Adverse Child Health Outcomes Research Articles

Intimate partner violence and childhood health outcomes in 37 sub-Saharan African countries: an analysis of demographic health survey data from 2011 to 2022

Understanding the contribution of intimate partner violence (IPV) to childhood health outcomes (eg, morbidity and mortality) is crucial for improving child survival in sub-Saharan Africa. This comprehensive study aimed to explore the associations between maternal exposure to physical, sexual, or emotional violence and adverse childhood health outcomes in sub-Saharan Africa. We analysed Demographic Health Survey datasets from 37 sub-Saharan African countries from 2011 to 2022. A generalised linear mixed model was used to examine the associations between maternal physical violence, sexual violence, or emotional violence, and early childhood health outcomes (eg, acute respiratory infection, diarrhoea, undernutrition, and child mortality). A random effects meta-analysis was used to calculate pooled odds ratios (ORs) for adverse childhood health outcomes. The odds of undernutrition and mortality were 55% and 58% higher among children younger than 5 years born to mothers who were exposed to physical and sexual violence, respectively. 238 060 children younger than 5 years were included. Children whose mothers experienced physical violence (adjusted OR 1·33, 95% CI 1·29-1·42), sexual violence (1·47, 1·34-1·62), emotional violence (1·39, 1·32-1·47), or a combination of emotional and sexual violence (1·64, 1·20-2·22), or a combination of all the three forms of violence (1·88, 1·62-2·18) were associated with an increased odds of developing diarrhoeal disease. Similarly, children whose mothers experienced physical violence (1·43, 1·28-1·59), sexual violence (1·47, 1·34-1·62), emotional violence (1·39, 1·32-1·47), or a combination of emotional and sexual violence (1·48, 1·16-1·89), or a combination of all three forms of violence (1·66, 1·47-1·88) were positively associated with symptoms of acute respiratory infection. We found a strong link between maternal exposure to IPV and health outcomes for children younger than 5 years in sub-Saharan Africa, with minor variations across countries. To address childhood morbidity and mortality attributed to IPV, interventions need to be tailored for specific countries. Burkina Faso, Burundi, Chad, Comoros, Gabon, Liberia, Nigeria, Sierra Leone, South Africa, and Uganda should be priority nations. None.

Web-Based Intervention (SunnysideFlex) to Promote Resilience to Posttraumatic Stress Disorder Symptoms During Pregnancy: Development and Pilot Study.

Approximately 4% to 8% of pregnant individuals meet the criteria for current posttraumatic stress disorder (PTSD), a known risk factor for a multitude of adverse maternal and child health outcomes. However, PTSD is rarely detected or treated in obstetric settings. Moreover, available prenatal PTSD treatments require in-person services that are often inaccessible due to barriers to care. Thus, web-based interventions offer great potential in extending PTSD treatment to high-risk pregnant individuals by providing affordable, accessible care. However, there are currently no web-based interventions designed specifically for the treatment of PTSD symptoms during pregnancy. This study aims to develop and pilot a 6-week, web-based, cognitive behavioral therapy intervention for PTSD, SunnysideFlex, in a sample of 10 pregnant women with current probable PTSD. Consistent with established guidelines for developing and testing novel interventions, the focus of this pilot study was to evaluate the initial feasibility and acceptability of the SunnysideFlex intervention and preintervention to postintervention changes in PTSD and depression symptoms. This approach will allow for early refinement and optimization of the SunnysideFlex intervention to increase the odds of success in a larger-scale clinical trial. The SunnysideFlex intervention adapted an existing web-based platform for postpartum depression, Sunnyside for Moms, to include revised, trauma-focused content. A total of 10 pregnant women in weeks 16 to 28 of their pregnancy who reported lifetime interpersonal trauma exposure (ie, sexual or physical assault) and with current probable PTSD (scores ≥33 per the PTSD checklist for DSM-5) were enrolled in the SunnysideFlex intervention. Assessments took place at baseline and 6 weeks (postintervention). All participants were retained through the postintervention assessment period. Engagement was high; participants on average accessed 90% of their lessons, logged on to the platform at least weekly, and reported a generally positive user experience. Moreover, 80% (8/10) of participants demonstrated clinically meaningful reductions in PTSD symptoms from baseline to postintervention, and 50% (5/10) of participants no longer screened positive for probable PTSD at postintervention. Most (6/10, 60%) of the participants maintained subclinical depression symptoms from baseline to postintervention. Findings from this small pilot study indicate that SunnysideFlex may be a feasible and acceptable mechanism for delivering PTSD intervention to high-risk, trauma-exposed pregnant women who might otherwise not have opportunities for services. Larger-scale trials of the intervention are necessary to better understand the impact of SunnysideFlex on PTSD symptoms during pregnancy and the postpartum period.

Exploring determinants of early marriage among women in Bangladesh: A multilevel analysis.

Early marriage, defined as marriage under the age of 18, is widely recognized as a human rights violation with deleterious consequences on women's health and well-being. It persists as a significant global public health issue, predominantly being practiced in South Asian countries. In Countries like Bangladesh, this practice contributes to an increase in early pregnancies among women of reproductive age, further exacerbating adverse maternal and child health outcomes. While certain predictors of early marriage are recognized, additional investigation is warranted due to diverse socio-economic and demographic circumstances. This study, therefore, aimed to identify the prevalence and determinants of early marriage among women in Bangladesh. This study included a total weighted sample of 18,228 married women aged 18 to 49 years, extracted from the most recent nationally representative Bangladesh Demography and Health Survey (2017-18). We estimated the survey weighted pooled prevalence of early marriage among women and stratified by their different characteristics. We used multilevel mixed-effect binary logistic regression model and estimated the odds ratios (ORs) with their 95% confidence intervals (CIs) to identify the individual-, household-, and community-level factors associated with early marriage practice. All analyses were performed by Stata software version 18. Overall, 74.27% [95% CI: 73.15, 75.35] women got married before reaching the age of 18 years. Early marriage was more prevalent in Rajshahi (82.69%), Rangpur (81.35%), and Khulna division (79.32%). Women with higher education (OR = 0.10, 95% CI: 0.08, 0.12), husband's higher education (OR = 0.57, 95% CI: 0.48, 0.67), and non-Muslim women (OR = 0.46, 95% CI: 0.40, 0.52) were associated with a lower likelihood of experiencing early marriage. Compared to those household heads aged ≤35 years, the likelihood of early marriage among women was lower for those household heads aged 36-55 years (OR = 0.84, 95% CI: 0.76, 0.93) and >55 years (OR = 0.78, 95% CI: 0.69-0.88). Women aged 18-24 years (OR = 1.24, 95% CI: 1.10, 1.40), husbands with agricultural occupation (OR = 1.22, 95% CI:1.06, 1.41), middle wealth index level (OR = 1.14, 95% CI: 1.02, 1.28), family size five or more (OR = 1.21, 95% CI: 1.11, 1.31), and rural residence (OR = 1.17, 95% CI: 1.04, 1.30) were more likely to experience early marriage. This study underscores the alarming prevalence of early marriage among women in Bangladesh, with three-fourths experiencing early marriage, particularly in specific regions. Notably, women education and older household heads were significantly associated with a reduced likelihood of early marriage. Our findings suggest that culturally sensitive interventions should focus on empowering older household heads, alongside initiatives to increase awareness among younger household heads, and enhance education, particularly in rural and impoverished households. These efforts could potentially alter socio-cultural practices and reduce early marriage in Bangladesh.

Adverse childhood experiences predict anxiety during postpartum and early childhood parenting

Perinatal anxiety disorders (PAD) affect one in five pregnant/postpartum people and are associated with adverse maternal and child health outcomes. Effective treatment and prevention rely on early identification and management of risk factors. Our study fills a gap in literature about how maternal adverse childhood experiences (ACEs) relate to PAD during and beyond the postpartum period. Using longitudinal data from a population-based sample of mothers in Colorado, USA (N = 1116), we evaluated whether maternal ACEs predicted self-reported anxiety symptoms, measured six times between 3 and 36 months postpartum. A mixed mean model of anxiety was fit with ACEs as the predictor and maternal age, race, ethnicity, education, marital status, and parity as covariates. Controlling for sociodemographic covariates, mothers reporting four or more ACEs had significantly higher levels of anxiety than those reporting less than four ACEs (b = 0.84, 95% CI (0.53, 1.15), p<.001) over the three-year period. Mothers of younger age at time of birth (25–34 years vs. <24 years: b=-0.54, 95% CI (-1.00, −0.08), p=.02) and non-Hispanic ethnicity (b = 0.47, 95% CI (0.09, 0.85), p=.01) were also found to have higher anxiety over this period. Our findings support screening for and addressing maternal ACEs early in obstetric care and well-child visits through trauma-informed, strengths-based approaches that promote maternal, child, and intergenerational well-being.

Vitamin D Supply of Twins during Fetal Life, Its Relation to Anthropometric Parameters of Newborns and the Analysis of Other Factors Related to Birth Size

Background/Objectives: Vitamin D deficiencies are very common in pregnant women, raising concerns about adverse health outcomes in children. This issue has hardly been studied in multiple pregnancies, the prevalence of which has been steadily increasing. Therefore, our study investigated the relationship between newborns’ anthropometric parameters and the concentration of 25(OH)D in maternal blood of women with twin pregnancies and umbilical cord blood. Methods: The study included 50 women who gave birth after the 36th week of twin gestation. The concentration of 25(OH)D was determined in maternal blood collected during the antenatal period and in the umbilical cord blood of 100 newborns. Anthropometric parameters of the newborns (birth weight, length and head and chest circumference) were obtained from hospital records. Data on nutrition and lifestyle during pregnancy were collected from the patients during an interview conducted by a dietitian. Results: No relationship between maternal and neonatal cord blood vitamin D concentrations and any of the anthropometric parameters of the newborns was found. However, only 6% of the mothers and 13% of the newborns had vitamin D deficiency (≤20 ng/mL). The type of pregnancy and maternal height were the main factors associated with neonatal size. Newborns from dichorionic pregnancies were on average 202 g heavier (p &lt; 0.001) and 1 cm longer (p = 0.006) than newborns from monochorionic pregnancies. Newborns of mothers ≤160 cm in height had on average 206 g lower birth weight (p = 0.006) and were 3.5 cm shorter (p = 0.003) compared to newborns of taller mothers. Conclusions: Therefore, in our study, the neonatal size of twins was not related to the vitamin D status but to other factors such as the type of pregnancy and maternal height.

Exploring Screen Time and Its Effects on Children's Mental Health: A Cross-Sectional Study.

Background The increasing prevalence of screen-based activities among children has raised concerns about potential mental health effects. This study investigates the relationship between screen time and mental health outcomes in children aged 6 to 14 years in Saudi Arabia and Bahrain, focusing on emotional symptoms, conduct problems, hyperactivity, peer problems, and depressive symptoms. Methods A cross-sectional study was conducted with 670 children recruited through stratified random sampling. Data were collected using self-reported questionnaires and parental surveys from January to June 2024. Screen time was assessed across four activities: TV viewing, smartphone usage, computer/tablet use, and video game playing, recorded separately for weekdays and weekends. Mental health was evaluated using the Strengths and Difficulties Questionnaire (SDQ) and the Children's Depression Inventory (CDI). Descriptive statistics and Pearson correlation coefficients were used to analyze the data. Results Participants reported a mean total screen time of 7.25 ± 2.4 hours on weekdays and 8.4 ± 2.65 hours on weekends. Smartphone usage (2.75 ± 1.3 hours/day) was the most common activity. Emotional symptoms, conduct problems and depressive symptoms were significantly correlated with both weekday and weekend total screen time (weekday r = 0.43, r = 0.31, and r = 0.49, respectively, p < 0.001; weekend r = 0.47, r = 0.33, and r = 0.54, respectively, p < 0.001). Smartphone usage had the strongest association with depressive symptoms (r = 0.46, p < 0.001). Conclusion This study identifies a significant positive correlation between increased screen time and adverse mental health outcomes in children, particularly emotional symptoms and depressive symptoms. The findings emphasize the need for public health strategies to manage screen time and promote healthier digital habits to mitigate the potential negative effects on children's mental health.

Factors associated with essential newborn care practices among non-institutional births in urban Bangladesh: evidence from Bangladesh Urban Health Survey 2021

ABSTRACT Background Non-institutional births remain prevalent in low- and middle-income countries, associated with a majority of adverse maternal and child health outcomes, including maternal and child mortality. Ensuring essential newborn care (ENC) practices for these non-institutional births is crucial for reducing these adverse outcomes. This study aimed to identify the prevalence, and factors associated with the adoption of ENC practices among non-institutional births in urban Bangladesh. Methods A total of 2,165 children’s data were analyzed, extracted from the 35,186 ever-married women interviewed in the 2021 Bangladesh Urban Health Survey. Six ENC components and their level (lowest/none, moderate, and highest) were considered as the outcome variables. Several socio-demographic factors were considered as the explanatory variables. Multivariate binary and multinomial logistic regression model were used to explore the association between outcome and explanatory variables. Results Approximately 49% of all mothers reported practicing the highest level of ENC. Among the individual components, the highest adherence was observed for the use of a disinfected instrument to cut the umbilical cord (90%). The likelihood of adopting the highest level of ENC practices was higher among mothers with relatively higher education and wealth quintiles and lower among those residing in slum and other urban areas of city corporations compared to non-slum areas. Mothers living in the Khulna and Sylhet divisions had a lower likelihood of adopting the highest level of ENC practices. Conclusion Awareness building programs are needed to educate the population, particularly mothers, about the importance of practicing ENC for improving maternal and child health outcomes.

Exposure to agricultural pesticides and wheezing among 5-12-year-old children in the Imperial Valley, CA, USA.

Exposure to pesticides has been linked to adverse respiratory health outcomes in children. We leveraged the Children's Assessing Imperial Valley Respiratory Health and the Environment cohort located in the rural community of Imperial Valley near the US-Mexico border. We calculated the kilograms of total pesticides applied within 400 m of children's residential addresses for the years 2016-2020. Estimated pesticide usage near homes was categorized into three groups (none vs. low vs. high [split at the median]). All health variables (i.e., asthma status and wheezing) were derived from a parent-reported questionnaire on respiratory health. We used generalized linear models, controlling for child sex, the language of survey, health insurance, respondents' highest education, and exposure to environmental secondhand smoking, to calculate prevalence differences between none versus low and high exposure to agricultural pesticides. Approximately 62% of the 708 children (aged 5-12 years) lived within 400 m of at least one pesticide application within 12 months prior to survey administration. Exposure to pesticides within 400 m of children's residences was associated with 12-month prior wheeze. Those in the "high" exposure group had a prevalence of wheezing that was 10 (95% confidence interval: 2%, 17%) percentage points higher than among children not exposed to pesticide applications. Associations for high exposure to specific categories of pesticide applications, sulfur only, all pesticides except sulfur, chlorpyrifos, and glyphosate, also were observed with a higher prevalence of wheezing than among children not exposed to pesticide applications. We observed associations between living near pesticide applications and more wheeze symptoms among children.

Affective symptoms in pregnancy are associated with the vaginal microbiome

BackgroundComposition of the vaginal microbiome in pregnancy is associated with adverse maternal, obstetric, and child health outcomes. Therefore, identifying sources of individual differences in the vaginal microbiome is of considerable clinical and public health interest. The current study tested the hypothesis that vaginal microbiome composition during pregnancy is associated with an individual's experience of affective symptoms and stress exposure. MethodsData were based on a prospective longitudinal study of a medically healthy community sample of 275 mother-infant pairs. Affective symptoms and stress exposure and select measures of associated biomarkers (diurnal salivary cortisol, serum measures of sex hormones) were collected at each trimester; self-report, clinical, and medical records were used to collect detailed data on socio-demographic factors and health behavior, including diet and sleep. Vaginal microbiome samples were collected in the third trimester (34–40 weeks) and characterized by 16S rRNA sequencing. Identified taxa were clustered into three community clusters (CC1–3) based on dissimilarity of vaginal microbiota composition. ResultsResults indicate that depressive symptoms during pregnancy were reliably associated with individual taxa and CC3 in the third trimester. Prediction of functional potential from 16S taxonomy revealed a differential abundance of metabolic pathways in CC1–3 and individual taxa, including biosynthetic pathways for serotonin and dopamine. We did not find robust evidence linking symptom- and stress-related biomarkers and CCs. ConclusionsOur results provide further evidence of how prenatal psychological distress during pregnancy alters the maternal-fetal microbiome ecosystem that may be important for understanding maternal and child health outcomes.

Evaluating Emotional Eating in Children from the Perspective of Parents: Psychometric Properties of the Parent Version of the Emotional Eating Scale Adapted for Children and Adolescents.

Emotional eating is associated with adverse health outcomes in children, including elevated weight status. Currently, there is not a well-validated parent-report measure of emotional eating for young children. This study assessed the reliability and validity of the 10-item parent version of the Emotional Eating Scale Adapted for Children and Adolescents (EES-C) Short-Form. The participants were 207 parents and 144 children from the southern United States. They completed the parent- and child-report EES-C Short-Form and responded to measures related to child eating behaviors, mood, and gratitude. The parent-report EES-C Short-Form demonstrated good internal consistency reliability (Cronbach's alpha = 0.94). Test-retest reliability was also supported, as evidenced by a medium correlation (ICC = 0.56, p < 0.001) between parent-rated emotional eating across two time points. Additionally, the measure demonstrated a significant correlation with a scale of emotional overeating (r = 0.25, p < 0.001)-a theoretically related construct. Supporting discriminant validity, the measure was not significantly related to a measure of parent-reported gratitude (r = 0.07, p = 0.30). A unidimensional model provided good fit for the data (CFI = 0.997, SRMR = 0.046). The results from the current study provide preliminary evidence supporting the reliability and validity of the parent version of the EES-C Short-Form. For the purpose of screening children in school or primary care settings, the EES-C Short-Form may be practical and helpful in identifying children who may be at risk of developing adverse health outcomes or more-severe eating disorder pathology.

Unveiling the effects of energy poverty on mental health of children in energy-poor countries

While existing literature extensively investigates the adverse effects of energy poverty on physical health, exploring its impacts on the mental well-being of school-aged children (5–14 years old) remain underexplored, particularly in the energy-deprived regions of South Asia and Sub-Saharan Africa. This research aims to bridge this gap by delving into the indirect pathways through which energy poverty influences the mental health of these children, explicitly examining anxiety and depression, with a particular focus on child abuse as a potential mediating factor. This study employs comprehensive data at both the country level, covering 52 energy-poor nations from 2000 to 2019, and the household level, covering 18 energy-poor nations. This study utilizes a two-step system generalized method of moment approach to unveil the significant relationships between energy poverty and heightened levels of anxiety and depression. Furthermore, the study employs advanced statistical methods to analyze household-level data, including multilevel logistic regression, Probit instrumental regression models, and mediation analysis. These analyses confirm a robust association between energy poverty and an increased likelihood of anxiety and depression among school-aged children. The study also uncovers a concerning link between energy poverty and child abuse, emphasizing its role as a contributing factor to adverse mental health outcomes in children. The findings of this study offer critical insights for policymakers, highlighting the urgent need for targeted interventions and policies aimed at alleviating the adverse mental health effects of energy poverty on children. By addressing this issue, policymakers can contribute to fostering children's overall well-being and development in energy-poor regions.

Where have I got to? Associations of age at marriage with marital household assets in educated and uneducated women in lowland Nepal.

Women's underage marriage (<18 years) is associated with adverse maternal and child health outcomes. Poverty in the natal household has been widely considered to be a key risk factor for underage marriage, but the evidence base is unreliable. When investigating this issue, most studies use marital wealth inappropriately, as a proxy for wealth in the natal household. In contrast, we investigated whether the timing of women's marriage was associated with the wealth of the households they marry into, and how this may vary by women's education level. This approach allows us to explore a different set of research questions which help to understand the economic value placed on the timing of women's marriage. We used data on 3,102 women aged 12-34 years, surveyed within 1 year of marriage, from the cluster-randomized Low Birth Weight South Asia Trial in lowland rural Nepal. Linear mixed-effects regression models investigated independent associations of women's marriage age and education level with marital household wealth, and their interactive effects. Models adjusted for marital household traits. We analysed the full sample, and then only the uneducated women, who comprised a substantial proportion in our sample. In the full sample, we found that each later year of women's marriage was associated with 1.5% lower asset score for those with primary education, and with 0.3% and 1.3% higher asset score for those with lower secondary or secondary/higher education, respectively. For uneducated women, relative to marrying ≤14 years, marrying at 15, 16, 17 and ≥18 years was associated with 1.5%, 4.4%, 2.4% and 6.2% greater marital asset score respectively. On average, marrying ≥18 years was associated with greater marital assets for secondary-educated women. There were only very modest benefits in terms of marital household wealth for delaying marriage beyond 16 years for uneducated women or those with low education. These findings elucidate potential trade-offs faced by families, including decisions over how much education, if any, to provide to daughters. They may help to understand the economic rationale underpinning the timing of marriage, and why early marriage remains common despite efforts to delay it.

Potential Health Risks of Indoor Particulate Matter Heavy Metals in Resource-Constrained Settings of South Africa

Evidence suggests that pollutants like particulate matter and heavy metals significantly impact health. This study investigated the determinants and sources of indoor PM2.5 heavy metals and assessed the health risk to children in Durban. Thirty households of mothers participating in the mother and child in the environment (MACE) birth cohort study were assessed for PM2.5 heavy metals. Multivariate linear regression was used to identify the determinants of PM2.5 heavy metals, while Pearson correlation and principal component analysis identified their sources. The health risk for children was assessed using measured metal concentrations. Proximity to industry, wall type, house age, and presence of windows increased some PM2.5 heavy metals, while cross ventilation reduced indoor PM2.5 As and Cu levels. Pearson correlation and principal component analysis indicated household, traffic, industrial, and natural sources as potential contributors. The health index was greater than 1, and cancer risk values for PM2.5 As and Pb exceeded acceptable levels. The findings highlight the toxicity of indoor air due to heavy metals and the potential for adverse health outcomes in children. To protect vulnerable groups, it is essential to prevent exposure to high-risk metals.

Termination of Parental Rights on the Grounds of Intellectual/Developmental Disability: An Overlooked Policy and Health Issue

ABSTRACTIn the United States, 37 states and 4 territories allow for the termination of parental rights (TPR) due to parental disability. Twenty‐eight of these states and all four of the territories specifically include parental intellectual developmental disability (IDD). Policies that call for the TPR based on factors outside of parental abuse or neglect have myriad negative effects on individuals, families and communities, including long‐term adverse health outcomes for children who have been removed from parental custody, delays in prenatal care for pregnant people whose stigmatized identities may result in involuntary TPR and an increased burden on already overtaxed child welfare systems. This paper analyses policies and proposes an alternative policy modelled after advocacy from other groups of parents with marginalized identities.

Exposure to parental problem drinking during adolescence and symptoms of depression and anxiety in young adulthood: A Swedish national cohort study.

Previous research has shown associations between parental problem drinking and adverse mental health outcomes in children. However, while many studies assess parental alcohol problems based on clinical measures, longitudinal studies that investigate the impact of potentially less severe levels of parental alcohol problems are scarce. The aim of this study was to examine if the existence and severity of child-reported parental problem drinking in adolescence is associated with symptoms of depression and anxiety in young adult men and women. Data was obtained from the Swedish national cohort study Futura01, including 3143 participants born in 2001 who were surveyed in 2017 (age 15-16) and 2022 (age 20-21). Parental problem drinking was measured at age 15-16 with the short version of The Children of Alcoholics Screening Test. Depression and anxiety symptoms were measured at age 20-21 with the Patient Health Questionnaire-4. Registry information on gender, parental education and parental country of birth were included as covariates. The results demonstrated an exposure-response pattern, with greater severity of parental problem drinking associated with an increased probability of reporting depression and anxiety symptoms 5 years later. The association between parental problem drinking and subsequent depression symptoms was however present only in females. Adolescents exposed to parental problem drinking have elevated risks of long-term adverse mental health. These risks increase with greater severity of parental problem drinking. It is thus crucial with efforts preventing parental problem drinking and efforts promoting health among children and adolescents who are exposed.

Short term air pollution exposure during pregnancy and associations with maternal immune markers

BackgroundAir pollution exposure during pregnancy has been associated with numerous adverse pregnancy, birth, and child health outcomes. One proposed mechanism underlying these associations is maternal immune activation and dysregulation. We examined associations between PM2.5 and NO2 exposure during pregnancy and immune markers within immune function groups (TH1, TH2, TH17, Innate/Early Activation, Regulatory, Homeostatic, and Proinflammatory), and examined whether those associations changed across pregnancy. MethodsIn a pregnancy cohort study (n = 290) in Rochester, New York, we measured immune markers (using Luminex) in maternal plasma up to 3 times during pregnancy. We estimated ambient PM2.5 and NO2 concentrations at participants’ home addresses using a spatial-temporal model. Using mixed effects models, we estimated changes in immune marker concentrations associated with interquartile range increases in PM2.5 (2.88 μg/m3) and NO2 (7.82 ppb) 0–6 days before blood collection, and assessed whether associations were different in early, mid, and late pregnancy. ResultsIncreased NO2 concentrations were associated with higher maternal immune markers, with associations observed across TH1, TH2, TH17, Regulatory, and Homeostatic groups of immune markers. Furthermore, the largest increases in immune markers associated with each 7.82 ppb increase in NO2 concentration were in late pregnancy (e.g., IL-23 = 0.26 pg/ml, 95% CI = 0.07, 0.46) compared to early pregnancy (e.g., IL-23 = 0.08 pg/ml, 95% CI = −0.11, 0.26). ConclusionsResults were suggestive of NO2-related immune activation. Increases in effect sizes from early to mid to late pregnancy may be due to changes in immune function over the course of pregnancy. These findings provide a basis for immune activation as a mechanism for previously observed associations between air pollution exposure during pregnancy and reduced birthweight, fetal growth restriction, and pregnancy complications.

Particulate Matter Exposure and Default Mode Network Equilibrium During Early Adolescence.

Background: Air pollution exposure has been associated with adverse cognitive and mental health outcomes in children, adolescents, and adults, although youth may be particularly susceptible given ongoing brain development. However, the neurodevelopmental mechanisms underlying the associations among air pollution, cognition, and mental health remain unclear. We examined the impact of particulate matter (PM2.5) on resting-state functional connectivity (rsFC) of the default mode network (DMN) and three key attention networks: dorsal attention, ventral attention, and cingulo-opercular. Methods: Longitudinal changes in rsFC within/between networks were assessed from baseline (9-10 years) to the 2-year follow-up (11-12 years) in 10,072 youth (M ± SD = 9.93 + 0.63 years; 49% female) from the Adolescent Brain Cognitive Development (ABCD®) study. Annual ambient PM2.5 concentrations from the 2016 calendar year were estimated using hybrid ensemble spatiotemporal models. RsFC was estimated using functional neuroimaging. Linear mixed models were used to test associations between PM2.5 and change in rsFC over time while adjusting for relevant covariates (e.g., age, sex, race/ethnicity, parental education, and family income) and other air pollutants (O3, NO2). Results: A PM2.5 × time interaction was significant for within-network rsFC of the DMN such that higher PM2.5 concentrations were associated with a smaller increase in rsFC over time. Further, significant PM2.5 × time interactions were observed for between-network rsFC of the DMN and all three attention networks, with varied directionality. Conclusion: PM2.5 exposure was associated with alterations in the development and equilibrium of the DMN-a network implicated in self-referential processing-and anticorrelated attention networks, which may impact trajectories of cognitive and mental health symptoms across adolescence.

Gestational weight gain below recommendations and adverse maternal and child health outcomes for pregnancies with overweight or obesity: a United States cohort study

BackgroundThe current Institute of Medicine (IOM) pregnancy weight gain guidelines were developed using the best available evidence but were limited by substantial knowledge gaps. Some have raised concern that the guidelines for individuals affected by overweight or obesity are too high and contribute to short- and long-term complications for the mother and child. ObjectivesTo determine the association between pregnancy weight gain below the lower limit of the current IOM recommendations and risk of 10 adverse maternal and child health outcomes among individuals with overweight and obesity. MethodsWe used data from a prospective cohort study of United States nulliparae with prepregnancy overweight (n = 955) or obesity (n = 897) followed from the first trimester to 2–7 y postpartum. We used multivariable Poisson regression to relate pregnancy weight gain z-scores with a severity-weighted composite outcome consisting of ≥1 of 10 adverse outcomes (gestational diabetes, preeclampsia, unplanned cesarean delivery, maternal postpartum weight increase >10 kg, maternal postpartum metabolic syndrome, infant death, stillbirth, preterm birth, small-for-gestational age birth, and childhood obesity). ResultsPregnancy weight gain z-scores below, within, and above the IOM-recommended ranges occurred in 5%, 13%, and 80% of pregnancies with overweight and 17%, 13%, and 70% of pregnancies with obesity. There was a positive association between pregnancy weight gain z-scores and all adverse maternal outcomes, childhood obesity, and the composite outcome. Pregnancy weight gain z-scores below the lower limit of the recommended ranges (<6.8 kg for overweight, <5 kg for obesity) were not associated with the severity-weighted composite outcome. For example, compared with the lower limit, adjusted rate ratios (95% confidence interval) for z-scores of −2 standard deviations in pregnancies with overweight (equivalent to 3.6 kg at 40 wk) and obesity (−2.8 kg at 40 wk) were 0.99 (95% confidence interval [CI]: 0.91, 1.06) and 0.97 (95% CI: 0.87, 1.07). ConclusionsThese findings support arguments to decrease the lower limit of recommended weight gain ranges in these prepregnancy body mass index groups.

Vulnerability in Children with Celiac Disease: Findings from a Scoping Review.

(1) Background: The scientific literature highlights that children diagnosed with celiac disease (CD) are at a heightened risk of experiencing physical, psychological, and social challenges, impacting their overall healthy childhood development. However, there remains a lack of a clear understanding regarding the factors that contribute to this vulnerability. The purpose of this study is to analyze and map the evidence on the sociopsychosomatic vulnerability of these children and identify gaps in this topic. (2) Methods: Following Joanna Briggs Institute's guidelines for scoping reviews, we executed a detailed search of key electronic databases and explored the grey literature to capture a broad spectrum of studies. Our focus was on identifying research that looked into the multiple dimensions of vulnerability-physical, psychological, and social-in children with CD. We included a diverse range of study designs as well as systematic reviews, ensuring a comprehensive analysis. The selection process was stringent, utilizing clearly defined inclusion and exclusion criteria. (3) Results: We identified 61 studies that met our inclusion criteria. The review highlighted significant adverse health outcomes in children with CD and elucidated various individual and environmental determinants that influenced these vulnerabilities. It also underscored the lack of assessment tools to evaluate the risk of health problems in this population. (4) Conclusions: The findings underscore a critical need for further research to deepen our understanding of the vulnerabilities associated with CD in children. Developing targeted assessment tools will be crucial in stratifying health risks and enhancing care strategies for this vulnerable population.

Prevalence and associations between micronutrient deficiencies and growth indicators of 10-18-year-old female adolescents living in Vietnam

Although in recent decades progress has been made in reducing the global burden of micronutrient deficiencies (MNDs), nonetheless MNDs prevalence remains high in some populations(1). Among the micronutrients, deficiencies in iron, zinc and vitamin A are particularly prevalent, and causally associated with adverse health outcomes for children and adolescents. The aim of this study was to examine the prevalence and associations between MNDs and components of the double burden of malnutrition in female adolescents utilizing the nationally representative Vietnam General Nutrition Survey 2020.1,471 female adolescents were included and categorised into: pre-adolescent (10-12-year-old), middle-adolescent (13-15-year-old), and late-adolescent (16-18-year-old) groups. Biomarkers of micronutrients, anthropometry, and sociodemographic data were selected for analyses. WHO growth reference values were applied to define stunting (height-for-age z-score (HAZ) &lt; −2 SD), thinness (BMI-for-age z-score (BAZ) &lt; −2 SD) and overweight (BAZ &gt; 1). Iron deficiency was defined as serum ferritin&lt;15μg/L (&lt;70 μg/L for individuals with inflammation), vitamin A insufficiency (VAI) as serum retinol&lt;1.05 μmol/L, zinc deficiency was based on Zinc International Consultative Group Recommendation, and inflammation as C-reactive protein &gt;5 mg/L or α1-acid glycoprotein &gt;1 g/L. One or multiple MNDs were defined as individuals with ≥ 1 MNDs.Data were analysed by STATA 17 (STATA Corporation, US). Descriptive and logistic regression analyses were performed based on the sampling weight adjustments for the estimation at population level. Multivariate logistic regressions between MNDs and growth indicators were presented as crude (COR) and 95% confidence intervals or adjusted odds ratio (AOR), after adjusting for sociodemographic variables (age, ecological area, demographic, ethnicity, and wealth index) and inflammation.Compared to the pre-adolescent group, prevalence of stunting doubled in late adolescence (12.4% to 26.8%). Meanwhile, the prevalence of overweight and thinness decreased with age (29.7% to 22.0% and 9.4% to 2.7%, respectively). Overall, the prevalence of MNDs increased with age. Zinc deficiency occurred most often in the entire cohort (39.8% in 10-18) and contributed the most to multi-MNDs. Prevalence of one or multiple MNDs increased with age, from 58.1% in pre-adolescence to 80% in late adolescence. In logistic regression analyses adjusting for inflammation and sociodemographic factors, stunting increased the risk of having ≥1 MNDs (AOR: 1.94 (1.3, 2.88), p=0.002), but not individual MND alone. Thinness increased the risk of VAI (AOR: 2.38 (1.34, 4.22), p=0.005). No association was found between any MND and overweight, although overweight was protective against zinc deficiency (COR: 0.76 (0.59, 0.99), p=0.04) in the unadjusted model.Female late adolescents in Vietnam had a higher prevalence of stunting and MNDs, but lower prevalence of thinness and overweight in comparison to pre-adolescents. Stunting was a risk factor associated with having one or multiple MNDs. Thinness was associated with higher risk of VAI. No association was found between overweight and MNDs in this cohort.