133 results on '"Mahalingaiah, Shruthi"'
Search Results
102. Is there a common mechanism underlying air pollution exposures and reproductive outcomes noted in epidemiologic and in vitro fertilization lab-based studies?
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Mahalingaiah, Shruthi, primary
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- 2018
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103. Marijuana use and fecundability in a North American preconception cohort study
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Wise, Lauren A, primary, Wesselink, Amelia K, additional, Hatch, Elizabeth E, additional, Rothman, Kenneth J, additional, Mikkelsen, Ellen M, additional, Sørensen, Henrik Toft, additional, and Mahalingaiah, Shruthi, additional
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- 2017
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104. Editorial introductions.
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Mahalingaiah, Shruthi and Sagoe, Dominic
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- 2023
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105. Residential Proximity to Roadways and Ischemic Placental Disease in a Cape Cod Family Health Study
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Wesselink, Amelia, primary, Carwile, Jenny, additional, Fabian, María, additional, Winter, Michael, additional, Butler, Lindsey, additional, Mahalingaiah, Shruthi, additional, and Aschengrau, Ann, additional
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- 2017
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106. Cardiovascular risk factors among women with self-reported infertility
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Mahalingaiah, Shruthi, primary, Sun, Fangui, additional, Cheng, J. Jojo, additional, Chow, Erika T., additional, Lunetta, Kathryn L., additional, and Murabito, Joanne M., additional
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- 2017
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107. Targets to treatmetabolic syndrome in polycystic ovary syndrome
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Mahalingaiah, Shruthi Diamanti-Kandarakis, Evanthia
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Introduction: Metabolic syndrome is comprised of a combination of the following states: increased insulin resistance, dyslipidemia, cardiovascular disease, and increased abdominal obesity. Women with polycystic ovary syndrome (PCOS) have an increased risk of developing metabolic syndrome over the course of their lives. Metabolic syndrome increases risk of major cardiovascular events, morbidity, quality of life, and overall health care costs. Though metabolic syndrome in women with PCOS is an area of great concern, there is no effective individual medical therapeutic to adequately treat this issue. Areas Covered: This article will review key aspects of metabolic syndrome in PCOS. We will discuss classic and novel therapeutics to address metabolic syndrome in women with PCOS. We will conclude with the importance of developing strategic interventions to increase the compliance to lifestyle and dietary modification, in addition to appreciation of the emerging pharmaceutical therapeutics available. Expert Opinion: Innovation in lifestyle modification, including diet, exercise, with and without dedicated stress reduction techniques is the future in treatment of metabolic syndrome in PCOS. Application of novel interventions, such as group medical care, may improve future adherence to lifestyle modification recommendations, in addition to or in combination with pharmaceutical therapeutics.
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- 2015
108. Do prenatal exposures pose a real threat to ovarian function? Bisphenol A as a case study.
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Mathew, Hannah and Mahalingaiah, Shruthi
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BISPHENOL A ,OVARIES ,FETAL development ,MORPHOGENESIS ,MENSTRUAL cycle - Abstract
Fetal development represents a time of potential vulnerability due to rapid cell division, organ development and limited fetal kidney/liver activity for detoxification and metabolism of exposures. Health effects of prenatal toxicant exposure have previously been described, but there is little cohesive evidence surrounding effects on ovarian function. Using bisphenol A (BPA) as a case study, we seek to examine whether a prominent prenatal environmental exposure can pose a real threat to human ovarian function. To do so, we broadly review human oogenesis and menstrual cycle biology. We then present available literature addressing prenatal bisphenol A and diverse outcomes at the level of the ovary. We highlight relevant human cohorts and mammalian models to review the existing data on prenatal exposures and ovarian disruption. Doing so suggests that while current exposures to BPA have not shown marked or consistent results, there is data sufficient to raise concerns regarding ovarian function. Challenges in the examination of this question suggest the need for additional models and pathways by which to expand these examinations in humans. [ABSTRACT FROM AUTHOR]
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- 2019
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109. The Menstrual Cycle as a Vital Sign: a comprehensive review
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Rosen Vollmar, Ana K., Mahalingaiah, Shruthi, and Jukic, Anne Marie
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Some medical professional organizations have advocated for including the menstrual cycle as a vital sign in adolescence, but not in adulthood. However, documenting menstrual cycle patterns is not routine clinical or research practice. Vital signs are used to predict health outcomes, indicate needed treatment, and monitor a clinical course. They can help identify pathologies, affirm wellness, and are responsive to exposures. Here we review the scientific evidence showing how the menstrual cycle meets these criteria and should therefore be treated as a vital sign. Using key words and controlled vocabulary terms, we carried out multiple literature searches, prioritizing the inclusion of systematic reviews, meta-analyses, and clinical practice guidelines. This review describes how the menstrual cycle is a health indicator, can cyclically impact health conditions, and its associations with long-term post-menopausal health outcomes. We review exposures influencing the menstrual cycle, evidence underlying its use to optimize wellness, and available tools for documenting cycles. Supplementary materials include patient handouts on menstrual cycle tracking, and an index of related clinical practice guidelines and reviews by subject. The menstrual cycle is a vital sign from menarche through menopause, an underutilized but powerful tool for understanding gynecological and general health.
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- 2024
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110. Cosmetics use and age at menopause: is there a connection?
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Chow, Erika T., primary and Mahalingaiah, Shruthi, additional
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- 2016
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111. Clinical vignettes and global health considerations of infertility care in under-resourced patients
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Chow, Erika Tiffanie, primary and Mahalingaiah, Shruthi, additional
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- 2016
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112. Update on primary ovarian insufficiency
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Hewlett, Meghan, primary and Mahalingaiah, Shruthi, additional
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- 2015
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113. Bisphenol A is not detectable in media or selected contact materials used in IVF
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Mahalingaiah, Shruthi, Hauser, Russ, Patterson, Donald G., Jr., Woudneh, Million, and Racowsky, Catherine
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- 2012
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114. Targets to treat metabolic syndrome in polycystic ovary syndrome
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Mahalingaiah, Shruthi, primary and Diamanti-Kandarakis, Evanthia, additional
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- 2015
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115. Prenatal drinking-water exposure to tetrachloroethylene and ischemic placental disease: a retrospective cohort study
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Carwile, Jenny L, primary, Mahalingaiah, Shruthi, additional, Winter, Michael R, additional, and Aschengrau, Ann, additional
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- 2014
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116. Air Pollution Exposures During Adulthood and Risk of Endometriosis in the Nurses’ Health Study II
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Mahalingaiah, Shruthi, primary, Hart, Jaime E., additional, Laden, Francine, additional, Aschengrau, Ann, additional, and Missmer, Stacey A., additional
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- 2014
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117. Does a woman’s educational attainment influence in vitro fertilization outcomes?
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Mahalingaiah, Shruthi, primary, Berry, Katharine F., additional, Hornstein, Mark D., additional, Cramer, Daniel W., additional, and Missmer, Stacey A., additional
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- 2011
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118. Prolactin can modulate CD4+T‐cell response through receptor‐mediated alterations in the expression of T‐bet
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Tomio, Ayako, primary, Schust, Danny J, additional, Kawana, Kei, additional, Yasugi, Toshiharu, additional, Kawana, Yukiko, additional, Mahalingaiah, Shruthi, additional, Fujii, Tomoyuki, additional, and Taketani, Yuji, additional
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- 2008
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119. Do increasing c-section rates lower the risks of shoulder dystocia or brachial plexus injury?
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Greenberg, James, primary, Mahalingaiah, Shruthi, additional, and Mcelrath, Thomas, additional
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- 2006
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120. Editorial introductions
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Mahalingaiah, Shruthi and Sagoe, Dominic
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- 2022
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121. Prolactin can modulate CD4+ T-cell response through receptor-mediated alterations in the expression of T-bet.
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Tomio, Ayako, Schust, Danny J, Kawana, Kei, Yasugi, Toshiharu, Kawana, Yukiko, Mahalingaiah, Shruthi, Fujii, Tomoyuki, and Taketani, Yuji
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PROLACTIN ,T cells ,CELL receptors ,IMMUNOGLOBULINS ,STEROIDS ,TRANSCRIPTION factors ,CELLULAR immunity - Abstract
Low-dose prolactin induces proinflammatory responses and antibody production, whereas high-dose prolactin suppresses these responses. Mechanisms for these opposing effects remain incompletely defined. We have previously demonstrated that T-bet, a key transcription factor directing T helper type 1 inflammatory responses, is regulated by female steroid hormones in human mucosal epithelial cells via Stat1 and 5 pathways. T-bet was also modulated in a CD4
+ T cell line by prolactin exposure. Prolactin rapidly induced T-bet transcription through phosphorylation of JAK2 and Stat5, but not Stat1. Phosphorylated Stat5 then bound to the T-bet regulatory region. These effects were weaker with high-dose prolactin exposures. Upon long-term prolactin exposure, low-dose prolactin induced T-bet expression, whereas high-dose prolactin tended to suppress it. Prolactin induced the suppressors of cytokine signaling (SOCS) 1 and 3 in a dose-dependent manner. With high-dose exposure, this was associated with an inhibition of the phosphorylation of T-bet regulatory region-bound Stat5. Further, the dose-dependent prolactin effects on T-bet expression were confirmed in murine primary CD4+ T cells. These data suggest that the divergent immune effects of low- and high-dose prolactin may involve modulation of T-bet and alterations in the balance of the prolactin/JAK2/Stat5 and the prolactin/SOCS1 and 3 pathways.Immunology and Cell Biology (2008) 86, 616–621; doi:10.1038/icb.2008.29; published online 15 April 2008 [ABSTRACT FROM AUTHOR]- Published
- 2008
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122. Substitution and reduction of platinum(IV) complexes by a nucleotide, guanosine 5'-monophosphate.
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Sunhee Choi and Mahalingaiah, Shruthi
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PLATINUM compounds , *PHOSPHATES , *REACTIVITY (Chemistry) - Abstract
Investigates the reactivity of a series of platinum(IV) anticancer complexes with different reduction potentials toward 5'-guanosine monophosphate (5'-GMP). Cathodic reduction potentials of the platinum complexes; Initial substitution of a platinum ligand by a 5'-GMP molecule; Formation of the intermediate.
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- 1999
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123. Editorial introductions
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Mahalingaiah, Shruthi and Sagoe, Dominic
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- 2021
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124. Air Pollution Exposures During Adulthood and Risk of Endometriosis in the Nurses’ Health Study II
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Mahalingaiah, Shruthi, Hart, Jaime E., Laden, Francine, Aschengrau, Ann, and Missmer, Stacey A.
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Background: Particulate matter and proximity to large roadways may promote disease mechanisms, including systemic inflammation, hormonal alteration, and vascular proliferation, that may contribute to the development and severity of endometriosis. Objective: Our goal was to determine the association of air pollution exposures during adulthood, including distance to road, particulate matter < 2.5 μm, between 2.5 and 10 μm, and < 10 μm, (PM2.5, PM10–2.5, PM10), and timing of exposure with risk of endometriosis in the Nurses’ Health Study II. Methods: Proximity to major roadways and outdoor levels of PM2.5, PM10–2.5, and PM10 were determined for all residential addresses from 1993 to 2007. Multivariable-adjusted time-varying Cox proportional hazard models were used to estimate the relation between these air pollution exposures and endometriosis risk. Results: Among 84,060 women, 2,486 incident cases of surgically confirmed endometriosis were identified over 710,230 person-years of follow-up. There was no evidence of an association between endometriosis risk and distance to road or exposure to PM2.5, PM10–2.5, or PM10 averaged over follow-up or during the previous 2- or 4-year period. Conclusions: Traffic and air pollution exposures during adulthood were not associated with incident endometriosis in this cohort of women. Citation: Mahalingaiah S, Hart JE, Laden F, Aschengrau A, Missmer SA. 2014. Air pollution exposures during adulthood and risk of endometriosis in the Nurses’ Health Study II. Environ Health Perspect 122:58–64; http://dx.doi.org/10.1289/ehp.1306627
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- 2013
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125. Temporal Variability and Predictors of Urinary Bisphenol A Concentrations in Men and Women
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Meeker, John D., Calafat, Antonia M., Ye, Xiaoyun, Mahalingaiah, Shruthi, Pearson, Kimberly Hope, Petrozza, John Christopher, and Hauser, Russ B.
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bisphenol A ,endocrine disruptors ,environment ,human ,pregnancy - Abstract
Background: Bisphenol A (BPA) is used to manufacture polymeric materials, such as polycarbonate plastics, and is found in a variety of consumer products. Recent data show widespread BPA exposure among the U.S. population.Objective Our goal in the present study was to determine the temporal variability and predictors of BPA exposure. Methods: We measured urinary concentrations of BPA among male and female patients from the Massachusetts General Hospital Fertility Center. Results: Between 2004 and 2006, 217 urine samples were collected from 82 subjects: 45 women (145 samples) and 37 men (72 samples). Of these, 24 women and men were partners and contributed 42 pairs of samples collected on the same day. Ten women became pregnant during the follow-up period. Among the 217 urine samples, the median BPA concentration was 1.20 μg/L, ranging from below the limit of detection (0.4 μg/L) to 42.6 μg/L. Age, body mass index, and sex were not significant predictors of urinary BPA concentrations. BPA urinary concentrations among pregnant women were 26% higher (–26%, +115%) than those among the same women when not pregnant (p > 0.05). The urinary BPA concentrations of the female and male partner on the same day were correlated (r = 0.36; p = 0.02). The sensitivity of classifying a subject in the highest tertile using a single urine sample was 0.64. Conclusion: We found a nonsignificant increase in urinary BPA concentrations in women while pregnant compared with nonpregnant samples from the same women. Samples collected from partners on the same day were correlated, suggesting shared sources of exposure. Finally, a single urine sample showed moderate sensitivity for predicting a subject’s tertile categorization.
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- 2007
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126. Adult air pollution exposure and risk of infertility in the nurses' health study II
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Mahalingaiah, Shruthi
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- Epidemiology, Infertility, Air pollution, Ovulatory infertility, Roadway proximity
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BACKGROUND: Exposures to air pollution has been associated with lower conception and fertility rates. However, the impact of pollution on infertility is unknown. OBJECTIVES: To examine the associations of roadway proximity (a measure of traffic exposure) and particulate matter (PM) air pollution and incidence of infertility. METHODS: Proximity to major roadways and ambient exposures to particulate matter less than 10 microns (PM10), between 2.5 and 10 microns (PM2.5-10), and less than 2.5 microns (PM2.5) were determined for all residential addresses for 36,294 members of the prospective Nurses' Health Study II cohort from 1993 to 2003. Infertility was defined by report of attempted conception for ≥12 months without success. Participants were able to report if evaluation was sought and if so, offer multiple clinical indications for infertility. Multivariable adjusted Cox proportional hazard models were used to estimate the relation between each exposure and infertility risk. RESULTS: Over 213,416 person-years, there were 2,508 incident reports of infertility. Results for overall infertility were inconsistent across exposure types. We observed a small increased risk in those living closer to compared to farther from a major road, multivariable adjusted hazard ratio (HR)=1.11(95% confidence interval (CI) = 1.02-1.20). Among those reporting primary infertility, risk was greater with closer distance to road and for all PM size fractions and exposure time windows. The multivariable adjusted HR (95%CI) for women living closer to compared to farther from a major road for primary infertility was 1.37 (1.22-1.52), while for secondary infertility HR=1.07 (0.95-1.21). In addition, the HR for every 10 mcg increase in cumulative PM2.5 among women with primary infertility was 1.61 (1.35-1.92), while it was 1.1 (0.91-1.33) for those with secondary infertility. CONCLUSIONS: This study suggests exposures to traffic and PM may be associated with a small increased risk of infertility, especially primary infertility.
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- 2015
127. Polycystic ovary syndrome underdiagnosis patterns by individual-level and spatial social vulnerability measures.
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Silva EL, Lane KJ, Cheng JJ, Popp Z, Van Loeneny BD, Coull B, Hart JE, James-Todd T, and Mahalingaiah S
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Objective: To use electronic health records (EHR) data at Boston Medical Center (BMC) to identify individual-level and spatial predictors of missed diagnosis, among those who meet diagnostic criteria for PCOS., Methods: The BMC Clinical Data Warehouse was used to source patients who presented between October 1, 2003 and September 30, 2015 for any of the following: androgen blood tests, hirsutism, evaluation of menstrual regularity, pelvic ultrasound for any reason, or PCOS. Algorithm PCOS cases were identified as those with International Classification of disease (ICD) codes for irregular menstruation and either an ICD code for hirsutism, elevated testosterone lab, or polycystic ovarian morphology as identified using natural language processing on pelvic ultrasounds. Logistic regression models were used to estimate odds ratios (ORs) of missed PCOS diagnosis by age, race/ethnicity, education, primary language, body mass index (BMI), insurance type and social vulnerability index (SVI) score., Results: In the 2003-2015 BMC-EHR PCOS at-risk cohort (n=23,786), there were 1,199 physician-diagnosed PCOS cases and 730 algorithm PCOS cases. In logistic regression models controlling for age, year, education, and SVI scores, Black/African American patients were more likely to have missed a PCOS diagnosis (OR = 1.69 [95% CI, 1.28, 2.24]) compared to non-Hispanic White patients, and relying on Medicaid or charity for insurance was associated with an increased odds of missed diagnosis when compared to private insurance (OR = 1.90 [95% CI, 1.47, 2.46], OR = 1.90 [95% CI, 1.41, 2.56], respectively). Higher SVI scores were associated with increased odds of missed diagnosis in univariate models., Conclusions: We observed individual-level and spatial disparities within the PCOS diagnosis. Further research should explore drivers of disparities for earlier intervention., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)
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- 2024
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128. Signs of Potential Androgen Excess Across the Lifespan in a US-based Digital Cohort Study.
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Wolf AT, Wang Z, Onnela JP, Baird DD, Jukic AMZ, Curry CL, Fischer-Colbrie T, Williams MA, Hauser R, Coull BA, and Mahalingaiah S
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Context: Androgen excess (AE)-related symptoms can vary widely and may appear across the life course., Objective: We assessed the prevalence of signs of potential AE and heterogeneity by demographic/health characteristics., Methods: We used data of 24 435 participants who consented and enrolled during November 2019 to December 2022 in a US digital cohort to evaluate the prevalence and heterogeneity of self-reported signs of potential AE: possible hirsutism (having thick coarse hair on ≥4 of 8 body locations), hair level on the chin, hair loss on top of the head, and moderate to severe acne., Results: The prevalence of possible hirsutism, having several/a lot of hair on the chin, significantly reduced hair/visible scalp on top of the head, and moderate to severe acne were 6.9%, 12.6%, 1.7%, and 31.8%, respectively. While possible hirsutism and moderate to severe acne decreased with age (range: 18-86 years), hair on the chin and hair loss on the head increased with age. Participants who self-identified as Hispanic or South Asian reported a higher prevalence of possible hirsutism (11.2%, 16.9%, vs 6.3% among non-Hispanic White participants). Participants with higher body mass index had a higher prevalence of possible hirsutism. Moderate to severe acne was more common among those with polycystic ovary syndrome. Possible hirsutism and hair loss were less common among participants using hormones for contraception., Conclusion: In this large cohort, signs of potential AE varied by demographic and health factors. These results could provide a new understanding of how potential AE may appear differently in diverse groups, informing future work to develop more inclusive evaluation at a population level., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)
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- 2024
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129. Early Pregnancy Plasma Per- and Polyfluoroalkyl Substances (PFAS) and Maternal Midlife Adiposity.
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Burdeau JA, Stephenson BJK, Chavarro JE, Mahalingaiah S, Preston EV, Hivert MF, Oken E, Calafat AM, Rifas-Shiman SL, Zota AR, and James-Todd T
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Context: Evidence suggests that exposure to per- and polyfluoroalkyl substances (PFAS) increases the risk of developing cardiometabolic disease risk factors. Limited research has evaluated associations between PFAS, assessed during pregnancy, a sensitive window for maternal endocrine effects, and long-term maternal adiposity., Objective: Estimate associations of early pregnancy measures of individual PFAS, and PFAS mixtures, with maternal adiposity in midlife., Methods: We studied 547 Project Viva participants with measures of early pregnancy (mean gestation 10.0 weeks; mean age 32.5 years) plasma concentrations of 6 PFAS and midlife adiposity outcomes (mean follow-up 17.7 years; mean age 50.7 years), including weight, waist circumference (WC), trunk fat mass (TFM), and total body fat mass (TBFM). We used linear regression and Bayesian Kernel Machine Regression (BKMR)., Results: Linear regression estimated higher midlife weight per doubling of perfluorooctane sulfonate (PFOS) (3.8 kg [95% CI: 1.6, 5.9]) and 2-(N-ethyl-perfluorooctane sulfonamido) acetate (2.3 kg [95% CI: 0.9, 3.7]). BKMR analyses of single PFAS plasma concentrations (comparing the 25th percentile concentration to the 75th percentile) showed a positive association between PFOS and midlife adiposity (weight: 7.7 kg [95% CI: 4.0, 11.5]; TFM: 1.2 kg [95% CI: 0.0, 2.3]; TBFM: 3.0 kg [95% CI: 0.8, 5.2]), but inverse associations with perfluorononanoate (weight: -6.0 kg [95% CI: -8.5, -3.5]; WC: -1.8 cm [95% CI: -3.2, -0.3]; TFM: -0.8 kg [95% CI: -1.5, -0.1]; TBFM: -1.4 kg [95% CI: -2.7, -0.3]) and perfluorohexane sulfonate (TFM: -0.8 kg [95% CI: -1.5, -0.1]; TBFM: -1.4 kg [95% CI: -2.6, -0.2]). No associations were observed with the overall PFAS mixture., Conclusion: Select PFAS, assessed in pregnancy, may differentially affect maternal midlife adiposity, influencing later-life maternal cardiometabolic health., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. See the journal About page for additional terms.)
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- 2024
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130. Understanding the Strengths and Limitations of Online Oocyte Cryopreservation Calculators.
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Wolf AT, Minis E, and Mahalingaiah S
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Between 2010 and 2016, elective oocyte cryopreservation (OC) increased in use by 880% in the United States; however, there have been increasing reports of regret among patients after elective OC. There is a growing need for individualized counseling on the timing and number of oocytes to cryopreserve for patients to make informed choices and set realistic expectations, but currently available tools seem to be insufficient. The purpose of this review is to describe the OC calculators currently available online, identify sources of regret, and illustrate the need for unified counseling tools for improved patient care and education. OC calculators were identified via Google search. Only calculators that cite scientific literature were included in the review. Calculators for in vitro fertilization or embryo transfer were excluded. Thirteen OC calculators were found; however, only six cited literature supporting the calculator's design. When entering the same hypothetical patient parameters for age and number of oocytes cryopreserved, the calculators provided drastically different probabilities of live births. The lack of cohesive online educational materials creates confusion and stress for patients considering OC, leading to unrealistic expectations and increased feelings of regret thereafter. Physicians need tools to provide comprehensive guidance to patients seeking to cryopreserve oocytes., Competing Interests: The authors declare no conflict of interest and nothing to disclose., (Thieme. All rights reserved.)
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- 2024
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131. Evaluation of Menstrual Cycle Tracking Behaviors in the Ovulation and Menstruation Health Pilot Study: Cross-Sectional Study.
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Adnan T, Li H, Peer K, Peebles E, James K, and Mahalingaiah S
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- Humans, Female, Adolescent, Young Adult, Adult, Menstruation, Cross-Sectional Studies, Pilot Projects, Menstrual Cycle, Ovulation, Contraceptive Agents, Mobile Applications, Gastrointestinal Diseases, Gastroesophageal Reflux
- Abstract
Background: Menstrual cycle tracking apps (MCTAs) have potential in epidemiological studies of women's health, facilitating real-time tracking of bleeding days and menstrual-associated signs and symptoms. However, information regarding the characteristics of MCTA users versus cycle nontrackers is limited, which may inform generalizability., Objective: We compared characteristics among individuals using MCTAs (app users), individuals who do not track their cycles (nontrackers), and those who used other forms of menstrual tracking (other trackers)., Methods: The Ovulation and Menstruation Health Pilot Study tested the feasibility of a digitally enabled evaluation of menstrual health. Recruitment occurred between September 2017 and March 2018. Menstrual cycle tracking behavior, demographic, and general and reproductive health history data were collected from eligible individuals (females aged 18-45 years, comfortable communicating in English). Menstrual cycle tracking behavior was categorized in 3 ways: menstrual cycle tracking via app usage, that via other methods, and nontracking. Demographic factors, health conditions, and menstrual cycle characteristics were compared across the menstrual tracking method (app users vs nontrackers, app users vs other trackers, and other trackers vs nontrackers) were assessed using chi-square or Fisher exact tests., Results: In total, 263 participants met the eligibility criteria and completed the digital survey. Most of the cohort (n=191, 72.6%) was 18-29 years old, predominantly White (n=170, 64.6%), had attained 4 years of college education or higher (n= 209, 79.5%), and had a household income below US $50,000 (n=123, 46.8%). Among all participants, 103 (39%) were MCTA users (app users), 97 (37%) did not engage in any tracking (nontrackers), and 63 (24%) used other forms of tracking (other trackers). Across all groups, no meaningful differences existed in race and ethnicity, household income, and education level. The proportion of ever-use of hormonal contraceptives was lower (n=74, 71.8% vs n=87, 90%, P=.001), lifetime smoking status was lower (n=6, 6% vs n=15, 17%, P=.04), and diagnosis rate of gastrointestinal reflux disease (GERD) was higher (n=25, 24.3% vs n=12, 12.4%, P=.04) in app users than in nontrackers. The proportions of hormonal contraceptives ever used and lifetime smoking status were both lower (n=74, 71.8% vs n=56, 88.9%, P=.01; n=6, 6% vs n=11, 17.5%, P=.02) in app users than in other trackers. Other trackers had lower proportions of ever-use of hormonal contraceptives (n=130, 78.3% vs n=87, 89.7%, P=.02) and higher diagnostic rates of heartburn or GERD (n=39, 23.5% vs n=12, 12.4%, P.03) and anxiety or panic disorder (n=64, 38.6% vs n=25, 25.8%, P=.04) than nontrackers. Menstrual cycle characteristics did not differ across all groups., Conclusions: Our results suggest that app users, other trackers, and nontrackers are largely comparable in demographic and menstrual cycle characteristics. Future studies should determine reasons for tracking and tracking-related behaviors to further understand whether individuals who use MCTAs are comparable to nontrackers., (©Tatheer Adnan, Huichu Li, Komal Peer, Elizabeth Peebles, Kaitlyn James, Shruthi Mahalingaiah. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 27.10.2023.)
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- 2023
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132. Predicting polycystic ovary syndrome (PCOS) with machine learning algorithms from electronic health records.
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Zad Z, Jiang VS, Wolf AT, Wang T, Cheng JJ, Paschalidis IC, and Mahalingaiah S
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Introduction: Predictive models have been used to aid early diagnosis of PCOS, though existing models are based on small sample sizes and limited to fertility clinic populations. We built a predictive model using machine learning algorithms based on an outpatient population at risk for PCOS to predict risk and facilitate earlier diagnosis, particularly among those who meet diagnostic criteria but have not received a diagnosis., Methods: This is a retrospective cohort study from a SafetyNet hospital's electronic health records (EHR) from 2003-2016. The study population included 30,601 women aged 18-45 years without concurrent endocrinopathy who had any visit to Boston Medical Center for primary care, obstetrics and gynecology, endocrinology, family medicine, or general internal medicine. Four prediction outcomes were assessed for PCOS. The first outcome was PCOS ICD-9 diagnosis with additional model outcomes of algorithm-defined PCOS. The latter was based on Rotterdam criteria and merging laboratory values, radiographic imaging, and ICD data from the EHR to define irregular menstruation, hyperandrogenism, and polycystic ovarian morphology on ultrasound., Results: We developed predictive models using four machine learning methods: logistic regression, supported vector machine, gradient boosted trees, and random forests. Hormone values (follicle-stimulating hormone, luteinizing hormone, estradiol, and sex hormone binding globulin) were combined to create a multilayer perceptron score using a neural network classifier. Prediction of PCOS prior to clinical diagnosis in an out-of-sample test set of patients achieved AUC of 85%, 81%, 80%, and 82%, respectively in Models I, II, III and IV. Significant positive predictors of PCOS diagnosis across models included hormone levels and obesity; negative predictors included gravidity and positive bHCG., Conclusions: Machine learning algorithms were used to predict PCOS based on a large at-risk population. This approach may guide early detection of PCOS within EHR-interfaced populations to facilitate counseling and interventions that may reduce long-term health consequences. Our model illustrates the potential benefits of an artificial intelligence-enabled provider assistance tool that can be integrated into the EHR to reduce delays in diagnosis. However, model validation in other hospital-based populations is necessary.
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- 2023
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133. Covid-19 vaccination and menstrual cycle length in the Apple Women's Health Study.
- Author
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Gibson EA, Li H, Fruh V, Gabra M, Asokan G, Jukic AMZ, Baird DD, Curry CL, Fischer-Colbrie T, Onnela JP, Williams MA, Hauser R, Coull BA, and Mahalingaiah S
- Abstract
Background: COVID-19 vaccination may be associated with change in menstrual cycle length following vaccination., Methods: We conducted a longitudinal analysis within a subgroup of 14,915 participants in the Apple Women's Health Study (AWHS) who enrolled between November 2019 and December 2021 and met the following eligibility criteria: were living in the U.S., met minimum age requirements for consent, were English speaking, actively tracked their menstrual cycles, and responded to the COVID-19 Vaccine Update survey. In the main analysis, we included tracked cycles recorded when premenopausal participants were not pregnant, lactating, or using hormonal contraceptives. We used conditional linear regression and multivariable linear mixed-effects models with random intercepts to estimate the covariate-adjusted difference in mean cycle length, measured in days, between pre-vaccination cycles, cycles in which a vaccine was administered, and post-vaccination cycles within vaccinated participants, and between vaccinated and unvaccinated participants. We further compared associations between vaccination and menstrual cycle length by the timing of vaccine dose within a menstrual cycle (i.e., in follicular or luteal phase). We present Bonferroni-adjusted 95% confidence intervals to account for multiple comparisons., Results: A total of 128,094 cycles (median = 10 cycles per participant; interquartile range: 4-22) from 9,652 participants (8,486 vaccinated; 1,166 unvaccinated) were included. The average within-individual standard deviation in cycle length was 4.2 days. Fifty-five percent of vaccinated participants received Pfizer-BioNTech's mRNA vaccine, 37% received Moderna's mRNA vaccine, and 7% received the Johnson & Johnson/Janssen vaccine (J&J). We found no evidence of a difference between mean menstrual cycle length in the unvaccinated and vaccinated participants prior to vaccination (0.24 days, 95% CI: -0.34, 0.82).Among vaccinated participants, COVID-19 vaccination was associated with a small increase in mean cycle length (MCL) for cycles in which participants received the first dose (0.50 days, 95% CI: 0.22, 0.78) and cycles in which participants received the second dose (0.39 days, 95% CI: 0.11, 0.67) of mRNA vaccines compared with pre-vaccination cycles. Cycles in which the single dose of J&J was administered were, on average, 1.26 days longer (95% CI: 0.45, 2.07) than pre-vaccination cycles. Post-vaccination cycles returned to average pre-vaccination length. Estimates for pre vs post cycle lengths were 0.14 days (95% CI: -0.13, 0.40) in the first cycle following vaccination, 0.13 days (95% CI: -0.14, 0.40) in the second, -0.17 days (95% CI: -0.43, 0.10) in the third, and -0.25 days (95% CI: -0.52, 0.01) in the fourth cycle post-vaccination. Follicular phase vaccination was associated with an increase in MCL in cycles in which participants received the first dose (0.97 days, 95% CI: 0.53, 1.42) or the second dose (1.43 days, 95% CI: 1.06, 1.80) of mRNA vaccines or the J&J dose (2.27 days, 95% CI: 1.04, 3.50), compared with pre-vaccination cycles., Conclusions: COVID-19 vaccination was associated with an immediate short-term increase in menstrual cycle length overall, which appeared to be driven by doses received in the follicular phase. However, the magnitude of this increase was small and diminished in each cycle following vaccination. No association with cycle length persisted over time. The magnitude of change associated with vaccination was well within the natural variability in the study population. Menstrual cycle change following COVID-19 vaccination appears small and temporary and should not discourage individuals from becoming vaccinated.
- Published
- 2022
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