Adverse Child Health Outcomes Research Articles

Novel DNA methylation sites associated with cigarette smoking among African Americans

ABSTRACTIntroduction: Cigarette smoking has been associated with adverse health outcomes for mothers and children and is a major contributor to heart disease. Although cigarette smoking is known to affect the epigenome, few studies have been done in African American populations. In this study, we investigated the association between cigarette smoking and DNA methylation (DNAm) among African Americans from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure Study (InterGEN), and the Genetic Epidemiology Network of Arteriopathy (GENOA).Methods: The InterGEN study aims to examine the effects of genetic and psychological factors on blood pressure among African American women and their children. Current cigarette smoking was assessed at baseline. DNAm of saliva was assessed using the 850K EPIC Illumina BeadChip for Epigenome-Wide Association analyses. A replication study was conducted among 1100 participants in the GENOA study using the same BeadChip.Results: After controlling for age, body mass index, population structure and cell composition, 26 epigenome-wide significant sites (FDR q < 0.05) were identified, including the AHRR and PHF14 genes associated with atherosclerosis and lung disease, respectively. Six novel CpG sites were discovered in the InterGEN sample and replicated in the GENOA sample. Genes mapped include RARA, FSIP1, ALPP, PIK3R5, KIAA0087, and MGAT3, which were largely associated with cancer development.Conclusion: We observed significant epigenetic associations between smoking and disease-associated genes (e.g., cardiovascular disease, lung cancer). Six novel CpG sites were identified and replicated across saliva and blood samples.

Material Hardships and Health Care Utilization Among Low-Income Children with Special Health Care Needs

ObjectiveMaterial hardships, defined as difficulty meeting basic needs, are associated with adverse child health outcomes, including suboptimal health care utilization. Children with special health care needs (CSHCN) may be more vulnerable to the effects of hardships. Our objective was to determine associations between material hardships and health care utilization among CSHCN. MethodsWe conducted a cross-sectional study surveying caregivers of 2- to 12-year-old CSHCN in a low-income, urban area. Independent variables were parent-reported material hardships: difficulty paying bills, food insecurity, housing insecurity, and health care hardship. Dependent variables were parent-reported number of emergency department (ED) visits, any hospital admission, and any unmet health care need. We used negative binomial and logistic regression to assess for associations between each hardship and each outcome. ResultsWe surveyed 205 caregivers between July 2017 and May 2018 and analyzed the data in 2018. After adjustment, difficulty paying bills (incidence rate ratio [IRR], 1.51; 95% confidence interval [CI], 1.08–2.12) and health care hardship (IRR, 1.72; 95% CI, 1.08–2.75) were associated with higher rates of ED visits. There were no associations between hardships and hospital admission. Difficulty paying bills (adjusted odds ratio [AOR], 2.13; 95% CI, 1.14–3.98), food insecurity (AOR, 1.95; 95% CI, 1.02–3.71), and housing insecurity (AOR, 2.71; 95% CI, 1.36–5.40) were associated with higher odds of unmet health care need. ConclusionsMaterial hardships were associated with higher rates of ED visits and greater unmet health care need among low-income CSHCN. Future examination of the mechanisms of these associations is needed to enhance support for families of CSHCN.

Effects of birth spacing on adverse childhood health outcomes: evidence from 34 countries in sub-Saharan Africa

Background: Interpregnancy intervals (IPI) are independently associated with maternal, perinatal, infant and child outcomes. Birth spacing is a recommended tool to reduce adverse health outcomes especially among children. This study aims to determine the prevalence of adverse child health outcomes in sub-Saharan Africa (SSA) countries and to examine the association between the length of preceding birth interval child health outcomes.Methods: Secondary data from Demographic and Health Survey (DHS) in 34 SSA countries with 299 065 births was used in this study. The outcome variables were infant mortality, low birth weight, stunting, underweight, wasting, overweight and anemia. Percentage was used in univariate analysis. Cox proportional hazard regression was used to examine association between the adjusted model of preceding birth interval and infant mortality. Multinomial and binary logistic regression models were used to examine the association between under-five children adverse health outcomes and interpregnancy birth interval.Results: Infant mortality was lowest in Gambia (3.4%) and highest in Sierra Leone (9.3%). Comoros (16.8%) accounted for the highest percentage of low birth weight (<2.5 kg). Child stunting was as high as 54.6% in Burundi. IPIs of <24 months, 24–36 months, 37–59 months and ≤60 months accounted for 19.3, 37.8, 29.5 and 13.4% respectively. Median IPI was 34 months. Results from Cox proportional hazard regression showed that children with preceding birth interval <24 months had 57% higher risk of infant mortality, compared to children with IPI of 24–36 months (Hazard ratio (HR) = 1.57; 95%CI: 1.45, 1.69). However, there were 19% and 10% reduction in the risk of infant mortality at IPIs of 37–59 months and ≥60 months, compared to 24–36 months IPI (37–59 months: HR = 0.81; 95%CI: 0.75, 0.87; ≥60 months: HR = 0.90; 95%CI: 0.81, 0.99).Conclusion: The findings of this study suggest the need for urgent intervention to promote the recommended interpregnancy interval of 24–36 months to reduce adverse child health outcomes. These data also bring into limelight the importance of exclusive breastfeeding to enhance proper nutritional approach and to prolong lactational amenorrhea. Health care system stakeholders would find this study interesting as a base for policy formulation and implementation.

Identifying clusters from multidimensional symptom trajectories in postpartum women.

Depressive symptoms, stress, fatigue, and lack of sleep are often experienced by women in the perinatal period and are potential contributors to adverse maternal and child health outcomes. To explore the evolution of symptoms and identify groups of women of similar severity and patterns, we utilized clustering of multidimensional symptom trajectories. In an observational study data were collected from pregnant women in the 3rd trimester (36 weeks prenatal) and in the postnatal period at weeks 1 and 2 as well as at 1-, 2-, 3-, and 6-months postpartum. Depressive symptoms and maternal stress were measured using the Edinburg Postnatal Depression Scale (EPDS) and the Perceived Stress Scale (PSS), respectively. Self-reported duration of sleep and levels of fatigue also were collected. A model-based clustering approach was used to classify women by their symptom severity. The sample included 151 pregnant women with a 6-month follow-up. Two clusters were identified. Cluster 1 (n = 43) comprised women with fewer depressive symptoms, less perceived stress, lower likelihood of being fatigued, increased sleep duration and a negative trend in EPDS (β = -0.05, CI [-0.09, -0.001]), and PSS (β = -0.09, CI [-0.17, -0.01]). Cluster 2 (n = 108) comprised women with higher EPDS and PSS scores, increased likelihood of fatigue and lower sleep duration with a positive trend in sleep hours (β = -0.02, CI [0.01, 0.03]). Pro-inflammatory markers interleukin-6 and tumor necrosis factor-α were associated with longer sleep duration and fewer depressive symptoms, respectively. Using this methodology in maternal and child health research can potentially predict women's risk of developing severe symptoms and help clinicians provide timely interventions.

Mercury Exposure and Poor Nutritional Status Reduce Response to Six Expanded Program on Immunization Vaccines in Children: An Observational Cohort Study of Communities Affected by Gold Mining in the Peruvian Amazon.

Background: Poor nutritional status combined with mercury exposure can generate adverse child health outcomes. Diet is a mediator of mercury exposure and evidence suggests that nutritional status modifies aspects of mercury toxicity. However, health impacts beyond the nervous system are poorly understood. This study evaluates antibody responses to six vaccines from the expanded program on immunization (EPI), including hepatitis B, Haemophilus influenzae type B, measles, pertussis, tetanus, and diphtheria in children with variable hair mercury and malnutrition indicators. Methods: An observational cohort study (n = 98) was conducted in native and non-native communities in Madre de Dios, Peru, a region with elevated mercury exposure from artisanal and small-scale gold mining. Adaptive immune responses in young (3–48 months) and older children (4–8 year olds) were evaluated by vaccine type (live attenuated, protein subunits, toxoids) to account for differences in response by antigen, and measured by total IgG concentration and antibody (IgG) concentrations of each EPI vaccine. Mercury was measured from hair samples and malnutrition determined using anthropometry and hemoglobin levels in blood. Generalized linear mixed models were used to evaluate associations with each antibody type. Results: Changes in child antibodies and protection levels were associated with malnutrition indicators, mercury exposure, and their interaction. Malnutrition was associated with decreased measles and diphtheria-specific IgG. A one-unit decrease in hemoglobin was associated with a 0.17 IU/mL (95% CI: 0.04–0.30) decline in measles-specific IgG in younger children and 2.56 (95% CI: 1.01–6.25) higher odds of being unprotected against diphtheria in older children. Associations between mercury exposure and immune responses were also dependent on child age. In younger children, one-unit increase in log10 child hair mercury content was associated with 0.68 IU/mL (95% CI: 0.18–1.17) higher pertussis and 0.79 IU/mL (95% CI: 0.18–1.70) higher diphtheria-specific IgG levels. In older children, child hair mercury content exceeding 1.2 µg/g was associated with 73.7 higher odds (95% CI: 2.7–1984.3) of being a non-responder against measles and hair mercury content exceeding 2.0 µg/g with 0.32 IU/mL (95% CI: 0.10–0.69) lower measles-specific antibodies. Log10 hair mercury significantly interacted with weight-for-height z-score, indicating a multiplicative effect of higher mercury and lower nutrition on measles response. Specifically, among older children with poor nutrition (WHZ = −1), log10 measles antibody is reduced from 1.40 to 0.43 for low (<1.2 µg/g) vs. high mercury exposure, whereas for children with good nutritional status (WHZ = 1), log10 measles antibody is minimally changed for low vs. high mercury exposure (0.72 vs. 0.81, respectively). Conclusions: Child immune response to EPI vaccines may be attenuated in regions with elevated mercury exposure risk and exacerbated by concurrent malnutrition.

Client-tailored maternity care to increase maternal empowerment: cluster randomized controlled trial protocol; the healthy pregnancy 4 All-2 program

BackgroundThe postpartum period is an important period for preventive strategies as common maternal and child health risks may become manifest. Women with a lower socioeconomic status tend to have lower maternal empowerment. Increasing their risks of adverse maternal and child health outcomes. This study aims to assess the effectiveness of a primary care level intervention. Delivered to maternity care assistants, aiming to increase maternal empowerment postpartum.MethodsThis study is part of the Dutch nationwide “Healthy Pregnancy 4 All-2” (HP4All-2) program, which aims to identify vulnerable mothers and young children at risk of adverse health outcomes, and subsequently improve their care. This program targets women from deprived neighborhoods.A pragmatic cluster randomized controlled trial will be undertaken in 12 maternity care organizations. Maternity care organizations in urban municipalities (i.e. the clusters) will be randomized to either a systematic risk assessment during pregnancy with emphasis on identification of non-medical risk factors for adverse maternal and neonatal health outcomes, and subsequent adaptation of care towards a client-tailored approach during pregnancy and the postpartum period, or solely the systematic risk assessment. The primary outcome is the prevalence of a low maternal empowerment score postpartum. Secondary maternal outcomes cover health-related quality of life, postnatal depression, smoking, alcohol consumption, illicit drug use. Finally, maternal and neonatal health care utilization postpartum are recorded. All outcomes will be analyzed according to the intention-to-treat principle, using multi-level mixed effects models.DiscussionThe study will contribute to evidence regarding the effectiveness of client-tailored, risk-based maternity care to increase maternal empowerment postpartum.Trial registrationNetherlands Trial Registry (NTR) 6311, registered 03-27-2017.

Screening for and Managing Parental Depression within the Primary Care Setting to Prevent Adverse Child Health Outcomes

Screening for and Managing Parental Depression within the Primary Care Setting to Prevent Adverse Child Health Outcomes

The perception of pre- and post-natal marijuana exposure on health outcomes: A content analysis of Twitter messages.

The prevalence of marijuana use during pregnancy ranges from 3-30% , and most of this is for recreational purposes. Marijuana exposure during pregnancy has been linked with low birth weight babies and other adverse child health outcomes. Twitter is a popular news and social networking outlet, and is frequently used to access information about population health and behavior. The primary objective of this study was to investigate the types of messages disseminated on Twitter about marijuana use and infant and maternal health. The secondary objective was to describe the reported health outcomes associated with prenatal and postnatal marijuana use. Tweets were collected from the inception of Twitter (2006) until April 2017. If tweets included links, these links were examined to investigate the source of the message and to clarify the user's intent. In total, 550 tweets were captured, with most tweets (77.6%) having a neutral tweet tone, suggesting uncertainty about the health effects associated with pre- and post-natal marijuana exposure. The sources attached to the original tweets, however, were more likely to report on negative health outcomes. The most common health outcomes associated with prenatal marijuana exposure were: poor brain development (27.3%), inadequate development of the nervous system (23.6%), low birth weight (23.3%), poor behavioral outcomes (21.0%), and infant memory issues (19.3%). The inverse association between marijuana use and the quality and quantity of milk produced by the mother was the most commonly reported tweet for the lactation period.

Are We Serving the Most At-Risk Communities? Examining the Reach of a South Carolina Home Visiting Program.

In addition to individual-level characteristics, characteristics of the social and physical environments in which individuals reside may adversely impact health outcomes. Careful attention to the role of "place" can result in programs that successfully deliver services to those most at risk. This retrospective, cross-sectional study used geocoded residential addresses from 3090 households enrolled in a South Carolina (SC) home visiting program, 2013-2016, and corresponding years of data for maternal and child health outcomes obtained from vital records data. ZIP Code Tabulation Areas (ZCTAs) served as the primary geographic unit of analysis. ZCTAS with high volumes of birth or adverse maternal and child health outcomes for any of 10 indicators were flagged. Distribution of enrolled households across highest-risk ZCTAs was calculated. Of 379 ZCTAS with reported data, 152 had 8 or more risk flags. Of the 152 highest-risk ZCTAs, 33 also had high birth volumes. Fifty-seven of the 152 highest-risk ZCTAs had no enrollees; seven of the 33 highest-risk/highest-volume ZCTAS had no enrollees. Service delivery gaps existed despite a statewide, county-level needs assessment conducted prior to program implementation. This study suggests methods to identify service areas of need, as an ongoing effort toward program improvement.

Inter-partner violence during pregnancy, maternal mental health and birth outcomes in Vietnam: A systematic review

IntroductionIntimate partner violence (IPV) is common worldwide and associated with maternal mental disorders and adverse child health outcomes. Research in this field in Vietnam is still nascent, although some substantial studies have emerged in recent years. The objective of this review was to estimate the prevalence of IPV during pregnancy in Vietnam and examine its impact upon women and children at an early age. MethodsWe searched seven bibliographic databases (from 1970 to 2018), browsed grey literature sources, and consulted experts. Two review authors independently extracted data and assessed risk of bias with using the Newcastle – Ottawa Quality Assessment Tool for non-randomized studies. A meta-analysis was conducted using the Mantel-Haenszel fixed-effect approach to estimate pooled effect (odds ratio) of Prenatal IPV (P-IPV) on maternal Common Mental Disorder (CMD). ResultsThe selection process produced eight eligible studies of 4598 participants. Six studies were pooled. The estimated proportions of IPV during pregnancy ranged from 5.9% to 32.5% depending on the form of IPV. P-IPV is strongly associated with greater risk of both mental disorders and adverse birth outcomes (preterm labor and low-birth-weight). The meta-analysis revealed that women exposed to P-IPV have a 4-fold increased risk for prenatal CMD compared to non-abused peers (OR = 3.69, 95% CI (2.51–5.42), I2 = 36%). Women exposed to physical P-IPV had five-fold increased odds of premature labour, OR = 5.5, 95% CI (2.1–14.1) and almost six-fold increased odds of having low-birth-weight neonates, OR = 5.7, 95% CI (2.2–14.9). DiscussionTo improve mother and child well-being in Vietnam, multifaceted health policies should include routine screening for IPV and mental disorders in the antenatal care system. Taken together, the evidence supports calls for national programs in Vietnam to eliminate gender inequality and promote awareness of the serious harms caused by IPV.

Determinants of prenatal exposure to perfluoroalkyl substances in the Slovak birth cohort

BackgroundPerfluoroalkyl substances (PFASs) are man-made fluorinated compounds with endocrine-disrupting properties, detected in 99% of serum samples worldwide and associated with adverse childhood health outcomes. The aim of this study was to describe determinants of prenatal exposure to PFASs in Slovakia. MethodsThis study was based on Slovak multicentric prospective mother-child cohort PRENATAL (N = 796). Cord blood samples were collected within 2010–2012 and PFASs were analyzed in a subpopulation of 322 newborns. Concentrations of perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), perfluorooctanoic acid (PFOA) and perfluorononanoic acid (PFNA) were measured in the samples of cord blood using an ultrahigh-performance liquid chromatography- mass spectrometry (U-HPLC−MS) method. From questionnaires, we obtained information on medical history of mother, socio-demographic factors, nutrition and environmental factors. Association between maternal characteristics and PFASs exposure was analyzed using multivariable linear regression models. ResultsThe highest cord blood concentration (geometric mean ± SD) was observed for PFOA (0.79 ± 2.21 ng/ml) followed by PFOS (0.36 ± 2.56 ng/ml), PFNA (0.20 ± 2.44 ng/ml) and PFHxS (0.07 ± 2.36 ng/ml). Primiparity was associated with higher levels of all four PFAS: PFOS (exp. β = 1.25; 95%CI[1.03; 1.53]), PFOA (exp. β = 1.49; 95%CI[1.18; 1.89]), PFNA (exp. β = 1.30; 95%CI[1.05; 1.60]) and PFHxS (exp. β = 1.49; 95%CI [1.20; 1.86]). In addition, maternal age category 29 years and more was associated with higher PFNA and PFHxS levels (exp. β = 1.27; 95%CI[1.04; 1.55] and exp. β = 1.30; 95%CI[1.06; 1.60], respectively) and higher educational level of mother was associated with higher PFNA levels (exp. β = 1.32; 95%CI[1.04; 1.68]). Higher fish consumption was associated with lower PFNA levels (exp. β = 0.49; 95%CI[0.26; 0.92]). ConclusionsWe observed that PFASs cord blood concentrations were comparable or lower than those measured in western or northern European countries. We identified parity as the main determinant of PFASs exposure in our population and maternal age and education as factors that might be associated with exposure to certain PFASs.

Gestational weight gain charts for different body mass index groups for women in Europe, North America, and Oceania

BackgroundGestational weight gain differs according to pre-pregnancy body mass index and is related to the risks of adverse maternal and child health outcomes. Gestational weight gain charts for women in different pre-pregnancy body mass index groups enable identification of women and offspring at risk for adverse health outcomes. We aimed to construct gestational weight gain reference charts for underweight, normal weight, overweight, and grades 1, 2 and 3 obese women and to compare these charts with those obtained in women with uncomplicated term pregnancies.MethodsWe used individual participant data from 218,216 pregnant women participating in 33 cohorts from Europe, North America, and Oceania. Of these women, 9065 (4.2%), 148,697 (68.1%), 42,678 (19.6%), 13,084 (6.0%), 3597 (1.6%), and 1095 (0.5%) were underweight, normal weight, overweight, and grades 1, 2, and 3 obese women, respectively. A total of 138, 517 women from 26 cohorts had pregnancies with no hypertensive or diabetic disorders and with term deliveries of appropriate for gestational age at birth infants. Gestational weight gain charts for underweight, normal weight, overweight, and grade 1, 2, and 3 obese women were derived by the Box-Cox t method using the generalized additive model for location, scale, and shape.ResultsWe observed that gestational weight gain strongly differed per maternal pre-pregnancy body mass index group. The median (interquartile range) gestational weight gain at 40 weeks was 14.2 kg (11.4–17.4) for underweight women, 14.5 kg (11.5–17.7) for normal weight women, 13.9 kg (10.1–17.9) for overweight women, and 11.2 kg (7.0–15.7), 8.7 kg (4.3–13.4) and 6.3 kg (1.9–11.1) for grades 1, 2, and 3 obese women, respectively. The rate of weight gain was lower in the first half than in the second half of pregnancy. No differences in the patterns of weight gain were observed between cohorts or countries. Similar weight gain patterns were observed in mothers without pregnancy complications.ConclusionsGestational weight gain patterns are strongly related to pre-pregnancy body mass index. The derived charts can be used to assess gestational weight gain in etiological research and as a monitoring tool for weight gain during pregnancy in clinical practice.

Maternal psychological distress during pregnancy and childhood health outcomes: a narrative review.

Maternal psychological distress is common in pregnancy and may influence the risk of adverse outcomes in children. Psychological distress may cause a suboptimal intrauterine environment leading to growth and developmental adaptations of the fetus and child. In this narrative review, we examined the influence of maternal psychological distress during pregnancy on fetal outcomes and child cardiometabolic, respiratory, atopic and neurodevelopment-related health outcomes. We discussed these findings from an epidemiological and life course perspective and provided recommendations for future studies. The literature in the field of maternal psychological distress and child health outcomes is extensive and shows that exposure to stress during pregnancy is associated with multiple adverse child health outcomes. Because maternal psychological distress is an important and potential modifiable factor during pregnancy, it should be a target for prevention strategies in order to optimize fetal and child health. Future studies should use innovative designs and strategies in order to address the issue of causality.

Maternal grand multiparity and intention to use modern contraceptives in Nigeria

BackgroundGrand multiparity and low contraceptive prevalence are dominant among Nigerian women. These elevate the risk of unintended pregnancies, high-risk fertility and adverse maternal and child health outcomes among women in the country, particularly grand multiparous women. Studies have examined predictors of intention to use modern contraceptives among women of reproductive age. However, these studies did not ascertain the extent to which grand multiparity is associated with intention to use modern contraceptives. This study examined association between grand multiparity and intention to use modern contraceptives in Nigeria.MethodsThe study pooled data from 2003 to 2013 Nigeria Demographic and Health Surveys. The weighted sample size analysed was 34,302 women. The outcome variable was intention to use contraceptive. The main explanatory variable was parity with specific attention to grand multiparity. Unadjusted multinomial logistic regression coefficients were used to examine association between specific explanatory or control variables and intention to use contraceptives while the adjusted multinomial logistic regression was applied to further examine associated factors of intention to use contraceptives relative to being uncertain about future contraceptive use. Four multinomial logistic regression models were fitted using Stata 14.ResultsMore than half of respondents do not intend to use contraceptives, while less than one-fifth of respondents intend to use contraceptives in the future. Across the four fitted models, the relative risks of intention to use compared with being uncertain about future contraceptive use were significantly lower among grand multiparous women. Results further revealed pregnancy termination, fertility planning status, exposure to mass media family planning messages, knowledge of modern contraceptives, ideal family size, remarriage, household power relations, and maternal education as other key factors influencing expected risk of intention to use contraceptives relative to being uncertain about future contraceptive use.ConclusionMaternal grand multiparity is significantly associated with intention to use contraceptives among women in Nigeria. The development of a specific population and health programme to target grand multiparous women is imperative in the country. Such programme could be integrated into existing national family planning programme through specific contraceptive education, counselling and information for high parous women.

The Association between Paternal Job Stress and Maternal Child Corporal Punishment: Evidence from a Population-Based Survey in Metropolitan Japan

Although child corporal punishment can lead to adverse health outcomes in children, this practice remains prevalent in Japan. This study investigates whether, under Asian family norms, fathers’ job stress is a risk factor for mothers’ frequent use of child corporal punishment. A study sample of 522 children ages 0 to 6 years was obtained from a population-based survey in Tokyo. Data from mothers’ self-reports of maternal caretaker child corporal punishment were regressed on paternal job stress using logistic regression analysis. Covariates include child age (months), child gender, number of children in the household, maternal education, maternal adverse childhood experiences, and annual household income. Maternal psychological distress was hierarchically included in the model. Paternal job stress was significantly associated with maternal frequent use of child corporal punishment independent of maternal psychological distress and other known risk factors such as child’s age, maternal education, and maternal adverse childhood experiences. The results indicate that job stress may be a risk factor for parental child corporal punishment. Employers can contribute to improving children’s health and safety in the household by designing workforce policies to reduce employee’s stress and by offering psychoeducational programs for parents.

Maternal experiences of intimate partner violence and C-reactive protein levels in young children in Tanzania

Intimate partner violence (IPV) is a critical public health issue that impacts women and children across the globe. Prior studies have documented that maternal experiences of IPV are associated with adverse psychological and physical health outcomes in children; however, research on the underlying physiological pathways linking IPV to these conditions is limited. Drawing on data from the 2010 Tanzania Demographic and Health Survey, we examined the relationship between maternal report of IPV in the past 12 months and inflammation among children ages 6 months to 5 years. Our study included 503 children who were randomly selected to provide a blood sample and had a mother who had ever been married and who had completed the Domestic Violence Module, which collected information on physical, sexual, and emotional violence. Analyses were stratified based on a threshold for acute immune activation status, defined by the threshold of CRP > 1.1 mg/L for young children in Tanzania. In bivariate analyses, healthy children whose mothers reported IPV showed a marginally elevated median CRP level compared to children whose mothers did not report IPV (0.35 vs. 0.41 mg/L; p = 0.13). Similarly, among children with active or recent infections, those whose mothers reported IPV had an elevated median CRP compared to children whose mothers did not (4.06 vs 3.09 mg/L; p = 0.03). In adjusted multiple variable regression models to account for child, mother, and household characteristics, maternal IPV was positively associated with (log) CRP in both healthy children and children with active or recent infection. Although longitudinal research with additional biomarkers of inflammation is needed, our results provide support for the hypothesis that inflammation may function as a biological pathway linking maternal IPV to poor psychological and physical health outcomes among children of mothers who are victimized—and this may extend to very young children and children in non-Western contexts.

AB007. Alcohol &amp; child health in rural Kenya: patterns of use, abuse and associations with child health

Background: Alcohol is one of the leading contributors to non-communicable disease in the developed and developing world. Children of alcoholic parents have more emotional & health problems, school failure, learning disabilities, and criminality than their counterparts. There are limited studies describing the relationship between parental alcoholism and child malnutrition. In 2014, rates of malnutrition increased at Kisii Teaching & Refferal Hospital in Western Kenya. Community-based participatory research in the Gesoni sub-location of Kisii revealed alcoholism to be a primary perceived cause of adverse child health outcomes and a major health priority for the community. To determine the prevalence of alcohol use and associations with adverse child health outcomes in Gesoni, Kenya.

Prevention of Excessive Gestational Weight Gain by Nutrition Education Intervention: A Randomized Controlled Trial

Background: A great proportion of pregnant women gain weight above the recommendations of the Institute of Medicine (IOM), which is associated with adverse maternal and child health outcomes. We did not find any nutrition education intervention in this field and the available significant results are related to lifestyle trials. Thus, we examined the effect of a nutrition education intervention on gestational weight gain and adherence to IOM limits as the first study in this field. We surveyed the impact of the intervention on the birth anthropometric indices, as well. Methods: 192 pregnant mothers were recruited to this prospective randomized clinical trial from 15 health centers, five hospitals, and 15 private obstetrical offices in Isfahan. They were randomly divided into an intervention (n = 96) or a control (n = 96) group. Each woman met the same nutritionist at the time of enrollment for nutrition assessment and an individualized nutrition intervention plan was developed. Then, the nutrition education intervention including three 45 - 60 min training sessions at 6 - 10, 18, and 26 weeks of pregnancy was performed. Results: The proportion of excessive gestational weight gain (GWG) during pregnancy decreased in the interventional group (27.9% vs. 46.0%, P = 0.01). In addition, the mean of total GWG in the intervention group decreased significantly compared to the control group (13.11 ± 3.95 vs. 15.37 ± 5.16, P = 0.001). The nutrition education intervention did not decrease the mean of birth weight, length, and head circumference in the intervention group compared to the control group (P > 0.05). Conclusions: Nutrition education considering the national comprehensive guidelines is effective to prevent excessive GWG and control GWG without adverse effects on the birth size.

Household Food Insecurity and Psychosocial Dysfunction in Ecuadorian Elementary Schoolchildren.

Household food insecurity (HFI) is a major global public health and pediatric concern due to its reported association with adverse child nutrition, growth, and health outcomes. Psychosocial dysfunction is a major cause of childhood disability. US and Canadian studies have linked HFI to poorer overall psychosocial dysfunction and specific dysfunction types in school-aged children, i.e., internalizing, externalizing, and attention behaviors. However, it is uncertain whether prior findings are generalizable to low- and middle-income country (LMIC) settings. We conducted a cross-sectional study to explore the association of HFI with psychosocial dysfunction in 6-12-year-old public elementary schoolchildren (n=279) residing in low-income neighborhoods in Quito, Ecuador. Maternal caregivers were interviewed to obtain data on child psychosocial dysfunction (Pediatric Symptom Checklist, PSC), food security (Household Food Security Survey Module), and maternal mental health (SF-36 Mental Composite Summary). Capillary blood samples were obtained from child participants to measure hemoglobin levels. The data were analyzed using general linear models with adjustment for covariates. The results revealed that HFI was associated with significantly higher overall average PSC scores (p=0.002) and with internalizing (p=0.001) and externalizing (p=0.03) but not attention subscale scores. However, anemia was independently associated with PSC attention subscale scores (p=0.015). This is the first study to report on the relationship between HFI and psychosocial dysfunction in school-aged children in a LMIC setting. It highlights the importance of improving policies and programs protecting vulnerable households from HFI. In addition to improving health and nutrition, such improvements could potentially reduce the burden of child psychosocial dysfunction.

Maternal pre-pregnancy obesity and health care utilization and costs in the offspring

Background/objectiveThe association between maternal pre-pregnancy obesity and adverse child health outcomes is well described, but there are few data on the relationship with offspring health service use. We examined the influence of maternal pre-pregnancy obesity on offspring health care utilization and costs over the first 18 years of life.MethodsThis was a population-based retrospective cohort study of children (n = 35,090) born between 1989 and 1993 and their mothers, who were identified using the Nova Scotia Atlee Perinatal Database and linked to provincial administrative health data from birth through 2014. The primary outcome was health care utilization as determined by the number and cost of physician visits, hospital admissions and days, and high utilizer status (>95th percentile of physician visits). The secondary outcome was health care utilization by ICD chapter. Maternal pre-pregnancy weight was categorized as normal weight, overweight, or obese. Multivariable-adjusted regression models were used to examine the association between maternal weight status and offspring health care use.ResultsChildren of mothers with pre-pregnancy obesity had more physician visits (10%), hospital admissions (16%), and hospital days (10%) than children from mothers of normal weight over the first 18 years of life. Offspring of mothers with obesity had C$356 higher physician costs and C$1415 hospital costs over 18 years than offspring of normal weight mothers. Children of mothers with obesity were 1.74 times more likely to be a high utilizer of health care and had higher rates of physician visits and hospital stays for nervous system and sense organ disorders, respiratory disorders, and gastrointestinal disorders compared to children of normal weight mothers.ConclusionOur findings suggest that maternal pre-pregnancy overweight and obesity are associated with slightly higher offspring health care utilization and costs in the first 18 years of life.