Annals of Epidemiology

Editorial Board

2010-08-01

Intimate Partner Violence as a Risk Factor for Postpartum Depression Among Canadian Women in the Maternity Experience Survey

Hind A. Beydoun, Ban Al-Sahab, May A. Beydoun, Hala Tamim — 2010-08-01

Purpose: Intimate partner violence is a worldwide public health concern that predominantly affects women of reproductive age. The purpose of this study was to evaluate the effect of exposure to intimate partner violence before, during, or after pregnancy on postpartum depression in a nationally representative sample of Canadian women.Methods: A cross-sectional analysis was performed with the use of data from the Maternity Experience Survey conducted by Statistics Canada in 2006. A population-based sample of 8542 women 15 years and older who delivered singleton live births was selected from all Canadian provinces and territories; of those, 6421 completed a computer-assisted telephone interview. Recent experiences with and threats of physical or sexual violence by an intimate partner were examined in relation to postpartum depression assessed through the Edinburgh Postpartum Depression Scale.Results: The prevalence of postpartum depression was 7.5% (95% confidence interval, 6.8−8.2). Controlling for confounders, odds of postpartum depression were significantly greater among women who reported partner violence in the past two years as opposed to those who did not (adjusted odds ratio, 1.61; 95% confidence interval, 1.06−2.45).Conclusions: Intimate partner violence is positively associated with postpartum depression among Canadian women. Implications for healthcare practice are discussed.

Does Chocolate Intake During Pregnancy Reduce the Risks of Preeclampsia and Gestational Hypertension?

Audrey F. Saftlas, Elizabeth W. Triche, Hind Beydoun, Michael B. Bracken — 2010-08-01

Purpose: Chocolate consumption is associated with favorable levels of blood pressure and other cardiovascular disease risk markers. We analyzed a prospective cohort study to determine whether regular chocolate intake during pregnancy is associated with reduced risks of preeclampsia and gestational hypertension (GH).Methods: Subjects were recruited from 13 prenatal care practices in Connecticut (1988−1991). In-person interviews were administered at <16 weeks' gestation to ascertain risk factors for adverse pregnancy outcomes. Hospital delivery and prenatal records were abstracted to classify preeclampsia (n = 58), GH (n = 158), and normotensive pregnancies (n = 2351). Chocolate consumption (servings/week) during the first and third trimesters was ascertained at initial interview and immediately postpartum, respectively. Consumers of less than 1 serving/week comprised the referent group. Adjusted odds ratios (aORs) were estimated by the use of logistic regression.Results: Chocolate intake was more frequent among normotensive (80.7%) than preeclamptic (62.5%) or GH women (75.8%), and associated with reduced odds of preeclampsia (first trimester: aOR, 0.55; 95% confidence interval [95% CI], 0.32−0.95; third trimester: aOR, 0.56; 95% CI, 0.32−0.97). Only first trimester intake was associated with reduced odds of GH (aOR,0.65; 95% CI, 0.45−0.87).Conclusions: These findings provide additional evidence of the benefits of chocolate. Prospective studies are needed to confirm and delineate protective effects of chocolate intake on risk of preeclampsia.

Maternal Body Composition, Smoking, and Hyperemesis Gravidarum

2010-08-01

Purpose: To study associations between maternal prepregnant body mass index (BMI), smoking, and hyperemesis gravidarum (hyperemesis).Methods: The sample consisted of 33,467 primiparous women from the Norwegian Mother and Child Cohort Study (1999−2008). Data on hyperemesis, BMI, education, maternal age, eating disorders, maternal and paternal smoking habits were obtained from questionnaires. All associations were studied by logistic regression.Results: Altogether, 353 (1.1%) women had hyperemesis. Among non-smokers, both underweight and obese women were more likely to develop hyperemesis than normal-weighted women: odds ratio (OR), 2.36; 95% confidence interval (95% CI), 1.43−3.88 and OR, 1.48; 95% CI, 1.00−2.20, respectively. No associations were found among smokers. Women who smoked daily (OR, 0.44; 95% CI, 0.32−0.60) or occasionally (OR, 0.64; 95% CI, 0.44−0.93) had lower risk of hyperemesis than non-smokers. No effect of partner's smoking habits was observed.Conclusions: Both underweight and obesity were associated with hyperemesis, but only among non-smokers. Maternal prepregnant smoking reduced the risk of hyperemesis, whereas partner's smoking habits had no effect.

Measurement of Dietary Intake of Fatty Acids in Pregnant Women: Comparison of Self-Reported Intakes with Adipose Tissue Levels

2010-08-01

Purpose: Dietary fatty acids affect several pregnancy outcomes including fetal growth and development. We compared self-reported intakes with concentrations of fatty acids in adipose tissue in pregnant women.Methods: The study was nested within Geração XXI, a birth cohort assembled in Portugal. Intake was assessed by nine food diaries (FDs) completed throughout pregnancy and an FFQ administered in the immediate postpartum period. A gluteal adipose tissue sample was obtained from 23 women.Results: FDs and FFQ estimated similar percentages of saturated (SFA), monounsaturated (MUFA), and polyunsaturated fatty acids (PUFA), but the adipose tissue yielded a lower percentage of SFA and higher percentages of MUFA and PUFA. Correlations between FDs and adipose tissue ranged from r = 0.50 for trans fatty acids to r = −0.19 for linolenic acid. The proportion of women categorized in opposite tertiles by these two methods ranged from 4.3% to 30.4%. Correlations between FFQ and adipose tissue were even weaker and levels of misclassification higher.Conclusions: The correlations observed in this study between self-reported intakes and tissue concentrations are weaker than those observed in a similar study conducted among nonpregnant women, suggesting that adipose tissue levels of fatty acids may be a poor biomarker of dietary intake in pregnancy.

Early or Recurrent Preterm Birth and Maternal Cardiovascular Disease Risk

2010-08-01

Purpose: Preterm birth (PTB) has been associated with a later increased risk of maternal cardiovascular disease (CVD). We hypothesized a more pronounced relation between early or recurrent PTB and maternal CVD risk.Methods: We related PTB severity (earlier gestational age at delivery) and recurrence (≥2) among women with births from 1973–1983 in Denmark (n = 427,765) to maternal CVD morbidity or mortality (1977–2006). Birth data were linked to CVD hospitalizations and deaths identified in national registers and data were analyzed using Cox proportional hazards models.Results: Women with a prior PTB had excess CVD after adjustment for age, parity, and education (hazard ratio [HR] = 1.36 [95% confidence interval (CI): 1.31, 1.41]). This was only modestly attenuated when women with preeclampsia or small for gestational age births were excluded, and the relationship was stronger for CVD mortality (HR = 1.98 [1.73, 2.26]). Recurrent PTB was associated with higher CVD morbidity compared to women with one PTB, particularly for ischemic events (HR = 1.78 [1.40, 2.27] vs. 1.22 [1.09, 1.36]). Risk was similarly elevated among women with early, moderate, and late PTB. Sensitivity analysis suggested that confounding by smoking only partly explained these associations.Conclusions: Women with PTB, especially recurrent PTB, were at increased risk for CVD, suggesting common causes of these conditions.

Association of Glycemic Index and Glycemic Load With Risk of Incident Coronary Heart Disease Among Whites and African Americans With and Without Type 2 Diabetes: The Atherosclerosis Risk in Communities Study

2010-08-01

Purpose: In this study we examined whether high glycemic index (GI) and glycemic load (GL) diets are associated with increased risk of developing coronary heart disease (CHD) in Whites and African Americans with and without type 2 diabetes.Methods: Data on 13,051 patients ages 45 to 64 years from the Atherosclerosis Risk in Communities study were analyzed. The ARIC food frequency questionnaire baseline data provided GI and GL indices. A propensity score was created to estimate the effect of a patient's covariates on energy-adjusted GI or GL. During a maximum of 17 years of follow-up, 1683 cases of CHD (371 with diabetes and 1312 without diabetes) were recorded.Results: For every 5-units increase in GI, there was a 1.16-fold (95% confidence interval [95% CI], 1.01−1.33) increased risk of incident CHD in African Americans. For every 30-units increase in GL, there was a 1.11-fold (95% CI, 1.01−1.21) increased risk of incident CHD in Whites. High GL was an especially important CHD risk factor for Whites without diabetes (per 30-units increase; hazard ratio, 1.14; 95% CI, 1.02−1.26). However, these relationships were not seen in individuals with diabetes.Conclusions: Nutritional advice to reduce the GI and GL in diets of African Americans and Whites subjects (without diabetes) may play a role in reducing CHD risk.

Socioeconomic and Ethnic Disparities in Cardiovascular Risk In the United States, 2001–2006

Arun S. Karlamangla, Sharon Stein Merkin, Eileen M. Crimmins, Teresa E. Seeman — 2010-08-01

Purpose: To quantify socioeconomic status and ethnic differences in risk for coronary heart disease (CHD) accrued from major risk factors in the United States.Methods: Data came from the National Health and Nutrition Examination Survey 2001–2006. Outcomes examined were (a) 10-year risk for CHD events as predicted by the National Cholesterol Education Program Adult Treatment Panel III 2004 Updated Guidelines; and (b) the prevalence of the metabolic syndrome and overt diabetes mellitus (a CHD risk-equivalent).Results: Strong inverse socioeconomic gradients with risk were present in all race/ethnicity groups except foreign-born Mexican American men, and were attenuated by controls for physical activity, smoking, and abdominal obesity. In contrast, race/ethnicity disparities were seen in some but not all socioeconomic strata, with some non-Hispanic Blacks and US-born Mexican Americans having higher risk and some foreign-born Mexican Americans having lower risk.Conclusions: Disparities in cardiovascular risk in the United States are primarily related to socioeconomic status and less to race/ethnicity. Socioeconomically disadvantaged individuals should be targeted for lifestyle counseling and early screening for risk factors, regardless of race/ethnicity, to reduce social disparities in cardiovascular outcomes.

Design and Implementation of the Hispanic Community Health Study/Study of Latinos

2010-08-01

Purpose: The Hispanic Community Health Study (HCHS)/Study of Latinos (SOL) is a comprehensive multicenter community based cohort study of Hispanics/Latinos in the United States.Methods: The Study rationale, objectives, design, and implementation are described in this report.Results: The HCHS/SOL will recruit 16,000 men and women who self-identify as Hispanic or Latino, 18 to 74 years of age, from a random sample of households in defined communities in the Bronx, Chicago, Miami, and San Diego. The sites were selected so that the overall sample would consist of at least 2000 persons in each of the following origin designations: Mexican, Puerto Rican and Dominican, Cuban, and Central and South American. The study includes research in the prevalence of and risk factors for heart, lung, blood and sleep disorders, kidney and liver function, diabetes, cognitive function, dental conditions, and hearing disorders.Conclusions: The HCHS/SOL will (1) characterize the health status and disease burden in the largest minority population in the United States; (2) describe the positive and negative consequences of immigration and acculturation of Hispanics/Latinos to the mainstream United States life-styles, environment and health care opportunities; and (3) identify likely causal factors of many diseases in a population with diverse environmental exposures, genetic backgrounds, and early life experiences.

Sample Design and Cohort Selection in the Hispanic Community Health Study/Study of Latinos

2010-08-01

Purpose: The Hispanic Community Health Study (HCHS)/Study of Latinos (SOL) is a multicenter, community-based cohort study of Hispanic/Latino adults in the United States. A diverse participant sample is required that is both representative of the target population and likely to remain engaged throughout follow-up. The choice of sample design, its rationale, and benefits and challenges of design decisions are described in this study.Methods: The study design calls for recruitment and follow-up of a cohort of 16,000 Hispanics/Latinos 18–74 years of age, with 62.5% (10,000) over 44 years of age and adequate subgroup sample sizes to support inference by Hispanic/Latino background. Participants are recruited in community areas surrounding four field centers in the Bronx, Chicago, Miami, and San Diego. A two-stage area probability sample of households is selected with stratification and oversampling incorporated at each stage to provide a broadly diverse sample, offer efficiencies in field operations, and ensure that the target age distribution is obtained.Conclusions: Embedding probability sampling within this traditional, multisite cohort study design enables competing research objectives to be met. However, the use of probability sampling requires developing solutions to some unique challenges in both sample selection and recruitment, as described here.

2010-08-01

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2010-08-01

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2010-08-01

Annals of Epidemiology

Editorial Board

Intimate Partner Violence as a Risk Factor for Postpartum Depression Among Canadian Women in the Maternity Experience Survey

Does Chocolate Intake During Pregnancy Reduce the Risks of Preeclampsia and Gestational Hypertension?

Maternal Body Composition, Smoking, and Hyperemesis Gravidarum

Measurement of Dietary Intake of Fatty Acids in Pregnant Women: Comparison of Self-Reported Intakes with Adipose Tissue Levels

Early or Recurrent Preterm Birth and Maternal Cardiovascular Disease Risk

Association of Glycemic Index and Glycemic Load With Risk of Incident Coronary Heart Disease Among Whites and African Americans With and Without Type 2 Diabetes: The Atherosclerosis Risk in Communities Study

Socioeconomic and Ethnic Disparities in Cardiovascular Risk In the United States, 2001–2006

Design and Implementation of the Hispanic Community Health Study/Study of Latinos

Sample Design and Cohort Selection in the Hispanic Community Health Study/Study of Latinos

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