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High TSH levels and thyroid autoimmunity in early pregnancy may detrimentally affect pregnancy and birth outcomes.

These findings suggest that antenatal and postnatal maternal psychological well-being has important consequences on early child neurodevelopment.

OBJECTIVES To determine the association of multiple chronic conditions with risk of incident mild cognitive impairment (MCI)/dementia. DESIGN Prospective cohort study SETTING Olmsted County, Minnesota. PARTICIPANTS Cognitively normal individuals (N=2,176) enrolled in the Mayo Clinic Study of Aging (MCSA). MEASUREMENTS Participants were randomly selected from the community and evaluated by a study coordinator, a physician, and underwent neuropsychometric testing at baseline and at 15-month intervals to assess diagnoses of MCI and dementia. We electronically captured information on International Classification of Diseases, ninth revision (ICD-9) codes for chronic conditions in the five years prior to enrollment using the Rochester Epidemiology Project medical records linkage system. We defined multimorbidity as having two or more chronic conditions and examined the association of multimorbidity with MCI/dementia using Cox proportional hazards models. RESULTS Among 2,176 cognitively normal participants (mean [±SD] age 78.5 [±5.2] years; 50.6% men), 1,884 (86.6%) had multimorbidity. The risk of MCI/dementia was elevated in persons with multimorbidity (hazard ratio [HR]: 1.38; 95% confidence interval [CI], 1.05–1.82). The HR was stronger in persons with ≥4 conditions (HR: 1.61; 95%CI, 1.21–2.13) compared to persons with only 0 or 1 conditions, and for men (HR: 1.53, 95% CI, 1.01– 2.31) than for women (HR: 1.20, 95% CI, 0.83– 1.74). CONCLUSION In older adults, having multiple chronic conditions is associated with an increased risk of MCI/dementia. This is consistent with the hypothesis that multiple etiologies may contribute to MCI and late-life dementia. Preventing chronic diseases may be beneficial in delaying or preventing MCI or dementia.

Objectives To investigate the association of trimester-specific gestational weight gain with offspring fetal growth, obesity risk, and cardio-metabolic health outcomes from birth up to 4 years of age. Study design We conducted the present study in 977 mother-child pairs of the pregnancy cohort “Rhea” study in Crete, Greece. We measured birth weight, body mass index from 6 months to 4 years of age, waist circumference, skinfold thickness, blood pressure, and blood levels of lipids, C-reactive protein, and adipose tissue hormones at 4 years of age. We used multiple linear and log Poisson regression models to examine the association of exposure with continuous or binary outcomes respectively. Results Greater rate of gestational weight gain in the first trimester of pregnancy (per 200 g/week) was associated with increased risk of overweight/obesity from 2 years [RR: 1.25, (95% CI: 1.09, 1.42)] to 4 years of age [RR: 1.15, (95% CI: 1.05, 1.25)], but not with birth size. Each 200 gr/week of weight gain in the first trimester of pregnancy was also associated with greater risk of high waist circumference [RR: 1.13, (95% CI: 1.04, 1.23)], high sum of skinfold thickness [RR: 1.15 (95% CI: 1.02, 1.29)] and higher diastolic blood pressure at 4 years of age [β: 0.43 mmHg (95% CI: 0.00, 0.86)]. Greater rate of gestational weight gain during the second and third trimesters of pregnancy (per 200 gr/week) was associated with greater risk of large for gestational age neonates [RR: 1.22, (95% CI: 1.02, 1.45)] and higher levels of cord blood leptin [ratio of geometric means: 1.08 (95% CI: 1.00, 1.17)], but not with child anthropometry at later ages. Conclusion Timing of gestational weight gain may differentially influence childhood cardio-metabolic outcomes.

1Background Children born preterm or with a small-size-for-gestational-age are at increased 2

Background In adults, adherence to the Mediterranean diet has been inversely associated with cardiovascular risk, but the extent to which diet in pregnancy is associated with offspring adiposity is unclear. We aimed to investigate the association between adherence to Mediterranean diet in pregnancy and offspring cardiometabolic traits in two pregnancy cohorts. Methods We studied 997 mother-child pairs from Project Viva in Massachusetts, USA, and 569 pairs from the Rhea study in Crete, Greece. We estimated adherence to the Mediterranean diet with an a priori defined score (MDS) of 9 foods and nutrients (0 to 9). We measured child weight, height, waist circumference, skin fold thicknesses, blood pressure (BP), and blood levels of lipids, c-reactive protein, and adipokines in mid-childhood (median 7.7 years) in Viva, and in early childhood (median 4.2 years) in Rhea. We calculated cohort-specific effects, and pooled effects estimates with random-effects models for cohort and child age. Results In Project Viva the mean (SD) MDS was 2.7 (1.6); in Rhea it was 3.8 (1.7). In the pooled analysis, for each 3-point increment in the MDS, offspring BMI z score was lower by 0.14 units (95% CI, −0.15 to −0.13), waist circumference by 0.39cm (95% CI, −0.64 to −0.14), and the sum of skin fold thicknesses by 0.63mm (95% CI, −0.98 to −0.28). We also observed lower offspring systolic (−1.03 mmHg; 95% CI, −1.65 to −0.42) and diastolic BP (−0.57mmHg; 95% CI, −0.98 to −0.16). Conclusion Greater adherence to Mediterranean diet during pregnancy may protect against excess offspring cardiometabolic risk.

IMPORTANCE Brain amyloid deposition is a marker of Alzheimer disease (AD) pathology. The population-based prevalence and outcomes of amyloid positivity in a population without dementia are important for understanding the trajectory of amyloid positivity to clinically significant outcomes and for designing AD prevention trials. OBJECTIVE To determine prevalence and outcomes of amyloid positivity in a population without dementia. DESIGN, SETTING, AND PARTICIPANTS In the prospective, population-based Mayo Clinic Study of Aging in Olmsted County, Minnesota, participants without dementia were randomly selected from the county population and were clinically and cognitively evaluated at baseline and every 15 months from August 1, 2008, to September 18, 2018. They were also invited to undergo carbon 11-Pittburgh compound B positron emission tomography (PET) imaging. EXPOSURES Amyloid positivity (defined as a standardized uptake value ratio >1.42 on PET). MAIN OUTCOMES AND MEASURES Prevalence of amyloid positivity in the Olmsted County population without dementia and risk of progression from no cognitive impairment (ie, normal cognition for age) to incident amnestic MCI (aMCI) and from MCI or aMCI to incident AD dementia. RESULTS Of 3894 participants, 1671 underwent PET imaging and were included in the study; 2198 did not undergo imaging, and 25 were excluded for other reasons. The mean (SD) age of participants was 71.3 (9.8) years; 892 (53.4%) were men, and 179 (10.7%) had prevalent MCI. The prevalence of amyloid positivity without cognitive impairment in the population without dementia increased from 2.7% (95% CI, 0.5% to 4.9%) in persons aged 50 to 59 years to 41.3% (95% CI, 33.4% to 49.2%) in those aged 80 to 89 years at baseline. Prevalence of amyloid-positive MCI in the population without dementia increased from 0% in persons aged 50 to 59 years to 16.4% (95% CI, 10.3% to 22.5%) in those aged 80 to 89 years. The incident aMCI risk increased more than 2-fold in participants without cognitive impairment who were amyloid positive vs those who were amyloid negative (hazard ratio [HR], 2.26; 95% CI, 1.52 to 3.35; P < .001). The risk of AD dementia was 1.86 (95% CI, 0.89 to 3.88; P = .10) for amyloid-positive participants with MCI vs amyloid-negative participants with MCI, 1.63 (95% CI, 0.78 to 3.41; P = .20) for participants with aMCI who were amyloid positive vs amyloid negative, and 2.56 (95% CI, 1.35 to 4.88; P = .004) for amyloid-positive participants who were either without cognitive impairment or had aMCI vs those who were amyloid negative. Global cognitive and memory domain z scores declined significantly in amyloid-positive individuals during follow-up. The mean (SD) follow-up time from baseline was 3.7 (1.9) years to incident aMCI and 3.8 (2.0) years to incident AD dementia. CONCLUSIONS AND RELEVANCE Population-based prevalence of amyloid-positive status and progression rates of amyloid positivity provide valid information for designing AD prevention trials and assessing the public health outcomes of AD preventi...