Long-term Adverse Health Outcomes Research Articles

Long-term Cognitive, Psychological, and Health Outcomes Associated With Child Abuse and Neglect.

Potential long-lasting adverse effects of child maltreatment have been widely reported, although little is known about the distinctive long-term impact of differing types of maltreatment. Our objective for this special article is to integrate findings from the Mater-University of Queensland Study of Pregnancy, a longitudinal prenatal cohort study spanning 2 decades. We compare and contrast the associations of specific types of maltreatment with long-term cognitive, psychological, addiction, sexual health, and physical health outcomes assessed in up to 5200 offspring at 14 and/or 21 years of age. Overall, psychological maltreatment (emotional abuse and/or neglect) was associated with the greatest number of adverse outcomes in almost all areas of assessment. Sexual abuse was associated with early sexual debut and youth pregnancy, attention problems, posttraumatic stress disorder symptoms, and depression, although associations were not specific for sexual abuse. Physical abuse was associated with externalizing behavior problems, delinquency, and drug abuse. Neglect, but not emotional abuse, was associated with having multiple sexual partners, cannabis abuse and/or dependence, and experiencing visual hallucinations. Emotional abuse, but not neglect, revealed increased odds for psychosis, injecting-drug use, experiencing harassment later in life, pregnancy miscarriage, and reporting asthma symptoms. Significant cognitive delays and educational failure were seen for both abuse and neglect during adolescence and adulthood. In conclusion, child maltreatment, particularly emotional abuse and neglect, is associated with a wide range of long-term adverse health and developmental outcomes. A renewed focus on prevention and early intervention strategies, especially related to psychological maltreatment, will be required to address these challenges in the future.

Audit of paediatrician recognition of children's vulnerability to harm at the Royal Children's Hospital, Melbourne.

Vulnerable children can be defined as those at risk of child abuse and neglect and long-term adverse health, neurodevelopmental and behavioural outcomes. This study examined whether a cohort of paediatricians and advanced trainees at the Royal Children's Hospital, Melbourne, recognised children's vulnerability. We reviewed the clinical note in the electronic medical record (EMR) for 425 new patients presenting to five paediatric clinics between 1 July 2017 and 31 December 2017. We examined paediatrician documentation of adverse childhood experiences (ACE), risk and resilience factors, referrals for intervention to improve psychosocial well-being and the application of 'vulnerable child' alert flags in the EMR to indicate vulnerability to harm. Children were deemed vulnerable if the paediatrician explicitly stated it in the EMR, if the child had a 'vulnerable child' alert placed in their record or had an appropriate referral for management of neurodevelopmental trauma. Of the original cohort, 8% was documented as vulnerable, 21% had a referral for intervention and 2% had a 'vulnerable child' alert. Overall, paediatricians infrequently documented ACE, risk and protective factors. The odds of identifying vulnerability increased with each added risk factor recorded (odds ratio (OR) 2.6, P < 0.001, 95% confidence interval (1.9-3.5)), with an ACE score was >4 (OR 72, P < 0.001 (14.3-361)) and decreased with each added protective factor recorded (OR 0.6, P < 0.001 (0.5-0.8)). Paediatricians infrequently document ACE, risk and protective factors and rarely 'flag' children's vulnerability to harm. Identification of the vulnerable child is correlated with documentation of risk and resilience factors at the initial consultation.

Perceptions and Attitudes Toward a Mobile Phone App for Mental Health for College Students: Qualitative Focus Group Study.

BackgroundMany college students who have mental health issues do not receive professional care for various reasons. Students who do not receive help often have both short- and long-term adverse health outcomes. Mobile apps for mental health services such as MySSP, a service provided to college students through their university, may help eliminate barriers to seeking mental health care and result in more positive outcomes for college students.ObjectiveThis qualitative study aims to better understand college students’ perceptions and attitudes toward the adoption and use of a mobile phone app for mental health, MySSP, using the technology acceptance model (TAM).MethodsA series of nine focus groups were conducted with college students (N=30) between February and May 2019 at a large, public Midwestern university. The moderator’s guide was based on the TAM, and focus group sessions primarily focused on the use and knowledge of apps for mental health, specifically, MySSP. The focus group transcriptions were hand-coded to develop a set of themes that encompassed students’ perceptions and attitudes toward MySSP.ResultsThe analysis of the focus groups suggested the following themes: (1) existing awareness of the app, (2) perceived usefulness, (3) perceived ease of use, (4) attitudes toward apps for mental health and MySSP, and (5) social influence.ConclusionsThe results of this study provide deeper insights into the perceptions of a mobile app for mental health among college students. Future research should explore the specific contexts in which an app for mental health will be most effective for college students.

Sleep health and predicted cognitive effectiveness of nurses working 12-hour shifts: an observational study

BackgroundDue to the 24hr nature of society, shift work has become an integral part of many industries. Within the literature there exists an abundance of evidence linking shift work-related sleep restriction and fatigue with errors, accidents, and adverse long-term health outcomes. ObjectiveThe study goal was to physiologically measure sleep patterns and predicted cognitive decline of nurses working both 12hr day and night shifts to address the growing concern about sleep restriction among healthcare workers. DesignThis study presents the results of a quasi-experimental, mixed between-within design where the sleep of 12hr day and night shift nurses was measured using ReadiBand wrist actigraphs. The between groups component was comprised of day v. night shift nurses. The within groups component was comprised of two separate measurement periods for each nurse—once for three consecutive days while they were working shifts (on duty) and once for three consecutive days off work (off duty). SettingParticipants wore the wrist actigraph at home and in the hospital, and were instructed to adhere to their regular sleep schedule. ParticipantsParticipants were recruited from two hospitals in Washington State (n=90). Participants were 48 night- and 42 day-shift nurses. All participants worked 12-hour shifts. MethodsSleep was measured using ReadiBand wrist actigraphs, which are licensed with the Sleep, Activity, Fatigue, and Task Effectiveness (SAFTEtm) Alertness Score model, a biomathematical model that predicts cognitive effectiveness based on sleep/wake schedule. ReadiBands also calculate sleep quantity, sleep efficiency, and sleep latency. Results were analysed in SPSS (v26) through multilevel modelling. ResultsDifferences were observed in sleep quantity, efficiency, and latency based on shift type (day vs. night) and shift duty (on vs. off). The most extreme differences, however, were noted in cognitive effectiveness (SAFTEtm), whereby night shift nurses experienced substantial decline—frequently into the “high risk” zone—throughout their shifts compared to day shift nurses. ConclusionsThe present study identifies sleep characteristics that differ between day and night nurses working 12-hour shifts using objective measurements of sleep. Biomathematical modelling can offer a novel method to estimate hours of greatest cognitive decline, and have implications for policy around shift duration, timing, and overtime allocation.

Inflammasomes in the Pathophysiology of Maternal Obesity: Potential Therapeutic Targets to Reduce Long-Term Adverse Health Outcomes in the Mother and Offspring.

Over the past 20 years, the prevalence of obesity has risen dramatically worldwide, with an increase in occurrence among women in their reproductive age. Obesity during pregnancy is associated with significantly increased maternal and fetal morbidity and mortality. In addition to the short-term adverse health outcomes, both mother and the child are prone to develop cardiovascular, metabolic and neurological disorders. Although associations between obesity during pregnancy and adverse maternalfetal health outcomes are clear, the complex molecular mechanisms underlying maternal obesity remain largely unknown. This review describes multimeric self-assembling protein complexes, namely inflammasomes, as potential molecular targets in the pathophysiology of maternal obesity. Inflammasomes are implicated in both normal physiological and in pathophysiological processes that occur in response to an inflammatory milieu throughout gestation. This review highlights the current knowledge of inflammasome expression and its activity in pregnancies affected by maternal obesity. Key discussions in defining pharmacological inhibition of upstream as well as downstream targets of the inflammasome signaling cascade; and the inflammasome platform, as a potential therapeutic strategy in attenuating the pathophysiology underpinning inflammatory component in maternal obesity are presented herein.

China urgently needs a nationwide scoliosis screening system.

Scoliosis is the most common spine deformity and is defined as a radiological lateral Cobb angle of at least 10 degrees (1). Adolescent idiopathic scoliosis (AIS), occurs in individuals aged 10-18 years and disproportionately affects females (2,3). Severe spinal curvature may be related to adverse long-term health outcomes. Early identification and effective intervention could stop or slow the curve progression of mild scoliosis before skeletal maturity. A meta-analysis showed that the pooled prevalence of scoliosis among primary and middle school students in China was 1.02% (95% confidence interval 0.85%-1.18%) (4). There are more than 300 million Chinese adolescents aged 10-18 years, so there could be millions with AIS. Early detection, diagnosis and treatments are urgently needed to improve long-term outcomes.

Association of Professional Football Cumulative Head Impact Index Scores With All-Cause Mortality Among National Football League Players

Long-term adverse health outcomes, particularly those associated with repetitive head impacts, are of growing concern among US-style football players in the US and Canada. To assess whether exposure to repetitive head impacts during a professional football career is associated with an increase in the risk of all-cause mortality. This retrospective cohort study included 13 912 players in the 1969 to 2017 National Football League (NFL) seasons. All cause-mortality up until July 1, 2018, was included. Data collection was performed from July 13, 2017, to July 1, 2018, as reported in the Pro Football Reference. The main exposure was a professional football cumulative head impact index (pfCHII). The pfCHII was measured by combining cumulative padded practice time and games played summed during seasons of play reported in the Pro Football Reference and a player position risk adjustment from helmet accelerometer studies. Demographic characteristics except for the pfCHII were calculated for 14 366 players with complete follow-up. The pfCHII was calculated for 13 912 players (eliminating the 454 specials teams players). Cox proportional hazards regression was used to compare hazard ratios (HRs) of death by repetitive head impacts. Analyses were unadjusted and adjusted for birth year, body mass index, and height. Among 14 366 NFL players who had follow-up for analysis, the mean (SD) age was 47.3 (14.8) years, the mean (SD) body mass index was 29.6 (3.9), and 763 of 14 366 players (5.3%) had died. Among 13 912 players in the pfCHII analysis, the median pfCHII was 32.63 (interquartile range, 13.71-66.12). A 1-log increase in pfCHII was significantly associated with an increased hazard of death for the 1969 to 2017 seasons (HR, 2.02; 95% CI, 1.21-3.37; P = .01) after adjustment. The quadratic pfCHII was also statistically significant (HR, 0.91; 95% CI, 0.85-0.98; P = .01), indicating that the hazard of death increased at a decreasing rate, whereas the pfCHII increased. The findings suggest that an increase in repetitive head impacts is associated with an increased hazard of death among NFL players. Reduction in repetitive head impacts from playing football or other activities through additional rule and equipment changes may be associated with reduced mortality.

Deported Men's and Father's Perspective: The Impacts of Family Separation on Children and Families in the U.S.

Background: Family separation due to the deportation of a migrant is pervasive, yet less is known about its potential impacts on the social, economic and mental well-being of families remaining in the United States.Methods: We conducted a mixed-methods study. In 2013, 303 Mexican male nationals completed an interviewer-administered questionnaire at a free clinic in Tijuana, Mexico. For this analysis, participants were: (1) ≥18 years; (2) seeking services; (3) Spanish or English speakers and (4) reported a U.S. deportation. Participants answered migration history items and open-ended questions regarding the impact of their deportation on U.S.-based family members. We present descriptive statistics and illustrative quotes for themes identified in the qualitative text data. Using a grounded-theory approach, we considered all data to develop a conceptual framework that others may use to study the consequences of family separation due to deportation.Results: Nearly two-thirds of participants reported living in the U.S. for 11+ years, a similar proportion reported 2+ deportations, and 31% reported being banned from re-entering the U.S. for 11+ years. More than one-half of participants were separated from their nuclear families (spouse/partner and/or children). Deportees who were separated from any family members reported that their families lost income for basic needs (rent/utilities: 50%, food: 44%, clothing: 39%, daycare: 16%, health insurance: 15%); school participation was also negatively impacted (31%). Qualitative data revealed that children ≤18 years remaining in the U.S. experienced mental health symptoms post-parental deportation (i.e., persistent crying, depression, sadness, anger, resentment). Deported fathers consistently expressed frustration at being unable to provide love, care, support, mentorship for their children. Based on our mixed-methods approach, we propose a framework to systematically study the consequences of family separation due to the deportation of fathers.Conclusion: Findings are consistent with the extant research. Binational interventions to support families that experience forced-separation are needed to mitigate short and long-term adverse mental health outcomes, especially among youth in the U.S., and other unfavorable family and household-level outcomes. Funding to understand the implications of maternal deportation and for longitudinal qualitative and quantitative research on migrant-focused interventions and related outcomes is needed.

Abstract P383: Trends in Selected Chronic Conditions and Behavioral Risk Factors Among Women of Reproductive Age: Behavioral Risk Factor Surveillance System, 2011-2017

Introduction: Chronic disease causes significant morbidity and mortality across the lifespan. Public health approaches that reduce or prevent risk factors along with effective management of chronic diseases can improve health. This study describes trends of chronic conditions and related risk factors among reproductive aged women. Methods: Data from the 2011-2017 Behavioral Risk Factor Surveillance System, a representative state-based telephone survey of health behavior in US adults, were analyzed among 265,544 women of reproductive age, 18-44 years. We estimated adjusted prevalence ratios (APR) using predicted marginals to assess trends over time for 12 chronic conditions and related risk factors accounting for age, race/ethnicity, education, and health care coverage. Results: From 2011-2017, estimates of the following decreased: smoking (20.7%—15.9%; P-value &lt;0.001), gestational diabetes (3.1%—2.7%; 0.003), and high cholesterol (19.0%—16.7%, 2011-2015; &lt;0.001). Whereas the estimates increased for depression (20.4%—24.9%; &lt;0.001), and obesity (24.6%—27.6%; &lt;0.001). There were no differences over time for heavy alcohol consumption, binge drinking, diabetes, pregnancy-related high blood pressure, or high blood pressure. In the adjusted analysis, WRA were more likely to report asthma (APR=1.06; 95%CI=1.01—1.11), physical inactivity (1.08; 1.04—1.12), obesity (1.15; 1.11—1.19), and depression (1.29; 1.25—1.34) in 2017 compared to 2011. They were less likely to report high cholesterol (0.89; 0.85—0.94; 2011-2015), smoking (0.86; 0.82—0.89); and gestational diabetes (0.84; 0.75—0.94). Conclusions: Future research should examine why some chronic conditions and related risk factors improved while others worsened. That research may support the development of targeted interventions to promote improvements and reverse the worsening trends in chronic disease and related risk factors, potentially preventing adverse reproductive and long-term health outcomes among women of reproductive age.

Long-term outcomes of acute kidney injury and strategies for improved care.

Acute kidney injury (AKI), once viewed predominantly as a self-limited and reversible condition, is now recognized as a growing problem associated with significant risks of adverse long-term health outcomes. Many cohort studies have established important relationships between AKI and subsequent risks of recurrent AKI, hospital re-admission, morbidity and mortality from cardiovascular disease and cancer, as well as the development ofchronic kidney disease and end-stage kidney disease. In both high-income countries (HICs) and low-income or middle-income countries (LMICs), several challenges exist in providing high-quality, patient-centered care following AKI. Despite advances in our understanding about the long-term risks following AKI, large gaps in knowledge remain about effective interventions that can improve the outcomes of patients. Therapies for high blood pressure, glycaemic control (for patients with diabetes), renin-angiotensin inhibition and statins might be important in improving long-term cardiovascular and kidney outcomes after AKI. Novel strategies that incorporate risk stratification approaches, educational interventions and new models of ambulatory care following AKI have been described, and some of these are now being implemented and evaluated in clinical studies in HICs. Care for AKI in LMICs must overcome additional barriers due to limited resources for diagnosis and management.

Updates on Assessment and Monitoring of the Postnatal Growth of Preterm Infants.

Assessing and monitoring the physical growth of preterm infants is fundamental to NICU care. The goals of nutritional care are to approximate the growth and body composition of the healthy fetus and to support optimal brain development while minimizing future cardiometabolic risk. Both poor and excessive growth predict adverse long-term health outcomes. Growth curves are clinical tools used to assess the preterm infant's growth status. Several growth curves for preterm infants were developed in the past decade. To use them effectively, clinicians need to understand how each growth curve was developed; the underlying reference population; intended use; and strengths and limitations. Intrauterine growth curves are references that use size at birth to represent healthy fetal growth. These curves serve 2 purposes-to assign size classifications at birth and to monitor postnatal growth. The INTERGROWTH-21 st preterm postnatal growth standards were developed to compare the postnatal growth of preterm infants to that of healthy preterm infants rather than the fetus. Individualized weight growth curves account for the water weight loss that frequently occurs after birth. In addition, body mass index (BMI) curves are now available. In this review, we discuss the main characteristics of growth curves used for preterm infants as well as the use of percentiles, z scores, and their change over time to evaluate size and growth status. We also review the differences in body composition between preterm infants at term-equivalent age and term-born infants and the potential role of monitoring proportionality of growth using BMI curves.

Advances in community-acquired pneumonia.

Community-acquired pneumonia is one of the commonest and deadliest of the infectious diseases, yet our understanding of it remains relatively poor. The recently published American Thoracic Society and Infectious Diseases Society of America Community-acquired pneumonia guidelines acknowledged that most of what we accept as standard of care is supported only by low quality evidence, highlighting persistent uncertainty and deficiencies in our knowledge. However, progress in diagnostics, translational research, and epidemiology has changed our concept of pneumonia, contributing to a gradual improvement in prevention, diagnosis, treatment, and outcomes for our patients. The emergence of considerable evidence about adverse long-term health outcomes in pneumonia survivors has also challenged our concept of pneumonia as an acute disease and what treatment end points are important. This review focuses on advances in the research and care of community-acquired pneumonia in the past two decades. We summarize the evidence around our understanding of pathogenesis and diagnosis, discuss key contentious management issues including the role of procalcitonin and the use or non-use of corticosteroids, and explore the relationships between pneumonia and long-term outcomes including cardiovascular and cognitive health.

Profiling epigenetic changes in human cell line induced by atrazine exposure

How environmental chemicals can affect and exert their toxic effect at a molecular level has gained significant interest in recent years, not only for understanding their immediate health implications over exposed individuals, but also for their subsequent progeny. Atrazine (ATZ) is a commonly used herbicide in the U.S. and a long-suspected endocrine disrupting chemical. The molecular mechanism conferring long-term adverse health outcomes, however, remain elusive. Here, we explored changes in epigenetic marks that arise after exposure to ATZ at selected doses using image-based analysis coupled with data clustering. Significant decreases in methylated CpG (meCpG) and histone 3 lysine 9 tri-methylated (H3K9me3) were observed in the selected human cell line with a clear spatial preference. Treating cells with ATZ leads to the loss of a subpopulation of cells with high meCpG levels as identified in our clustering and histogram analysis. A similar trend was observed in H3K9me3 potentially attributing to the cross-talking between meCpG and H3K9me3. Changes in meCpG are likely to be associated with alterations in epigenetic enzyme expression levels regulating meCpG and persist after the removal of ATZ source which collectively provide a plausible mechanism for long-term ATZ-induced toxicity.

Testicular Cancer Survivorship.

Testicular cancer (TC) is the most common cancer among men aged 18 to 39 years. It is highly curable, with a 10-year relative survival approaching 95% due to effective cisplatin-based chemotherapy. Given the increasing incidence of TC and improved survival, TC survivors (TCS) now account for approximately 4% of all US male cancer survivors. They have also become a valuable cohort for adult-onset cancer survivorship research, given their prolonged survival. Commensurately, long-term treatment-related complications have emerged as important survivorship issues. These late effects include life-threatening conditions, such as second malignant neoplasms and cardiovascular disease. Moreover, TCS can also experience hearing loss, tinnitus, neurotoxicity, nephrotoxicity, pulmonary toxicity, hypogonadism, infertility, anxiety, depression, cognitive impairment, and chronic cancer-related fatigue. Characterization of the number and severity of long-term adverse health outcomes among TCS remains critical to develop risk-stratified, evidence-based follow-up guidelines and to inform the development of preventive measures and interventions. In addition, an improved understanding of the long-term effects of TC treatment on mortality due to noncancer causes and second malignant neoplasms remains paramount. Future research should focus on the continued development of large, well-characterized clinical cohorts of TCS for lifelong follow-up. These systematic, comprehensive approaches can provide the needed infrastructure for further investigation of long-term latency patterns of various medical and psychosocial morbidities and for more in-depth studies investigating associated etiopathogenetic pathways. Studies examining premature physiologic aging may also serve as new frontiers in TC survivorship research.

Customized versus population birth weight charts for identification of newborns at risk of long-term adverse cardio-metabolic and respiratory outcomes: a population-based prospective cohort study

BackgroundCustomized birth weight charts take into account physiological maternal characteristics that are known to influence fetal growth to differentiate between physiological and pathological abnormal size at birth. It is unknown whether customized birth weight charts better identify newborns at risk of long-term adverse outcomes than population birth weight charts. We aimed to examine whether birth weight classification according to customized charts is superior to population charts at identification of newborns at risk of adverse cardio-metabolic and respiratory health outcomes.MethodsIn a population-based prospective cohort study among 6052 pregnant women and their children, we measured infant catch-up growth, overweight, high blood pressure, hyperlipidemia, liver steatosis, clustering of cardio-metabolic risk factors, and asthma at age 10. Small size and large size for gestational age at birth was defined as birth weight in the lowest or highest decile, respectively, of population or customized charts. Association with birth weight classification was assessed using logistic regression models.ResultsOf the total of 605 newborns classified as small size for gestational age by population charts, 150 (24.8%) were reclassified as appropriate size for gestational age by customized charts, whereas of the total of 605 newborns classified as large size for gestational age by population charts, 129 (21.3%) cases were reclassified as appropriate size for gestational age by customized charts. Compared to newborns born appropriate size for gestational age, newborns born small size for gestational age according to customized charts had increased risks of infant catch-up growth (odds ratio (OR) 5.15 (95% confidence interval (CI) 4.22 to 6.29)), high blood pressure (OR 2.05 (95% CI 1.55 to 2.72)), and clustering of cardio-metabolic risk factors at 10 years (OR 1.66 (95% CI 1.18 to 2.34)). No associations were observed for overweight, hyperlipidemia, liver steatosis, or asthma. Newborns born large-size for gestational age according to customized charts had higher risk of catch-down-growth only (OR 3.84 (95% CI 3.22 to 4.59)). The direction and strength of the observed associations were largely similar when we used classification according to population charts.ConclusionsSmall-size-for-gestational-age newborns seem to be at risk of long-term adverse cardio-metabolic health outcomes, irrespective of the use of customized or population birth weight charts.

Prevention of Long-term Adverse Health Outcomes With Cardiorespiratory Fitness and Physical Activity in Childhood Acute Lymphoblastic Leukemia Survivors.

Most childhood acute lymphoblastic leukemia (ALL) survivors develop chronic treatment-related adverse effects several years after the end of therapy. A regular practice of physical activity and a good cardiorespiratory fitness have the potential to reduce the risk of chronic disease and improve quality of life. The aim of this study was to evaluate in a cohort of ALL survivors, the association between a good cardiorespiratory fitness or the respect of physical activity guidelines and major long-term health outcomes. In total, 247 ALL survivors underwent a cardiopulmonary exercise test, completed a physical activity questionnaire and a battery of clinical examinations. We calculated the odds ratio to obtain the preventive fraction (PF) to evaluate the effects of the cardiorespiratory fitness and physical activity levels on health outcomes (ie, obesity, metabolic health, cardiac health, cognitive health and mood, bone health). Despite their young age, 88% of the participants presented at least one adverse health outcome, and 46% presented ≥3. Their cardiorespiratory fitness was also lower than expected with a median VO2 peak reaching 84% of the predicted value. In the analyses using cardiorespiratory fitness, statistically significant PFs were observed for obesity (0.30), low-high-density lipoprotein-cholesterol (0.21) and depression (0.26). In the physical activity level analyses, statistically significant PFs were observed for obesity, depression, and low bone mineral density, with a PF of 0.55, 0.81, and 0.60, respectively. Our results indicate that a good cardiorespiratory fitness and physical activity level induced a preventive action for most health outcomes studied and was associated with a lower late adverse effects prevalence in ALL survivors.

Epigenetic modification of the pentose phosphate pathway and the IGF-axis in women with gestational diabetes mellitus.

Aim: Gestational diabetes mellitus (GDM) has been linked with adverse long-term health outcomes for the fetus and mother. These effects may be mediated by epigenetic modifications. Materials & methods: Genome-wide RNA sequencing was performed in placental tissue and maternal blood in six GDM and six non-GDM pregnancies. Promoter region DNA methylation was examined for selected genes and correlated with gene expression to examine an epigenetic modulator mechanism. Results: Reductions of mRNA expression and increases in promoter methylation were observed for G6PD in GDM women, and for genes encoding IGF-binding proteins in GDM-exposed placenta. Conclusion: GDM involves epigenetic attenuation of G6PD, which may lead to hyperglycemia and oxidative stress, and the IGF-axis, which may modulate fetal macrosomia.

Preterm Birth: A Narrative Review of the Current Evidence on Nutritional and Bioactive Solutions for Risk Reduction.

Preterm birth (PTB) (<37 weeks of gestation) is the leading cause of newborn death and a risk factor for short and long-term adverse health outcomes. Most cases are of unknown cause. Although the mechanisms triggering PTB remain unclear, an inappropriate increase in net inflammatory load seems to be key. To date, interventions that reduce the risk of PTB are effective only in specific groups of women, probably due to the heterogeneity of its etiopathogenesis. Use of progesterone is the most effective, but only in singleton pregnancies with history of PTB. Thus, primary prevention is greatly needed and nutritional and bioactive solutions are a promising alternative. Among these, docosahexaenoic acid (DHA) is the most promising to reduce the risk for early PTB. Other potential nutrient interventions include the administration of zinc (possibly limited to populations with low nutritional status or poor zinc status) and vitamin D; additional preliminary evidence exists for vitamin A, calcium, iron, folic acid, combined iron-folate, magnesium, multiple micronutrients, and probiotics. Considering the public health relevance of PTB, promising interventions should be studied in large and well-designed clinical trials. The objective of this review is to describe, summarize, and discuss the existing evidence on nutritional and bioactive solutions for reducing the risk of PTB.

Sociocultural and interpersonal influences on latina women's beliefs, attitudes, and experiences with gestational weight gain.

Latinos are the largest and fastest-growing minority group in the U.S., and Latina women represent the largest portion of minority births, having the highest birth rate in the U.S. for over 20 years. In addition, Latina women are at increased risk of entering pregnancy being overweight or having obesity and gaining excess gestational weight. Excess gestational weight gain (GWG) has short- and long-term adverse health outcomes for the woman and her child. Although culturally tailored interventions show promise toward promoting healthy GWG among Latina women, findings from current interventions have had mixed results, suggesting the need for further tailoring to meet the needs of this heterogeneous population group. This qualitative study was designed to explore first-time pregnant, low-income Latina women’s beliefs, attitudes, and experiences with GWG. The study employed qualitative research using semi-structured interviews conducted with 23 first-time pregnant Latina women between 22 and 36 weeks of gestation. Interviews were conducted by trained bilingual staff, transcribed verbatim, and analyzed using thematic analysis. Results showed that participants were uncertain if their GWG was within a healthy range. Although the majority of participants knew that GWG should be limited, they were not sure what the amount should be. In addition, the majority of participants reported attitudes of acceptance of and resignation to excessive GWG as being part of pregnancy. Several women appeared to believe that they did not have control over their weight gain during pregnancy. Moreover, analysis identified that sociocultural and interpersonal factors such as social support influence the beliefs, attitudes, and experiences with GWG of the low-income, majority immigrant Latina women who participated in this study. Study findings can be used to further tailor prenatal care practices and interventions aimed at altering modifiable risk factors associated with excess GWG among Latinas. Future interventions designed for low-income, immigrant Latina women that consider sociocultural influences on women’s beliefs and attitudes related to GWG, as well as the influence of social support networks on women’s health behaviors during pregnancy, will likely be more effective in preventing excessive GWG.

SUN-248 ADVERSE HEALTH OUTCOMES AFTER INCIDENT PNEUMONIA IN PATIENTS WITH CHRONIC KIDNEY DISEASE: DATA ANALYSIS FROM STOCKHOLM CREATININE MEASUREMENT PROJECT

Pneumonia is a leading cause of hospitalization and mortality worldwide. Increased pneumonia hospitalizations has been observed in patients with chronic kidney disease (CKD). Little is known about the short and long-term adverse health outcomes of pneumonia in this population. This question is of public health relevance, both for improving risk stratification and for motivating the implementation of vaccination campaigns in patients with CKD.