Adverse Child Outcomes Research Articles

Screen time among kindergarten children in the Australian Capital Territory (including a comparison of First Nations and non-Indigenous children)

BackgroundAustralian First Nations children have poorer outcomes across a range of health measures. High levels of screen time are associated with a range of adverse health outcomes. Gaps remain in our knowledge on the association between screen time and health outcomes for different demographic groups, including First Nations children. We aimed to describe the screen time behaviours of First Nations and non-Indigenous kindergarten children in the Australian Capital Territory (ACT) and identify any associated disparities in key health outcomes.Methods5,516 children participated in the cross-sectional population-based ACT Kindergarten Health Check (KHC) survey, including 146 First Nations children. The association between screen time of more than two hours per day and health outcomes (body mass index, respiratory health, development and wellbeing) was assessed for both First Nations and non-Indigenous cohorts using comparative statistics.ResultsNon-Indigenous children who had an average of more than two hours of screen time per day were 1.5 (95% CI, 1.3–1.7) times more likely to be overweight/obese, 1.2 (95% CI, 1.0-1.4) times more likely to have had a wheeze/whistle in their chest in the 12 months before the KHC, 1.5 (95% CI, 1.3–1.7) times more likely to have developmental concerns and 1.5 (95% CI, 1.3–1.8) times more likely to have reduced wellbeing measures compared to non-Indigenous children with screen time of two hours or less per day. None of these associations were statistically significant amongst First Nations children.ConclusionsScreen time of more than two hours per day is associated adverse health outcomes in non-Indigenous children, including overweight/obesity, respiratory problems, developmental concerns, and reduced wellbeing. Further analysis is required to enable a more robust assessment of the effect of screen time on health outcomes for First Nations children.

Two Decades of Child Welfare System Contact in the Global North: A Research Note on Trends in 44 Countries.

Child maltreatment and child welfare system contact are both associated with an elevated risk of adverse outcomes in childhood, adolescence, and adulthood. Yet, data on variation in system contact are available for only a handful of countries, limiting knowledge about the societal correlates of system contact. As reported in this research note, we identified, collected, and harmonized administrative data on child welfare agency investigations, confirmed maltreatment, and placements into out-of-home care for 44 countries in the Global North. We analyzed 15 sociodemographic factors commonly associated with child maltreatment and child welfare system contact. Results support three core conclusions. First, data are much more available on late-stage system contact (e.g., foster care caseloads) than for early-stage system contact (e.g., investigations). Second, whereas early-stage contact tended to be on the rise in most countries, late-stage contact was stable or declining. Cross-national variation in these trends was generally less substantial than cross-national variation in levels of child welfare system contact, indicating relatively stable cross-national differences. Third, cross-national variation in out-of-home care largely reflected, but was not reducible to, regional and sociocultural variation: we find little evidence for universal drivers of foster care caseloads across the Global North.

513 Adverse developmental outcomes in children with prenatal substance exposure living in rural Appalachia

513 Adverse developmental outcomes in children with prenatal substance exposure living in rural Appalachia

Diagnostic accuracy of early neonatal MRI in predicting adverse motor outcomes in children born preterm: Systematic review and meta-analysis.

(https://doi.org/10.1111/dmcn.16216)

Prenatal cannabis use and adverse health outcomes in neonates and early childhood.

Prenatal cannabis use and adverse health outcomes in neonates and early childhood.

Birth Outcomes of Infants Born to Mothers with Alopecia Areata: A Nationwide Population-based Study in Korea.

Data on pregnancy outcomes in patients with alopecia areata (AA) are limited. The aim of this study is to determine the association between maternal AA and risk of adverse birth outcomes in children. A retrospective cohort study was conducted on 45,328 children born to mothers with AA and 4,703,253 controls born to mothers without AA using the Korean National Health Insurance Claims database from 2002 to 2016. Multivariate logistic regression analyses were performed to evaluate the association between maternal AA and the birth outcomes of their children. Infants born to mothers with AA exhibited a significantly higher risk of preterm birth (odds ratio [OR] 1.39, 95% CI 1.33-1.45; adjusted OR [aOR] 1.07, 95% CI 1.01-1.13), low birthweight (OR 1.36, 95% CI 1.30-1.42; aOR 1.11, 95% CI 1.05-1.17), and Caesarean section birth (OR 1.24, 95% CI 1.22-1.26; aOR 1.12, 95% CI 1.08-1.15) than controls. In addition, the risk of congenital malformations was also significantly higher in infants born to mothers with AA (OR 1.19, 95% CI 1.15-1.22; aOR 1.10, 95% CI 1.07-1.14), especially for malformations of the urinary (OR 1.33, 95% CI 1.19-1.48; aOR 1.16, 95% CI 1.04-1.29) and musculoskeletal (OR 1.19, 95% CI 1.12-1.27; aOR 1.12, 95% CI 1.05-1.19) systems, than controls. Maternal AA is associated with an increased risk of adverse birth outcomes in infants.

The relationship between maternal age, obesity and child mortality: a cross-sectional study using 2013-2014 Demographic and Health Survey in Democratic Republic of the Congo at national, and sub-national levels.

To investigate the relationship between maternal age and nutritional status, and test associations between maternal nutritional status and child mortality with a focus on maternal obesity. Secondary analysis of data from nationally representative cross-sectional sample of women of reproductive ages (15-49 years) and their children under 5 years. The outcome variable for maternal nutritional status was BMI, classified into underweight (BMI < 18·50 kg/m2), normal weight (18·50-24·99 kg/m2), overweight (25·0-29·9 kg/m2) and obesity (>=30·0 kg/m2). Child mortality was captured with five binary variables measuring the risk of dying in specific age intervals (neonatal, post-neonatal, infant, childhood and under-five mortality). The most recent Demographic and Health Surveys from Democratic Republic of Congo (DRC). The final samples consisted of 7892 women of reproductive ages (15-49 years) and 19 003 children aged 0-59 months. The prevalence of obesity was estimated at 3·4 %; it increased with maternal age. Furthermore, obesity unevenly affected provinces in the Democratic Republic of the Congo: Kinshasa, South Kivu, North Kivu and Maniema were most affected. Finally, maternal obesity showed mixed effects on child mortality. The prevalence of obesity is still low; however, provinces are unevenly affected. Therefore, interventions and programmes to improve nutrition should incorporate geographical disparities to tackle adverse child outcomes associated with maternal obesity, to limit negative consequences of maternal obesity, including non-communicable diseases which might be a strong impediment to reach Sustainable Development Goals (SDG) 2 and 3.

Biomarkers predicting postoperative adverse outcomes in children with congenital heart disease: a systematic review and meta-analysis.

To statistically analyze biomarkers predicting postoperative outcomes in children with congenital heart disease (CHD). PubMed, Embase, Cochrane Library, and Web of Science were performed to search up to February 2024. The measured outcomes were biomarkers, mortality, length of hospital stay, complication rates, and infection rates. Adults with CHD were excluded. Standard deviation or odds ratio (OR) with 95% confidence interval (95% CI) were extracted. A random-effects model synthesized SMDs or ORs with 95% CIs. Sensitivity analysis investigated heterogeneity, and Egger's test assessed publication bias. Seventeen eligible articles were included, the biomarkers involved include serum lactate, NT-Pro BNP, PaO2, serum creatinine, C1-INH activity, ST2, serum chloride concentration, GH, glycemia, cTOI, NLR, serum albumin, and glucose levels, with 2,888 patients who underwent surgery(modified Norwood procedure, arterial switch procedure, biventricular repair etc.). Serum lactate was higher in the postoperative death group (SMD: 1.18, 95% CI: 0.59-1.77). Lower postoperative N-terminal pro-B-type natriuretic peptide (NT-pro BNP) levels were associated with lower mortality (OR: 0.23, 95% CI: 0.08-0.68) and shorter mechanical ventilation time (OR: 0.40, 95% CI: 0.18-0.90). Higher serum albumin levels were associated with longer hospital stays (OR: 3.12, 95% CI: 1.66-5.84). Significant heterogeneity was found in serum creatinine, B-type natriuretic peptide (BNP), serum lactate, and NT-Pro BNP. Publication bias was detected in some studies. Serum lactate, NT-Pro BNP, and serum albumin are reliable biomarkers for predicting adverse outcomes in children with CHD after surgery. PROSPERO [CRD42024512753].

The hidden impact of GLP-1 receptor agonists on endometrial receptivity and implantation.

Increasing infertility rates represent a growing medical challenge in modern societies resulting from a complex interplay of sociocultural trends, lifestyle factors, exposure to environmental toxins, and underlying health problems. Women's fertility is particularly vulnerable to these shifts. The obesogenic lifestyle not only accelerates weight gain, but also disrupts ovulation driving the rise in infertility. Among several medications used for treating obesity and type 2 diabetes, glucagon-like peptide-1 receptor agonists (GLP-1RAs) show promising improvement in female fertility most likely by stimulating ovulation. However, the effects of GLP-1RAs on the endometrium remain unclear. Further studies are needed to investigate the impact of GLP-1RAs on endometrial receptivity and embryo implantation and early development. The aim of this study is to address the knowledge gap regarding the effects of GLP-1RAs on human reproduction, with special focus on the endometrium. Understanding these mechanisms may help to develop new strategies for improving fertility treatment, reduce implantation failureand address potential safety concerns regarding teratogenicity and adverse developmental outcomes for children born to women conceiving during or soon after GLP-1RA treatment.

Multi-ancestry GWAS of severe pregnancy nausea and vomiting identifies risk loci associated with appetite, insulin signaling, and brain plasticity.

While most pregnancies are affected by nausea and vomiting, hyperemesis gravidarum (HG) is at the severe end of the clinical spectrum and is associated with dehydration, undernutrition, and adverse maternal, fetal, and child outcomes. Herein we performed a multi-ancestry genome-wide association study (GWAS) of severe nausea and vomiting of pregnancy of 10,974 cases and 461,461 controls across European, Asian, African, and Latino ancestries. We identified ten significantly associated loci, of which six were novel (SLITRK1, SYN3, IGSF11, FSHB, TCF7L2, and CDH9), and confirmed previous genome-wide significant associations with risk genes GDF15, IGFBP7, PGR, and GFRAL. In a spatiotemporal analysis of placental development, GDF15 and TCF7L2 were expressed primarily in extra villous trophoblast, and using a weighted linear model of maternal, paternal, and fetal effects, we confirmed opposing effects for GDF15 between maternal and fetal genotype. Conversely, IGFBP7 and PGR were primarily expressed in developing maternal spiral arteries during placentation, with effects limited to the maternal genome. Risk loci were found to be under significant evolutionary selection, with the strongest effects on nausea and vomiting mid-pregnancy. Selected loci were associated with abnormal pregnancy weight gain, pregnancy duration, birth weight, head circumference, and pre-eclampsia. Potential roles for candidate genes in appetite, insulin signaling, and brain plasticity provide new pathways to explore etiological mechanisms and novel therapeutic avenues.

Association Between Parental Adverse Childhood Experiences and Offspring's Risk of Suboptimal Health: A Systematic Review and Meta-Analysis.

Previous reviews and meta-analysis have not adequately explored the impact of specific parental adverse childhood experiences (ACEs) subtypes on offspring's health. This updated systematic review and meta-analysis aimed to investigate the association between parental ACE subtypes and various offspring health outcomes. A comprehensive search was conducted in electronic databases including PubMed, Web of Science, the Cochrane Library, WANFANG, and China National Knowledge Infrastructure for studies published in English and Chinese from January 1, 1998, until July 18, 2023. Two independent reviewers screened studies, extracted data, and assessed study quality using the Newcastle-Ottawa Scale. A random-effects model was applied to generate pooled odds ratios (ORs) and 95% confidence interval (95% CI). A total of 47 eligible studies were included in the final analysis. Overall, parental ACEs were significantly associated with several offspring's health outcomes, including preterm birth (PTB), low birth weight (LBW), total developmental delay, social-emotional problems, and behavioral problems (total, externalizing and internalizing behaviors), with ORs ranging from 1.06 to 3.02. Specific subtypes of parental ACEs, such as household dysfunction, sexual abuse, and physical abuse (but not emotional abuse) were significantly associated with PTB. Household dysfunction was notably linked to delayed cognition ability in offspring. Parental sexual abuse, physical abuse, emotional abuse, and emotional neglect were significantly correlated with social-emotion problems, with the expception of household dysfunction. Regarding total behavioral problems, parental household dysfunction, physical abuse, emotional abuse, physical neglect, and peer bullying were all significantly associated with children's behavioral issues, except for emotional neglect. There is a positive correlation between parental household dysfunction, sexual abuse, physical abuse, emotional abuse, emotional neglect, physical neglect, peer bullying, and neighborhood-related adversity and their children's externalizing behavior problems. These findings underscore the significant impacts of parental ACEs on multiple adverse health outcomes in children, with specific parental ACEs subtypes exerting unique effects. This highlight the significance of comprehending the intergenerational effects of different ACE subtypes, and emphasizes the urgency of interventions to address these issues.

An e-Learning Intervention for Professionals to Promote Family-Centered Cancer Care When a Significant Caregiver for Children Is at End of Life: Mixed Methods Evaluation Study.

Families are often unsure how best to prepare dependent children for the death of a significant caregiver with a poor cancer prognosis and seek guidance and support from health care teams. Health and social care professionals (hereafter referred to as professionals) often lack educational opportunities to gain the desired knowledge, skills, and confidence to provide family-centered supportive cancer care. e-Learning has positively impacted access and reach, improving educational opportunities in health care. We aimed to evaluate the acceptability, usability, and effectiveness of an evidence-based, theory-driven e-learning intervention to equip and promote professionals' self-efficacy to deliver family-centered supportive cancer care when a significant caregiving member for dependent children is at the end of life. Guided by the "person-based approach," a mixed methods outcome evaluation was used. To determine the effect on self-efficacy, participants completed a validated pretest and posttest 12-item self-efficacy survey. The use of one-on-one, remote semistructured interviews and single-item questions determined the usability by professionals of the e-learning intervention and the acceptability of perceived learning in clinical practice. To generate enhanced insights, quantitative and qualitative data were integrated through a 4-stage, modified pillar integration process. Overall, 158 participants completed the pretest survey for the e-learning resource, with 99 (62.7%) completing the posttest survey. Semistructured interviews were conducted with 12 professionals at least 1 month after the intervention. Findings highlighted a statistically significant improvement in posttest self-efficacy (99/158, 62.7%; P<.001). Usability of the e-learning intervention was positive, with participants reporting that it was clear and organized (mean 4.84, SD 0.373), the layout was appealing (mean 4.71, SD 0.539), the language was easy to understand (mean 4.71, SD 0.407), and graphics and media were purposeful (mean 4.76, SD 0.495) and engaging (mean 4.67, SD 0.703). Determining acceptability, participants considered that the intervention would positively impact practice (mean 4.60, SD 0.589) and increase knowledge (mean 4.56, SD 0.677), with appropriate practical examples to support learning (mean 4.58, SD 0.610). Following engagement with the e-learning intervention, professionals reported preparedness to deliver supportive adult-professional end-of-life cancer care, when an adult with significant caregiving responsibilities is dying. Findings demonstrated transferable learning to additional contexts, such as other close adult-child relational bonds (grandparents) and to life-limiting conditions. The systematic and iterative person-based approach optimized the acceptability of a novel e-learning intervention, having the potential to promote family-centered supportive end-of-life cancer care. This accessible e-learning intervention makes an important contribution to the recognized global gap of educational interventions in this field. Equipping professionals with family-centered supportive end-of-life care improves self-efficacy and preparedness to engage in challenging conversations, with the potential to promote better outcomes for affected adults and children and mediate adverse outcomes for adults and children before and after bereavement.

A nested case-control study of adverse outcomes in children with diabetic ketoacidosis.

Adverse Outcomes (death or ICU stays longer than 48h) in children with diabetic ketoacidosis (DKA) or hyperglycemic-hyperosmolar syndrome (HHS) can be predicted by a composite risk score based on severity of hyperglycemia and acidosis, and presence of type 2 diabetes. Because most high-risk patients nevertheless do not experience an Adverse Outcome, we tried to identify differences in management or other clinical characteristics that influenced outcomes. In a previously defined group of 4565 admissions for DKA-HHS in 2010-2023, 109 had Adverse Outcomes. We conducted a nested case-control study using the composite risk score to match 84 cases from the Adverse Outcome group with an equal number of controls without or with briefer ICU stays of 0-24 hours. The groups did not differ in risk score or initial pH, maximum blood glucose, or proportion with type 2 diabetes. However, the case group had more patients with new-onset diabetes and higher initial serum sodium and BUN. The case group had slower resolution of hyperglycemia, acidosis and hypernatremia. The groups did not differ in total administered fluid bolus volumes, total fluid volumes or urine output at 12 and 24 hours. Total insulin received did not differ between groups after 12 hours, but cases were more likely to still require intravenous insulin at 24 hours. Hypernatremia is more likely to be present at admission and to persist over the first 24 h of treatment in children with DKA-HHS who have Adverse Outcomes. This is not associated with differences in management.

Time-out under scrutiny: examining the relationships among the discipline strategy time-out, child well-being and attachment and exposure to adversity.

Discipline is a crucial aspect of parenting, shaping child development and behaviour. Time-out, a widely used disciplinary strategy with a strong evidence-base, has recently come under scrutiny with concerns about potential adverse effects on children's emotional development and attachment, particularly for those with a history of adversity. To contribute critical empirical insights to the current controversy surrounding time-out by exploring the associations among time-out implementation, parent-child attachment and child mental health, and whether adversity exposure moderated these associations. This cross-sectional study utilised a nationally representative sample of 474 primary caregivers in Australia, with children aged 6-8 years, who completed an online survey. Measures included the Implementation of Time-out Scale, Adverse Life Experiences Scale, Primary Attachment Style Questionnaire, Strengths and Difficulties Questionnaire and Spence Child Anxiety Scale. Appropriately implemented time-out was associated with enhanced mental health and attachment, while inappropriate time-out correlated with adverse child outcomes. Exposure to adversity moderated the relationship between time-out implementation and child well-being, such that children exposed to adversity were most likely to experience attachment enhancement from appropriately implemented time-out. Despite recent concerns of harm caused by time-out, particularly for children with a history of adversity, findings support the beneficial impact of time-out on child well-being and attachment when implemented in accordance with evidence-based parameters. Combatting misinformation and disseminating evidence-based time-out guidelines is crucial for promoting child well-being and attachment, especially for children who have experienced adversity.

Prenatal and Postnatal Exposure to Organophosphate Esters and Replacement Flame Retardant Mixtures and Childhood Respiratory Outcomes

BackgroundEarly life exposure to single organophosphate esters (OPEs) and replacement brominated flame retardants (RBFRs) has been associated with adverse childhood respiratory outcomes, but the effects of OPE and RBFR mixtures are unknown. Methods377 pregnant women were recruited to the Health Outcomes and Measures of Environment (HOME) Study from 2003 to 2006 in Cincinnati, Ohio and later delivered singleton infants. We measured house dust OPEs and RBFRs prenatally at 20 weeks of gestation and postnatally at child age of 12 months and urinary OPEs prenatally at 16 and 26 weeks of gestation and at delivery and postnatally at child ages of 12 and 24 months. We performed Quantile G-computation (QG-computation) and Bayesian Kernel Machine Regression (BKMR) to assess the association of the exposure mixtures with wheeze and hay fever by child age of 5 years and evaluate the individual exposure effects and their interactions within the mixtures. ResultsIn QG-computation, a quartile increase in all urinary OPEs sampled at age 12 months was associated with 16% higher risk of wheeze (RR: 1.16, 95% CI: 1.01, 1.35). In BKMR, mixtures of prenatal OPEs and RBFRs, urinary OPEs at 16 weeks of gestation or 12 months of age and prenatal average urinary OPEs were associated with higher risk of childhood wheeze. Mixtures of prenatal average urinary OPEs were positively associated with childhood hay fever. When other exposures were fixed at their median value, prenatal dust tris(2-chloroethyl) phosphate (TCEP) and urinary bis(1,3-dichloro-2-propyl) phosphate (BDCIPP) were associated with higher hay fever risk, while dust prenatal tris(1-chloro-2-propyl) phosphate (TCIPP) was associated with lower risk. ConclusionsThese results suggest that early life exposure to OPE and RBFR mixtures may be risk factors for adverse respiratory outcomes in childhood.

Multi-ancestry GWAS of severe pregnancy nausea and vomiting identifies risk loci associated with appetite, insulin signaling, and brain plasticity.

While most pregnancies are affected by nausea and vomiting, hyperemesis gravidarum (HG) is at the severe end of the clinical spectrum and is associated with dehydration, undernutrition, and adverse maternal, fetal, and child outcomes. Herein we performed a multi-ancestry genome-wide association study (GWAS) of severe nausea and vomiting of pregnancy of 10,974 cases and 461,461 controls across European, Asian, African, and Latino ancestries. We identified ten significantly associated loci, of which six were novel ( SLITRK1 , SYN3 , IGSF11 , FSHB , TCF7L2 , and CDH9), and confirmed previous genome-wide significant associations with risk genes GDF15 , IGFBP7 , PGR , and GFRAL . In a spatiotemporal analysis of placental development, GDF15 and TCF7L2 were expressed primarily in extra villous trophoblast, and using a weighted linear model of maternal, paternal, and fetal effects, we confirmed opposing effects for GDF15 between maternal and fetal genotype. Conversely, IGFBP7 and PGR were primarily expressed in developing maternal spiral arteries during placentation, with effects limited to the maternal genome. Risk loci were found to be under significant evolutionary selection, with the strongest effects on nausea and vomiting mid-pregnancy. Selected loci were associated with abnormal pregnancy weight gain, pregnancy duration, birth weight, head circumference, and pre-eclampsia. Potential roles for candidate genes in appetite, insulin signaling, and brain plasticity provide new pathways to explore etiological mechanisms and novel therapeutic avenues.

In utero exposure to per - and polyfluoroalkyl substances (PFAS) associates with altered human infant T helper cell development.

Environmental exposures to chemical toxicants during gestation and infancy can dysregulate multiple developmental processes, causing lifelong effects. There is compelling evidence of PFAS-associated immunotoxicity in adults and children. However, the effect of developmental PFAS exposure on infant T-cell immunity is unreported, and, if present, could be implicated in immune-related health outcomes. We seek to model longitudinal changes in CD4+ T-cell subpopulations from birth through 12 months and their association with in-utero PFAS exposure and postnatal CD4+ T-cell frequencies and functions. Maternal-infant dyads were recruited as part of the UPSIDE-ECHO cohort during the first trimester between 2015 and 2019 in Rochester, New York; dyads were followed through the infant's first birthday. Maternal PFAS concentrations (PFOS, PFOA, PFNA, and PFHXS) were quantified in serum during the second trimester using high-performance liquid chromatography and tandem mass spectrometry. Infant lymphocyte frequencies were assessed at birth, 6- and 12-months using mass cytometry and high-dimensional clustering methods. Linear mixed-effects models were employed to analyze the relationship between maternal PFAS concentrations and CD4+ T-cell subpopulations (n=200). All models included a PFAS and age interaction and were adjusted for parity, infant sex, and pre-pregnancy body mass index. In-utero PFAS exposure correlated with multiple CD4+ T-cell subpopulations in infants. The greatest effect sizes were seen in T-follicular helper (Tfh) and T-helper 2 (Th2) cells at 12 months. A log 2 -unit increase in PFOS was associated with lower Tfh [0.17% (95%CI: -0.30, -0.40)] and greater Th2 [0.27% (95%CI: 0.18, 0.35)] cell percentages at 12 months. Similar trends were observed for PFOA, PFNA, and PFHXS. Maternal PFAS exposures correlate with cell-specific changes in the infant T-cell compartment, including key CD4+ T-cell subpopulations that play central roles in coordinating well-regulated, protective immunity. Future studies into the role of PFAS-associated T-cell distribution and risk of adverse immune-related health outcomes in children are warranted.

Yoga-based lifestyle intervention for antenatal depression (YOGA-D): study protocol for a pilot randomized controlled trial

Background Depression during pregnancy is associated with pre-term labor, low birthweight, post-partum depression and adverse child outcomes. There are concerns about the safety of anti-depressant medications during pregnancy. Many pregnant women with antenatal depression are neither aware about their depression nor do they have access to non-pharmacological interventions for depression. Evidence suggests that pre-natal yoga can improve antenatal depression. Yoga is native to the Indian culture and women can practice yoga as a ‘self-care’ intervention with minimal training. There is no study till date on the efficacy of yoga on antenatal depression in pregnant women in a low resource (rural) setting in India. This pilot randomized controlled trial aims to study the feasibility, acceptability, and preliminary efficacy of a YOGA -based lifestyle intervention for Antenatal D epression (YOGA-D) in Maharashtra, India. Methods We will undertake a single-blind individual randomized parallel group-controlled pilot trial with 1:1 allocation ratio. Adult women with 12–26 weeks of pregnancy, without any obstetric or medical complications will be randomly allocated to either the active intervention group (Yoga-Sanskar (YS)) or the Enhanced Usual Care (EUC) group. Trained yoga instructors will teach a pre-defined yoga sequence to the participants in the YS arm. In the EUC arm, participants will receive a single session of health education. We will assess trial feasibility using the recruitment, retention, and study completion rates. The primary outcome of depression will be measured using the translated Marathi version of the Patient Health Questionnaire-9. Assessments will be at the baseline, three-months post-randomization, and post-delivery. Discussion This study will help us to understand the barriers in implementation of a yoga-based intervention for antenatal depression in a low-resource/rural setting in Maharashtra, India. Based on the learnings of this pilot trial, we plan to undertake an explanatory randomized controlled trial in the next few months. Registration CTRI (CTRI/2024/05/067176; 10/05/2024).

Early onset and increasing disparities in neurodevelopmental delays from birth to age 6 in children from low socioeconomic backgrounds.

To analyze the complex relationship between socioeconomic status (SES) and neurodevelopmental achievements by investigating the temporal dynamics of these associations from birth to age 6. This retrospective cohort study was conducted over 6 years using population-based data from the National Health Insurance Service and integrated data from the National Health Screening Program for Infants and Children. Participants were children born between 2009 and 2011 in Korea without neurodevelopmental delays with potential developmental implications. We analyzed results from the Korean Developmental Screening Test, administered at age 6, which covered overall assessment and six domains of gross and fine motor function, cognition, language, sociality, and self-care. The secondary outcome was to determine when neurodevelopmental outcomes began after birth and how these differences changed over time. Of 276,167 individuals (49.2% males), 66,325, 138,980, and 60,862 had low, intermediate, and high SES, respectively. Neurodevelopmental delays observed across all developmental domains were more prevalent in the low-SES group than in the high-SES group. Disparities in neurodevelopment according to these statuses were apparent as early as age 2 and tended to increase over time (interaction, P < 0.001). The cognition and language domains exhibited the most substantial disparities between SES levels. These disparities persisted in subgroup analyses of sex, birthweight, head circumference, birth data, and breastfeeding variables. Low SES was significantly associated with an increased risk of adverse neurodevelopmental outcomes in preschool children, particularly those affecting cognitive and language domains. These differences manifested in early childhood and widened over time.

Evaluation of Postoperative Outcomes Following Early and Late Palate Repair: A Preclinical Study.

To quantitatively assess the impact of early versus late surgical intervention on midfacial growth using a mouse model. A full-thickness mucoperiosteal flap surgery was performed on newborn (P17) mice and on neonatal (P30) mice. High-resolution micro-computed tomographic imaging coupled with histomorphometric analyses was used to assess craniomaxillofacial growth. Histology and immunohistochemical analyses were used to assess cellular and molecular responses postsurgery. Early surgical intervention at P17 resulted in significant midfacial growth arrest, with pronounced maxillary hypoplasia. Histomorphometric analyses revealed significant (P < 0.05) growth disruptions in the mid-palatal suture complex, including premature removal of the cartilaginous growth plate and its replacement by bone. In the suture itself, cell proliferation was significantly reduced (P < 0.05) compared with controls. The same surgical intervention performed in mice at P30 did not lead to significant midfacial growth arrest. Early surgical intervention in a mouse model mirrors the adverse growth outcomes in children undergoing early cleft repair. Molecular and cellular observations accompanying this midfacial growth arrest may inform therapeutic strategies to mitigate midfacial growth disturbances in patients and highlight the need for refined surgical techniques to minimize adverse growth outcomes.