Chained Risk Assessment for Life-Long Disease Burden of Early Exposures–Demonstration of Concept Using Prenatal Maternal Smoking
Abstract
:1. Introduction
2. Materials and Methods
2.1. Identification of Relevant Health Endpoints
- Meta-analysis with statistically significant pooled risk estimate;
- Background disease burden of reported endpoint is available;
- Free full text is available in English.
2.2. Nested Risk Model
3. Results
4. Discussion
4.1. Biological Plausibility
4.2. Uncertainties
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Population Attributable Fraction Input | Maternal Smoking | Preterm Birth (PTB) | Low Birth Weight (LBW) | Childhood Overweight and Obesity (12–18 Years) | |
---|---|---|---|---|---|
Overweight | Obesity | ||||
Definition | Tobacco smoking | Gestational age < 37 weeks | Birth weight < 2500 g | BMI ≥ 25 at | BMI ≥ 30 |
Exposure only during 1st trimester throughout pregnancy | 6.8 % a [16] 7.0 % b [16] | n/a [15] 4 %[16] | 3 % [16] 3 % [16] | n/a 14% [28] | n/a 3% [28] |
Risk estimate (RR) | 1.38 [15] | 1.11 a [15] 2.22 b [15] | 1.37 [29] | 1.55 [29] | |
Population attributable fraction only during 1st trimester throughout pregnancy | n/a 0.03 b | 0.01 a 0.08 b | n/a 0.03 b | n/a 0.04 b |
Endpoint | Age Group | Background Burden (in DALY) | Attributable Disease Burden (in DALY) | |||||
---|---|---|---|---|---|---|---|---|
Maternal Smoking | Preterm Birth | Low Birth Weight | Childhood Overweight & Obesity | Total | ||||
1 | Cancer | |||||||
1.1 | Acute leukemia | <20 years | 806 | 3.9 | 6.8 | n/a | 32 | 43 |
1.2 | Lymphoma | <20 years | 238 | 7 | n/a | n/a | n/a | 7 |
1.3 | Nervous system cancer | <20 years | 832 | 5.2 | n/a | n/a | n/a | 5.2 |
1.4 | Testicular cancer | <20 years | 11 | n/a | n/a | 0.22 | n/a | 0.22 |
1.5 | Wilms’ tumor | <20 years | 95 | n/a | 1.6 | n/a | n/a | 1.6 |
1.6 | Other cancer a | ≥20 years | 41,647 | n/a | n/a | n/a | 2570 | 2570 |
2 | Cardiovascular | |||||||
2.1 | Coronary heart disease | All ages | 157,588 | n/a | n/a | 2066 | 3184 | 5250 |
2.2 | Essential hypertension | All ages | 12,532 | n/a | 153 | n/a | 1323 | 1477 |
2.3 | Stroke | All ages | 71,952 | n/a | n/a | n/a | 5088 | 5088 |
3 | Mental & cognitive disorders | |||||||
3.1 | Depression | ≥20 years | 292 | n/a | n/a | 2.6 | 3.5 | 6.1 |
3.2 | Autism | All ages | 4528 | n/a | 55 | 167 | n/a | 223 |
3.3 | Attention Deficit/Hyperactivity Disorder | All ages | 703 | n/a | 43 | n/a | 4.2 | 47 |
3.4 | Intellectual disability | All ages | 1059 | n/a | 42 | n/a | n/a | 42 |
4 | Other groups | |||||||
4.1 | Diabetes | All ages | 55,898 | n/a | 1059 | 977 | 15,987 | 18,023 |
4.2 | Asthma | All ages | 13,809 | 39 | 14 | 189 | 47 | 290 |
4.3 | Congenital anomalies b | All ages | 8593 | 115 | n/a | n/a | n/a | 115 |
4.4 | Chronic kidney disease | All ages | 11,807 | n/a | n/a | 506 | n/a | 506 |
Sum | 382,388 | 170 | 1376 | 3909 | 28,241 | 33,696 | ||
Indirectly attributable to maternal smoking | 170 | 35 | 167 | 839 | 1211 | |||
Indirectly attributable to maternal smoking (%) | 3 % | 4 % | 3 % | 4 % |
Health Effect | Maternal Smoking | Risk Factor | ||
---|---|---|---|---|
Preterm Birth | Low Birth Weight | Childhood Overweight/Obesity | ||
Cardiovascular diseases | ||||
Atherosclerosis | [37] | |||
Cognitive and Mental | ||||
Pediatric Quality of Life Inventory Index | [38] | |||
Academic performance | [39] | |||
Higher education qualification | [40] | |||
Intelligence | [41] | |||
Criminal/Deviant behaviour | [42] | |||
Social benefits | [40] | |||
Respiratory | ||||
Wheezing | [43,44] | [45] | [45,46] | |
Decreased lung function (FEF75, FEV1, FVC) | [47] | [47,48] | ||
Metabolic | ||||
Cortisol secretion | [49] | [50] | ||
Metabolic syndrome | [32] | [51] | ||
Total cholesterol | [52] | [53] | ||
Other | ||||
Congenital anomalies | [54] | |||
Age at menarche | [55] | |||
Bone mineral density | [56] | |||
Periodontal disease | [57] |
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Rumrich, I.K.; Vähäkangas, K.; Viluksela, M.; Hänninen, O. Chained Risk Assessment for Life-Long Disease Burden of Early Exposures–Demonstration of Concept Using Prenatal Maternal Smoking. Int. J. Environ. Res. Public Health 2020, 17, 1472. https://doi.org/10.3390/ijerph17051472
Rumrich IK, Vähäkangas K, Viluksela M, Hänninen O. Chained Risk Assessment for Life-Long Disease Burden of Early Exposures–Demonstration of Concept Using Prenatal Maternal Smoking. International Journal of Environmental Research and Public Health. 2020; 17(5):1472. https://doi.org/10.3390/ijerph17051472
Chicago/Turabian StyleRumrich, Isabell K., Kirsi Vähäkangas, Matti Viluksela, and Otto Hänninen. 2020. "Chained Risk Assessment for Life-Long Disease Burden of Early Exposures–Demonstration of Concept Using Prenatal Maternal Smoking" International Journal of Environmental Research and Public Health 17, no. 5: 1472. https://doi.org/10.3390/ijerph17051472