Children Birth Research Articles

Socioeconomic inequalities in high-risk fertility behaviour among Nigerian women: A non-experimental population-based study.

High-risk fertility behaviour (HRFB) has adverse health, social and economic effects on women. An understanding of socioeconomic inequalities is needed to design effective interventions targeted to lower maternal morbidity and mortality due to HRFB. The objective was to quantify socioeconomic inequalities in HRFB among Nigerian women. This was a cross-section study that used population-based data. A sample of 21,792 Nigerian women aged 15-49 years from the 2018 Nigeria Demographic Health Survey was analyzed. Percentage was employed in univariate analysis. In addition, concentration index was used to assess the extent of inequalities in HRFB. This was further decomposed to ascertain the explanatory components' relative contributions to the socioeconomic inequalities in HRFB. The weighted prevalence of HRFB (63.5%; 95% CI: 62.6-64.4%), included <18 years at childbirth (4.9%; 95% CI:4.5-5.3%), >34 years at childbirth (18.3%; 95% CI: 17.6-19.0%), >3 children birth order (49.6%; 95% CI: 48.7-50.5%) and <24 months at preceding birth interval (17.0% 95% CI: 16.3-17.6%) were estimated. Education (Contri: 50.3997%, Ec: 0.2771), wealth (Contri: 27.2811%, Ec: 0.2665), socioeconomic disadvantaged (Contri: 14.9163%, Ec: -0.0996), religion (Contri: 13.8636%, Ec: -0.0496), region (Contri: 11.1724%, Ec: 0.0711), partner education (Contri: 7.1351%, Ec: 0.2138), media use (Contri: 4.5064%, Ec: 0.1449) and family motility (Contri: 3.7890%, Ec: -0.0281) were positive contributors to HRFBs among Nigerian women. However, age (Contri: -14.6237, Ec: 0.0089) and history of contraceptive use (Contri: -8.7723, Ec: -0.2094) were negative contributors to HRFBs among women of reproductive age in Nigeria. Women who have low socioeconomic level reported higher prevalence of HRFB. Targeted interventions are required to lower HRFB among Nigerian women from poor households and with no formal education. Women should get counselling and assistance from healthcare and educational institutions to help them adopt healthy sexual and reproductive practices.

Heterogeneity in health and lifestyle among preschool children with migrant background in Sweden

Abstract Background Parental country of birth and socioeconomic status affect children’s health, lifestyle, and access to care. But inequality patterns may vary depending on the outcome and indicator being studied. While prior studies have focused on single health outcomes, this study assessed the relationship between parental migrant status and a range of health and lifestyle indicators among 3-year-old children. Methods Using an outcome-wide approach, we analyzed data from cross-sectional population-based surveys of 3-year-old (2014-2018) in Northern Sweden, which included 9,099 children aged 33-42 months. The surveys were administered to parents. Logistic and linear regressions were performed to examine the association between parents’ place of birth and outcome indicators. Additionally, we controlled for parents’ income and education using multiple regression models. Results Children with at least one migrant parent were perceived by their parents to have poorer health (OR:1.5, CI:1.01-2.36) and more socio-emotional problems (OR: 2.8, CI: 2.20-3.59) compared to those with two Swedish parents. While there were no significant differences in estimated BMI, lifestyle indicators showed that these children consumed more sweets (OR:4.5, CI: 3.02-6.58), less milk (OR: 1.3, CI: 1.09-1.55), fewer vegetables (OR:1.6; CI: 1.22-2.05) and brushed their teeth less frequently (OR: 2.8, CI: 2.17-3.53). However, they spent more time playing outdoors on weekdays (OR:1.6, CI:1.22-2.00) and weekends (OR: 1.5, CI: 1.18-1.94), but screen time remained consistent between weekdays and weekends. Conclusions Parental migrant status has varying impacts on children’s health and lifestyle, with some indicators showing worse outcomes for children with migrant parents compared to those with Swedish parents, while others do not. An outcome-wide approach is crucial for targeted actions to strengthen protective factors and mitigate risk factors, and ultimately reduce inequalities in early childhood. Key messages • The link between parental migrant status and children’s well-being is complex. Not all indicators show worse outcomes, inequality patterns vary based on the specific outcome and indicator measured. • An outcome-wide approach is crucial to identify action areas for targeted interventions to reinforce protective factors and mitigate risk factors, and ultimately reduce inequalities during childhood.

Regional patterns in minimum diet diversity failure and associated factors among children aged 6-23 months in India.

Background About 35% of the global child deaths and 11% of the total disease burden are due to inadequate nutrition. While in India, 1 in 3 children are underweight and stunted, and 1 in 5 children are wasted. Methods Using multivariate and descriptive statistical analysis, we examined the prevalence, determinants of minimum diet diversity failure (MDDF) and trends of MDDF across different regions of India among children aged 6-23 months. Dietary pattern in 8 food groups was also examined using the National Family and Health Survey (NFHS) data from 2005-06 to 2019-21. Results Overall, MDDF in India has decreased from 87.4% (2005-06) to 77.1% (2019-21). The central region (84.6%) reported the highest prevalence of MDDF in 2019-21. Children of illiterate and rural residing mothers with no mass media exposure, children of the first birth order and children not exposed to counselling and health check-ups at Anganwadi/Integrated Child Development Services (ICDS) centres, children with low birth weight and anaemic, and who belonged to a large family had greater likelihood for MDDF. Conclusion To tackle the high prevalence of MDDF, a holistic action is needed from the government, i.e. improved public distribution system (PDS), intensified Integrated Child Development Scheme (ICDS) programme, use of social media, and nutrition counselling through local self-governance.

Association of different types of abortions with neonatal outcomes in subsequent pregnancy.

Abortion is an important issue that concerns all women. It holds great significance to investigate the correlation between various types of abortion histories and the neonatal outcomes of subsequent pregnancies. This retrospective cohort study included pregnant women who gave birth to singleton live-born in Shanghai First Maternity and Infant Hospital from 2016 to 2020 (n = 75 773). Women with a history of abortion, including spontaneous abortion (SAB) and induced abortion (IA), were included in the exposed group, and the remaining were included in the unexposed group. The main outcomes were birthweight and preterm birth in the subsequent pregnancy. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association of maternal abortion history with birthweight and risk of preterm birth in subsequent pregnancy. Women who have experienced SAB history had an increased risk of delivering very low birth weight (VLBW) and preterm birth children, with (OR = 1.63, 95% CI = 1.15-2.32; OR = 1.38, 95% CI = 1.07-1.79). However, women with a history of IA were at greater risk of macrosomia (OR = 1.16; 95% CI = 1.06-1.27). We also observed that the likelihood of delivering a VLBW baby was heightened by the number of SAB occurrences (OR = 0.87, 95% CI = 0.54-1.38; OR = 1.84, 95% CI = 1.01-3.36, OR = 5.71, 95% CI = 3.21-10.15). Our study indicates that pregnant women with a history of SAB are at an increased risk of delivering VLBW infants and experiencing preterm labour. The risk is positively associated with the number of SABs. Conversely, women with a history of IA are more likely to deliver macrosomic infants.

Pedagogic mediation for praxis development: supporting leaders and mentors in the English ECEC context

ABSTRACT Pedagogic mediation from Pedagogy-in-Participation in Portugal, as a context-specific approach to professional development, provides a participatory framework through which practice enhancements are supported. This research introduced ten ECEC leaders and mentors, within a specific local authority in England, to the democratic nature of pedagogic mediation and provided a community of practice within which this could be explored. Leaders and mentors documented their own reflections over several months and noted how they applied the elements of openness, listening, suspending and encountering to their professional role, supporting outcomes for children birth to four years of age. Reflective narratives were shared and a focus group supported the evaluation of pedagogic mediation within this English context. All ten leaders and mentors found pedagogic mediation helpful within their professional role. Specifically, the element of suspending was found to be most useful as it provided leaders and mentors licence to enable additional time for development and this in turn supported a more participatory approach. Whilst small-scale and context-specific, this research illustrates the benefits of contextual professional development undertaken at a flexible pace.

Stepped-Care Web-Based Parent Support Following Congenital Heart Disease: Protocol for a Randomized Controlled Trial.

Early neurodevelopmental risks, compounded with traumatic medical experiences, contribute to emotional and behavioral challenges in as many as 1 in 2 children with congenital heart disease (CHD). Parents report a strong need for supports; yet, there remains a lack of accessible, evidence-based behavioral interventions available for children with CHD and their families. I-InTERACT-North is a web-based stepped-care mental health program designed to support family well-being and reduce behavioral concerns through positive parenting for children with early medical complexity. In previous pilot studies, the program was effective in increasing positive parenting skills and decreasing child behavior problems, with high parent-reported acceptability. This paper presents the protocol for the first randomized study of stepped-care parent support for families of children with CHD. This study will involve a single-site, 2-arm, single-blind randomized controlled trial to evaluate (1) the feasibility and acceptability of a web-based stepped-care parent support program (I-InTERACT-North) and (2) the effectiveness of the program in enhancing positive parenting skills and reducing behavioral concerns among families of children with CHD. Families will be randomized (1:1) to either receive treatment or continue with care as usual for 12 months. Randomization will be stratified by child's sex assigned at birth and baseline parent-reported child behavior intensity. Primary outcomes include positive parenting skills and child behavior at baseline, 3 months, 6 months, and 12 months. Secondary outcomes include parental mental health, quality of life, service usage, and feasibility including program reach and adherence. A sample size of 244 families will provide >95% power to detect an effect size of d=0.64. Based on attrition data from pilot studies, a target of 382 families will be enrolled. Parent reports of acceptability, adoption, and suggested adaptability of the program will be examined using cross-case thematic analyses. Primary efficacy analysis will be conducted using an intent-to-treat approach. Generalized estimating equations will be used to examine changes in positive parenting. Child behavior, quality of life, and parent mental health will be tested with repeated-measures analyses. Additional sensitivity and replication analyses will also be carried out. Recruitment began in February 2024, and recruitment and follow-up will continue until January 2029. We anticipate results in late 2029. This study aims to test the effectiveness of I-InTERACT-North web-based stepped-care parent support in improving positive parenting skills and reducing child behavior problems in families of children with CHD compared with a care as usual control group. Results will inform future clinical implementation and expansion of this program among families of children with early medical conditions. ClinicalTrials.gov NCT06075251; https://clinicaltrials.gov/study/NCT06075251. DERR1-10.2196/64216.

Reducing stunting and underweight through mother’s birth spacing: evidence from Ghana

BackgroundResearchers over the years have underscored the role of birth spacing on maternal health, however, inadequate maternal repletion due to shorter birth intervals could also affect the health of the child. Even so, limited studies exist on the linkage between birth spacing and child nutrition. This study examines the association between birth spacing and child stunting and underweight using the 2014 Ghana Demographic and Health Survey.MethodsThe study sourced data on 1, 904 children less than 59 months from the 2014 Ghana Demographic and Health Survey. The study employed bivariate analysis and logistic regressions to establish the association between birth spacing, and child stunting and underweight.ResultsThe analyses reveal that childbirth spacing between 24 and 35 months (OR = 0.62, 95% CI: 0.38–0.99; p < 0.05), 36 to 47 months (OR = 0.42, 95% CI: 0.25–0.70; p < 0 0.01), and beyond 47 months (OR = 0.47, 95% CI: 0.28–0.78; p < 0.01) have lower odds of child stunting than children with birth spacing less than 24 months. Children with birth spacing between 24 and 35 months (OR = 0.53, 95% CI: 0.29–0.98; p < 0.05), 36 to 47 months (OR = 0.44, 95% CI: 0.22–0.90; p < 0.01) and beyond 47 months (OR = 0.49, 95% CI: 0.26–0.94; P < 0.05) have lower odds of being underweight than those with birth spacing less than 24 months.ConclusionThe study reveals that mothers with a birth spacing of at least two to three years compared to their counterparts with less than two years of birth spacing have lower odds of having a stunted and underweight child under age five. The study recommends that Ghana Health Service and other healthcare providers should educate mothers on the gains of birth spacing of at least two years on their children.

Prioritising children’s participation in research: including children’s voices in updating a national early learning framework

ABSTRACT Involving children as stakeholders and including their voices in updating the Australian Early Years Learning Framework (for children birth to age 5) was a focus of this project design. The design was grounded in participatory approaches with a children’s rights perspective, as the team prioritised seeking children’s views and encouraging their agency on matters that affect them. This three-stage research project across 15 months sought children’s input in each stage. Research methods consisted of everyday playful activities supported by educators in early childhood environments using dialogic drawing, talking circles and discussions using photo elicitation. Educators received information to support their use of these methods. While parents/carers gave ethical consent, children’s assent was obtained. Across the three stages, analysis of children’s drawings, comments and discussions showed the importance of their relationships with educators, their friends and the relationships between their educators and families. These findings demonstrate the importance of educators building reciprocal, respectful relationships with children and their families and between children. Further, these research methods fitted with the foundational pedagogical practices of the educators, with educators commenting on how useful they were and children on how they enjoyed using them.

Maternal diet during pregnancy and adaptive changes in the maternal and fetal pancreas have implications for future metabolic health.

Fetal and neonatal development is a critical period for the establishment of the future metabolic health and disease risk of an individual. Both maternal undernutrition and overnutrition can result in abnormal fetal organ development resulting in inappropriate birth size, child and adult obesity, and increased risk of Type 2 diabetes and cardiovascular diseases. Inappropriate adaptive changes to the maternal pancreas, placental function, and the development of the fetal pancreas in response to nutritional stress during pregnancy are major contributors to a risk trajectory in the offspring. This interconnected maternal-placental-fetal metabolic axis is driven by endocrine signals in response to the availability of nutritional metabolites and can result in cellular stress and premature aging in fetal tissues and the inappropriate expression of key genes involved in metabolic control as a result of long-lasting epigenetic changes. Such changes result is insufficient pancreatic beta-cell mass and function, reduced insulin sensitivity in target tissues such as liver and white adipose and altered development of hypothalamic satiety centres and in basal glucocorticoid levels. Whilst interventions in the obese mother such as dieting and increased exercise, or treatment with insulin or metformin in mothers who develop gestational diabetes, can improve metabolic control and reduce the risk of a large-for-gestational age infant, their effectiveness in changing the adverse metabolic trajectory in the child is as yet unclear.

Pregnancy and childbirth in Takayasu arteritis in Japan: A nationwide retrospective study.

This study aimed to understand the status quo of medical treatments of the primary disease and pregnancy outcomes in patients with Takayasu arteritis (TAK) and children's birth outcomes. This study retrospectively enrolled patients with TAK who conceived after the disease onset and were managed at medical facilities participating in the Japan Research Committee of the Ministry of Health, Labor, and Welfare for Intractable Vasculitis. This study enrolled 51 cases and 68 pregnancies 2019-2021. Of these, 48 cases and 65 pregnancies (95.6%) resulted in delivery and live-born babies. The median age of diagnosis and delivery was 22 and 31, respectively. Preconception therapy included prednisolone (PSL) in 51 (78.5%, median 7.5 mg/day), immunosuppressants in 18 (27.7%), and biologics in 12 (18.5%) pregnancies. Six cases underwent surgical treatment before pregnancy. Medications during pregnancy included PSL in 48 (73.8%, median: 9 mg/day), immunosuppressants in 13 (20.0%), and biologics in 9 (13.8%) pregnancies. Enlargement of an aneurysm was reported in one pregnancy, which might be associated with increased circulating plasma volume. TAK relapsed in 4 (6.2%) and 8 (12.3%) pregnancies during pregnancy and after delivery, respectively. Additionally, 13/62 (20.9%) preterm infants and 17/59 (28.8%) low birth weight infants were observed, and none had serious postnatal abnormalities. Of the 51 confirmed infants, 42 (82.4%) were exclusively breastfed or mixed with formula. Most pregnancies in TAK were manageable with PSL at ≤10 mg/day. Relapse during pregnancy and postpartum occurred in <20% of pregnancies.

Risk factors of children's low birth weight and infant mortality in Bangladesh: Evidence from binary logistic regression and Cox PH models.

Low birth weight is recognized as a pivotal risk factor affecting child survival and growth. Although Bangladesh has made commendable progress in public health, an infant mortality rate of 38 per 1000 live births and a 16% prevalence of low birth weight remain significant concerns compared to other developing countries. This situation poses a significant challenge for the formulation of future health policies in Bangladesh. As a result, this study aims to identify potential risk factors contributing to low birth weight and infant mortality among children in Bangladesh. The data is extracted from the 2014 Bangladesh Demographic and Health Survey. The response variables are infant mortality and low birth weight. In the bivariate analysis, Log-rank tests and Chi-square tests of independence were conducted. Cox proportional hazards and binary logistic regression models were utilized to determine the impact of risk factors on infant mortality and low birth weight. This study identified several significant factors associated with children's low birth weight, including wealth index, parental education, birth order, twin births, mother's body mass index, and child sex. Additionally, wealth index, parental education, twin status, media exposure, birth order, antenatal care visits, prenatal care assistance, and low birth weight were identified as potential risk factors for infant mortality in Bangladesh. This study revealed that maternal and child characteristics, along with knowledge about child health care during pregnancy, can potentially reduce the risk of low birth weight and infant mortality among children in Bangladesh. To improve child health and survival, policymakers should prioritize community-based health education programs, and encourage parents to seek healthcare information from institutional medical facilities during pregnancy and after birth.

Maternal Antenatal Depression Is Associated With Metabolic Alterations That Predict Birth Outcomes and Child Neurodevelopment and Mental Health

BackgroundEvidence regarding metabolic alterations associated with maternal antenatal depression (AD) is limited, and their role as potential biomarkers that improve the prediction of AD and adverse childbirth, neurodevelopmental, and mental health outcomes remains unexplored. MethodsIn a cohort of 331 mother-child dyads, we studied associations between AD (a history of medical register diagnoses and/or a Center for Epidemiological Studies Depression Scale score during pregnancy ≥ 20) and 95 metabolic measures analyzed 3 times during pregnancy. We tested whether the AD-related metabolic measures increased variance explained in AD over its risk factors and in childbirth, neurodevelopmental, and mental health outcomes over AD. We replicated the findings in a cohort of 416 mother-child dyads. ResultsElastic net regression identified 15 metabolic measures that collectively explained 25% (p < .0001) of the variance in AD, including amino and fatty acids, glucose, inflammation, and lipids. These metabolic measures increased the variance explained in AD over its risk factors (32.3%, p < .0001 vs. 12.6%, p = .004) and in child gestational age (9.0%, p < .0001 vs. 0.7%, p = .34), birth weight (9.0%, p = .03 vs. 0.7%, p = .33), developmental milestones at the age of 2.3 to 5.7 years (21.0%, p = .002 vs. 11.6%, p < .001), and any mental or behavioral disorder by the age of 13.1 to 16.8 years (25.2%, p = .03 vs. 5.0%, p = .11) over AD, child sex, and age. These findings were replicated in the independent cohort. ConclusionsAD was associated with alterations in 15 metabolic measures, which collectively improved the prediction of AD over its risk factors and birth, neurodevelopmental, and mental health outcomes in children over AD. These metabolic measures may become biomarkers that can be used to identify at-risk mothers and children for personalized interventions.

We Must Consider Infrastructure when Attempting to Scale up Autism EBIs: A Case Example from Early Intervention Systems.

In the autism field, there is increasing interest in translating evidence-based interventions (EBIs) into systems that serve young autistic children and their families. Public Early Intervention systems have been a focal point of research-based implementation efforts given that these systems are federally mandated to provide services to children birth to three years of age with developmental delays under Part C of the Individuals with Disabilities Education Act. Although a growing number of research studies are now training Early Intervention providers to deliver autism EBIs, this work has been conducted on a relatively small scale and has only just begun to consider the alignment of these models with Early Intervention systems and whether sufficient infrastructure exists to scale up these training efforts and to sustain their public health impact. This commentary aims to address this gap by reviewing factors that have been found to uniformly impact the scale-up of EBIs across diverse public systems (Fagan 20, 1147-1168, 2019), and to extend this framework to the implementation of EBIs within public Early Intervention systems. These factors include developer and funder capacity, the public's awareness of and support for EBIs, the system's leadership support for EBI use, the capacity for community engagement in implementation efforts, the availability of a skilled workforce capable of delivering EBIs, and the capacity for data monitoring and quality improvement. This commentary discusses how these factors may specifically impact the scale-up of autism EBIs within EI systems to support toddlers and young, autistic children, and implications for autism researchers.

Preliminary development of a brief parent-report gender identity alignment/distress screener for children.

This research develops a brief, and preliminary, parent-report screener to assess gender identity alignment/distress in children. The increasing prevalence of children not identifying with their sex at birth, the length and outdated language of existing gender identity measures, and the need to assess gender identity among children (as opposed to adolescent/adult measures) motivate a screener. A survey containing 14 items from existing instruments was administered to a diverse set of 1110 parents of children ages 3-12. Exploratory and confirmatory factor analyses, followed by multiple indicators and multiple causes (MIMIC) modelling, were used to develop a 5-item, unidimensional screener that may assess gender identity alignment/distress. The screener may be suitable to identify children who experience misalignment between their gender and sex assigned at birth and parents or children for whom this misalignment causes distress. These families may benefit from additional resources and conversations between paediatric staff and children about their gender identity, including education for parents, and/or referrals for specialty care. Future research should further streamline and validate this preliminary screener, examine its convergence with gender identity and distress measures and explore including children's perspectives.

Determinants of birth weight and length: an analysis of the 2020 mothers' cohort register data

A woman's nutritional status significantly impacts the qualities of the baby she delivers, as assessed by the baby's weight and length at birth. This study aimed to identify factors influencing birth weight and length using a retrospective case-control design with secondary data collected from the mothers' cohort register at the Community Health Center in 2020-2021. The study included 100 samples, comprising 25 cases and 75 controls. Several determinants of birth weight and length were examined: the mother's age (OR=4.1, 95% CI 1.41-12.0), weight gain during pregnancy (OR=3.6, 95% CI 1.051-12.553), mid-upper arm circumference (OR=2.9, 95% CI 1.061-8.220), hemoglobin level (OR=4.711, 95% CI 1.57-14.11), and iron supplement intake (OR=1.837, 95% CI 0.600-5.624), with hemoglobin level identified as the most influential factor on birth qualities. Mothers with less than normal hemoglobin levels have a 4.7 times higher risk of delivering babies of lower weight and length than mothers with normal hemoglobin levels. The impact of low hemoglobin in pregnant women includes reduced oxygen supply for both the mother and fetus, resulting in low birth weight, child anemia, premature birth, and child mortality. Given these significant effects, it is crucial to establish standards for health services in Indonesia, ensuring that pregnant women with low hemoglobin receive comprehensive care aligned with Indonesia's Sustainable Development Goals (SDGs) standards.

P-241 The in vivo human uterine pH and uterine fluid composition differs from pH and composition of clinically used in vitro preimplantation embryo culture media

Abstract Study question To study the pH and uterine fluid composition in the human uterus three days after a positive LH test or ovum pick-up. Summary answer The uterine pH three days after a positive LH test or ovum pick-up was 6.8. Concentrations of 37 components were determined in uterine fluid. What is known already In assisted reproductive technologies (ART), the in vitro culture of human preimplantation embryos is known to play a crucial role in the success of In Vitro Fertilization (IVF) treatments. It affects live birth rates and child outcomes such as birth weight. Numerous commercial embryo culture media are routinely used in clinical practice worldwide, but their composition is primarily based on laboratory-based clinical insights and experimental studies with animal models. Studies on the natural human preimplantation embryo environment during the physiologically relevant time of the menstrual cycle are limited. Study design, size, duration A cross sectional clinical study was conducted to study the uterine pH and the composition of human uterine fluid. The uterine pH was measured in 53 women on the third day after LH surge (N = 46) or ovum pickup (N = 7), as that time in the menstrual cycle is associated with endometrial receptivity for embryo implantation. Twenty-two samples of aspirated uterine fluid, that were collected at the same time, were analyzed for the concentrations of thirty-seven components. Participants/materials, setting, methods Healthy women of reproductive age with normal functional uterine anatomy were included. Uterine pH was determined using pH probe inserted through outer sheath of an Embryo Transfer (ET) catheter at the lithotomy position. Uterine fluid was then aspirated using a syringe connected to outer sheath of this ET catheter. Collected samples were analyzed using a Cobas 8000 chemistry analyser and ultra-performance liquid chromatography-tandem mass spectrometry. Main results and the role of chance The mean pH in the uterine cavity on the third day after a positive LH test (6.75 ± 0.22) or ovum pick-up (6.82 ± 0.18) was clearly lower than the pH used in routine clinical practice for preimplantation embryo culture (pH 7.3 ± 0.1). Calcium, phosphate, lactate(L), pyruvate, albumin and 21 amino acids were present at different concentrations in human uterine fluid compared to most commonly used preimplantation embryo culture media. Immunoglobulins, citrulline, ornithine and uric acid were present in uterine fluid, but not in clinically used culture media. Limitations, reasons for caution As the uterine cavity is only one part of the reproductive tract, our measurements do not fully represent the complete in vivo environment of preimplantation embryo development. We only studied 37 components, recognizing that uterine fluid likely contains additional components. Wider implications of the findings The observed differences between the uterine pH and the composition of uterine fluid and the pH and composition of preimplantation embryo culture media used in routine clinical practice could be a starting point to further optimize in vitro embryo culture in ART treatments. Trial registration number Not applicable

Concomitant use of antidepressants and benzodiazepines during pregnancy and associated risk of congenital malformations: a population-based cohort study in Taiwan

Despite the frequent co-administration of antidepressants and benzodiazepines, the association between such concomitant use during pregnancy and the risk of congenital malformations remains inadequately explored. This study aims to examine the association between concomitant use of antidepressants and benzodiazepines during the first trimester and organ-specific congenital malformations. We conducted a population-based cohort study using Taiwan's National Birth Certificate Application database, the Maternal and Child Health database, and Taiwan's National Health Insurance database. Pregnant people aged 15-50 years with singleton births between Jan 1, 2004, and Dec 31, 2018, were included. Use of antidepressants and benzodiazepines was defined as at least one prescription during the first trimester, and concomitant use was defined as the overlapping prescription of both drugs with an overlapping prescription period. The primary outcomes were overall congenital malformations and eight organ-specific malformations, consisting of the nervous system, heart, respiratory system, oral cleft, digestive system, urinary system, genital system, and limb malformations. Logistic regression models with propensity score fine stratification weighting approach were used to control for measured confounders. Analyses controlling for confounding by indication and sibling comparison analyses were done to address unmeasured confounders. No individuals with lived experience participated in the research or writing process. The cohort included 2 634 021 singleton pregnancies, and 8599 (0·3%) individuals were concomitant users of antidepressants and benzodiazepines during the first trimester (mean age at delivery was 31·8 years [SD 5·2] for pregnancies with exposure to antidepressants and benzodiazepines vs 30·7 years [SD 4·9] for pregnancies without exposure). All study participants were female, and information about ethnicity was not available. Absolute risk of overall malformations was 3·81 per 100 pregnancies with exposure, compared with 2·87 per 100 pregnancies without exposure. The propensity score-weighted odds ratios (weighted ORs) did not suggest an increased risk for overall malformations (weighted OR 1·10, 95% CI 0·94-1·28), heart defects (1·01, 0·83-1·23), or any of the other organ-specific malformations, except for digestive system malformations, for which the weighted OR remained statistically significant after adjustment (1·63, 1·06-2·51). The absence of an increased risk for overall congenital malformations associated with concomitant use of antidepressants and benzodiazepines was supported by the analyses controlling for confounding by indication and sibling-matched comparisons. The findings of this study suggest that the concomitant use of antidepressants and benzodiazepines during the first trimester is not associated with a substantial increase in risk for most malformation subtypes. However, considering other potential adverse effects of using both medications concomitantly, a thorough assessment of the risks and benefits is crucial for clinical decision making. National Science and Technology Council.

‘출생 등록될 권리’의 실현을 위한 헌법적 쟁점

All children must be registered at birth so that they can grow and develop peacefully under the protection and support of the state and society. However, as members of the community, children receive legal guarantees only after they are granted legal status through birth registration. in the case of unregistered children whose birth is not registered, they are not protected by the basic right to survival and social safety net. in the case of children who require assistance from others in the process of growing mentally and physically, their existence as members of the community must first be confirmed in order to guarantee and realize their human rights. Therefore, in this article, we examine the implications of birth registration from the perspective of children's rights and the current status and problems of Korea's birth registration system through the decisions of the Constitutional Court and the Supreme Court. in this regard, in order to confirm the legal nature of the right to birth registration, we examine the discussion on the legal nature of the right to birth registration through the decisions of the Constitutional Court. Finally, in order to prevent omission of child birth registration, Analyze the contents of the amendment to the ‘Act on Registration of Family Relations, etc.’, which is the legal basis for the introduction of the birth notification system, and the ‘Special Act on Crisis Pregnancy and Protected Birth Support and Child Protection’, which is the legal basis for the introduction of the protected childbirth system. Afterwards, the limitations of these laws and ways to improve them are presented.

The sleep and activity database for the early years (SADEY) study: design and methods

BackgroundCanada, Australia, the World Health Organization and other countries have released 24-hour movement guidelines for the early years which integrate physical activity, sedentary behaviour, and sleep, focusing on supporting children to achieve a healthy 24-hour day. The guideline evidence synthesis, however, highlighted the dearth of high-quality evidence, particularly from large-scale studies. The Sleep and Activity Database for the Early Years (SADEY) project aims to assemble a large, pooled database of 24-hour movement behaviours and health indicators in young children (birth to 5.99 years), to advance knowledge in these areas. This paper describes the SADEY design and methods.MethodsData sets were identified with > 100 children and device-measured (hip-worn ActiGraph accelerometers) physical activity and sedentary behaviour, parent-reported or device-measured sleep, and at least one health outcome: physical (BMI, waist circumference, blood pressure), social-emotional (Strength and Difficulties Questionnaire), cognitive (Early Years Toolbox), or motor development (Test of Gross Motor Development 2). Led by the University of Wollongong co-ordinating centre, the SADEY project collates the datasets to create a pooled database.FindingsTo date, 13 studies from 7 countries have been included in the database. Ethics clearance and data sharing agreements have been secured for all studies and the SADEY 1.0 database is being assembled including ~ 8,000 participants.DiscussionSADEY will be used to address questions of global importance to public health policy and practice, for example – Is the mix of movement behaviours across the 24-hour day associated with healthy development?, What is the optimal mix of these behaviours?, and; What factors can be targeted to support young children in achieving the optimal mix of 24-hour movement behaviours? Additionally, SADEY seeks to develop and disseminate protocols, develop capacity on the device-based measurement of movement behaviours, and seeks partnerships with stakeholders that promote knowledge translation on movement behaviours to support healthy development among young children.

A Systematic Review of the Role of Multimodal Resources for Inclusive STEM Engagement in Early-Childhood Education

This paper presents the findings from a systematic review of 29 websites and 13 frameworks that provide STEM (Science, Technology, Engineering, Mathematics) educational resources for parents, educators, and children (birth–8 years of age). Our theoretical approach is rooted within a social semiotic perspective that has indicated that multimodality enables children to use different types of expression to communicate a message or share an idea. Using the PRISMA methodology and the narrative document analysis approach, the themes that emerged included how the content and resources available on the websites addressed whether multimodality supported STEM engagement in an inclusive manner. The findings revealed that there were scarce multimodal resources that engaged children with fun, interactive, and meaningful opportunities to be autonomous learners (e.g., children had agency) (n = 11 out of 29), moving between the digital and hands-on physical spaces (n = 8 out of 29), employing gamification for deep learning (n = 4 out of 29), and piquing children’s imagination, inquiry, and creativity, and links to everyday STEM scenarios were hardly present (n = 10 out of 29). The implications lie in addressing early STEM engagement by considering children’s learning abilities and agency, bearing in mind parents/educators’ sociocultural backgrounds, confidence in STEM awareness, and multimodal avenues for communicating STEM learning and inquiry.