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  • 1.
    Bornehag, Carl-Gustaf
    et al.
    Department of Health, Karlstad University, Karlstad, Sweden; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
    Lindh, Christian
    Laboratory Medicine, Lund University, Lund, Sweden.
    Reichenberg, Abraham
    Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA.
    Wikström, Sverre
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Unenge Hallerback, Maria
    Department of Health, Karlstad University, Karlstad, Sweden.
    Evans, Sarah F.
    Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
    Sathyanarayana, Sheela
    Department of Pediatrics, University of Washington, Seattle, USA.
    Barrett, Emily S.
    Department of Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA.
    Nguyen, Ruby H. N.
    University of Minnesota, Minneapolis, Minnesota, USA.
    Bush, Nicole R.
    Department of Psychiatry and Pediatrics, Center for Health and Community, University of California, San Francisco, California, USA.
    Swan, Shanna H.
    Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
    Association of Prenatal Phthalate Exposure With Language Development in Early Childhood2018Inngår i: JAMA pediatrics, ISSN 2168-6203, E-ISSN 2168-6211Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Importance: Prenatal exposure to phthalates has been associated with neurodevelopmental outcomes, but little is known about the association with language development.

    Objective: To examine the association of prenatal phthalate exposure with language development in children in 2 population-based pregnancy cohort studies.

    Design, Setting, and Participants: Data for this study were obtained from the Swedish Environmental Longitudinal Mother and Child, Asthma and Allergy (SELMA) study conducted in prenatal clinics throughout Värmland county in Sweden and The Infant Development and the Environment Study (TIDES) conducted in 4 academic centers in the United States. Participants recruited into both studies were women in their first trimester of pregnancy who had literacy in Swedish (SELMA) or English or Spanish (TIDES). This study included mothers and their children from both the SELMA study (n = 963) and TIDES (n = 370) who had complete data on prenatal urinary phthalate metabolite levels, language delay, and modeled covariables. For SELMA, the data were collected from November 1, 2007, to June 30, 2013, and data analysis was conducted from November 1, 2016, to June 30, 2018. For TIDES, data collection began January 1, 2010, and ended March 29, 2016, and data analysis was performed from September 15, 2016, to June 30, 2018.

    Main Outcomes and Measures: Mothers completed a language development questionnaire that asked the number of words their children could understand or use at a median of 30 months of age (SELMA) and 37 months of age (TIDES). The responses were categorized as fewer than 25, 25 to 50, and more than 50 words, with 50 words or fewer classified as language delay.

    Results: In the SELMA study, 963 mothers, 455 (47.2%) girls, and 508 [52.8%] boys were included. In TIDES, 370 mothers, 185 (50.0%) girls, and 185 (50.0%) boys were included in this analysis. The prevalence of language delay was 10.0% in both SELMA (96 reported) and TIDES (37 reported), with higher rates of delay in boys than girls (SELMA: 69 [13.5%] vs 27 [6.0%]; TIDES: 12 [12.4%] vs 14 [7.6%]). In crude analyses, the metabolite levels of dibutyl phthalate and butyl benzyl phthalate were statistically significantly associated with language delay in both cohorts. In adjusted analyses, a doubling of prenatal exposure of dibutyl phthalate and butyl benzyl phthalate metabolites increased the odds ratio (OR) for language delay by approximately 25% to 40%, with statistically significant results in the SELMA study (dibutyl phthalate OR, 1.29 [95% CI, 1.03-1.63; P = .03]; butyl benzyl phthalate OR, 1.26 [95% CI, 1.07-1.49; P = .003]). A doubling of prenatal monoethyl phthalate exposure was associated with an approximately 15% increase in the OR for language delay in the SELMA study (OR, 1.14; 95% CI, 1.00-1.31; P = .05), but no such association was found in TIDES (OR, 0.98; 95% CI, 0.79-1.23).

    Conclusions and Relevance: In findings from this study, prenatal exposure to dibutyl phthalate and butyl benzyl phthalate was statistically significantly associated with language delay in children in both the SELMA study and TIDES. These findings, along with the prevalence of prenatal exposure to phthalates, the importance of language development, and the inconsistent results from a 2017 Danish study, suggest that the association of phthalates with language delay may warrant further examination.

  • 2.
    Bornehag, C.-G.
    et al.
    Karlstad University, Karlstad, Sweden.
    Reichenberg, A.
    Icahn School of Medicine at Mount Sinai, NY, USA.
    Unenge Hallerback, M.
    Karlstad University, Karlstad, Sweden.
    Wikström, Sverre
    Karlstad University, Karlstad, Sweden.
    Koch, H. M.
    Institute of the Ruhr-University, Bochum, Germany.
    Jonsson, B. A.
    Lund University, Lund, Sweden.
    Swan, S. H.
    Icahn School of Medicine at Mount Sinai, NY, USA.
    Prenatal exposure to acetaminophen and children's language development at 30 months2018Inngår i: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 51, s. 98-103Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To examine prenatal APAP exposure in relation to language development in offspring at 30 months of age.

    METHOD: A population-based pregnancy cohort study including 754 women who enrolled in the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy (SELMA) study in pregnancy week 8-13. Two exposure measures were used: (1) maternally reported number of APAP tablets taken between conception and enrollment; (2) APAP urinary concentration at enrollment. Language development at 30 months was assessed by nurse's evaluation and parental questionnaire, including the number of words the child used (<25, 25-50 and >50). Main study outcome; parental report of use of fewer than 50 words, termed language delay (LD).

    RESULTS: 59.2% of women enrolled in weeks 8-13 reported taking APAP between conception and enrollment. APAP was measurable in all urine samples and urinary APAP was correlated with the number of APAP taken during pregnancy (P<0.01). Language delay was more prevalent in boys (12.6%) than girls (4.1%) (8.5% in total). Both the number of APAP tablets and urinary APAP concentration were associated with greater LD in girls but not in boys. The adjusted odds ratio (OR) for LD among girls whose mothers reported >6 vs. 0 APAP tablets was 5.92 (95% confidence interval (CI) 1.10-31.94). The OR for LD in girls whose mothers' urinary APAP was in the highest compared to the lowest quartile was 10.34 (95% CI 1.37-77.86). While it cannot be ruled out, our available data do not support confounding by indication.

    CONCLUSIONS: Given the prevalence of prenatal APAP use and the importance of language development, these findings, if replicated, would suggest that pregnant women should limit their use of this analgesic during pregnancy.

  • 3.
    Derakhshan, Arash
    et al.
    Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands; Department of internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
    Shu, Huan
    Department of Environmental Science and Analytical Chemistry, Stockholm University, Stockholm, Sweden.
    Broeren, Maarten A. C.
    Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, De Run, The Netherlands.
    de Poortere, Ralph A.
    Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, De Run, The Netherlands.
    Wikström, Sverre
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Peeters, Robin P.
    Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands; Department of internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
    Demeneix, Barbara
    Laboratoire d'Evolution des Régulations Endocriniennes, Muséum National d'Histoire Naturelle, Paris, France.
    Bornehag, Carl-Gustaf
    Division of Public Health Sciences, Karlstad University, Karlstad, Sweden; Icahn School of Medicine at Mount Sinai, New York City NY, USA.
    Korevaar, Tim I. M.
    Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands; Department of internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
    Reference ranges and determinants of thyroid function during early pregnancy: the SELMA study2018Inngår i: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 103, nr 9, s. 3548-3556Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Context: Establishing reference ranges as well as identifying and quantifying the determinants of thyroid function during pregnancy is important for proper clinical interpretation and optimizing research efforts. However, such data are sparse, specifically for (F)T3 measurements and most studies do not take into account thyroid antibodies or hCG.

    Objective: To determine reference ranges and to identify/quantify determinants of TSH, FT4, FT3, TT4 and TT3.

    Design, Setting and Participants: This study included 2,314 participants of the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy study, a population-based prospective pregnancy cohort of mother-child pairs. Reference ranges were calculated by 2.5-97.5th percentiles after excluding TPOAb and/or TgAb positive women.

    Intervention: None.

    Main Outcome Measures: TSH, FT4, FT3, TT4 and TT3 in prenatal serum.

    Results: After exclusion of TPOAb positive women, reference range were: TSH: 0.11-3.48 mU/L, FT4: 11.6-19.4 pmol/L, FT3: 3.72-5.92 pg/mL, TT4: 82.4-166.2 pmol/L and TT3: 1.28-2.92 nmol/L. Additional exclusion of TgAb positive women did not change the reference ranges substantially. Exposure to tobacco smoke, as assessed by questionnaires and serum cotinine, was associated with lower TSH and higher FT3 and TT3. BMI and gestational age were the main determinants of TSH (only for BMI), FT4, FT3, TT4 and TT3.

    Conclusions: We show that the exclusion of TgAb positive women on top of excluding TPOAb positive women hardly affects clinical reference ranges. We identified various relevant clinical determinants of TSH, FT4, FT3, TT4 and TT3 which could reflect endocrine disrupting effects and/or effects on thyroid hormone transport or deiodination.

  • 4.
    Mellström, Elisabeth
    et al.
    Karlstad Central Hospital, Karlstad, Sweden; Queen Silvia Children’s Hospital, Gothenburg, Sweden.
    Forsman, Cecilia
    Örebro University, Örebro, Sweden.
    Engh, Lisbet
    Karlstad University, Karlstad, Sweden.
    Hallerbäck, Maria Unenge
    Karlstad University, Karlstad, Sweden; University of Gothenburg, Gothenburg, Sweden.
    Wikström, Sverre
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Methylphenidate and Reduced Overweight in Children With ADHD2020Inngår i: Journal of Attention Disorders, ISSN 1087-0547, E-ISSN 1557-1246, Vol. 24, nr 2, s. 246-254Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: The objective of this study was to investigate odds ratios of overweight/obesity in children with ADHD and to compare the change in body mass index (BMI) after initiation of methylphenidate treatment in normal versus overweight/obese children.

    METHOD: This population-based study included 724 children (<18 years), of whom 197 were girls. Odds ratios for overweight and obesity were calculated, comparing the study group with a reference group from the same area. After initiation of methylphenidate treatment, changes in BMI were assessed for up to 3 years.

    RESULTS: Children with ADHD had an odds ratio of 1.87 (95% confidence interval [CI]: [1.60, 2.19]) for overweight/obesity. A decrease in BMI standard deviation score was identified 1 to 3 years into treatment. The decrease was beneficially greater in overweight/obese as compared with normal weight children-mean ( SD) -0.64 (0.80) versus -0.39 (0.68); p = .001-and greater in girls.

    CONCLUSION: Medication with methylphenidate may facilitate favorable weight development in children with ADHD and overweight/obesity.

  • 5.
    Shu, Huan
    et al.
    Department of Environmental Science and Analytical Chemistry, Stockholm University, Stockholm, Sweden; Dept. of Health Sciences, Karlstad University, Karlstad, Sweden.
    Lindh, Christian H.
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Wikström, Sverre
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Bornehag, Carl-Gustaf
    Dept. of Health Sciences, Karlstad University, Karlstad, Sweden; Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America.
    Temporal trends and predictors of perfluoroalkyl substances serum levels in Swedish pregnant women in the SELMA study2018Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, nr 12, artikkel-id e0209255Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Perfluoroalkyl substances (PFAS) are used in numerous consumer products. They are persistent, bioaccumulating, and suspected to be endocrine disrupting chemicals (EDCs). A growing body of research has reported the association between PFAS exposure and adverse health effects. Concerns have been raised with special focus in childhood development.

    METHODS: Perfluoroheptanoic acid (PFHpA), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), perfluoroundecanoic acid (PFUnDA), perfluorododecanoic acid (PFDoDA), perfluorohexane sulfonate (PFHxS) and perfluorooctane sulfonate (PFOS) were analyzed by LC/MS/MS in serum from 1,616 pregnant women in the Swedish SELMA study. The serum samples were collected in the first trimester (median week 10). Least square geometric means (LSGM) of PFAS were estimated for each year period for, adjusted for potential determinants including parity, fish intake in the family, and mother's age.

    RESULTS: Six PFAS (PFNA, PFDA, PFUnDA, PFHxS, PFOA, and PFOS) were detected above levels of detection (LOD) in more than 99% of the SELMA women, while PFHpA, and PFDoDA were detected above LOD in 73.4% and 46.7% respectively. Parity, maternal age, maternal smoking, and fish intake during pregnancy were found to be significantly associated (p<0.05) with serum PFAS levels in the pregnant women. Finally, serum concentration of six PFAS (PFNA, PFDA, PFHxS, PFHpA, PFOA and PFOS) were significantly decreasing (range 14-31%) during the period of 30 months from 2007-2010.

    CONCLUSIONS: Our analysis shows that six out of eight PFAS could be identified in serum of more than 99% of SELMA subjects with a significant slightly decreasing trend for five of these compounds. Furthermore, parity, higher fish intake and mothers age are determinants for serum levels of PFAS in pregnant women.

  • 6.
    Shu, Huan
    et al.
    Dept. of Health Sciences, Karlstad University, Karlstad, Sweden.
    Wikström, Sverre
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Jönsson, Bo A. G.
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Lindh, Christian H.
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Svensson, Åke
    Department of Dermatology, Lund University, Lund, Sweden.
    Nånberg, Eewa
    Dept. of Health Sciences, Karlstad University, Karlstad, Sweden.
    Bornehag, Carl-Gustaf
    Dept. of Health Sciences, Karlstad University, Karlstad, Sweden; Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.
    Prenatal phthalate exposure was associated with croup in Swedish infants2018Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, nr 6, s. 1011-1019Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: This study examined whether prenatal phthalate exposure was associated with lower or upper airway inflammation in infants.

    METHODS: From 2007-2010 we used liquid chromatography tandem mass spectrometry, adjusted for creatinine, to analyse 14 phthalate metabolites and one phthalate replacement in the urine of 1,062 Swedish mothers at a median of 10 weeks of pregnancy. This was used to determine any associations between prenatal phthalate exposure and croup, wheezing or otitis in their offspring until 12 months of age, using logistic regression, adjusted for potential confounders.

    RESULTS: There were significant associations between phthalate metabolites of butyl-benzyl phthalate (BBzP) and di-ethyl-hexyl phthalate (DEHP) concentrations in maternal prenatal urine and croup in 1,062 infants during the first year of life, when adjusted for potential confounders. A dose response relationship was found between prenatal phthalates exposure and maternal reported croup in the children, with a significant association in boys. There was no clear indication with regard to associations between prenatal phthalate exposure and wheezing or otitis media in the children during the first year of life.

    CONCLUSION: Our analysis suggests that exposure to BBzP and DEHP phthalates was associated with maternal reports of croup in infants up to 12 months of age.

  • 7.
    Tanner, Eva M.
    et al.
    Icahn School of Medicine at Mount Sinai, New York NY, United States.
    Hallerbäck, Maria Unenge
    Karlstad University, Karlstad, Sweden.
    Wikström, Sverre
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Karlstad University, Karlstad, Sweden.
    Lindh, Christian
    Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Kiviranta, Hannu
    National Institute for Health and Welfare, Helsinki, Finland.
    Gennings, Chris
    Icahn School of Medicine at Mount Sinai, New York NY, United States.
    Bornehag, Carl-Gustaf
    Icahn School of Medicine at Mount Sinai, New York NY, United States; Karlstad University, Karlstad, Sweden.
    Early prenatal exposure to suspected endocrine disruptor mixtures is associated with lower IQ at age seven2020Inngår i: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 134, artikkel-id 105185Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Endocrine disrupting chemicals (EDCs) are xenobiotics with the ability to interfere with hormone action, even at low levels. Prior environmental epidemiology studies link numerous suspected EDCs, including phthalates and bisphenol A (BPA), to adverse neurodevelopmental outcomes. However, results for some chemicals were inconsistent and most assessed one chemical at a time.

    OBJECTIVES: To evaluate the overall impact of prenatal exposure to an EDC mixture on neurodevelopment in school-aged children, and identify chemicals of concern while accounting for co-exposures.

    METHODS: Among 718 mother-child pairs from the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy study (SELMA) study, we used Weighted Quantile Sum (WQS) regression to assess the association between 26 EDCs measured in 1st trimester urine or blood, with Wechsler Intelligence Scale for Children (IV) Intelligence Quotient (IQ) scores at age 7 years. Models were adjusted for child sex, gestational age, mother's education, mother's IQ (RAVEN), weight, and smoking status. To evaluate generalizability, we conducted repeated holdout validation, a machine learning technique.

    RESULTS: Using repeated holdout validation, IQ scores were 1.9-points (CI = -3.6, -0.2) lower among boys for an inter-quartile-range (IQR) change in the WQS index. BPF made the largest contribution to the index with a weight of 14%. Other chemicals of concern and their weights included PBA (9%), TCP (9%), MEP (6%), MBzP (4%), PFOA (6%), PFOS (5%), PFHxS (4%), Triclosan (5%), and BPA (4%). While we did observe an inverse association between EDCs and IQ among all children when training and testing the WQS index estimate on the full dataset, these results were not robust to repeated holdout validation.

    CONCLUSION: Among boys, early prenatal exposure to EDCs was associated with lower intellectual functioning at age 7. We identified bisphenol F as the primary chemical of concern, suggesting that the BPA replacement compound may not be any safer for children. Future studies are needed to confirm the potential neurotoxicity of replacement analogues.

  • 8.
    Wikholm, Emma
    et al.
    Karlstad Central Hospital, Karlstad, Sweden.
    Malmborg, Petter
    Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Forssberg, Maria
    Karlstad Central Hospital, Karlstad, Sweden.
    Hederos, Carl-Axel
    Karlstad Central Hospital, Karlstad, Sweden.
    Wikström, Sverre
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Iron Deficiency Is Common During Remission in Children With Inflammatory Bowel Disease2016Inngår i: Global pediatric health, ISSN 2333-794X, Vol. 3Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim was to study prevalence of iron deficiency in children with inflammatory bowel disease (IBD) during remission. In addition, there was an observational evaluation of hematological response to oral iron. A population-based retrospective study including 90 Swedish children (median 13 years) with IBD was performed. Patient records covered in median 25 months. Iron deficiency was present in 70/77 children (91%) in which iron status could be assessed. In clinical and biochemical remission, iron deficiency was found in 57/67 (85%) of children, and 23 (34%) of them had iron deficiency anemia. Thirty-six iron-deficient children were prescribed oral iron supplementation and 32 (89%) improved hemoglobin levels over 6 months. In conclusion, iron deficiency is common during clinical remission in children with IBD, even in cohorts with low prevalence of anemia. Therefore, regular biochemical screening for iron deficiency is warranted during all stages of disease, irrespective of symptoms and inflammatory blood markers.

  • 9.
    Wikström, Sverre
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Holst, Elisabet
    Laboratoriemedicin - Medicinsk mikrobiologi, Lunds universitet, Lund, Sweden..
    Spädbarnsbotulism: skäl att inte ge honung till barn under ett år2017Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, artikkel-id ELMFArtikkel i tidsskrift (Fagfellevurdert)
    Abstract [sv]

    Infant botulism - why honey should be avoided for children up to one year Infant botulism means that Clostridium botulinum colonize and produce toxin in the infant gut, usually during the first year of life. Illness severity varies widely and the incidence may be under-estimated. Infant botulism should be considered in cases of acute muscle weakness or floppiness in infants, especially when accompanied by constipation or feeding difficulties. Respiratory failure and need for mechanical ventilation is common, but full recovery is gradually obtained. Diagnosis is based on stool culture and toxin detection in stool. Botulinum spores are frequently present in honey, which should consequently be avoided for infants.

  • 10.
    Wikström, Sverre
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Hövel, Holger
    Department of Pediatrics and Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden.
    Hansen Pupp, Ingrid
    Department of Pediatrics and Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden.
    Fellman, Vineta
    Department of Pediatrics and Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden.
    Hüppi, Petra S.
    Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland.
    Ley, David
    Department of Pediatrics and Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden.
    Hellström-Westas, Lena
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Early Electroencephalography Suppression and Postnatal Morbidities Correlate with Cerebral Volume at Term-Equivalent Age in Very Preterm Infants2018Inngår i: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 113, nr 1, s. 15-20Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Early brain activity is associated with long-term outcome. Establishing a relation also with postnatal brain growth may increase our understanding of early life influences on preterm brain development.

    OBJECTIVES: The aim of this study was to investigate whether early electroencephalography (EEG) activity in infants born very preterm is associated with brain volumes at term, and whether postnatal morbidity affects this association.

    METHODS: Very preterm infants (n = 38) with a median gestational age (GA) of 25.6 weeks had early recordings of single-channel EEG. The percentage of suppressed EEG, i.e., interburst intervals (IBI%) between 24 and 72 h of age, was analyzed in relation to brain volumes on magnetic resonance imaging performed at term-equivalent age, taking into account neonatal morbidities.

    RESULTS: Early electrocortical depression and a higher IBI% were associated with increased cerebrospinal fluid volume (CSFV) and lower total brain volume relative to intracranial volume, also after adjustment for GA, postnatal morbidities, morphine administration, and postnatal head growth. Overall, an increase in IBI% to 1 SD from the mean corresponded with an increase in CSFV to +0.7 SD and a decrease in brain volume to -0.7 SD. The presence of 2 or more postnatal morbidities were associated with around 10% lower brain volumes.

    CONCLUSIONS: More suppressed early EEG activity of very preterm infants is associated with lower brain volume and increased CSFV at term age, also when adjusting for postnatal morbidities. The findings indicate the importance of pre- and early postpartal determinants of postnatal brain growth, possibly also including activity-dependent mechanisms for brain growth.

  • 11.
    Wikström, Sverre
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Health Sciences, Karlstad University, Karlstad, Sweden.
    Lin, Ping-I
    Department of Health Sciences, Karlstad University, Karlstad, Sweden.
    Lindh, Christian H.
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Shu, Huan
    Department of Health Sciences, Karlstad University, Karlstad, Sweden; Department of Environmental Science and Analytical Chemistry, Stockholm University, Stockholm, Sweden.
    Bornehag, Carl-Gustaf
    Department of Health Sciences, Karlstad University, Karlstad, Sweden; Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
    Maternal serum levels of perfluoroalkyl substances in early pregnancy and offspring birth weight2019Inngår i: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Perfluoroalkyl substances (PFASs) are widespread, bioaccumulating, and persistent and show placental transfer. Emerging research indicates associations between prenatal exposure and low birth weight. The aim of this study was to assess the associations between first trimester exposure to PFASs and birth weight (BW) in the Swedish Environmental, Longitudinal, Mother and child, Asthma and allergy (SELMA) study and examine whether associations differ between girls and boys.

    METHODS: Eight PFASs were analyzed in maternal serum (median: 10 weeks of pregnancy). Associations between prenatal PFAS exposure and birth outcomes with BW, BW for gestational age, and birth small for gestational age (SGA) were assessed in 1533 infants, adjusted for potential confounders and stratified by sex.

    RESULTS: Increased maternal perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnDA) were associated with lower BW, lower BW for gestational age, and SGA birth. Associations were significant only in girls, where prenatal exposure in the upper quartile was associated with a 93-42-g lower BW when compared with that of the lowest quartile exposure. The associations were not mediated by effects on gestational age.

    CONCLUSIONS: We found associations between prenatal exposure for five different PFASs and birth weight, with more pronounced associations in girls than in boys.

  • 12.
    Wikström, Sverre
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Health Sciences, Karlstad University, Karlstad, Sweden.
    Lindh, Christian H.
    Division of Occupational and environmental Medicine, Lund University, Lund, Sweden.
    Shu, Huan
    Department of Health Sciences, Karlstad University, Karlstad, Sweden; Department of environmental Science and Analytical chemistry, Stockholm University, Stockholm, Sweden .
    Bornehag, Carl-Gustaf
    Department of Health Sciences, Karlstad University, Karlstad, Sweden; Department of Preventive Medicine, icahn School of Medicine at Mount Sinai, New York, USA.
    Early pregnancy serum levels of perfluoroalkyl substances and risk of preeclampsia in Swedish women2019Inngår i: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, artikkel-id 9179Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Preeclampsia is a major cause of maternal and fetal morbidity. Emerging research shows an association with environmental exposures. The present aim was to investigate associations between early pregnancy serum levels of perfluoroalkyl substances (PFAS) and preeclampsia. Within the Swedish SELMA study, eight PFAS were measured at median 10 gestational weeks and cases of preeclampsia were postnatally identified from registers. Associations between individual PFAS and preeclampsia were assessed, adjusting for parity, age, weight and smoking. Out of 1,773 women in the study group, 64 ( 3.6%), developed preeclampsia. A doubling of PFOS and PFNA exposure, corresponding to an inter-quartile increase, was associated with an increased risk for preeclampsia of about 38-53% respectively. Serum PFOS within the highest quartile was associated with an odds ratio of 2.68 ( CI 95%: 1.17-6.12), equal to the increased risk associated with nulliparity, when compared to exposure in the first quartile. The same associations were identified, although with higher risk estimates, in analyses restricted to nulliparous women. For other PFAS, there were no associations. In conclusion and consistent with limited previous research only on PFOS, increasing serum levels of PFOS and PFNA during early pregnancy were associated with a clinically relevant risk of preeclampsia, adjusting for established confounders.

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