Antenatal Drug Research Articles

Antenatal depression and drug use among deaf and hard-of-hearing birthing parents: results from a U.S. National Survey.

This study aimed to investigate antenatal depression and drug use among deaf and hard-of-hearing (DHH) birthing parents who use American Sign Language (ASL), spoken English, or bilingually both ASL and English. DHH participants in the United States responded to the Survey on Pregnancy Experiences of Deaf and Hard-of-Hearing Women. Respondents self-reported their antenatal depression diagnoses and drug use (i.e., pain relievers, cannabis, or illicit drugs) during their last pregnancy. Poisson regression models were used to estimate prevalence ratios, adjusting for age, race/ethnicity, education, marital status, and parity. The average age of respondents (n = 587) was 35 years. Respondents were predominantly non-Hispanic white (80%), college educated (60%), and married (74%). Relative to DHH English-speakers, DHH ASL-users had lower prevalence of reporting antenatal depression diagnosis (aPR = 0.40, 95% CI: 0.23 to 0.72). DHH people who reported antenatal depression diagnosis had higher prevalence of reporting antenatal drug use (PR = 2.34, 95% CI: 1.65 to 3.33). There were no significant associations between preferred language and antenatal drug use. DHH ASL-users are less likely to report receiving an antenatal depression diagnosis compared to DHH English-speakers. Given well-documented patient-provider communication barriers among DHH ASL-users, it is unclear if the lower prevalence observed in this study is the result of inadequate or inaccessible screening during pregnancy. Future work should consider universal use of linguistically appropriate screening tools for DHH birthing parents in both clinical and research settings.

The current state of the problem, clinical-pathogenetic approaches to the diagnosis and management tactics of fetal growth restriction

Fetal growth restriction is a common complication of pregnancy with a complex etiology and limited possibilities of diagnosis and treatment. The relevance of this difficult obstetric problem is determined by various published diagnostic criteria, relatively low detection rates, and limited options for prevention and treatment.Fetal growth restriction is defined as the inability of the fetus to reach its genetically determined growth potential, most often due to abnormal placentation. Forms of fetal growth restriction with early or late onset are distinguished based on the gestational age determined during prenatal ultrasound diagnosis. According to most recommendations, the 32nd week of pregnancy is set as the cut-off point for distinguishing between early and late onset fetal growth restriction.The definition underlying this classification is based on differences between these two phenotypes of fetal growth restriction in severity, natural history, Doppler findings, association with hypertensive complications, placental features, and management. It is important to distinguish two separate conditions: fetal growth restriction and small-for-gestational fetus, which differ in short-term and long-term perinatal outcomes.A fetus is defined as small for gestational age if the estimated weight or weight of the fetus at birth is below the 10th percentile. Fetal growth restriction is diagnosed if the estimated fetal weight is below the 3rd percentile or a combination of pathological blood flow in the umbilical arteries and/or uterine arteries in fetuses with an estimated weight below the 10th percentile. It can also occur in fetuses and newborns with a body weight above the 10th percentile.The need to distinguish between fetal growth restriction and small-for-gestational-age fetus is related to the fact that fetal growth restriction is the main cause of stillbirth, neonatal death, higher perinatal morbidity, as well as increased risk of diseases in adulthood.The article analyzes the approaches to differentiating fetal growth restriction from small growth retardation in terms of fetal gestation period and further increasing the accuracy of diagnosis, as well as the modern concept of pathogenesis, with an emphasis on oxidant stress as a key molecular mechanism of adverse outcomes. Appropriate interventions during pregnancy to reduce perinatal complications should include antenatal monitoring and drug therapy.

Impact of antenatal antiretroviral drug exposure on the growth of children who are HIV-exposed uninfected: the national South African Prevention of Mother to Child Evaluation cohort study

BackgroundThe relationship between in-utero antiretroviral (ARV) drug exposure and child growth needs further study as current data provide mixed messages. We compared postnatal growth in the first 18-months of life between children who are HIV-exposed uninfected (CHEU) with fetal exposure to ARV drugs (prophylaxis or triple-drug therapy (ART)) and CHEU not exposed to ARVs. We also examined other independent predictors of postnatal growth.MethodsWe analysed data from a national prospective cohort study of 2526 CHEU enrolled at 6-weeks and followed up 3-monthly till 18-months postpartum, between October 2012 and September 2014. Infant anthropometry was measured, and weight-for-age (WAZ) and length-for-age (LAZ) Z-scores calculated. Generalized estimation equation models were used to compare Z-scores between groups.ResultsAmong 2526 CHEU, 617 (24.4%) were exposed to ART since -pregnancy (pre-conception ART), 782 (31.0%) to ART commencing post-conception, 879 (34.8%) to maternal ARV prophylaxis (Azidothymidine (AZT)), and 248 (9.8%) had no ARV exposure. In unadjusted analyses, preterm birth rates were higher among CHEU with no ARV exposure than in other groups. Adjusting for infant age, the mean WAZ profile was lower among CHEU exposed to pre-conception ART [-0.13 (95% confidence interval − 0.26; − 0.01)] than the referent AZT prophylaxis group; no differences in mean WAZ profiles were observed for the post-conception ART (− 0.05 (− 0.16; 0.07)), None (− 0.05 (− 0.26; 0.16)) and newly-infected (− 0.18 (− 0.48; 0.13)) groups. Mean LAZ profiles were similar across all groups. In multivariable analyses, mean WAZ and LAZ profiles for the ARV exposure groups were completely aligned. Several non-ARV factors including child, maternal, and socio-demographic factors independently predicted mean WAZ. These include child male (0.45 (0.35; 0.56)) versus female, higher maternal education grade 7–12 (0.28 (0.14; 0.42) and 12 + (0.36 (0.06; 0.66)) versus ≤ grade7, employment (0.16 (0.04; 0.28) versus unemployment, and household food security (0.17 (0.03; 0.31). Similar predictors were observed for mean LAZ.ConclusionFindings provide evidence for initiating all pregnant women living with HIV on ART as fetal exposure had no demonstrable adverse effects on postnatal growth. Several non-HIV-related maternal, child and socio-demographic factors were independently associated with growth, highlighting the need for multi-sectoral interventions. Longer-term monitoring of CHEU children is recommended.

Increase of cannabis and cocaine use by pregnant women in France from 2005 to 2018: Insights of the annual cross sectional OPPIDUM survey

Substance use disorders during pregnancy are associated with antenatal, neonatal and long-term adverse drug reactions in children. The aim of this study was to describe, using data from OPPIDUM survey, the evolution of illicit substance use or diverted prescription drug use among pregnant women visiting French addiction care centres from 2005 to 2018. The current study focused on women of childbearing age (15-44years old) identified as pregnant, and included in the OPPIDUM survey from 2005 to 2018. OPPIDUM is a French nationwide survey repeated each year since 1995, which anonymously collects information on drug abuse and dependence observed in patients recruited in addiction care centres. Patterns of illicit substance use, psychoactive medications, and opioid maintenance treatment (OMT) were described over time (by period of 2 years) and changes between 2005-2006 and 2017-2018 were investigated. From 2005 to 2018, 784 pregnant women were included in the OPPIDUM survey (median age 28, interquartile range (IQR): 25-33). The proportion of women using exclusively cannabis (1.2% vs. 17.1%, P=0.0004) and cocaine (including crack) use (4.7% vs. 14.3%, P=0.0384) significantly increased over the period. Considering the first substance reported as leading to dependence, heroin significantly decreased (78.8% vs. 50.0%, P=0.0002) whereas cannabis significantly increased (5.9% vs. 25.7%, P=0.0005). This study highlighted an important change of patterns of drug use by French pregnant women over a 14-year-period. Health professionals must be aware of these changes to adapt prevention and care among women of childbearing age and pregnant women.

Comparison of abusive head trauma versus non-inflicted subdural haematoma in infants: A retrospective cohort study.

To compare the characteristics of subdural haematoma (SDH) in children under the age of 2 years, between inflicted, otherwise known as abusive head trauma (AHT), and non-inflicted aetiologies. This was a retrospective cohort study of 37 cases of SDH in children under the age of 2 years presenting to the ED at an Australian tertiary children's hospital between January 2009 and December 2012 and been assessed by the Child Protection Unit. SDH aetiology was classified into AHT and non-inflicted groups, based on child protection interagency outcome. These groups were compared to determine clinical associations with AHT. Of the 37 infants with SDH, 20 cases were deemed due to AHT, whereas 17 cases were determined to be non-inflicted SDH (15 cases due to accidental trauma and two cases due to congenital benign enlargement of the subarachnoid space). SDH due to AHT was associated with antenatal maternal drug use, previous Department of Child Safety involvement, delayed presentation, history of seizures, floppiness or altered level of consciousness; extracranial findings of fractures, bruising or retinal haemorrhages; radiological findings of >5 mm depth, bilateral, inter-hemispheric blood, posterior fossa blood and diffusion restriction; and outcomes of death or permanent disability. Non-inflicted SDH was associated with witnessed injury, falls and scalp haematoma on imaging. Infant SDH due to AHT accounts for high mortality and morbidity. Early identification of these patients in the ED with referral to specialised units that investigate for potential child abuse is essential.

Epidemiology of Malaria in Pregnancy and Associated Risk Factors in Nigeria: a Review

Each year, an estimated number of 300–500 million people are infected with malaria parasite, with an undesirable effect of over one million deaths. Pregnant women as well as young children, non-immune travellers visiting malaria-endemic zones are at the highest risk of suffering or experiencing life - threatening malaria infection. Maternal immunity, parasite density, parity, inadequate antenatal care services, drug misuse and abuse as well intermitted preventive treatment drug failure cum resistance are the most associated risk factors of malaria in pregnancy obtainable in endemic regions of sub-Saharan Africa. Identification and understanding of these factors will play a major role in reducing the burden as well as eliminating malaria disease among pregnant women living in endemic regions.

The Duogynon controversy and ignorance production in post-thalidomide West Germany.

This article examines the West German controversy over Duogynon, a ‘hormone pregnancy test’ and the drug at the centre of the first major, international debate over iatrogenic birth defects in the post-thalidomide era. It recovers an asymmetrical power struggle over the uneven distribution of biomedical knowledge and ignorance (about teratogenic risk) that pitted parent-activists, whistleblowers and investigative journalists against industrialists, scientific experts and government officials. It sheds new light on the nexus of reproduction, disability, epidemiology and health activism in West Germany. In addition, it begins to recover an internationally influential discourse that, in the post-thalidomide world, seems to have resuscitated antenatal drug use as safe until proven harmful.

50 Years Ago in TheJournalofPediatrics: Neonatal Platelet Aggregation: Effects of Antenatal Aspirin

Corby DG, Schulman I. The Effects of Antenatal Drug Administration on Aggregation of Platelets of Newborn Infants. Pediatr Pharmacol Ther 1971;79:307-13. Fifty years ago in The Journal, Corby and Schulman described the effect of antenatal drugs on neonatal platelet aggregation. They compared cord blood from term infants with maternal blood, after different antenatal drug intake. Aspirin was the most potent drug, leading to significantly impaired platelet aggregation in the neonates. The methodology for assessment of platelet aggregation was discovered in the 1950s, and the method used, light transmission aggregometry, is still the gold standard for aggregation testing.1Hechler B. Dupuis A. Mangin P.H. Gachet C. Platelet preparation for function testing in the laboratory and clinic: Historical and practical aspects.Res Pract Thromb Haemos. 2019; 3: 615-625Crossref PubMed Scopus (19) Google Scholar Antenatal drugs are well-known to have potential detrimental effects on the fetus, as it has been shown for aspirin; for most drugs the effects are dose dependent. Aspirin in small doses from less than 16 to 36 weeks of gestation significantly reduce preeclampsia, and is recommended by the World Health Organization.2Cui Y. Zhu B. Zheng F. Low-dose aspirin at ≤16 weeks of gestation for preventing preeclampsia and its maternal and neonatal adverse outcomes: a systematic review and meta-analysis.Exp Ther Med. 2018; 15: 4361-4369PubMed Google Scholar Studies like Corby and Schulman's contributed to the understanding of the effects of antenatal drug use, and were important in minimizing potential ill effects for the fetus during pregnancy. Although we now know that aggregation in cord blood does not reflect aggregation in peripheral blood, Corby and Schulman's result still have significance, because aspirin has been shown to have these effects also in peripheral blood, although of somewhat lesser severity.3Grevsen A.K. Hviid C.V.B. Hansen A.K. Hvas A.M. Platelet count and function in umbilical cord blood versus peripheral blood in term neonates.Platelets. 2020; 6: 1-7Google Scholar Fifty years after this publication, we have achieved a substantial leap forward in our understanding of antenatal drug use and potential effects on the fetal development and well-being, thanks to several studies and publications on the topic, like Corby and Schulman's study.

Are point-of-care urine drug testing devices suitable for antenatal drug screening? A study verifying the Alere® Drug Screen Test Cup for the detection of six classes of drug in a pregnant population.

Currently, there are no national guidelines for antenatal drug testing. At Colchester Hospital, we use a strategy of screen-only using point-of-care testing to detect illicit drug use in pregnancy. To determine the suitability of this approach, we have compared the results of urine analysis by point-of-care testing with another NHS specialist clinical toxicology service that uses confirmation mass spectrometry. A total of 482 anonymized random urine specimens from antenatal clinics were tested for six drug classes: amphetamine, benzodiazepines, buprenorphine, cocaine, methadone and opiates using the Alere™ Drug Screen Urine Test Cup. The manufacturer's claims for positive cut-off and result stability were verified using spiked blank urine. Confirmatory testing was performed using ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) for detection of 26 individual drugs. Of 473 urine samples with adequate volume for point-of-care screening, 4.4% tested positive: 19 opiate and 2 cocaine. Concordance between point-of-care screening and UPLC-MS/MS confirmation was 97.9% for all drugs and 78.9% for opiates. Using spiked urine, only positive results for opiates were stable when read up to the manufacturer's recommended time of 60 min. The key advantages of using point-of-care devices to detect drug use in pregnancy are that is convenient and cheap. However, the clinical utility of point-of-care testing is limited by its poor sensitivity. Best practice is to confirm results using a more specific and sensitive method. As a result of this study, we are now reviewing our own procedures to consider introducing routine confirmation by mass spectrometry.

Knowledge and practices: Risk perceptions of COVID-19 and satisfaction with preventive measures at workplace among maternity care providers in Pakistan

INTRODUCTIONWhile all healthcare services across the globe deferred non-urgent surgeries, labor wards provided maternity care during the COVID-19 pandemic continuously. This study assesses the knowledge and practices of obstetricians and midwives about personal protective equipment (PPE); their risk perception of COVID-19 and satisfaction with the preventive measures adopted at their workplace.METHODSA questionnaire designed according to the World Health Organization’s advice on rational use of personal protective equipment for COVID-19 was administered to 452 Pakistani maternity care providers between 1 July and 30 July 2020.RESULTSMost (85%) had adequate knowledge and 78.8% had good practices regarding PPE use. The perceived risk of contracting COVID-19 was lower than for influenza and tuberculosis. Perceived risk of contracting COVID-19 was highest for outpatient clinics. Fewer midwives compared to obstetricians (23.3% vs 32.9 %, p=0.001) were satisfied with the job security provided. Only 19.5% were satisfied with the social distancing measures at their setups. Less than one-third (31%) were satisfied with the PPE available to them.CONCLUSIONSThe participants had good knowledge and practices regarding PPE. The perceived risk of contracting COVID-19 was lower than for contracting influenza; however, they were concerned about contracting COVID-19 in outpatient clinics and emergency rooms. They had poor satisfaction with the measures adopted by hospital managements regarding job security and social distancing.

Drug use according to risk classification and associated factors among pregnant women: results from NISAMI cohort

This study aimed to investigate the factors associated with drug use in pregnancy by risk categories in pregnant women from Santo Antônio de Jesus, Bahia. It is a cross-sectional cohort study with 1,091 pregnant women attended in primary health care between 2012 and 2014. Drug use during pregnancy was classified according to the FDA’s pregnancy risk classification. Prevalence ratios and respective 95% confidence intervals were adjusted by Poisson regression with robust error variance. The prevalence of drug use was more pronounced in risk categories A, B, C, D, and X, respectively. The use of safe medication was associated with education, number of prenatal consultations, and health problems after data adjustment. Age greater than 24 years, onset of prenatal care during the first trimester, and have any health problem were factors associated with the use of risk medication. Quality prenatal care is important to ensure the safe and conscious use of drugs. Furthermore, investments in continuing vocational education that promote rational antenatal drug use are needed.

Self-reported compliance with routine prenatal medications by pregnant women in a tertiary hospital in Enugu State, Nigeria.

INTRODUCTIONCompliance to routine antenatal medications increases a woman’s chances of achieving a normal pregnancy and having a healthy baby. However, non-compliance is a commonly encountered problem in developing countries including Nigeria. This study investigated compliance to routine antenatal medications as reported by pregnant women receiving antenatal care in a tertiary hospital in Enugu State, Nigeria.METHODSA cross-sectional descriptive survey research design was adopted for the study while simple random sampling technique was used to select the 354 pregnant women at Enugu state teaching hospital. A validated structured questionnaire (α=0.72) was utilized for data collection. Analysis of data involved descriptive and inferential statistics.RESULTSOnly 32% of pregnant women had a good compliance to their routine antenatal drugs while forgetfulness (27.2%) and vomiting as a side effect of the drug (25.7%) were the major barriers to compliance with routine drugs. Furthermore, there was a statistically significant association between respondents’ compliance with antenatal drugs and number of children as well as level of income (p<0.001). No statistically significant association was found between education level and compliance.CONCLUSIONSNurses and other health workers should support pregnant women to set reminders for taking their medications and prescribe alternative dosage forms or products that will not induce vomiting. In addition, antenatal education should emphasize the benefits of adherence to routine taking of medications at every stage of pregnancy and the possible negative consequences of non-compliance.

Does performance-based financing curb stock-outs of essential medicines? Results from a randomised controlled trial in Cameroon.

In 2011, the government of Cameroon launched its performance-based financing (PBF) scheme. Our study examined the effects of the PBF intervention on the availability of essential medicines (EM). Randomised control trial whereby PBF and three distinct comparison groups were randomised in a total of 205 health facilities across three regions. Baseline data were collected between March and May 2012 and endline data 36months later. We defined availability of multiple EM groups by assessing stock-outs for at least one day over the 30days prior to the survey date and estimated changes attributable to PBF using a series of difference-in-difference regression models, adjusted for relevant facility-level covariates. Data were analysed stratified by region and area to assess effect heterogeneity. Our estimates suggest that PBF intervention had no effect on the stock-outs of antenatal care drugs (P=0.160), vaccines (P=0.396), integrated management of childhood illness drugs (P=0.681) and labour and delivery drugs (P=0.589). However, the intervention was associated with a significant reduction of 34% in stock-outs of family planning medicines (P=0.028). We observed effect heterogeneity across regions and areas, with significant decreases in stock-outs of family planning products in North-West region (P=0.065) and in rural areas (P=0.043). The PBF intervention in Cameroon had limited effects on the reduction of EMs stock-outs. These poor results were likely the consequence of partial implementation failure, ranging from disruption and discontinuation of services to limited facility autonomy in managing decision-making and considerable delay in performance payment.

Functional Language Network Connectivity in Children of Women with Epilepsy with Selective Antenatal Antiepileptic Drug Exposure.

Purpose:Children of women with epilepsy and antenatal antiepileptic drug (AED) exposure have increased risk of language dysfunction. Our objective was to compare language related functional MRI network connectivity (FC) of children with women with epilepsy with antenatal AED exposure (CAED) with that of healthy children (COAED) for delineating functional basis of the language dysfunction.Methods:CAED under prospective follow up in Kerala Registry of Epilepsy and Pregnancy were consecutively sampled. COAED were identified from volunteers with normal brain MRI. Clinical Evaluation of Language Fundamentals score (CELF) was used to assess language. Functional MRI done using verb generation paradigm to activate language areas and key language network nodes were identified. A multivariate ROI-to-ROI and Seed-to-Voxel based FC was done using the selected seed regions in the language areas located in the right and left hemisphere in all subjects using the CONN functional connectivity toolbox in SPM8 under MATLAB.Results:Strong connectivity was observed within the identified language network between all language nodes bilaterally in CAED compare to controls. The mean connectivity strength of language network (LN) on the left side in CAED was 9.63 ± 4.62 (Mean ± SD) while for COAED it was 6.96 ± 3.67 (p=0.0001). The mean connectivity strength of LN between CAED (4.86 ± 1.07) and COAED (4.32 ±1.2) on the right hemisphere was not statistically significant (p=0.18).Conclusion:CAED with impaired language function had significantly increased functional connectivity which may indicate poor differentiation and localization of language centers.

Drug Therapy Optimization and Impact of Counseling on Knowledge, Attitude and Practice of Antenatal Care among Pregnant Women

Background: Antenatal care (ANC) is a pregnancy care. Access to these services enables skilled health care professionals to identify and treat potential risks to expecting woman and unborn baby to ensure safe delivery. Deprived of proper care and inappropriate drug use during pregnancy, prenatal complications may rise. Objectives: To assess knowledge, attitude, and practice of antenatal care and drug related problems among study population. Method: A hospital based prospective study was conducted in OBG department of BLDEA's hospital Vijaypur, Karnataka. A total of 94 subjects were studied and reviewed for drug therapy related problems and were assessed for their knowledge, attitude and practice (KAP) of antenatal care using validated questioner for two successive follow-ups. Eclectic method of counseling was used to address gaps in KAP. All extracted data was documented and analyzed by paired t/ Wilcoxon signed rank test to report the impact of counseling. Result: Knowledge, attitude and practice scores were increased in the first and second follow-up, significance (p<0.001) of counseling was observed. There were 250 drugs from 19 different categories prescribed by the health care professional. Among that 14 pharmaceutical care issues detected by pharmacist were evaluated for appropriate intervention with health care professional and by providing proper counselling to study population. Conclusion: The present study reveals that there is a positive significance of the Pharmacist led drug therapy optimization and impact of counseling on knowledge, attitude and practice of antenatal care among pregnant women.

The Association Between Antenatal Maternal Self-reported Substance Use, Maternal Characteristics, and Obstetrical Variables.

Substance use disorders during pregnancy are a concern both to the public and medical community, because the negative consequences can be detrimental to both mother and the fetus. The accurate identification of prenatal drug exposure is necessary to determine appropriate medical and psychosocial intervention, and to identify risk factors that may affect outcomes for the mother and her newborn. The prevalence of prenatal drug exposure is very difficult to estimate because of flaws in all methods of identification. The study is designed to identify risk factors and demographic variables that contribute to nondisclosure of illicit and nonillicit substance use. In addition, this study aims to determine if nondisclosure leads to adverse neonatal outcomes. Newborns delivered with a positive meconium or urine toxicology, and/or known maternal exposure to illicit and nonillicit substances, were identified. Maternal records were reviewed for disclosure of substance use during pregnancy at admission for delivery along with other medical and demographic variables. Women with antenatal prescription drug use that may alter toxicology screens were excluded from analysis. Pediatric records were also reviewed to obtain neonatal variables. One hundred sixty-eight newborns were identified as having prenatal exposure to an illicit or nonillicit substance over the 4-year period. Eighty-six per cent (145/168) of women tested positive or their newborn tested positive for at least 1 illicit substance, and 49% (82/168) tested positive for multiple illicit substances. Fifty-four per cent (91/168) of women did not disclose using at least one illicit drug for which she or her newborn tested positive.With regards to maternal characteristics, there was no statistically significant difference between age (P = 0.958), parity (P = 0.300), or race (P = 0.531), and disclosure or failure to disclose about illicit drug use. However, patients who did not report prenatal illicit drug use (33/82 = 40%) were less likely (P = 0.049) to receive complete prenatal care (defined as 3 or more visits) compared with those who acknowledged their substance use (40/70 = 57%). Substance use disorders during pregnancy are an often underestimated cause of maternal, fetal, and neonatal complications. Limited studies have examined the relationship between maternal characteristics and associated illicit or nonillicit drug use. The absence of correlation between maternal demographics and disclosure of illicit substance use demonstrates the fact that all antepartum patients are at risk for these behaviors. Furthermore, the fact that women who did not disclose their illicit drug use were less likely to seek complete prenatal care reflects the need for physicians to provide a destigmatized healthcare environment, encouraging pregnant women to disclose their substance use so they can be provided with appropriate counseling and treatment.

Neonatal Head Circumference in Newborns With Neonatal Abstinence Syndrome.

To compare head circumference (HC) in neonates treated for neonatal abstinence syndrome (NAS) with control neonates without antenatal opioid exposure. Our prospective cohort study ran from April 1, 2014, through December 31, 2016. Newborns treated for NAS delivered from well-dated pregnancies ≥34 weeks' gestation were compared with newborns who were nonopioid exposed and matched for race, parity, mode of delivery, and gestational age. All mothers underwent serial antenatal urine drug testing. A minimum of 754 study participants were needed (377 in each group) to demonstrate an increase in the proportion of newborns with HCs less than or equal to the 10th percentile from 10% in controls to a minimum of 20% in NAS newborns with 90% power. A total of 858 neonates were enrolled (429 NAS cases and 429 controls). Mean HC for cases was 33.04 cm (±1.9 cm) compared with 33.99 cm (±2.0 cm) for controls (P < .0001). Among the 429 NAS cases, the mothers of 372 (87%) were on opioid medication-assisted treatment. For NAS cases, 30.1% (95% confidence interval: 25.8%-34.7%) had an HC less than or equal to the 10th percentile (129 of 429 neonates), and 8.2% (95% confidence interval: 5.8%-11.2%) had an HC less than or equal to the third percentile (35 of 429 neonates). Multivariate analysis was used and determined that only chronic opioid use during gestation resulting in a neonate who was NAS treated was a significant risk factor for the observed smaller HC. Chronic opioid use during pregnancy sufficient to cause NAS was associated with smaller HCs at birth. Most mothers were on opioid agonist medication-assisted treatment, which is currently the recommended treatment option during pregnancy.

A prospective study of the pattern of morbidity and medication use during antenatal and perinatal period in mothers of neonates admitted to neonatal intensive care unit of a tertiary care hospital

Background: Most drugs taken by pregnant women can cross the placenta (except high molecular weight drugs like heparin) and expose the foetus to pharmacologic and teratogenic effects. The drugs used in the late antenatal and intranatal period may have a potential perinatal and neonatal outcome.Methods: The pattern of maternal morbidity and drug use was assessed prospectively in 150 consecutive mothers of neonates admitted to NICU. The number of drugs used, therapeutic class, dose, route, frequency and purpose of use were recorded. The efficacy and safety of medications was assessed by neonatal outcome.Results: The most common maternal morbidity during pregnancy was PIH, eclampsia, hypothyroidism, GDM, PROM, oligohydromnias, anemiaorpolyhydromnias, and 4% (n=6) had more than one complication. Different therapeutic classes of drugs were used as per the prevailing clinical conditions or complications. The total number of drugs used was 26, with an average of 3.68 per subject. AMAs were the most commonly used drugs, chosen empirically and used in combination for prophylaxis or control of infections. Other classes of drugs were used for specific indications. None of the NICU admissions in the present study seem to be related to antenatal or perinatal drug exposure. The treatment outcome was very good in most of the subjects and no drug related adverse events or interactions were observed.Conclusions: Maternal morbidity and drugs administered to mother play an important role in improving the neonatal outcome.

Effects of Selected Socio-Demographic, Maternal, ServiceRelated and Psychological Risk Factors on Low Birth Weight Babies: An Unmatched Case Control Study

Background: Birth weight is considered as the most important factor in determining the neonatal and infant survival. Low Birth Weight (LBW) is an indicator of the socio-economic conditions and indirectly measures the maternal and child health. Objectives: This work was designed to find out effects of selected socio-demographic, maternal, service-related and psychological risk factors on low birth weight babies Methods: This is a hospital based unmatched case control study Findings: sleeping 26 kg/m2 (OR:2.13, 95% CI:1.27-3.58) were risk factors for LBW. Maternal height < 153 cm (OR: 0.5, 95% CI:0.34-0.73)was a protective factor. Conclusion: Sedentary life style, less sleeping, exposure to kitchen smoke, taking drugs other than routine antenatal drugs and Body Mass Index (BMI) ≥ 26 kg/m2 are modifiable risk factors for LBW. Low maternal height was a protective factor.

Mother-to-Child Transmission of HIV and HIV-Free Survival in Swaziland: A Community-Based Household Survey.

In Swaziland, no data are available on the rates of HIV infection and HIV-free survival among children at the end of the breastfeeding period. We performed a national crosssectional community survey of children born 18-24months prior to the study, in randomly selected constituencies in all 4 administrative regions of Swaziland, from April to June 2015. Mother-to-child transmission (MTCT) of HIV and HIV-free survival rates were calculated for all HIV-exposed children. The overall HIV-free survival rate at 18-24months was 95.9% (95% CI 94.1-97.2). The estimated proportion of HIV infected children among known HIV-exposed children was 3.6% (95% CI 2.4-5.2). Older maternal age, delivering at a health facility, and receiving antenatal antiretroviral drugs were independently associated with reduced risk for child infection or death. The Swaziland program for prevention of MTCT achieved high HIV-free survival (95.9%) and low MTCT (3.6%) rates at 18-24months of age when Option A (infant prophylaxis) of the WHO 2010 guidelines was implemented.