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bioRxiv2017

Diabetes and dementia incidence in Latin America; a 10/66 population-based cohort study

BackgroundDiabetes prevalence is already high in middle income countries, particularly among older people. Current evidence on diabetes as a risk factor for dementia is limited to cohort studies in high income countries. Few studies carried out fasting glucose assessments to identify undiagnosed cases, and assess diabetes control. We aimed to determine the association between both diagnosed diabetes and total diabetes (including undiagnosed cases) and incident dementia, examining also the impact of glycaemic control on dementia risk.\n\nMethodsPopulation-based cohort studies of those aged 65 years and over in sites in Cuba, Dominican Republic, Puerto Rico, Peru, Venezuela, and Mexico. Diagnosed diabetes was assessed through self-reported diagnosis, and undiagnosed diabetes through fasting blood samples (glucose >= 7mmol/L). Blood pressure, smoking, underactivity and waist circumference were assessed from questionnaires and physical examination. Incident 10/66 dementia (and subtypes), and mortality, were ascertained three to five years later.\n\nResults12,297 interviews were completed at baseline, with 80-95% responding by site. The at risk cohort comprised 10,945 dementia-free individuals, of whom 8,171 (75%) provided blood samples. Mean age varied from 72.0 to 75.1 years by site. Total diabetes prevalence was 43.5% in Puerto Rico, ranging from 11.5% to 27.0% in other sites. Most diabetes cases (50.2% to 68.4%) were not controlled (fasting glucose >7.0 mmol/L). 7,000 participants were followed up for 26,423 person-years with 659 incident dementia cases, and 905 dementia free deaths. Total diabetes was associated with incident 10/66 dementia (pooled meta-analysed adjusted sub-hazard ratio [pASHR] 1.25, 95% CI, 1.05-1.49, I2=48.6%), with a stronger association for uncontrolled (pASHR 1.47, 95% CI 1.19-1.81, I2=49.6%) than controlled cases (pASHR 1.29, 95% CI 0.95-1.74, I2=13.3%). Total diabetes was strongly associated with the incidence of vascular dementia (pASHR 2.25, 95% CI 1.24-4.08, I2=23.7%), but not Alzheimers Disease (pASHR 0.99, 95% CI 0.70-1.42, I2=49.0%).\n\nConclusionsDiabetes, particularly when poorly controlled, may increase dementia risk. There is considerable scope for improved detection and control of diabetes among older people in these settings, and hence an opportunity to carry out proof of concept prevention trials. Overlapping epidemics of these age dependent disorders will challenge poorly-resourced health systems in the future.

epidemiology↗

bioRxiv2017

Serology reflects a decline in the prevalence of trachoma in two regions of The Gambia

Trachoma is caused by Chlamydia trachomatis (Ct). It is targeted for global elimination as a public health problem. In 2014, a population-based cross-sectional study was performed in two previously trachoma-endemic areas of The Gambia. Participants of all ages from Lower River Region (LRR) (N = 1028) and Upper River Region (URR) (N = 840) underwent examination for trachoma and had blood collected for detection of antibodies against the Ct antigen Pgp3, by ELISA. Overall, 30 (1.6%) individuals had active trachoma; the prevalence in children aged 1-9 years was 3.4% (25/742) with no statistically significant difference in prevalence between the regions. There was a significant difference in overall seroprevalence by region: 26.2% in LRR and 17.1% in URR (p<0.0001). In children 1-9 years old, seroprevalence was 4.4% in LRR and 3.9% in URR. Reversible catalytic models using information on age-specific seroprevalence demonstrated a decrease in the transmission of Ct infection in both regions, possibly reflecting the impact of improved access to water, health and sanitation as well as mass drug administration campaigns. Serological testing for antibodies to Ct antigens is potentially useful for trachoma programmes, but consideration should be given to the coendemicity of sexually transmitted Ct infections.

epidemiology↗

bioRxiv2017

Unintended Consequences and the Paradox of Control: Management of Emerging Pathogens with Age-Specific Virulence

We project the long term incidence of Zika virus disease (ZVD) under varying hazards of infection and consider how the age-distribution of disease burden varies between these scenarios. Pathogens with age-structured disease outcomes, such as rubella and Zika virus, require that management decisions consider their impact not only on total disease incidence but also on distribution of disease burden within a population. In some cases, reductions of overall transmission can have the paradoxical effect of increasing the incidence of severe disease despite decreasing the total incidence. This happens because of corresponding increases in the average age of infection. Beginning with the current population structure and demographic rates of Brazil, we project forward total ZVD burden as measured by cases occurring in pregnant women and document the scenarios under which a paradox of control for Zika management emerges. We conclude that while a paradox of control can occur for ZVD, the higher total costs from increasing the average age of infection will only be realized after several decades and vanish under conservative discounting of future costs. This indicates that managers faced with an emerging pathogen should prioritize current disease incidence over potential increases in severe disease outcomes in the endemic state.\n\nAuthor SummaryThe intuitive response to an emerging outbreak is to halt, or at least reduce, transmission. However, in some circumstances, reducing overall transmission and incidence may be counterproductive from a public health perspective as public health interventions affect both the total level and the distribution of disease burden. We consider the scenarios under which reducing transmission of an emerging pathogen such as Zika virus may increase the costs associated with disease in the most vulnerable segments of the population - in this case, reproductive-age women. We conclude that after applying standard discounting rates to future cases, the \"paradox of control\" vanishes and reducing hazard of infection uniformly reduces the total costs associated with severe disease.

epidemiology↗

bioRxiv2017

The decline of malaria in Vietnam, 1991-2014

A central component of malaria control initiatives throughout the world is the use of artemisinin-based combination therapies (ACTs) for treatment of uncomplicated P. falciparium malaria. Despite the well-documented clinical efficacy of ACTs, the population-level effects of ACT case management on malaria transmission have not been studied thoroughly until recently. An ideal case study for the population-level effects of artemisinin use can be found in Vietnam, where a major increase of malaria cases in the 1980s was followed by the gradual adoption of artemisinin-based clinical case management. We assembled annual data from Vietnams National Institutes for Malariology, Parasitology, and Entomology showing the degree to which artemisinin therapies were adopted in different provinces, the effort placed on vector control, and the funding available to provincial malaria control programs, from 1991 to 2014. Data on urbanization were also collected for this period. We found that a 10% increase in the artemisinin proportion of treatments procured by a provincial control program corresponded to a 32.8% (95% CI: 27.7 - 37.5%) decline in estimated malaria cases; the association persisted and the effect size was nearly unchanged if confirmed cases or suspected cases were used. There was no consistent effect of vector control on malaria cases in Vietnam as a whole, nor was any effect found when the data were broken up regionally. The association between urbanization and malaria was generally negative and sometimes statistically significant. This was most pronounced in the central region of Vietnam, where a 10% increase in urbanization corresponded to a 43.3% (95% CI: 21.6 - 58.9%) decrease in suspected malaria incidence; this association was not statistically significant if confirmed cases or estimated cases were used. The decline of malaria in Vietnam from 1991 to 2014 can largely be attributed to the rapid adoption of artemisinin-based drugs. Recent analyses of aggregated data from Africa have shown that insecticide-treated nets have had the greatest effect on lowering malaria prevalence over the past fifteen years, suggesting that the success of different types of malaria interventions is region specific. Continuing global efforts on malaria elimination should focus on both vector control measures and increased access to artemisinin-combination therapies.

epidemiology↗

bioRxiv2017

International risk of yellow fever spread from the ongoing outbreak in Brazil

The largest Yellow Fever (YF) outbreak in a decade in Latin America is underway in the Southeast of Brazil. In this article we provide a quantitative assessment of the risk of travel-related international spread of YF. We argue that mitigating the risk of imported YF cases seeding local transmission requires heightened surveillance in the southern United States, Latin America (especially Argentina, Chile and Uruguay) and Europe (especially Portugal, Spain, Italy and Germany).

epidemiology↗

bioRxiv2017

A National Estimate of the Health and Cost Burden of Escherichia coli Bacteraemia in the Hospital Setting: The Importance of Antibiotic Resistance.

BackgroundAntibiotic resistance poses a threat to public health and a burden to healthcare systems. Escherichia coli causes more bacteraemia cases in England than any other bacterial species, these infections, in part due to their high incidence, also pose a significant antibiotic resistance burden. The main aim of this study was to estimate the impact of E. coli bacteraemia on patient in-hospital mortality and length of stay. Secondarily, this study also aimed to estimate the effect of antibiotic resistance on these outcomes.\n\nMethods and FindingsCase patients were adult E. coli bacteraemia patients infected between July 2011 and June 2012, as reported in an English national mandatory surveillance database, with susceptibility data taken from a national laboratory surveillance database. Control patients were all non-case, adult patients with an English hospital admission record. Case and control patient characteristics and admission information were taken from NHS Digital Datasets. Resistance was defined as non-susceptible and intermediate isolates, whilst susceptible was defined as susceptible and non-tested isolates. Time to in-hospital mortality and discharge was investigated through Cox proportional hazards models. To acquire estimates of excess length of stay, multistate models were constructed, with a unit bed day cost applied to estimate cost burden. The total number of case and control hospital spells was 14,051 and 8,919,275 respectively. Acquisition of E. coli bacteraemia was associated with a statistically significant increased daily risk of in-hospital mortality, especially for the first eight days of someones hospital admission [Hazard Ratio = 2.77 (95% confidence interval; 2.61-2.94)]. Antibiotic resistance did not seem to significantly increase this risk further, though did significantly reduce risk of experiencing a discharge event (dead or alive). E.coli bacteraemia was estimated to cost {pound}14,340,900 over the study period (rounded to the nearest {pound}100), with resistance associated with excess costs per infection of {pound}220 - {pound}420 dependent on resistance type, for those where a significant impact was found (rounded to the nearest {pound}10).\n\nConclusionsE. coli bacteraemia places a significant burden on patient health and on the hospital sector in England. Resistance is an important factor on length of stay with regards to such infections.

epidemiology↗

bioRxiv2017

Investigating the role of insulin in increased adiposity: Bi-directional Mendelian randomization study

Insulin may serve as a key causal agent which regulates fat accumulation in the body. Here we assessed the causal relationship between fasting insulin and adiposity using publicly-available results from two large-scale genome-wide association studies for body mass index and fasting insulin levels in a two-sample, bidirectional Mendelian Randomized approach. This approach is only valid on the condition that the two instruments are independent of one another. In analysis excluding overlapping loci, there was an increase of 0.20 (0.17, 0.23) log pmol/L fasting insulin per SD increase in BMI (P= 2.80 x 10-36), while there was a null effect of fasting insulin on BMI, with a 0.01 (-0.39, 0.38) SD decrease in BMI per log pmol/L increase in fasting insulin (P= 0.98). Furthermore, a high degree of heterogeneity in the causal estimates was obtained from the insulin-related variants, which may be attributed to varying mechanisms of action of the insulin-associated variants. Results were largely consistent when an Egger regression technique and weighted median and mode estimators were applied. Findings suggest that the positive correlation between adiposity and fasting insulin levels are at least in part explained by the causal effect of adiposity on increasing insulin, rather than vice versa.

epidemiology↗

bioRxiv2017

Myocardial injury in critically ill patients with community-acquired pneumonia

BackgroundMyocardial injury, as reflected by elevated cardiac troponin levels in plasma, is common in patients with community-acquired pneumonia (CAP), but its temporal dynamics and etiology remain unknown. Our aim was to determine the incidence of troponin release in patients with CAP and identify risk factors which may point to underlying etiologic mechanisms.\n\nMethodsWe included consecutive patients admitted with severe CAP to two intensive care units in the Netherlands between 2011 and 2015. High-sensitivity cardiac troponin I was measured daily during the first week. We used multivariable linear regression to identify variables associated with troponin release on admission, and mixed-effects regression to model the daily rise and fall of troponin levels over time.\n\nResultsAmong 200 eligible patients, 179 were included, yielding 792 observation days. A total of 152 (85%) patients developed raised troponin levels >26 ng/L. Baseline factors independently associated with troponin release included coronary artery disease (160% increase, 95% CI 7-529), smoking (304% increase, 95% CI 59-924), and higher APACHE IV score (2% increase, 95% CI 0.7-3.3), whereas Staphylococcus aureus as a causative pathogen was protective (67% reduction, 95% CI 9-88). Time-dependent risk factors independently associated with daily increase in troponin concentrations included reduced platelet count (1.7% increase, 95% CI 0.1-3.4), tachycardia (1.6% increase, 95% CI 0.3-3), hypotension (5.1% increase, 95% CI 1-9.4) and dobutamine use (38.4% increase 95% CI 8.8-76).\n\nConclusionsCardiac injury develops in a majority of patients with severe CAP. Myocardial oxygen supply-demand mismatch and activated coagulation are potential causes of this injury.

epidemiology↗

bioRxiv2017

Quantifying the Risk and Cost of Active Monitoring for Infectious Diseases

During outbreaks of deadly emerging pathogens (e.g., Ebola, MERS-CoV) and bioterror threats (e.g., smallpox), actively monitoring potentially infected individuals aims to limit disease transmission and morbidity. Guidance issued by CDC on active monitoring was a cornerstone of its response to the West Africa Ebola outbreak. There are limited data on how to balance the costs and performance of this important public health activity. We present a framework that estimates the risks and costs of specific durations of active monitoring for pathogens of significant public health concern. We analyze data from New York Citys Ebola active monitoring program over a 16-month period in 2014-2016. For monitored individuals, we identified unique durations of active monitoring that minimize expected costs for those at \"low (but not zero) risk\" and \"some or high risk\": 21 and 31 days, respectively. Extending our analysis to smallpox and MERS-CoV, we found that the optimal length of active monitoring relative to the median incubation period was reduced compared to Ebola due to less variable incubation periods. Active monitoring can save lives but is expensive. Resources can be most effectively allocated by using exposure-risk categories to modify the duration or intensity of active monitoring.

epidemiology↗

bioRxiv2017

ukbtools: An R package to manage and query UK Biobank data

SummaryThe UK Biobank is a resource that includes detailed health-related data on about 500,000 individuals and is available to the research community. ukbtools removes all the upfront data wrangling required to get a single dataset for statistical analysis, and provides tools to assist in quality control, query of disease diagnoses, and retrieval of genetic metadata.\n\nAvailabilityThe package is available for installation from the Comprehensive R Archive Network (CRAN), and includes a vignette describing the use of all functionality.\n\nContact ken.b.hanscombe@kcl.ac.uk, https://github.com/kenhanscombe/ukbtools

epidemiology↗

bioRxiv2017

Despite egg-adaptive mutations, the 2012-13 H3N2 influenza vaccine induced comparable antibody titers to the intended strain

BackgroundInfluenza vaccination aims to prevent infection by influenza virus and reduce associated morbidity and mortality; however, vaccine effectiveness (VE) can be modest, especially for subtype A/H3N2. Failure to achieve consistently high VE has been attributed both to mismatches between the vaccine and circulating influenza strains and to the vaccine's elicitation of protective immunity in only a subset of the population. The low H3N2 VE in 2012-13 was attributed to egg-adaptive mutations that created antigenic mismatch between the intended (A/Victoria/361/2011) and actual vaccine strain (IVR-165).\n\nMethodsWe investigate the basis of the low VE in 2012-2013 by evaluating whether vaccinated and unvaccinated individuals were infected by different viral strains and assessing the serologic responses to A/Victoria/361/2011 and the IVR-165 vaccine strain in an adult cohort before and after vaccination.\n\nResultsWe found no significant genetic differences between the strains that infected vaccinated and unvaccinated individuals. Vaccination increased titers to A/Victoria/361/2011 as much as to IVR-165. These results are consistent with the hypothesis that vaccination served merely to boost preexisting cross-reactive immune responses, which provided limited protection against infection with the circulating influenza strains.\n\nConclusionsIn contrast to suggestive analyses based on ferret antisera, low H3N2 VE in 2012-13 does not appear to be due to the failure of the egg-adapted strain to induce a response to the intended vaccine strain. Instead, low VE might have been caused by the emergence of anti-genically novel influenza strains and low vaccine immunogenicity in a subset of the population.

epidemiology↗

bioRxiv2017

Phenology supports the eco-environmental hypothesis for Ebola spillover events

Ebola virus disease outbreaks in animals (including humans and great apes) start with sporadic host switches from unknown reservoir species. The factors leading to such spillover events are little explored. Filoviridae viruses have a wide range of natural hosts and are unstable once outside hosts. Spillover events, which involve the physical transfer of viral particles across species, could therefore be directly promoted by conditions of host ecology and environment. In this report we outline a proof of concept that temporal fluctuations of a set of ecological and environmental variables describing the dynamics of the host ecosystem are able to predict such events of Ebola virus spillover to humans and animals. We compiled a dataset of climate and plant phenology variables and Ebola virus disease spillovers in humans and animals. We identified critical biotic and abiotic conditions for spillovers via multiple regression and neural networks based time series regression. Phenology variables proved to be overall better predictors than climate variables. African phenology variables are not yet available as a comprehensive online resource. Given the likely importance of phenology for forecasting the likelihood of future Ebola spillover events, our results highlight the need for cost-effective transect surveys to supply phenology data for predictive modelling efforts.

epidemiology↗

bioRxiv2017

Increased risk of many early-life diseases after surgical removal of adenoids and tonsils in childhood

BACKGROUNDSurgical removal of the adenoids and tonsils are common pediatric procedures, with conventional wisdom suggesting their absence has little impact on health or disease. However, little is known about long-term health consequences beyond the perioperative risks. Such ignorance is significant, for these lymphatic organs play important roles in both the development and the function of the immune system.\n\nMETHODSWe tested the long-term consequences of surgery in the population of Denmark by examining risk for 28 diseases with 1 million individuals followed from birth up to 30 years of age depending on whether any of three common surgeries (adenoidectomy, tonsillectomy, adenotonsillectomy) occurred in the first 9 years of life. To weigh costs and benefits, we also compared the absolute risks for these diseases to the risks for the conditions that these surgeries aimed to treat. We obtained robust results by using stratified Cox regressions with statistically well-powered samples of cases (with surgery) and controls (without surgery) whose general health was no different prior to surgery. We adjusted our estimates of risk for diseases occurring before surgery, stratified for sex (and other effects) and for 18 covariates, including parental disease history and birth metrics.\n\nRESULTSWe found significantly elevated relative risks for many diseases, with effects on respiratory, allergic and infectious disorders after removal of adenoids and tonsils being most pronounced. For some of these diseases, absolute risk increases were considerable. In comparison, many risks for conditions that surgeries aimed to treat were either not significantly different or significantly higher following surgery up to 30 years of age. This suggests that any immediate benefits of these surgeries may not continue longer-term, while resulting in slightly compromised early adult health due to significantly increased risk of many non-target diseases.\n\nCONCLUSIONSOur results indicate that surgical removal of tonsils and adenoids early in life are associated with longer-term health risks. They underline the importance of these organs and tissues for normal immune functioning and early immune development, and suggest that these longer-term disease risks may outweigh the short-term benefits of these surgeries.

epidemiology↗

bioRxiv2017

Dissecting causal pathways using Mendelian randomization with summarized genetic data: application to age at menarche and risk of breast cancer

Mendelian randomization is the use of genetic variants as instrumental variables to estimate causal effects of risk factors on outcomes. The total causal effect of a risk factor is the change in the outcome resulting from intervening on the risk factor. This total causal effect may potentially encompass multiple mediating mechanisms. For a proposed mediator, the direct effect of the risk factor is the change in the outcome resulting from a change in the risk factor keeping the mediator constant. A difference between the total effect and the direct effect indicates that the causal pathway from the risk factor to the outcome acts at least in part via the mediator (an indirect effect). Here, we show that Mendelian randomization estimates of total and direct effects can be obtained using summarized data on genetic associations with the risk factor, mediator, and outcome, potentially from different data sources. We perform simulations to test the validity of this approach when there is unmeasured confounding and/or bidirectional effects between the risk factor and mediator. We illustrate this method using the relationship between age at menarche and risk of breast cancer, with body mass index (BMI) as a potential mediator. We show an inverse direct causal effect of age at menarche on risk of breast cancer (independent of BMI) and a positive indirect effect via BMI. In conclusion, multivariable Mendelian randomization using summarized genetic data provides a rapid and accessible analytic strategy that can be undertaken using publicly-available data to better understand causal mechanisms.

epidemiology↗

bioRxiv2017

The causal direction in the association between Parkinson’s disease and cigarette or nicotine use

The association between cigarette use and Parkinsons disease (PD) has been well known in the literature since more than 50 years ago. Large population studies showed that smokers developed PD less often than non-smokers and that the duration of smoking was inversely proportional to PD risk. There are two primary hypotheses for this association in the literature. First, long-standing hypothesis, is that smoking cigarettes is neuroprotective. The second, recent hypothesis, is that there exists biological predisposition to PD, which also manifests in decreased stimulus seeking behavior, hence lesser likelihood to smoke or use nicotine (reverse causation). The objective of this article is to summarize the evidence available in the literature and evaluate the causality of the association between Parkinsons disease and smoking cigarettes or nicotine ingestion. It is found that the first, directly causal hypothesis is a stronger contributor to the effect, although the reversely causal mechanism could play a role. It is found that smokeless tobacco use decreases the risk of PD stronger than smoking cigarettes does, suggesting that nicotine is more important in neuroprotection than other cigarette smoke constituents.

epidemiology↗

bioRxiv2017

A model-based clustering method to detect infectious disease transmission outbreaks from sequence variation

Clustering infections by genetic similarity is a popular technique for identifying potential outbreaks of infectious disease, in part because sequences are now routinely collected for clinical management of many infections. A diverse number of nonparametric clustering methods have been developed for this purpose. These methods are generally intuitive, rapid to compute, and readily scale with large data sets. However, we have found that nonparametric clustering methods can be biased towards identifying clusters of diagnosis -- where individuals are sampled sooner post-infection -- rather than the clusters of rapid transmission that are meant to be potential foci for public health efforts. We develop a fundamentally new approach to genetic clustering based on fitting a Markov-modulated Poisson process (MMPP), which represents the evolution of transmission rates along the tree relating different infections. We evaluated this model-based method alongside five nonparametric clustering methods using both simulated and actual HIV sequence data sets. For simulated clusters of rapid transmission, the MMPP clustering method obtained higher mean sensitivity (85%) and specificity (91%) than the nonparametric methods. When we applied these clustering methods to published HIV-1 sequences from a study cohort of men who have sex with men in Seattle, USA, we found that the MMPP method categorized about half (46%) as many individuals to clusters compared to the other methods, and that the MMPP clusters were more consistent with transmission outbreaks. This new approach to genetic clustering has significant implications for the application of pathogen sequence analysis to public health, where it is critical to robustly and accurately identify clusters for the most cost-effective deployment of resources.

epidemiology↗

bioRxiv2017

Autistic traits and suicidal thoughts, plans and self-harm in late adolescence: population based cohort study

ImportanceThere have been recent concerns about a higher incidence of mortality by suicide in people with autism spectrum disorder (ASD). To our knowledge, no large cohort studies have examined which features of autism may lead to suicidal ideation and behaviour, and whether there are any potential modifiable mechanisms.\n\nObjectiveTo examine the hypothesis that ASD diagnosis and traits in childhood are associated with suicidal thoughts, plans and self-harm at 16 years, and that any of the observed associations are explained by depression in adolescence at 12 years.\n\nDesign, setting and participantsProspective investigation of associations between ASD diagnosis and autistic traits with suicidal ideation and behaviour and a potential risk pathway via depression in early adolescence in 5,031 members of the Avon Longitudinal Study of Parents and Children.\n\nMain outcomes and measuresHistory of self-harm with and without suicidal intent, suicidal thoughts and plans at 16 years assessed using a detailed self-report questionnaire. Exposures were ASD diagnosis and four measures (the coherence subscale of the Childrens Communication Checklist, the Social and Communication Disorders Checklist, a repetitive behaviour measure, and the sociability temperament subscale of the Emotionality, Activity and Sociability scale) dichotomised to represent the autism trait groups. Depressive symptoms in early adolescence were measured by the Short Moods and Feelings Questionnaire at 12 years.\n\nResultsChildren with impaired social communication had a higher risk of self-harm with suicidal intent (RR 2.10, 95% CI 1.28, 3.34), suicidal thoughts (1.42 times (95% CI 1.06, 1.91) and suicidal plans (RR 1.95, 95% CI 1.09, 3.47) by the age of 16 years as compared to those without. There was no evidence for an association between ASD diagnosis and the outcomes although these analyses were imprecise due to small numbers. There was also no evidence of an association between other autism trait measures and the outcomes. Approximately 32% of the total estimated association between social communication impairment and self-harm was explained by depressive symptoms at age 12 years.\n\nConclusionsImpairments in social communication are important in relation to suicidality. Early identification and management of depression may be a preventative mechanism and future research identifying other modifiable mechanisms may lead to preventative action or interventions against suicidal behaviour in this high-risk group.

epidemiology↗

bioRxiv2017

Maternal alcohol consumption during pregnancy and offspring epigenome-wide DNA methylation: findings from six general population-based birth cohorts

Some evidence suggests that light-to-moderate alcohol consumption during pregnancy is associated with adverse outcomes in the offspring, but the precise biological mechanisms underlying such associations are currently unknown. Epigenetic modifications have been suggested as one potential explanation.\n\nWithin the Pregnancy and Childhood Epigenetics (PACE) consortium, we performed meta-analysis to combine information from six population-based birth cohort studies to investigate DNA methylation at over 450,000 sites in the cord blood of newborns differentially exposed to alcohol in utero. We were primarily interested in the effects of sustained consumption throughout pregnancy (data available for five cohorts, 3,075 mother-child pairs), which represents a prolonged prenatal exposure to alcohol, but we also explored binge-drinking and timing-specific exposures. In addition to looking for differential methylation at individual CpG sites, we also used two different methods, Comb-P and DMRcate, to identify differentially methylated regions (DMRs).\n\nWe found no strong evidence of association between any of our alcohol exposure measures and DNA methylation at any individual CpG site. Using Comb-P, we identified 19 DMRs in the offspring of mothers who drank throughout pregnancy compared to the offspring of mothers who gave up drinking at the start of pregnancy, but these were not validated using DMRcate.\n\nIn this multi-cohort study of the general population we found no evidence that maternal alcohol consumption during pregnancy is associated with offspring cord blood DNA methylation, which is in stark contrast to the multiple, strong associations that previous studies have found for maternal smoking. However, it is possible that a combination of a larger sample size, higher doses, different timings of exposure and a more global assessment of genomic DNA methylation might show evidence of association.

epidemiology↗