend < < < Adjusted for ge, mritl sttus (single, mrried, nd other), occuption (bnk vs. techer), self-reported helth (poor/fir vs. excellent/very good/good), lcohol consumption (non-drinker, moderte, vs. high), nd body mss index; b Further djusted for depression (PHQ-9 continuous score). Tble 2. Associtions between vitl exhustion qurtiles nd three migrine ctegories mong mle nd femle prticipnts Vitl exhustion No migrine Probble migrine Strict migrine Mle (N = 1142) OR (95 CI) Adjusted OR OR (95 CI) Adjusted OR (95 CI) (95 CI) Qurtile 1 [0, 2] Qurtile 2 [3, 5] (0.89, 2.38) 1.45 (0.88, 2.38) (0.39, 2.54) 0.95 (0.37, 2.46) Qurtile 3 [6, 10] (1.37, 3.17) 2.06 (1.35, 3.14) (1.62, 6.16) 2.77 (1.40, 5.47) Qurtile 4 [11, 40] (1.50, 3.51) 2.20 (1.42, 3.40) (1.94, 7.38) 3.06 (1.54, 6.09) P-trend < < Femle (N = 748) Qurtile 1 [0, 3] Qurtile 2 [4, 7] (0.79, 2.15) 1.29 (0.78, 2.13) (0.64, 3.05) 1.30 (0.59, 2.88) Qurtile 3 [8, 13] (1.29, 3.33) 2.00 (1.23, 3.24) (1.58, 6.33) 2.97 (1.47, 6.01) Qurtile 4 [14, 40] (2.32, 6.15) 3.53 (2.15, 5.82) (4.06, 15.69) 7.45 (3.73, 14.88) P-trend < < < < Adjusted for ge, mritl sttus (single, mrried, nd other), occuption (bnk vs. techer), self-reported helth (poor/fir vs. excellent/very good/good), lcohol consumption (non-drinker, moderte, vs. high), nd body mss index ( ), nd 2.11 ( ) with the lowest qurtile s the reference (p-trend: ; Tble 1) Among women, the djusted ORs (95 CI) for successive qurtiles (lowest to highest) of vitl exhustion ssocited with ny migrine were 1.24 ( ), 2.04 ( ), nd 3.66 ( ) with the lowest qurtile s the reference (p-trend: <0.0001; Tble 1). Conclusion Vitl exhustion is ssocited with migrine in mles nd femle workers. This study indictes tht vitl exhustion exists mong the generl popultion in sub-shrn Afric s in other countries nd high levels of vitl exhustion is ssocited with migrine. Effective screening nd tretment would reduce psychitric comorbidities, including vitl exhustion, mong migrineurs. This reserch ws supported by n wrd from the Ntionl Institutes of Helth, Ntionl Institute of Minority Helth nd Helth Disprities (T37- MD001449). The uthors wish to thnk the stff of Addis Continentl Institute of Public Helth for their expert technicl ssistnce.

3 Migrines nd Risk of Post-Trumtic Stress Disorder mong Peruvin Pregnnt Women Christin Aponte *, Rigoberto Perez Hernndez *, Luren E. Friedmn b, Jun Crlos Velez c, Bizu Gelye b, Sixto E. Sánchez d,e, Michelle A. Willims b, nd B. Lee Peterlin f Multidisciplinry Interntionl Reserch Trining Progrm, Deprtment of Epidemiology, Hrvrd T. H. Chn School of Public Helth, Boston, MA, USA, b Deprtment of Epidemiology, Hrvrd T. H. Chn School of Public Helth, Boston, MA, USA, c Deprtmento de Rehbilitción, Hospitl del Trbjdor, Sntigo, Chile, d Universidd Perun de Ciencis Aplicds, Lim, Peru, e Asocición Civil PROESA, Lim, Peru, f Johns Hopkins School of Medicine Neurology, Bltimore, MD, USA; * Authors contributed eqully to this work Migrine often dversely ffects the helth of lrge popultions. Further, migrine in pregnncy hs been ssocited with dverse perintl helth outcomes. Migrine is Individully prevlence estimtes of both migrine nd post-trumtic stress disorder (PTSD) re higher mong women s compred to men. Mentl helth during pregnncy is of prticulr interest given the high burden of violence mong Peruvin women. There is lck of evidence for the ssocition between migrine nd PTSD in lower income countries. The objective of our study ws to exmine the ssocition between migrine nd PTSD mong cohort of Peruvin pregnnt women. Eliminte problems in pregnncy Improve current tretments Eliminte future problems for mother nd child 2,922 prticipnts of the Pregnncy Outcomes, Mternl nd Infnt Study Cohort between Februry 2012 nd Mrch Migrine ws chrcterized by the Interntionl Clssifiction of Hedche Disorders (ICHD)-III bet criteri. Depression ws mesured using the Spnish-lnguge Ptient Helth Questionnire-9 (PHQ-9) PTSD ws ssessed using the PTSD Checklist-Civilin Version. Multivrible logistic regression nlyses were performed to estimte odds rtios (OR) nd 95 confidence intervls (CI) djusted for confounders of pregnnt women fulfilled criteri for ny migrine (migrine 12.5; probble migrine 21.0) nd 37.4 fulfilled PTSD criteri (Tble 1). Women with ny migrine hd 1.97-fold incresed odds of PTSD (95 CI: ) s compred to those without migrine (Tble 2). Women with migrine lone (i.e. excluding probble migrine) hd 2.85-fold incresed odds of PTSD (95 CI: ), nd women with probble migrine hd 1.61-fold incresed odds of PTSD (95 CI: ) s compred to those without migrine (Tble 2). The comorbidity of depression further incresed the odds of PTSD in ll migrine ctegories s compred to women without either condition (Tble 3). Tble 1: Socio-demogrphic nd reproductive chrcteristics of the study popultion ccording to types of migrine in Lim, Peru Chrcteristics Discussion All prticipnts (N= 2,922) No migrine (N = 1,943) We found n ssocition between migrine nd PTSD, even fter djusting for nteprtum depression. Our findings extend the body of literture on the incresed risk of PTSD in those with migrine to include those with probble migrine nd pregnnt women. Tken together, these findings support the need for further reserch on the ssocition between migrine nd PTSD, including in pregnnt women, s well s the need for reserch evluting potentil tretment implictions of this comorbidity. Probble migrine (N = 613) Migrine (N = 366) Age (yers) ± ± ± ± Eduction (yers) Pre-pregnncy self-reported BMI < > Erly pregnncy mesured BMI < > Mestizo ethnicity Mrried/ living with prtner Employed Difficulty pying for bsics Hrd Not very hrd Difficulty pying for medicl cre Hrd Not very hrd Nulliprous Plnned pregnncy Gesttionl ge 9.23 ± ± ± ± Intimte prtner violence b Childhood buse No buse Physicl only Sexul only Both physicl nd sexul PTSD (PCL-C>=26) Depression (PHQ-9) Due to missing dt, percentges my not dd up to 100. men ± SD (stndrd devition): How mny weeks pregnnt were you during your first prentl cre visit? b Lifetime intimte prtner violence. For continuous vribles, ws clculted using the one-wy ANOVA; for ctegoricl vribles, ws clculted using the Chi-squre test. Tble 2. Assocition between migrine nd PTSD ssessed by the PTSD Check List - Civilin Version (PCL-C) during pregnncy Migrine Sttus No PTSD (N = 1,829) PTSD (N = 1,093) Undjusted OR Adjusted OR (95 CI) (95 CI) b (95 CI) c (95 CI) d No migrine Any migrine ( ) 2.37 ( ) 2.30 ( ) 1.97 ( ) Types of migrine No migrine Probble migrine ( ) 1.80 ( ) 1.76 ( ) 1.61 ( ) Migrine ( ) 3.81 ( ) 3.65 ( ) 2.85 ( ) Abbrevitions: OR, odds rtio; CI, confidence intervl. PTSD is defined s PCL-C score 26. b Adjusted for ge, mritl sttus, difficulty pying for the very bsics, nd difficulty pying for medicl cre. c Adjusted for ge, mritl sttus, difficulty pying for the very bsics, difficulty pying for medicl cre, nd lifetime intimte prtner violence. d Adjusted for ge, mritl sttus, difficulty pying for the very bsics, difficulty pying for medicl cre, lifetime intimte prtner violence, nd depression sttus. Tble 3. Assocition between migrine nd PTSD ssessed by the ssessed by the PTSD Check List - Civilin Version (PCL-C) during pregnncy strtified by depression sttus Migrine Without Depression No PTSD (N = 1,587) PTSD (N= 507) Undjusted OR Adjusted OR (95 CI) (95 CI) b (95 CI) c No migrine Any migrine ( ) 1.99 ( ) 1.93 ( ) Types of migrine No migrine Probble migrine ( ) 1.67 ( ) 1.62 ( ) Migrine ( ) 2.81 ( ) 2.76 ( ) Migrine With Depression No PTSD (N = 224) PTSD (N = 575) Undjusted OR Adjusted OR (95 CI) (95 CI) b (95 CI) c No migrine Any migrine ( ) 2.13 ( ) 2.09 ( ) Types of migrine No migrine Probble migrine ( ) 1.58 ( ) 1.59 ( ) Migrine ( ) 3.29 ( ) 3.13 ( ) PTSD is defined s PCL-C score 26. b Adjusted for ge, mritl sttus, difficulty pying for the very bsics, nd difficulty pying for medicl cre. c Adjusted for ge, mritl sttus, difficulty pying for the very bsics, difficulty pying for medicl cre, nd lifetime intimte prtner violence. This reserch ws supported by wrds from the Ntionl Institutes of Helth (NIH), Ntionl Institute of Minority Helth nd Helth Disprities (T37-MD ), nd the Eunice Kenney Shriver Ntionl Institute of Child Helth nd Humn Development (R01-HD ). The uthors wish to thnk the dedicted stff members of Asocicion Civil Proyectos en Slud (PROESA), Peru, nd Instituto Especilizdo Mterno Perintl, Peru, for their expert technicl ssistnce with this reserch.

4 Prevlence of Gesttionl Dibetes Mellitus nd its Assocition with Mternl Obesity: Findings from Universl Screening Fesibility Progrm in Lim, Peru Mrtinez, Stephnie Glori T. Lrrbure-Torrelv Miguel Angel Luque-Fernndez Sixto E. Snchez Pedro Mscro Snchez b, Jime Ingr b, Wlter Cstillo b, Rin Zumet b, Mirth Grnde d, Vicky Mott d, Percy Pcor e, Bizu Gelye, Michelle A. Willims b, c,, Deprtment of Epidemiology, Hrvrd School of Public Helth, Boston, MA, USA, b Instituto Ncionl Mterno Perintl de Lim, Lim, Perú, c Deprtmentos de Medicin y Ginecologí y Obstetrici Universidd Ncionl Universidd Ncionl Myor de Sn Mrcos, Lim, Perú, d Asocición Civil de Proyectos en Slud, AC.PROESA, Lim, Perú, e Deprtmento de Ginecologí y Obstetrici. Universidd Ncionl Myor de Sn Mrcos, Lim, Perú. Gesttionl dibetes mellitus (GDM) is noncommunicble disese ffecting pregnnt women with estimtes of GDM rnging from 6 to 13. Mternl Age (yers) Mestizo ethnicity Mrried or living with prtner Eductionl Sttus (yers) Mternl Eduction (yers) Pternl Eduction (yers) Employed Pre-Pregnncy BMI (kg/m2) <25 (norml weight) Mid-Pregnncy BMI (kg/m2) <25 (norml weight) Fmily History of Dibetes Depression Perceived Helth During Pregnncy Excellent Very Good Good Fir Poor Difficulty Pying for Bsics Very hrd/hrd Somewht hrd Not very hrd Food Insecurity Difficulties to Access Medicl Cre Very hrd/hrd Somewht hrd Not very hrd men ± stndrd devition perintl complictions. Risk fctors for GDM include fmily history of dibetes, dvnced mternl ge, nonwhite rce, previous unexplined stillbirth, obesity nd mjor depressive disorder. Peru, middle-income country, is one of the countries experiencing n epidemiologic trnsition with incresing burden of non-communicble disese risk fctors. We sought to exmine the prevlence of GDM nd ssocited risk fctors in cohort of pregnnt women in Lim, Peru. A cross-sectionl study ws conducted mong 1,300 Eligible prticipnts were pregnnt women who were 18 yers of ge or older, receiving prentl cre, hd gesttionl ge of gesttionl weeks, nd could spek, red nd write Spnish. GDM ws dignosed using n Orl Glucose Tolernce Test (OGTT) performed between 24 nd 28 gesttionl weeks using the Interntionl Assocition of Dibetes nd Pregnncy Study Groups (IADPSG) criteri. Depression sttus ws ssessed using the Ptient Helth Questionnire-9. Multivrite logistic regression models were used to identify risk fctors with GDM. Orl Glucose Tolernce Test GDM cses were identified through the use of the Orl Glucose Tolernce Test Glucose concentrtion threshold* mmol/l mg/dl *ADA criteri: One or more of these vlues from 75-g OGTT must be equled or exceeded for the dignosis of GDM. All prticipnts No GDM (N =1,095) GDM (N =205) ± ± 2.38 There is evidence tht women with GDM re t risk for pregnnt women ttending prentl clinic in Lim, Peru. Tble 1. Mternl sociodemogrphic chrcteristics (N = 1,300) Chrcteristics Glucose mesure Fsting plsm glucose 1-h plsm glucose 2-h plsm glucose d, ± ± ± ± Tble 2. Prevlence nd risk fctors of gesttionl dibetes Chrcteristics Crude OR (95CI) Mternl Age (yers) 1.03 ( ) Ethnicity Mestizo Other 1.02 ( ) Mritl Sttus Mrried or living with prtner Single or living lone/divorced 1.01 ( ) Mternl Eduction (yers) 1.23 ( ) 1.35 ( ) Prtner Eduction (yers) 1.55 ( ) 1.88 ( ) Pre-Pregnncy BMI (kg/m2) <25 (norml weight) 0.93 ( ) 1.49 ( ) Mid-Pregnncy BMI (kg/m2) <25 (norml weight) 1.28 ( ) 1.83 ( ) for trend Fmily History of Dibetes No/Don t Know Yes 1.53 ( ) Depression No Yes 1.52 ( ) Perceived Helth During Pregnncy Excellent Very Good 0.47 ( ) Good 0.70 ( ) Fir 0.62 ( ) Poor 0.73 ( ) Difficulty Pying for Bsics Very hrd/hrd Somewht hrd 1.19 ( ) Not very hrd 1.16 ( ) Adjusted Figure 1. Prevlence of GDM by fmily history of dibetes, mternl ge, pre-pregnncy BMI, nd mid-pregnncy BMI. Point estimtes nd 95CI re reported. Approximtely 16 of pregnnt women were dignosed with GDM. The prevlence of obesity nd depression were 24.4 nd 10.6, respectively (Tble 1). After djusting for confounders, mid-pregnncy obesity ws ssocited with 1.64-fold incresed odds of GDM (95CI: ) (Tble 2). Prticipnts with fmily history of dibetes hd 1.5- Adjusted OR (95CI) --- Multivrite OR (95CI) b 1.03 ( ) 1.05 ( ) 1.01 ( ) 1.10 ( ) 1.04 ( ) 0.79 ( ) 0.92 ( ) 1.13 ( ) 1.13 ( ) 0.52 ( ) 0.85 ( ) 1.72 ( ) 1.98 ( ) 0.86 ( ) 1.22 ( ) 0.90 ( ) 1.29 ( ) 1.18 ( ) 1.54 ( ) 1.23 ( ) 1.64 ( ) ( ) 1.53 ( ) 1.54 ( ) 0.52 ( ) 0.75 ( ) 0.63 ( ) 0.73 ( ) 0.62 ( ) 0.89 ( ) 0.69 ( ) 0.76 ( ) 1.24 ( ) 1.25 ( ) 1.18 ( ) 1.19 ( ) for ge (continuous) nd fmily history of dibetes (yes vs. no/don t know). b Min multivrite regression model djusted for ll chrcteristics (mternl ge, ethnicity, mritl sttus, mternl eduction, pternl eduction, mid-pregnncy BMI, fmily history of dibetes, depression, perceived helth during pregnncy, nd difficulty pying for the bsics) except pre-pregnncy BMI nd OR (95CI) from this model re reported here. A second multivrite regression model djusted for ll covrites except mid-pregnncy BMI nd the OR (95CI) for pre-pregnncy BMI is reported from this model. fold incresed odds of developing GDM (95CI: ) s compred to women without fmily history (Tble 2). Depression ws ssocited with 1.54-fold incresed odds of GDM (95 CI: ) (Tble 2). Discussion GDM is highly prevlent nd ws ssocited with mternl obesity, fmily history of dibetes nd nteprtum depression mong Peruvin women. Intervention progrms imed t erly dignoses nd mngement of GDM need to tke mternl obesity, fmily history of dibetes nd nteprtum depression into ccount. This reserch ws supported by Roche Dignostic Opertions Inc., project number nd Ntionl Institute for Minority Helth nd Helth Disprities, Ntionl Institutes of Helth (T37MD ). We wish to thnk the dedicted stff of Asocicion Civil Proyectos en Slud, Peru nd Instituto Ncionl Mterno Perintl, Peru, for their expert technicl ssistnce with this reserch.

5 Assocition between Migrine nd Suicidl Behviors mong Ethiopin Adults Bethnnie Jmerson-Dowlen 1, Hnn Y. Berhne 2, Luren E. Friedmn 1, Yemne Berhne 2, Michelle A. Willims 1, Bizu Gelye 1 1 Deprtment of Epidemiology, Hrvrd T.H. Chn School of Public Helth, Boston, MA, USA; 2 Addis Continentl Institute of Public Helth, Addis Abb, Ethiopi Migrine is prevlent neurologicl disorder, ffecting 38 million in the U.S. The prevlence of migrine in Africn countries is estimted between 3 to 10. Previous studies show ssocitions between migrine, depression nd suicidl behviors. The impct of migrine on ptients nd its ssocited risk fctors nd outcomes remins limited, prticulrly in low- nd middle-income countries. Few studies in low- nd middle-income countries hve investigted the ssocition between migrine nd suicidl behviors, prticulrly in sub-shrn Afric. To evlute the ssocition between migrine hedches nd suicidl behviors mong cohort of Ethiopin dults. We conducted cross-sectionl study of 1,060 dults in mjor hospitl in Ethiopi. Migrine clssifiction ws bsed on the Interntionl Clssifiction of Hedche Disorders-2 dignostic criteri. Depression nd suicidl behvior were ssessed using the Composite Interntionl Dignostic Interview (CIDI) mong ll study prticipnts. Multivrible logistic regression models were used to estimte djusted odds rtio (OR) nd 95 confidence intervls (95 CIs). Tble 1: Socio-demogrphic nd reproductive chrcteristics of the study popultion ccording to types of migrine (N = 1,060) Chrcteristics All No migrine Migrine prticipnts (N = 639) (N = 421) Age (yers) ± ± ± Sex Women <0.001 Men Mritl Sttus Mrried Never mrried Other Eduction Primry (1-6) <0.001 Secondry () College grdute Smoking sttus Never Former Current Alcohol consumption pst yer Non-drinker < once month dy week Kht chewing None Former Current Body mss index (kg/m 2 ) < Self-reported physicl helth Excellent/very good/good <0.001 Poor/fir Self-reported mentl helth Excellent/very good/good <0.001 Poor/fir Depression (pst yer) <0.001 Depression (lifetime) <0.001 Suicidl behvior <0.001 Suicidl idetion <0.001 Suicidl pln <0.001 Suicidl ttempt Men ± stndrd devition (SD). b Non-mutully exclusive subcomponents. For continuous vribles, ws clculted using the one-wy ANOVA; for ctegoricl vribles, ws clculted using the Chi-squre test. Conclusion Migrineurs were more likely to be women (p<0.001), hve less eduction (p=0.011), nd were more likely to report their physicl or mentl helth sttus s fir or poor (p<0.001) (Tble 1). Suicidl behviors were more common in migrineurs (61.9) thn in those without migrine (38.1) of prticipnts reported ny suicidl behviors, which included suicidl idetion (14.5), suicide plns (6.1), or suicide ttempts (4.2) (Tble 1). After djusting for confounders, migrine ws ssocited with 1.49-fold incresed odds of suicidl behvior (95Cl: ) compred to those who did not hve migrine (Tble 2). In prticipnts without depression, migrine ws significntly ssocited with suicidl behvior in fully djusted model (OR: 2.27, 95Cl: ) s compred to prticipnts without migrine. However, in prticipnts with depression, the ssocition ws not significnt (Tble 3). Tble 2. Assocition between migrine nd suicidl behvior (N = 1,060) No suicidl behvior (N = 900) Any suicidl behvior (N = 160) Undjusted OR (95 CI) Adjusted OR (95 CI) Adjusted OR (95 CI) b Adjusted OR (95 CI) c No Migrine Migrine ( ) 2.71 ( ) 2.70 ( ) 1.49 ( ) Adjusted for ge (continuous), sex, eduction, nd BMI ctegories. b Adjusted for ge (continuous), sex, eduction, BMI ctegories, kht chewing, nd pst yer lcohol consumption. c Adjusted for ge (continuous), sex, eduction, BMI ctegories, kht chewing, pst yer lcohol consumption, nd lifetime depression. Tble 3. Assocition between migrine nd suicidl behvior strtified by pst yer depression sttus (N = 1,060) Migrine Without Depression No suicidl behvior (N = 879) Any suicidl behvior (N = 111) Figure 1. Prevlence of suicidl behviors* (idetion, pln, nd ttempt) by sex *Non-mutully exclusive subcomponents Migrine hedches re ssocited with incresed odds of suicidl behviors in urbn-dwelling Ethiopin dults. Studies should further investigte this comorbidity nd possible risk fctors for these disorders. Physicins should be wre of the comorbidity between migrine, depression, nd suicidl behviors to implement effective screening nd tretment of these comorbid disorders. Undjusted OR (95 CI) Adjusted OR (95 CI) Adjusted OR (95 CI) b No migrine Migrine ( ) 2.27 ( ) 2.27 ( ) Migrine With Depression No suicidl behvior (N = 21) Any suicidl behvior (N = 49) No migrine Migrine ( ) 1.22 ( ) 1.64 ( ) Adjusted for ge (continuous), sex, eduction, nd BMI ctegories. b Adjusted for ge (continuous), sex, eduction, BMI ctegories, kht chewing, nd pst yer lcohol consumption Prevlence of suicidl behviors Suicidl Behvior Men (N=423) Suicidl Suicide Pln Idetion Suicidl Behviors* Women (N=637) Suicide Attempt Figure 2. Prevlence of suicidl behviors* (idetion, pln, nd ttempt) by migrine sttus Prevlence of suicidl behviors Suicidl Behvior No Migrine (N=639) *Non-mutully exclusive subcomponents Suicidl Suicide Pln Idetion Suicidl Behviors* This reserch ws supported by n wrd from the Ntionl Institutes of Helth, Ntionl Institute of Minority Helth nd Helth Disprities (T37-MD001449). The uthors wish to thnk the stff of Addis Continentl Institute of Public Helth for their ssistnce. Migrine (N=421) Suicide Attempt

6 Predicting Crdio-Metbolic Risk using Body Shpe Index (ABSI) nd Body Roundness Index (BRI) mong Ethiopin Adults Dniel Nguyen 1, Andrei Stefnescu 1, Hnn Y. Berhne 2, Yemne Berhne 2, Michelle A. Willims 1, Bizu Gelye 1 1 Deprtment of Epidemiology, Hrvrd T.H. Chn School of Public Helth, Boston, MA, USA; 2 Addis Continentl Institute of Public Helth, Addis Abb, Ethiopi The Body Mss Index (BMI) nd Wist Circumference (WC) re widely used nthropometric mesures for identifying crdiovsculr disese risk globlly. Recently, two new nthropometric mesures hve been proposed s better lterntives to BMI nd WC: the A Body Shpe Index (ABSI) nd Body Roundness Index (BRI). Both ABSI nd BRI re clculted re bsed on WC nd height. We sought to exmine the extent to which the trditionl (BMI nd WC) nd new mesures (ABSI nd BRI) of diposity cn predict metbolic syndrome (MetS) nd its components mong working dults in Ethiopi. The World Orgniztion STEPwise pproch ws used to collect sociodemogrphic dt, nthropometric mesurements, nd blood smples. Fsting blood glucose (FBG) nd lipid concentrtions were mesured using stndrd pproches. MetS ws defined ccording to the Interntionl Dibetes Federtion (IDF) criteri. Spermn s rnk correltion, receiver operting chrcteristic (ROC) curves, nd logistic regressions were used to determine the ssocitions between MetS nd four nthropometric indices: BMI, WC, ABSI, nd BRI. Among men, BRI ws most strongly ssocited with triglycerides [TG] (r=0.514), BMI ws strongly ssocited with systolic blood pressure[sbp] (r = 0.401) while WC ws strongly ssocited with distolic blood pressure [DBP] (r = 0.419). Among women, BRI ws strongly ssocited with TG (r = 0.478) nd DBP (r = 0.434). WC ws strongly ssocited with SBP (r = 0.443) nd FBG (r = 0.306). Review of the ROC curves shows tht BRI ws the best predictor for MetS (re under curve [AUC] = 0.94) mong men nd women (AUC = 0.87). BRI ws lso the best predictor of Mets components including elevted TG (AUC=0.77 nd 0.74,), elevted FBG (AUC=0.61 nd 0.63), nd elevted SBP (AUC=0.70 nd AUC=0.74) mong men nd women, respectively. Tble 2. Spermn s Rnk Correltion Coefficients for Anthropometric Mesures & Crdiovsculr Disese Risk Fctors Abbrevitions: BMI Body Mss Index; WC wist circumference; ABSI A Body Shpe Index; BRI Body Roundness Index. All coefficients re significnt t the 0.01 level except for those between ABSI nd HDL-C for both men nd women, which were not significnt (p > 0.25 in both cses). Figure 1. ROC Curves (AUC) for Metbolic Syndrome mong Men BMI (kg/m 2 ) WC (cm) ABSI BRI Men Fsting Blood Glucose (mg/dl) Triglyceride (mg/dl) HDL-C (mg/dl) Systolic Blood Pressure (mm Hg) Distolic Blood Pressure (mm Hg) Women Fsting Blood Glucose (mg/dl) Triglyceride (mg/dl) HDL-C (mg/dl) Systolic Blood Pressure (mm Hg) Distolic Blood Pressure (mm Hg) Figure 2. ROC Curves (AUC) for Metbolic Syndrome mong Women Tble 1. Chrcteristics of the Study Popultion Chrcteristic Men (N = 1165) Women (N = 759) P-Vlue * Age Men ± SD 35.7 ± ± Age Eduction Bchelor s < High School Smoking Sttus Never Smoker < Former Smoker Current Smoker Alcohol Consumption Low < Moderte High Current Kht Use < Excellent Self-Reported Helth BMI Underweight ( 18.5) < Norml ( ) Overweight ( ) Obese ( 30.0) Physicl Activity Low < Moderte High s for continuous vribles re obtined from Student s t-tests. s for ctegoricl vribles re obtined from chi squre tests of independence. BMI [0.88 ( )] WC [0.95 ( )] ABSI [0.76 ( )] BRI [0.94 ( )] Conclusion Among the four mesures of diposity, BRI is most strongly nd consistently ssocited with MetS nd MetS components mong both men nd women. Even though BMI is the most common mesure of diposity, it is limited in distinguishing between excess dipose tissue nd muscle mss. Findings from our study underscore the utility of using new nd trditionl diposity mesures in identifying crdiovsculr disese risk in resource-limited settings. BMI [0.84 ( )] WC [0.88 ( )] ABSI [0.72 ( )] BRI [0.87 ( )] This reserch ws supported by n wrd from the Ntionl Institutes of Helth, Ntionl Institute of Minority Helth nd Helth Disprities (T37- MD001449). The uthors wish to thnk the stff of Addis Continentl Institute of Public Helth for their expert technicl ssistnce.