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Reproductive health across the lifespan

Reproductive health across the lifespan. Scott Nelson Muirhead Chair in Obstetrics & Gynaecology. Reproduction in 10 seconds. Pregnancy and short term outcomes. Gestational weight gain in ALSPAC. Fraser et al Circulation 2010. Is this weight gain genetic?. FTO MC4R TMEM18 GNPDA2.

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Reproductive health across the lifespan

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  1. Reproductive health across the lifespan Scott Nelson Muirhead Chair in Obstetrics & Gynaecology

  2. Reproduction in 10 seconds

  3. Pregnancy and short term outcomes

  4. Gestational weight gain in ALSPAC Fraser et al Circulation 2010

  5. Is this weight gain genetic? FTO MC4R TMEM18 GNPDA2 Allele score No Yes No You can’t blame GWG on genetics Lawlor et al Am J ClinNutr2011

  6. GWG related to maternal adiposity 16 years later Fraser et al AJCN 2011

  7. Excess GWG associated with adiposity and adverse CVD profile at age 9 Fraser et al Circulation 2010

  8. Excess GWG associated with adiposity and adverse CVD profile at age 9 Lower GWG lower adiposity but similar CVD profile Fraser et al Circulation 2010

  9. Maternal glycosuria also increases obesity risk Glycosuria n = 232, Control n = 6,556 Lawlor et al Diabetologia2010 Patel et al Diabetes Care 2012 Adiposity effect still seen at age 15 years

  10. Determinants of BP during pregnancy BMI Smoking Parity Age MacDonald-Wallis et al J Hyper 2011

  11. Determinants of proteinuria Low probability of proteinuria High probability of proteinuria Young maternal age Higher BMI Nulliparity Twins MacDonald-Wallis et al PLOS One 2011

  12. Early differences in leading causes of prematurity MacDonald-Wallis et al Hypertension 2012

  13. HDP and offspring BP – is it just adiposity? Birthweight and gestational age Offspring blood pressure Paternal BMI Maternal BMI Child adiposity Hypertensive disorders of pregnancy Geelhoed et al Circulation 2010

  14. HDP only associated with BP at age 9-12 • No impact on Flow mediated dilatation, pulse wave velocity, distensibility coefficient, brachial artery diameter • No impact on adiposity • No impact on HDL-C, Trigs, ApoA1, ApoB, CRP, Il-6 • Not explained by familial adiposity Geelhoed et al Circulation 2010 Lawlor et al EHJ 2011

  15. Using pregnancy to predict CVD Abnormal birthweight Preterm Hypertensivedisorders Diabetes Fraser et al Circulation 2012

  16. HDP and pregnancy diabetes independently associated with 10 year CVD risk • Association with the calculated 10 year CVD Framingham risk score Preeclampsia OR=1.31 (95%CI: 1.11, 1.53) GDM 1.26 (0.95, 1.68) Fraser et al Circulation 2012

  17. ALSPAC a window on long term health Sattar et al BMJ 2002

  18. ALSPAC a window on long term health Chronic disease biomarkers Pregnancy andcord bloods Ovarian reserve & sperm

  19. ALSPAC a unique life course perspective Nelson and Lawlor et alfor RCOG

  20. Improving reproductive health • Naveed Sattar • Robbie Lindsay • John Deanfield • Aroon Hingorani • Debbie Lawlor • Abi Fraser • Corrie Macdonald-Wallis • Kate Tilling • Sumaiya Patel • Miranda Geelhoed • Sue Ring • George Davey Smith

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