{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:52:34Z","timestamp":1792173154273,"version":"4.4.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2020,7,28]],"date-time":"2020-07-28T00:00:00Z","timestamp":1595894400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,7,28]],"date-time":"2020-07-28T00:00:00Z","timestamp":1595894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006306","name":"Sigrid Jus\u00e9liuksen S\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006306","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010135","name":"Finska L\u00e4kares\u00e4llskapet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010135","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010116","name":"Medicinska Underst\u00f6dsf\u00f6reningen Liv och H\u00e4lsa","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010116","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005744","name":"Lastentautien Tutkimuss\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005744","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010113","name":"Wilhelm och Else Stockmanns Stiftelse","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010113","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004281","name":"Narodowe Centrum Nauki","doi-asserted-by":"publisher","award":["2018\/29\/N\/NZ7\/00991"],"award-info":[{"award-number":["2018\/29\/N\/NZ7\/00991"]}],"id":[{"id":"10.13039\/501100004281","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Diabetol"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Aims<\/jats:title>\n                <jats:p>We aimed to investigate associations between pre-pregnancy obesity, gestational diabetes (GDM), offspring body composition, and left ventricular diastolic and systolic function in early childhood.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This is an observational study, including 201 mother\u2013child pairs originating from the Finnish Gestational Diabetes Prevention Study (RADIEL; 96 with GDM, 128 with pre-pregnancy obesity) with follow-up from gestation to 6-year postpartum. Follow-up included dyads anthropometrics, body composition, blood pressure, and child left ventricular function with comprehensive echocardiography (conventional and strain imaging).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Offspring left ventricular diastolic and systolic function was not associated with gestational glucose concentrations, GDM, or pregravida obesity. Child body fat percentage correlated with maternal pre-pregnancy BMI in the setting of maternal obesity (<jats:italic>r<\/jats:italic>\u2009=\u20090.23, <jats:italic>P<\/jats:italic>\u2009=\u20090.009). After adjusting for child lean body mass, age, sex, systolic BP, resting HR, maternal lean body mass, pre-gestational BMI, and GDM status, child left atrial volume increased by 0.3\u00a0ml (95% CI 0.1, 0.5) for each 1% increase in child body fat percentage.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>No evidence of foetal cardiac programming related to GDM or maternal pre-pregnancy obesity was observed in early childhood. Maternal pre-pregnancy obesity is associated with early weight gain. Child adiposity in early childhood is independently associated with increased left atrial volume, but its implications for long-term left ventricle diastolic function and cardiovascular health remain unknown.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00592-020-01571-z","type":"journal-article","created":{"date-parts":[[2020,7,28]],"date-time":"2020-07-28T07:38:12Z","timestamp":1595921892000},"page":"1463-1472","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["No effect of gestational diabetes or pre-gestational obesity on 6-year offspring left ventricular function\u2014RADIEL study follow-up"],"prefix":"10.1007","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4761-374X","authenticated-orcid":false,"given":"Linda","family":"Litwin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johnny K. M.","family":"Sundholm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristiina","family":"R\u00f6n\u00f6","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saila B.","family":"Koivusalo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan G.","family":"Eriksson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taisto","family":"Sarkola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,7,28]]},"reference":[{"key":"1571_CR1","doi-asserted-by":"publisher","first-page":"453","DOI":"10.2337\/db08-1112","volume":"58","author":"BE Metzger","year":"2009","unstructured":"Metzger BE, Lowe LP, Dyer AR et al (2009) Hyperglycemia and adverse pregnancy outcome (HAPO) study: associations with neonatal anthropometrics. Diabetes 58:453\u2013459. https:\/\/doi.org\/10.2337\/db08-1112","journal-title":"Diabetes"},{"key":"1571_CR2","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1159\/000323741","volume":"100","author":"J Aman","year":"2011","unstructured":"Aman J, Hansson U, Ostlund I et al (2011) Increased fat mass and cardiac septal hypertrophy in newborn infants of mothers with well-controlled diabetes during pregnancy. Neonatology 100:147\u2013154. https:\/\/doi.org\/10.1159\/000323741","journal-title":"Neonatology"},{"key":"1571_CR3","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.earlhumdev.2003.11.006","volume":"77","author":"A Koz\u00e1k-B\u00e1r\u00e1ny","year":"2004","unstructured":"Koz\u00e1k-B\u00e1r\u00e1ny A, Jokinen E, Kero P et al (2004) Impaired left ventricular diastolic function in newborn infants of mothers with pregestational or gestational diabetes with good glycemic control. Early Hum Dev 77:13\u201322. https:\/\/doi.org\/10.1016\/j.earlhumdev.2003.11.006","journal-title":"Early Hum Dev"},{"key":"1571_CR4","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1056\/NEJM199709253371301","volume":"337","author":"RC Whitaker","year":"1997","unstructured":"Whitaker RC, Wright JA, Pepe MS et al (1997) Predicting Obesity in Young Adulthood from Childhood and Parental Obesity. N Engl J Med 337:869\u2013873. https:\/\/doi.org\/10.1056\/NEJM199709253371301","journal-title":"N Engl J Med"},{"key":"1571_CR5","doi-asserted-by":"publisher","first-page":"e198","DOI":"10.1542\/peds.114.2.e198","volume":"114","author":"PT Katzmarzyk","year":"2004","unstructured":"Katzmarzyk PT, Srinivasan SR, Chen W et al (2004) Body mass index, waist circumference, and clustering of cardiovascular disease risk factors in a biracial sample of children and adolescents. Pediatrics 114:e198\u2013e205. https:\/\/doi.org\/10.1542\/peds.114.2.e198","journal-title":"Pediatrics"},{"key":"1571_CR6","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1152\/physrev.00029.2013","volume":"94","author":"MA Hanson","year":"2014","unstructured":"Hanson MA, Gluckman PD (2014) Early developmental conditioning of later health and disease: physiology or pathophysiology? Physiol Rev 94:1027\u20131076. https:\/\/doi.org\/10.1152\/physrev.00029.2013","journal-title":"Physiol Rev"},{"key":"1571_CR7","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1007\/s00246-017-1584-y","volume":"38","author":"JE Zablah","year":"2017","unstructured":"Zablah JE, Gruber D, Stoffels G et al (2017) Subclinical decrease in myocardial function in asymptomatic infants of diabetic mothers: a tissue doppler study. Pediatr Cardiol 38:801\u2013806. https:\/\/doi.org\/10.1007\/s00246-017-1584-y","journal-title":"Pediatr Cardiol"},{"key":"1571_CR8","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1007\/s00125-010-1974-7","volume":"54","author":"AS Shah","year":"2011","unstructured":"Shah AS, Khoury PR, Dolan LM et al (2011) The effects of obesity and type 2 diabetes mellitus on cardiac structure and function in adolescents and young adults. Diabetologia 54:722\u2013730. https:\/\/doi.org\/10.1007\/s00125-010-1974-7","journal-title":"Diabetologia"},{"key":"1571_CR9","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1016\/J.ATHEROSCLEROSIS.2019.01.037","volume":"284","author":"JKM Sundholm","year":"2019","unstructured":"Sundholm JKM, Litwin L, R\u00f6n\u00f6 K et al (2019) Maternal obesity and gestational diabetes: Impact on arterial wall layer thickness and stiffness in early childhood\u2014RADIEL study six-year follow-up. Atherosclerosis 284:237\u2013244. https:\/\/doi.org\/10.1016\/J.ATHEROSCLEROSIS.2019.01.037","journal-title":"Atherosclerosis"},{"key":"1571_CR10","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1111\/dme.14089","volume":"37","author":"L Litwin","year":"2020","unstructured":"Litwin L, Sundholm JKM, R\u00f6n\u00f6 K et al (2020) Transgenerational effects of maternal obesity and gestational diabetes on offspring body composition and left ventricle mass: the Finnish gestational diabetes prevention study (RADIEL) 6-year follow-up. Diabet Med 37:147\u2013156. https:\/\/doi.org\/10.1111\/dme.14089","journal-title":"Diabet Med"},{"key":"1571_CR11","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1186\/1471-2393-14-70","volume":"14","author":"K R\u00f6n\u00f6","year":"2014","unstructured":"R\u00f6n\u00f6 K, Stach-Lempinen B, Klemetti MM et al (2014) Prevention of gestational diabetes through lifestyle intervention: study design and methods of a Finnish randomized controlled multicenter trial (RADIEL). BMC Pregnancy Childbirth 14:70. https:\/\/doi.org\/10.1186\/1471-2393-14-70","journal-title":"BMC Pregnancy Childbirth"},{"key":"1571_CR12","doi-asserted-by":"publisher","first-page":"S62","DOI":"10.2337\/dc09-S062","volume":"32","author":"American Diabetes Association","year":"2009","unstructured":"American Diabetes Association (2009) Diagnosis and classification of diabetes mellitus. Diabetes Care 32:S62\u2013S67. https:\/\/doi.org\/10.2337\/dc09-S062","journal-title":"Diabetes Care"},{"key":"1571_CR13","doi-asserted-by":"publisher","first-page":"235","DOI":"10.3109\/07853890.2010.515603","volume":"43","author":"A Saari","year":"2011","unstructured":"Saari A, Sankilampi U, Hannila M-L et al (2011) New Finnish growth references for children and adolescents aged 0 to 20 years: length\/height-for-age, weight-for-length\/height, and body mass index-for-age. Ann Med 43:235\u2013248. https:\/\/doi.org\/10.3109\/07853890.2010.515603","journal-title":"Ann Med"},{"key":"1571_CR14","doi-asserted-by":"publisher","first-page":"171","DOI":"10.3109\/03014460.2012.681800","volume":"39","author":"BJ Foster","year":"2012","unstructured":"Foster BJ, Platt RW, Zemel BS (2012) Development and validation of a predictive equation for lean body mass in children and adolescents. Ann Hum Biol 39:171\u2013182. https:\/\/doi.org\/10.3109\/03014460.2012.681800","journal-title":"Ann Hum Biol"},{"key":"1571_CR15","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1542\/peds.114.2.S2.555","volume":"114","author":"National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents","year":"2004","unstructured":"National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555\u2013576","journal-title":"Pediatrics"},{"key":"1571_CR16","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.1016\/j.echo.2006.09.001","volume":"19","author":"WW Lai","year":"2006","unstructured":"Lai WW, Geva T, Shirali GS et al (2006) Guidelines and standards for performance of a pediatric echocardiogram: a report from the task force of the pediatric council of the American society of echocardiography. J Am Soc Echocardiogr 19:1413\u20131430. https:\/\/doi.org\/10.1016\/j.echo.2006.09.001","journal-title":"J Am Soc Echocardiogr"},{"key":"1571_CR17","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1016\/j.echo.2010.03.019","volume":"23","author":"L Lopez","year":"2010","unstructured":"Lopez L, Colan SD, Frommelt PC et al (2010) Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the pediatric measurements writing group of the American society of echocardiography pediatric and congenital heart disease council. J Am Soc Echocardiogr 23:465\u2013467. https:\/\/doi.org\/10.1016\/j.echo.2010.03.019","journal-title":"J Am Soc Echocardiogr"},{"key":"1571_CR18","doi-asserted-by":"publisher","first-page":"e002167","DOI":"10.1161\/CIRCIMAGING.114.002167","volume":"8","author":"F Dallaire","year":"2015","unstructured":"Dallaire F, Slorach C, Hui W et al (2015) Reference values for pulse wave doppler and tissue doppler imaging in pediatric echocardiography. Circ Cardiovasc Imaging 8:e002167. https:\/\/doi.org\/10.1161\/CIRCIMAGING.114.002167","journal-title":"Circ Cardiovasc Imaging"},{"key":"1571_CR19","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1016\/j.echo.2016.03.018","volume":"29","author":"F Dallaire","year":"2016","unstructured":"Dallaire F, Slorach C, Bradley T et al (2016) Pediatric reference values and Z score equations for left ventricular systolic strain measured by two-dimensional speckle-tracking echocardiography. J Am Soc Echocardiogr 29:786\u2013793.e8. https:\/\/doi.org\/10.1016\/j.echo.2016.03.018","journal-title":"J Am Soc Echocardiogr"},{"key":"1571_CR20","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1161\/CIRCIMAGING.112.974428","volume":"5","author":"P Bhatla","year":"2012","unstructured":"Bhatla P, Nielsen JC, Ko HH et al (2012) Normal values of left atrial volume in pediatric age group using a validated allometric model. Circ Cardiovasc Imaging 5:791\u2013796. https:\/\/doi.org\/10.1161\/CIRCIMAGING.112.974428","journal-title":"Circ Cardiovasc Imaging"},{"key":"1571_CR21","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1016\/0002-9149(86)90771-X","volume":"57","author":"RB Devereux","year":"1986","unstructured":"Devereux RB, Alonso DR, Lutas EM et al (1986) Echocardiographic assessment of left ventricular hypertrophy: Comparison to necropsy findings. Am J Cardiol 57:450\u2013458. https:\/\/doi.org\/10.1016\/0002-9149(86)90771-X","journal-title":"Am J Cardiol"},{"key":"1571_CR22","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1016\/j.echo.2015.12.011","volume":"29","author":"BJ Foster","year":"2016","unstructured":"Foster BJ, Khoury PR, Kimball TR et al (2016) New reference centiles for left ventricular mass relative to lean body mass in children. J Am Soc Echocardiogr 29:441\u2013447e2. https:\/\/doi.org\/10.1016\/j.echo.2015.12.011","journal-title":"J Am Soc Echocardiogr"},{"key":"1571_CR23","doi-asserted-by":"publisher","first-page":"e0207632","DOI":"10.1371\/journal.pone.0207632","volume":"13","author":"S Blais","year":"2018","unstructured":"Blais S, Patenaude J, Doyon M et al (2018) Effect of gestational diabetes and insulin resistance on offspring\u2019s myocardial relaxation kinetics at three years of age. PLoS ONE 13:e0207632. https:\/\/doi.org\/10.1371\/journal.pone.0207632","journal-title":"PLoS ONE"},{"key":"1571_CR24","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1016\/j.jacc.2013.07.042","volume":"62","author":"AT Cote","year":"2013","unstructured":"Cote AT, Harris KC, Panagiotopoulos C et al (2013) Childhood obesity and cardiovascular dysfunction. J Am Coll Cardiol 62:1309\u20131319. https:\/\/doi.org\/10.1016\/j.jacc.2013.07.042","journal-title":"J Am Coll Cardiol"},{"key":"1571_CR25","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/j.echo.2011.12.018","volume":"25","author":"LP Koopman","year":"2012","unstructured":"Koopman LP, McCrindle BW, Slorach C et al (2012) Interaction between myocardial and vascular changes in obese children: a pilot study. J Am Soc Echocardiogr 25:401\u2013410.e1. https:\/\/doi.org\/10.1016\/j.echo.2011.12.018","journal-title":"J Am Soc Echocardiogr"},{"key":"1571_CR26","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.echo.2008.11.023","volume":"22","author":"SF Nagueh","year":"2009","unstructured":"Nagueh SF, Appleton CP, Gillebert TC et al (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22:107\u2013133. https:\/\/doi.org\/10.1016\/j.echo.2008.11.023","journal-title":"J Am Soc Echocardiogr"},{"key":"1571_CR27","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.echo.2016.01.011","volume":"29","author":"SF Nagueh","year":"2016","unstructured":"Nagueh SF, Smiseth OA, Appleton CP et al (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr 29:277\u2013314. https:\/\/doi.org\/10.1016\/j.echo.2016.01.011","journal-title":"J Am Soc Echocardiogr"},{"key":"1571_CR28","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1002\/9781118742440.ch8","volume-title":"Echocardiography in pediatric and congenital heart disease: from fetus to adult","author":"PC Frommelt","year":"2016","unstructured":"Frommelt PC (2016) Diastolic ventricular function assessment. In: Lai WW, Mertens LL, Cohen MS, Geva T (eds) Echocardiography in pediatric and congenital heart disease: from fetus to adult, 2nd edn. Wiley Blackwell, Oxford, UK, pp 132\u2013153","edition":"2"},{"key":"1571_CR29","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1161\/CIRCIMAGING.112.000175","volume":"6","author":"A Dragulescu","year":"2013","unstructured":"Dragulescu A, Mertens L, Friedberg MK (2013) Interpretation of left ventricular diastolic dysfunction in children with cardiomyopathy by echocardiography: problems and limitations. Circ Cardiovasc Imaging 6:254\u2013261. https:\/\/doi.org\/10.1161\/CIRCIMAGING.112.000175","journal-title":"Circ Cardiovasc Imaging"},{"key":"1571_CR30","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1007\/s00125-016-3931-6","volume":"59","author":"G Desoye","year":"2016","unstructured":"Desoye G, Nolan CJ (2016) The fetal glucose steal: an underappreciated phenomenon in diabetic pregnancy. Diabetologia 59:1089\u20131094. https:\/\/doi.org\/10.1007\/s00125-016-3931-6","journal-title":"Diabetologia"}],"container-title":["Acta Diabetologica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00592-020-01571-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00592-020-01571-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00592-020-01571-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,27]],"date-time":"2021-07-27T23:40:42Z","timestamp":1627429242000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00592-020-01571-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,28]]},"references-count":30,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["1571"],"URL":"https:\/\/doi.org\/10.1007\/s00592-020-01571-z","relation":{},"ISSN":["0940-5429","1432-5233"],"issn-type":[{"value":"0940-5429","type":"print"},{"value":"1432-5233","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,28]]},"assertion":[{"value":"12 May 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 July 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 July 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. The Ethics Board of Helsinki University Hospital approved the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The data that support the findings of this study are available from the corresponding author [LL], upon reasonable request.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Availability of data and material"}},{"value":"Informed written consent was obtained from all of the mothers.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}