{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T16:47:10Z","timestamp":1789750030634,"version":"4.0.1"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2022,3,26]],"date-time":"2022-03-26T00:00:00Z","timestamp":1648252800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Shandong Provincial Natural Science Foundation, China","award":["ZR2020MH064"],"award-info":[{"award-number":["ZR2020MH064"]}]},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,5,30]]},"abstract":"Abstract<\/jats:title>\n \n STUDY QUESTION<\/jats:title>\n Is the presence of polycystic ovary syndrome (PCOS) associated with more adverse infant outcomes in mothers with different types of diabetes?<\/jats:p>\n <\/jats:sec>\n \n SUMMARY ANSWER<\/jats:title>\n The presence of PCOS implies higher risks of total (medically indicated and spontaneously combined) and spontaneous preterm birth in mothers with non-insulin-treated type 2 diabetes and gestational diabetes mellitus (GDM), and lower risk of offspring being large for gestational age (LGA) in mothers with insulin-treated diabetes.<\/jats:p>\n <\/jats:sec>\n \n WHAT IS KNOWN ALREADY<\/jats:title>\n PCOS is suggested to be an independent risk factor for adverse infant outcomes, and it is highly prevalent in mothers with diabetes. However, the impact of PCOS on the associations of different types of maternal diabetes with preterm birth and offspring birth sizes has not been reported.<\/jats:p>\n <\/jats:sec>\n \n STUDY DESIGN, SIZE, DURATION<\/jats:title>\n This is a population-based cohort study including all live births between 1996 and 2014 in Finland. Children with concurrent maternal diagnoses that could cause signs and symptoms similar to PCOS were excluded. A total of 1\u00a0097\u00a0753 children were included.<\/jats:p>\n <\/jats:sec>\n \n PARTICIPANTS\/MATERIALS, SETTING, METHODS<\/jats:title>\n National registries were linked to identify births with maternal PCOS (n\u2009=\u200924\u00a0682), stratified by diabetes types. Logistic regression was used to examine the association of maternal PCOS and comorbid insulin-treated diabetes, non-insulin-treated type 2 diabetes or GDM with offspring LGA and small for gestational age (SGA). Generalized estimating equation was used to assess the risk of preterm birth in relation to maternal PCOS and diabetes. Potential interaction between PCOS and diabetes was evaluated on both additive and multiplicative scales.<\/jats:p>\n <\/jats:sec>\n \n MAIN RESULTS AND THE ROLE OF CHANCE<\/jats:title>\n Using mothers with no PCOS and no diabetes as the reference and adjusting for maternal and birth factors, there were higher risks of total (odds ratio (OR) 2.84, 95% CI 2.21\u2009\u2212\u20093.66 vs. OR 1.91, 95% CI 1.77\u2009\u2212\u20092.07, P\u2009=\u20090.01) and spontaneous (OR 4.02, 95% CI 2.94\u2009\u2212\u20095.50 vs. OR 2.35, 95% CI 2.13\u2009\u2212\u20092.59, P\u2009=\u20090.001) preterm birth for those with PCOS in mothers with non-insulin-treated type 2 diabetes and higher risks of total (OR 1.42, 95% CI 1.27\u20131.58 vs. OR 0.89, 95% CI 0.86\u20130.91, P\u2009=\u20090.0001) and spontaneous (OR 1.80, 95% CI 1.59\u20132.05 vs. OR 1.01, 95% CI 0.98\u20131.05, P\u2009=\u20090.0001) preterm birth for those with PCOS in mothers with GDM. Among mothers with type 2 diabetes, further adjusting for maternal BMI eliminated the difference in preterm birth risks between those with and those without PCOS, and adjustment for infertility treatment and pre-eclampsia also reduced the preterm risks associated with PCOS significantly. For mothers with GDM, however, the risks of total and spontaneous preterm birth remained higher for those with PCOS following these aforementioned adjustments or stratified analysis. The risk of offspring being LGA was lower for those with PCOS than those without PCOS among mothers with insulin-treated diabetes (OR 18.90, 95% CI 14.21\u201325.14 vs. OR 32.04, 95% CI 29.79\u201334.46, P\u2009=\u20090.0001), showing departure from additivity (relative excess risk due to interaction \u221211.74, 95% CI \u221216.17 to \u22127.31, P\u2009&lt;\u20090.001) and multiplicativity (P\u2009&lt;\u20090.001). PCOS did not alter the risk estimate of preterm birth in mothers with insulin-treated diabetes or offspring LGA and SGA in mothers with type 2 diabetes or GDM.<\/jats:p>\n <\/jats:sec>\n \n LIMITATIONS, REASONS FOR CAUTION<\/jats:title>\n The register-based diagnoses used in this study captured only women with PCOS seeking medical care and having live births. Including female infertility associated with anovulation as PCOS exposure was a risk for misclassification. Sample sizes for pregestational diabetes were small. Insulin purchase during pregnancy in those without a diabetes diagnosis was not accounted for in the analysis. For patients treated with insulin or other medications, we were unable to assess how they complied with such prescriptions. Also, maternal BMI was recorded only once in early pregnancy, thus the potential influence of gestational weight gain on birth outcomes could not be examined. Data on the causes for preterm birth were not available from the registers.<\/jats:p>\n <\/jats:sec>\n \n WIDER IMPLICATIONS OF THE FINDINGS<\/jats:title>\n The presence of PCOS implied higher risks of total and spontaneous preterm birth in mothers with type 2 diabetes or GDM, and lower risk of offspring being LGA in mothers with insulin-treated diabetes. The higher risks of preterm birth added by PCOS could be explained by prepregnancy BMI or in part by infertility treatment and pre-eclampsia in maternal non-insulin-treated type 2 diabetes, but not in maternal GDM. The differential effects of PCOS on the associations of different types of maternal diabetes with infant outcomes have implications for preventative strategies and clinical counseling for affected pregnancies.<\/jats:p>\n <\/jats:sec>\n \n STUDY FUNDING\/COMPETING INTEREST(S)<\/jats:title>\n This study was supported by Shandong Provincial Natural Science Foundation, China (ZR2020MH064 to X.C.), Shandong Province Medical and Health Technology Development Plan (2018WS338 to X.C.), the joint research funding of Shandong University and Karolinska Institute (SDU-KI-2019-08 to X.C. and C.L.), the Finnish National Institute for Health and Welfare: Drug and pregnancy project (M.G.), the Swedish Research Council (2014-10171 to C.L.), the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institute Stockholm County Council (SLL20170292 and SLL20190589 to C.L.), the Swedish Brain Foundation (FO2019-0201 and FO2020-0305 to C.L.). X.C. received grants from the China Scholarship Council at the beginning of the study. The authors have no competing interests to disclose.<\/jats:p>\n <\/jats:sec>\n \n TRIAL REGISTRATION NUMBER<\/jats:title>\n N\/A.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/humrep\/deac050","type":"journal-article","created":{"date-parts":[[2022,3,7]],"date-time":"2022-03-07T04:06:13Z","timestamp":1646625973000},"page":"1311-1323","source":"Crossref","is-referenced-by-count":28,"title":["Association of maternal polycystic ovary syndrome and diabetes with preterm birth and offspring birth size: a population-based cohort study"],"prefix":"10.1093","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4817-4849","authenticated-orcid":false,"given":"Xinxia","family":"Chen","sequence":"first","affiliation":[{"name":"School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University , Jinan, Shandong, China"},{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm, Sweden"},{"name":"Center for Molecular Medicine, Karolinska University Hospital , Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8254-7525","authenticated-orcid":false,"given":"Mika","family":"Gissler","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm, Sweden"},{"name":"Center for Molecular Medicine, Karolinska University Hospital , Stockholm, Sweden"},{"name":"Department of Information Services, Finnish Institute for Health and Welfare , Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4987-2718","authenticated-orcid":false,"given":"Catharina","family":"Lavebratt","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm, Sweden"},{"name":"Center for Molecular Medicine, Karolinska University Hospital , Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,3,26]]},"reference":[{"key":"2022060105571980700_deac050-B1","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1095\/biolreprod.108.067702","article-title":"Endocrine antecedents of polycystic ovary syndrome in fetal and infant prenatally androgenized female rhesus monkeys","volume":"79","author":"Abbott","year":"2008","journal-title":"Biol Reprod"},{"key":"2022060105571980700_deac050-B2","doi-asserted-by":"crossref","first-page":"139","DOI":"10.3109\/09513590.2015.1101438","article-title":"The effects of polycystic ovary syndrome on gestational diabetes mellitus","volume":"32","author":"Aktun","year":"2016","journal-title":"Gynecol Endocrinol"},{"key":"2022060105571980700_deac050-B3","doi-asserted-by":"crossref","first-page":"545","DOI":"10.3109\/14767050903214566","article-title":"Does the presence of polycystic ovary syndrome increase the risk of obstetrical complications in women with gestational diabetes?","volume":"23","author":"Alshammari","year":"2010","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2022060105571980700_deac050-B4","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1002\/pds.2159","article-title":"Nationwide register-based surveillance system on drugs and pregnancy in Finland 1996-2006","volume":"20","author":"Artama","year":"2011","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2022060105571980700_deac050-B5","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1111\/obr.12832","article-title":"The role of maternal obesity in infant outcomes in polycystic ovary syndrome\u2014a systematic review, meta-analysis, and meta-regression","volume":"20","author":"Bahri Khomami","year":"2019","journal-title":"Obes Rev"},{"key":"2022060105571980700_deac050-B6","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1093\/humupd\/dmw025","article-title":"The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance","volume":"22","author":"Balen","year":"2016","journal-title":"Hum Reprod Update"},{"key":"2022060105571980700_deac050-B7","doi-asserted-by":"crossref","first-page":"2841","DOI":"10.1093\/humrep\/dew218","article-title":"The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis","volume":"31","author":"Bozdag","year":"2016","journal-title":"Hum Reprod"},{"key":"2022060105571980700_deac050-B8","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1530\/eje.1.02200","article-title":"Maternal testosterone levels during pregnancy are associated with offspring size at birth","volume":"155","author":"Carlsen","year":"2006","journal-title":"Eur J Endocrinol"},{"key":"2022060105571980700_deac050-B9","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1210\/jc.2006-2017","article-title":"Management of the child born small for gestational age through to adulthood: a consensus statement of the International Societies of Pediatric Endocrinology and the Growth Hormone Research Society","volume":"92","author":"Clayton","year":"2007","journal-title":"J Clin Endocrinol Metab"},{"key":"2022060105571980700_deac050-B10","doi-asserted-by":"crossref","first-page":"4742","DOI":"10.1210\/jc.2007-1252","article-title":"Hormonal profile in women with polycystic ovarian syndrome with or without type 1 diabetes mellitus","volume":"92","author":"Codner","year":"2007","journal-title":"J Clin Endocrinol Metab"},{"key":"2022060105571980700_deac050-B11","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1038\/s41574-021-00576-0","article-title":"Type 1 diabetes mellitus and polycystic ovary syndrome","volume":"17","author":"Escobar-Morreale","year":"2021","journal-title":"Nat Rev Endocrinol"},{"key":"2022060105571980700_deac050-B12","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1038\/nrendo.2018.24","article-title":"Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment","volume":"14","author":"Escobar-Morreale","year":"2018","journal-title":"Nat Rev Endocrinol"},{"key":"2022060105571980700_deac050-B13","first-page":"7","article-title":"Obstetric and neonatal outcome in PCOS with gestational diabetes mellitus","volume":"8","author":"Foroozanfard","year":"2014","journal-title":"J Family Reprod Health"},{"key":"2022060105571980700_deac050-B14","doi-asserted-by":"crossref","first-page":"e0254895","DOI":"10.1371\/journal.pone.0254895","article-title":"No impact of gestational diabetes mellitus on pregnancy complications in women with PCOS, regardless of GDM criteria used","volume":"16","author":"Fougner","year":"2021","journal-title":"PLoS One"},{"key":"2022060105571980700_deac050-B15","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.fertnstert.2020.06.015","article-title":"Highly elevated level of antimullerian hormone associated with preterm delivery in polycystic ovary syndrome patients who underwent ovulation induction","volume":"115","author":"Kaing","year":"2021","journal-title":"Fertil Steril"},{"key":"2022060105571980700_deac050-B16","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1007\/s10654-011-9554-9","article-title":"Estimating measures of interaction on an additive scale for preventive exposures","volume":"26","author":"Knol","year":"2011","journal-title":"Eur J Epidemiol"},{"key":"2022060105571980700_deac050-B17","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1111\/aogs.13030","article-title":"Towards national comprehensive gestational diabetes screening\u2014consequences for neonatal outcome and care","volume":"96","author":"Koivunen","year":"2017","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2022060105571980700_deac050-B18","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1001\/jamapediatrics.2018.5541","article-title":"Associations of maternal diabetes and body mass index with offspring birth weight and prematurity","volume":"173","author":"Kong","year":"2019","journal-title":"JAMA Pediatr"},{"key":"2022060105571980700_deac050-B19","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1515\/jpm.2010.034","article-title":"Metabolic parameters and perinatal outcomes of gestational diabetes mellitus in women with polycystic ovary syndrome","volume":"38","author":"Li","year":"2010","journal-title":"J Perinat Med"},{"key":"2022060105571980700_deac050-B20","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1016\/j.fertnstert.2017.12.023","article-title":"Comparing the risk of adverse pregnancy outcomes of Chinese patients with polycystic ovary syndrome with and without antiandrogenic pretreatment","volume":"109","author":"Li","year":"2018","journal-title":"Fertil Steril"},{"key":"2022060105571980700_deac050-B21","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/S2213-8587(19)30002-6","article-title":"Use of metformin to treat pregnant women with polycystic ovary syndrome (PregMet2): a randomised, double-blind, placebo-controlled trial","volume":"7","author":"L\u00f8vvik","year":"2019","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2022060105571980700_deac050-B22","first-page":"1081","article-title":"Diabetes and pregnancy: national trends over a 15 year period","volume":"61","author":"Mackin","year":"2018","journal-title":"Diabetologia"},{"key":"2022060105571980700_deac050-B23","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1186\/s12884-020-03175-5","article-title":"Impact of comorbid polycystic ovarian syndrome and gestational diabetes mellitus on pregnancy outcomes: a retrospective cohort study","volume":"20","author":"Manoharan","year":"2020","journal-title":"BMC Pregnancy Childbirth"},{"key":"2022060105571980700_deac050-B24","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.fertnstert.2021.02.009","article-title":"Fertility outcomes in women with pre-existing type 2 diabetes-a prospective cohort study","volume":"116","author":"Mattsson","year":"2021","journal-title":"Fertil Steril"},{"key":"2022060105571980700_deac050-B25","doi-asserted-by":"crossref","first-page":"1914","DOI":"10.1093\/humrep\/deaa144","article-title":"Associations between polycystic ovary syndrome and adverse obstetric and neonatal outcomes: a population study of 9.1 million births","volume":"35","author":"Mills","year":"2020","journal-title":"Hum Reprod"},{"key":"2022060105571980700_deac050-B26","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.1093\/humrep\/deaa099","article-title":"Polycystic ovary syndrome as an independent risk factor for gestational diabetes and hypertensive disorders of pregnancy: a population-based study on 9.1 million pregnancies","volume":"35","author":"Mills","year":"2020","journal-title":"Hum Reprod"},{"key":"2022060105571980700_deac050-B27","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/S2213-8587(20)30406-X","article-title":"Characteristics and outcomes of pregnant women with type 1 or type 2 diabetes: a 5-year national population-based cohort study","volume":"9","author":"Murphy","year":"2021","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2022060105571980700_deac050-B28","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1093\/humupd\/dmv029","article-title":"Pregnancy complications in women with polycystic ovary syndrome","volume":"21","author":"Palomba","year":"2015","journal-title":"Hum Reprod Update"},{"key":"2022060105571980700_deac050-B29","doi-asserted-by":"crossref","first-page":"861","DOI":"10.2337\/dc11-1971","article-title":"The risk of a persistent glucose metabolism impairment after gestational diabetes mellitus is increased in patients with polycystic ovary syndrome","volume":"35","author":"Palomba","year":"2012","journal-title":"Diabetes Care"},{"key":"2022060105571980700_deac050-B30","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.2337\/diacare.24.6.1050","article-title":"Prevalence of polycystic ovary syndrome among premenopausal women with type 2 diabetes","volume":"24","author":"Peppard","year":"2001","journal-title":"Diabetes Care"},{"key":"2022060105571980700_deac050-B31","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.2337\/diacare.24.7.1297","article-title":"Identification of the source of androgen excess in hyperandrogenic type 1 diabetic patients","volume":"24","author":"Roldan","year":"2001","journal-title":"Diabetes Care"},{"key":"2022060105571980700_deac050-B32","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1093\/humrep\/deh098","article-title":"Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS)","volume":"19","author":"Rotterdam ESHRE\/ASRM-Sponsored PCOS Consensus Workshop Group","year":"2004","journal-title":"Hum Reprod"},{"key":"2022060105571980700_deac050-B33","doi-asserted-by":"crossref","first-page":"446","DOI":"10.3109\/07853890.2013.803739","article-title":"New population-based references for birth weight, length, and head circumference in singletons and twins from 23 to 43 gestation weeks","volume":"45","author":"Sankilampi","year":"2013","journal-title":"Ann Med"},{"key":"2022060105571980700_deac050-B34","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1016\/j.fertnstert.2016.06.040","article-title":"Polycystic ovary syndrome in type 2 diabetes: does it predict a more severe phenotype?","volume":"106","author":"Sim","year":"2016","journal-title":"Fertil Steril"},{"key":"2022060105571980700_deac050-B35","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.fertnstert.2015.04.044","article-title":"Changes in antimullerian hormone levels in early pregnancy are associated with preterm birth","volume":"104","author":"Stegmann","year":"2015","journal-title":"Fertil Steril"},{"key":"2022060105571980700_deac050-B36","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1210\/clinem\/dgab684","article-title":"Changes in serum cytokines throughout pregnancy in women with polycystic ovary syndrome","volume":"107","author":"Stokkeland","year":"2022","journal-title":"J Clin Endocrinol Metab"},{"key":"2022060105571980700_deac050-B37","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1177\/1403494812456637","article-title":"Quality of the Finnish Hospital Discharge Register: a systematic review","volume":"40","author":"Sund","year":"2012","journal-title":"Scand J Public Health"},{"key":"2022060105571980700_deac050-B38","first-page":"1887","article-title":"Robust causal inference using directed acyclic graphs: the R package \u2018dagitty\u2019","volume":"45","author":"Textor","year":"2016","journal-title":"Int J Epidemiol"},{"key":"2022060105571980700_deac050-B39","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/S2213-8587(19)30345-6","article-title":"Diabetes: a metabolic and reproductive disorder in women","volume":"8","author":"Thong","year":"2020","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2022060105571980700_deac050-B40","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1093\/humrep\/deab250","article-title":"Leveraging Northern European population history: novel low-frequency variants for polycystic ovary syndrome","volume":"37","author":"Tyrmi","year":"2022","journal-title":"Hum Reprod"},{"key":"2022060105571980700_deac050-B41","doi-asserted-by":"crossref","first-page":"e0246743","DOI":"10.1371\/journal.pone.0246743","article-title":"Polycystic ovary syndrome and extremely preterm birth: a nationwide register-based study","volume":"16","author":"Valgeirsdottir","year":"2021","journal-title":"PLoS One"}],"container-title":["Human Reproduction"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/humrep\/article-pdf\/37\/6\/1311\/43889802\/deac050.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/humrep\/article-pdf\/37\/6\/1311\/43889802\/deac050.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T05:58:33Z","timestamp":1654063113000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/humrep\/article\/37\/6\/1311\/6554412"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,26]]},"references-count":41,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,3,26]]},"published-print":{"date-parts":[[2022,5,30]]}},"URL":"https:\/\/doi.org\/10.1093\/humrep\/deac050","relation":{},"ISSN":["0268-1161","1460-2350"],"issn-type":[{"value":"0268-1161","type":"print"},{"value":"1460-2350","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,6,1]]},"published":{"date-parts":[[2022,3,26]]}}}