Maternal Self-report Research Articles

In search of a primary outcome for community-based newborn infection trials in Eastern Uganda: a nested cohort study within the BabyGel pilot trial

BackgroundDue to their immature immune system, neonates are at high risk of infection. This vulnerability when combined with limited resources and health education in developing countries can lead to sepsis, resulting in high global neonatal mortality rates. Many of these deaths are preventable. The BabyGel pilot trial tested the feasibility of conducting the main randomised trial, with the provision of alcohol handgel to postpartum mothers for prevention of neonatal infective morbidity in the rural community. This secondary analysis sought to evaluate the methods of detecting infections in babies up to 3 months of age.MethodsThe pilot two-arm cluster randomised controlled trial took place in 10 villages around Mbale, Eastern Uganda. Women were eligible and recruited antenatally if their gestation was ≥ 34 weeks. All infants of mothers participating in the BabyGel pilot trial were followed up for the first 3 months of life. Evidence for infant infection was collected using five different methods: clinician diagnosed infection, microbiologically confirmed infection, maternally reported infection, a positive infection screen using the World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) screening criteria, and reported antibiotic use identified during home and clinic visits. These methods were assessed quantitatively regarding the detection rates of suspected infections and qualitatively by exploring the challenges collecting data in the rural community setting.ResultsA total of 103 eligible women participated in the BabyGel pilot trial, with 1 woman delivering twins. Of the 99 mother-infant pairs who consented to participate in the study, 55 infants were identified with infection in total. Maternal report of illness provided the highest estimate, with mothers reporting suspected illness for 45 infants (81.8% of the total suspected infections identified). The WHO IMCI screening criteria identified 30 infants with suspected infection (54.5%), and evidence for antibiotic use was established in 22 infants (40%). Finally, clinician-diagnosed infection identified 19 cases (34.5%), which were also microbiologically confirmed in 5 cases (9.1%). Data collection in the rural setting was hindered by poor communication between mothers and the research team, limited staff awareness of the study in health centres resulting in reduced safeguarding of clinical notes, and widespread use of antibiotics prior to notification and clinical review. Furthermore, identification of suspected infection may not have been limited to severe infections, with ambiguity and no official clinical diagnosis being given to those identified solely by maternal report of infection.ConclusionsA high rate of suspected infection was identified spanning the five sources of data collection, but no ideal method was found for detection of community neonatal infection. Although maternal self-reports of infant infection provided the highest detection rate, data collection via each source was limited and may have identified minor rather than major infections. Future studies could utilise the IMCI screening tool to detect severe community infection leading to referral for clinical confirmation. This should be combined with weekly contact with mothers to detect maternally suspected illness. Obtaining more details of the symptoms and timescale will improve the accuracy when detecting the total burden of suspected disease, and advising participants to retain medication packaging and prescriptions will improve identification of antibiotic use.Trial registrationBabygel pilot trial - trial registration: ISCRCTN 67852437. Registered 02/03/2015.

Hospital breastfeeding support and exclusive breastfeeding by maternal prepregnancy body mass index.

Overweight and obese mothers in the United States have disproportionately lower rates of exclusive breastfeeding than mothers of normal weight. The Ten Steps to Successful Breastfeeding (Ten Steps), a series of evidence-based practices designed to support breastfeeding initiation, duration, and exclusivity, demonstrate effectiveness at the population level. It is unknown, however, whether they are consistently provided to women across all maternal body mass index (BMI) categories. We sought to determine whether pre-pregnancy BMI is associated with the implementation and effectiveness of the Ten Steps. We used data from Listening to Mothers III, a cross-sectional survey administered to a sample of mothers who delivered in U.S. hospitals between July 2011 and June 2012. Measures of the Ten Steps were based on maternal self-report on Listening to Mothers III. Our analytic sample was limited to mothers of term infants intending to breastfeed (N=1,506, weighted). We conducted chi-square testing and constructed weighted multivariable logistic regression models to account for potential confounders. Results suggest that two practices (i.e., holding their babies skin-to-skin for the first time and being encouraged to breastfeed on demand) were more strongly associated with exclusive breastfeeding among mothers with obesity than other mothers. Additionally, mothers with obesity reported holding babies skin-to-skin significantly less often than other mothers. Thus, interventions aimed at helping mothers with obesity to hold their babies skin-to-skin in the first hour and teaching them to breastfeed on demand have the potential to decrease the breastfeeding disparities in this population.

Associations of Hormonal Biomarkers With Mental Health and Healthy Behaviors Among Mothers of Very-Low-Birthweight Infants.

To examine the concurrent use of self-report questionnaires and hormonal biomarkers, specifically levels of testosterone and cortisol, along with demographic variables and corrected age (CA) in the assessment of mental health and healthy behaviors among mothers of very-low-birthweight (VLBW, BW < 1,500 g) infants at five time points over 2 years post birth. Data on 40 mothers from a neonatal intensive care unit of a tertiary medical center in the southeast United States were collected from the medical record, standard questionnaires for the mother (depressive symptoms, perceived stress, anxiety, mental health status, parenting stress, and healthy lifestyle behaviors), and biochemical measurement of maternal testosterone and cortisol using enzyme immunoassay at birth, 40 weeks' postmenstrual age, and 6, 12, and 24 months CA. Maternal self-report of mental health improved from birth to 6 or 12 months then worsened at 24 months. Mixed linear models showed that mothers with higher testosterone levels had more depressive symptoms and smoked more, whereas mothers with higher cortisol levels had healthier behaviors and exercised more. Testosterone levels were negatively correlated with cortisol levels. Marital status, education, and health insurance were the most predictive demographic variables for the levels of hormonal biomarkers, mental health, and healthy behaviors. The use of self-report and biochemical measurement was effective in assessing maternal mental health and healthy behaviors over 2 years post birth, when mothers of VLBW infants tend to experience more mental health problems and parenting difficulties than mothers of normal-BW full-term infants.

Risk perception, beliefs about medicines and medical adherence among pregnant and breastfeeding women with migraine: findings from a cross-sectional study in Norway

ObjectivesTo examine risk perception, beliefs about migraine medications and medical adherence among pregnant and breastfeeding women with migraine.Design and settingCross-sectional study conducted in Norway from October 2013 to February 2014....

Maternal Parenting Stress, Child Exuberance, and Preschoolers' Behavior Problems.

This study investigated whether child exuberance, an aspect of temperament related to emotion regulation, moderates the well-documented association between high parenting stress and increased risk for internalizing and externalizing problems during the preschool years. At 42months of age child exuberance was observed in 256 children (47% girls) and maternal self-reports on parenting stress were obtained. At 48months internalizing and externalizing problems were assessed through reports from both parents. Indeed, higher maternal parenting stress increased the risk for internalizing problems, and this association was more pronounced among children with high levels of exuberance. Existent emotion regulation difficulties in highly exuberant children may further heighten the risk conveyed by an unfavorable caregiving environment for developing internalizing problems.

Quantitation of Ethyl-β-D-Glucuronide in Human Umbilical Cord Tissue by Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS).

In utero exposure to alcohol may adversely affect the development of the embryo or fetus and result in adverse outcomes known as fetal alcohol spectrum disorders (FASD) which encompass a range of physical, behavioral, and cognitive impairments in the newborn. Since maternal self-reports are often unreliable, biomarkers of gestational alcohol consumption are necessary for accurate identification of exposed newborns at risk. Ethyl-β-D-glucuronide (EtG) is a minor phase II metabolite of ethyl alcohol (ethanol), formed by enzymatic conjugation of ethanol with glucuronic acid in the liver. As a direct biomarker for alcohol, detection of EtG in neonatal biological matrices provides accurate identification of maternal alcohol consumption and fetal alcohol exposure during pregnancy. This chapter describes the quantitation of EtG in human umbilical cord tissue by liquid chromatography tandem mass spectrometry (LC-MS/MS).

92. Does maternal folic acid supplementation reduce the risk of preeclampsia? A systematic review and meta-analysis of observational studies

Introduction Preeclampsia contributes significantly to maternal and neonatal morbidity and mortality worldwide. Maternal folic acid supplementation is recommended peri-conceptionally for the prevention of neural tube defects. Research suggests an association between folic acid supplementation during pregnancy and a reduced risk of preeclampsia. Objective A systematic review and meta-analysis was conducted to review the evidence of an association between maternal folic acid supplementation during pregnancy and preeclampsia risk. Methods The protocol for this review was prospectively registered with PROSPERO (CRD42015029310). Multiple scientific databases and unpublished literature were searched for relevant studies. Two reviewers independently reviewed studies against a priori inclusion and exclusion criteria. Study data was extracted and quality of each included study assessed. Meta-analysis was conducted to examine the effect of maternal folic acid supplementation on preeclampsia risk. Sub-group analysis was used to explore any sub-group differences between folic acid taken alone or in/alongside a multivitamin, on preeclampsia risk. Results Meta-analysis of eight cohort studies showed a significantly lower risk of preeclampsia with folic acid supplementation in comparison to no folic acid (Odds Ratio = 0.78 [95% CI = 0.63–0.98]). Heterogeneity between studies was moderately high (I-squared = 67%). No significant subgroup difference was found between folic acid taken alone vs folic acid taken in or with a multivitamin on the risk of preeclampsia (Chi-squared = 0.34 (p = 0.56); I-squared = 0%). Discussion This systematic review and meta-analysis found a modest association between maternal folic acid supplementation and reduction in preeclampsia risk, however the overall level of available evidence for the association is low. Further, well-designed prospective studies investigating this relationship are required. These should clearly define the duration and regularity of supplementation, control for the presence of multivitamins, measure folate biomarkers to validate maternal self-report of supplementation, and differentiate between preeclampsia sub-types in their outcomes.

Observed and self-reported assessments of caregivers' feeding styles: Variable- and person-centered approaches for examining relationships with children's eating behaviors

BackgroundDemandingness and responsiveness are dimensions used in general parenting as well as the feeding literature to measure parent attitudes and behaviors. These dimensions can be treated as continuous variables (variable-centered) or used to form groups of parents based on scores on each dimension (person-centered). Research focusing on these dimensions in the feeding domain has relied exclusively on maternal self-reports; observational studies of feeding styles have yet to be conducted. ObjectivesThe purpose of this study was to investigate the effectiveness of variable-centered versus person-centered analyses in examining relationships between maternal feeding styles, child eating behaviors, and child weight status using both self-reported and observational methods for assessing parental feeding style. MethodsParticipants included 137 low-income Head Start mothers and their preschoolers. Mothers completed the Caregiver's Feeding Styles Questionnaire and the Children's Eating Behavior Questionnaire. Parent/child interactions were observed during dinner meals at home and were coded using a previously developed coding system. ResultsMaternal demandingness during feeding was negatively associated with child BMI z-scores and positively associated with slowness in eating and satiety responsiveness. Maternal responsiveness was associated positively with enjoyment of food and associated negatively with food fussiness. Significant demandingness by responsiveness interactions showed that children of authoritarian mothers showed the highest levels of food fussiness and the lowest enjoyment of food. Overall, the findings were stronger for the self-report than for the observational measures and the variable-centered approach was clearly superior to the person-centered approach. ConclusionsThe current results indicate that for research purposes the variable-centered approach may be the most powerful for examining relationships between maternal feeding and child eating. However, for clinical purposes, the person-centered approach might be most informative.

Risk factors associated to tobacco and alcohol use in a large French cohort of pregnant women.

Tobacco and/or alcohol use during pregnancy is a major public health concern. The aim of our study was to identify risk factors associated to maternal alcohol and tobacco use assessed by maternal self-reports combined with biological measurements in meconium samples of cotinine and ethylglucuronide which reflect fetal exposure to tobacco and alcohol, respectively, during the 3rd trimester of pregnancy. We conducted a prospective study in three maternity hospitals in a large urban area during consecutive weeks (2010 and 2011). Maternal sociodemographic and clinical characteristics were assessed after delivery, using the French version of the Addiction Severity Index. Cotinine and ethylglucuronide were measured in meconium samples. Seven hundred and twenty-four women were included, and 645 meconium samples collected. Using multivariate analyses, we found that not being married or having a smoking partner predicts maternal tobacco use. In contrast, a decreased risk was associated with higher education level and wanted pregnancy. The risk for alcohol use increased when the mother had been in conflict with any relative or her partner for a long time throughout her life, as well as in case of previous treatment for any mental or emotional disorder. Using multivariate analyses and cotinine presence in meconium samples, the risks were similar except for marital status, which was not associated to cotinine presence. Community education and prevention programs should urgently be improved for all women of childbearing age with a special focus on those with past histories of mental or emotional disorders and addictive disorders. Smoking cessation should be recommended to both parents.

Chinese handwriting performance in preterm children in grade 2.

BackgroundFirst graders born prematurely perform poorly on handwriting speed and legibility. However, whether there are specific legibility factors in which preterm children demonstrate difficulty remains unknown. In addition, handwriting performance beyond the first grade and the influence of sex on handwriting performance in preterm children are still unclear. We aimed to investigate the influence of prematurity and sex on multiple dimensions of handwriting in grade two and to identify the contributors to performance.MethodsSixty-three preterm (34 boys and 29 girls) and 67 full-term (27 boys and 40 girls) peers in grade two were included. Class teachers were asked to complete the Chinese Handwriting Evaluation Form. A subgroup of 39 preterm children received assessments on intelligence, visual perception, tactile and kinesthetic sensation, and fine motor skills. Their inattention behavior was rated using a maternal self-report with a behavioral scale.ResultsBoys born prematurely exhibited poorer performance in the speed dimension than full-term boys (p = 0.008), whereas there was comparable performance in the two groups of girls (p = 0.221). In the dimensions related to legibility, preterm boys (32.4%) had a higher percentage of children with difficulty in the construction dimension than the other groups (preterm girls: 6.9%, full-term boys: 7.4%, full-term girls: 5.0%). However, no group difference was found in the dimensions of accuracy and directionality. Of the sensory-perceptual-motor factors, attention was the most significant predictor of accuracy in performance (p = 0.046) and speed dimensions (p = 0.001) in preterm children.ConclusionsBoys appear to be vulnerable to the adverse impacts of preterm birth in terms of performance in the dimensions of speed and construction in grade two. Based on the significant contribution of attention to handwriting performance in preterm children, assessment and intervention in the area of attention is strongly suggested for preterm children with handwriting problems.

Maternal early pregnancy obesity and related pregnancy and pre-pregnancy disorders: associations with child developmental milestones in the prospective PREDO Study.

Previous studies have linked maternal pre-pregnancy obesity (BMI ≥30 kg/m2) with suboptimal neurodevelopment in her offspring; however, the literature is not entirely consistent. Whether these effects are muddled by maternal self-reports of pre-pregnancy weight and height, or are driven or amplified by the well often comorbid hypertensive and diabetic pregnancy and pre-pregnancy disorders, remains unclear. We examined whether maternal early pregnancy obesity is associated with developmental delay in her offspring, and if the associations are driven or amplified by diabetic and hypertensive pregnancy and pre-pregnancy disorders. A total of 2504 mother-child dyads participated in the Prediction and Prevention of Pre-eclampsia and Intrauterine Growth Restriction (PREDO) study. Data on maternal early pregnancy obesity, pre-pregnancy, and gestational hypertension, pre-eclampsia, type 1 and gestational diabetes were derived from the Finnish Medical Birth Register. At the child's mean age of 42.1 (SD = 8.2) months the mothers completed the Ages and Stages Questionnaire (ASQ) Third edition for developmental milestones. Children of obese mothers had 1.81-2.74 (p-values <0.02) higher odds of failing to meet the development that is typical for a child's age (developmental domain score ≤-2SD below the child's age) on the communication, fine and gross motor, problem solving and personal/social skills and children of overweight mothers had 2.14 (p = 0.002) higher odds of failing to meet the development that is typical for the child's age on communication skills. Odds of developmental delay were also higher for children of mothers with pre-eclampsia and gestational diabetes. The associations were robust to covariates and confounders, the effects of overweight/obesity and pre-eclampsia were not driven by the other disorders, and overweight/obesity and hypertensive and diabetic disorders did not show additive effects. Maternal early pregnancy overweight, obesity, and pre-eclampsia are independently associated with neurodevelopmental delay in her offspring. Further studies unraveling the underlying mechanisms are warranted.

Gene–gene-environment interactions of prenatal exposed to environmental tobacco smoke, CYP1A1 and GSTs polymorphisms on full-term low birth weight: relationship of maternal passive smoking, gene polymorphisms, and FT-LBW

Objective: To examine the interaction effects of prenatal exposed to environmental tobacco smoke (ETS) and genotypes of cytochrome P4501A1 (CYP1A1), glutathione S-transferases (GSTs) on the risk of full-term low birth weight (FT-LBW).Study design: We conducted a case-control study among pregnant women at two Women and Children’s Hospitals in Guangdong, China (n = 910). Information was collected through interview, medical records review, and blood lab tests. Maternal selfreport and serum cotinine concentration were combined to define prenatal exposed to ETS. Logistic regression approach was applied for statistical analysis.Results: Our results showed that regardless of genotypes, prenatal exposed to ETS significantly increased the risk of FT-LBW. Then, two-way interactions showed increased prevalence of FT-LBW in prenatal exposed to ETS mothers with the CYP1A1 variant genotype (MspI “CC”), or with GSTT1-null genotype. Furthermore, three-way interactions showed that women with CYP1A1 variant (MspI “TC” or BsrDI “AG”) genotypes and GSTT1 “null” genotype had higher risk to give birth of FT-LBW. Additionally, among nonexposed ETS mothers, genotype did not independently confer adverse effects on FT-LBW.Conclusions: Our results revealed that prenatal exposed to ETS is independently associated with FT-LBW while gene polymorphisms of CYP1A1 and GSTs merely play modified roles in this process. This study extends understanding of three-way interaction, and stresses the need to tobacco control toward pregnant women for better pregnant outcomes.

717: Prenatal electronic cigarette, dual use and nicotine dependency

Prenatal tobacco use increases risk for nearly all adverse prenatal outcomes. Use of electronic cigarettes (ECIGS) has markedly increased with the perception that they are a safer alternative and may assist with smoking cessation. We previously reported nearly all pregnant women that use ECIGS also simultaneously use conventional cigarettes (dual users). The objective of this study was to identify patterns and predictors of prenatal dual cigarette use. An analysis of an ongoing, prospective multicenter trial using quota sampling was used. Pregnant women in their first trimester, aged 18-44, who currently used conventional cigarettes, ECIGS, or both (dual users) were included. Tobacco use categories were confirmed using preset cotinine limits and maternal self-report. Validated tools were used to measure nicotine dependence (Fagerstrom Test for Nicotine Dependence), expired air carbon monoxide (EACO) levels (Bedford) and depressive symptoms (Edinburgh Postnatal Depressions Scale, EDPS). Data analysis included descriptive statistics, univariate and multivariate analysis predicting the likelihood of nicotine dependence in pregnancy. All statistical analyses were performed using SAS v9.4 with an alpha of 0.05. Total sample included 117 women (dual, n=27; convention-only, n=90). EACO levels and number of cigarettes per day were similar between conventional and dual users. Prenatal dual use and increased depressive symptoms were significantly predictive of higher dependence (p=007). Controlling for age, race and education, dual users had an average of 1-point higher on the Fagerstrom index (beta=0.93; p=.034) with a range of 0-10, compared to conventional cigarette-only users. Every 5-point increase (range, 0-30) in depressive symptoms was associated with a 0.5 point increase in nicotine dependence (p=.019). Age, race and education were not associated with dependence in this sample. Pregnant dual users smoke similar amounts of cigarettes per day and have comparable EACO levels to conventional users, though exhibit higher levels of nicotine dependency, indicating ECIGS may not be effective smoking cessation aids during pregnancy. Further research is warranted to determine the effect of ECIGS on birth outcomes.

Effect of Preparation for Maternal Role Program on Self-esteem of Women Undergoing In-vitro Fertilization

Background: Primiparous mothers are likely to lose their sense of value in the absence of maternal skills, and mothers with a history of infertility may suffer from more anxiety and decreased self-esteem than their normal peers do. Aim: The aim of this study was to determine the effect of a maternal role preparation program on self-esteem of pregnant mothers undergoing in-vitro fertilization (IVF). Method: This randomized clinical trial was performed at Royan Institute in 2016. Sixty mothers undergoing IVF were assigned to intervention and control groups. The research instrument was a version of Maternal Self-Report Inventory. Before implementing the preparation program, the questionnaires were completed by both groups; then, the given preparation program was held in four sessions for mothers in the intervention group. Immediately after the completion of the program and one month later, both groups took the test again. To analyze the data, t-test, Chi-squared test, and repeated measures analysis of variance (ANOVA) were run in SPSS, version 21. Results: The mean ages of the intervention and control groups were 32.8±4.3 and 31.4±3.9 years, respectively. Repeated measures ANOVA showed no significant intergroup difference in the mean score of maternal self-esteem before the intervention; however, a significant difference was observed one month post-intervention between the intervention and control groups (P<0.001). Implications for Practice: The maternal preparation program could enhance maternal self-esteem. Thus, implementing such programs along with providing other infertility care services could contribute to preparation for assuming maternal role.

Cognitive factors and post‐partum depression: What is the influence of general personality traits, rumination, maternal self‐esteem, and alexithymia?

The objective was to assess the impact of cognitive factors on post-partum depression (PPD) symptoms. Because most of the literature data concern the immediate post-partum period or the first year post-partum, we notably sought to assess the longer term impact of cognitive factors on the symptoms of PPD. Two studies were performed. In a pilot study, 1-month post-partum, 63 women filled out a sociodemographic information sheet and completed the abbreviated, revised Eysenck Personality Questionnaire, the Ruminative Responses Scale, the Maternal Self-Report Inventory, and the Edinburgh Post-Natal Depression Scale. In the main study, 124 women additionally completed the Toronto Alexithymia Scale. The main study population was divided into 2 subgroups: women in the first year post-partum (n = 74) and those in the second year post-partum (n = 50). In the pilot study performed 1-month post-partum, brooding rumination and low self-esteem were significant predictors of the PPD symptom intensity. Neuroticism, brooding rumination, and low maternal self-esteem were also significant predictors of the PPD symptoms reported in the first year post-partum. Lastly, ruminative thoughts and alexithymia were significant predictors of the PPD symptoms reported in the second year post-partum. Our results suggest that alexithymia may be an important predictor of the incidence of this condition. The observation of differences in the PPD models as a function of the post-partum period may open up opportunities for developing novel PPD prevention/treatment programs.

Maternal support following childhood sexual abuse: Relationships to child-reported

Maternal support has been conceptualized as a key factor in predicting children’s functioning following sexual abuse; however, empirical evidence for this assumption is rather limited. Prior studies may have failed to find a relationship between maternal support and children’s outcomes due to the methodological weaknesses of the prior literature such as the use of maternal support measures without adequately reported psychometric properties. Moreover, relatively few studies have investigated whether maternal support corresponds with children’s own self-reported symptoms. The aim of the present study was to utilize the only published measure of maternal support with sufficient psychometrics, the Maternal Self-Report Support Questionnaire (MSSQ; Smith et al., 2010), to determine if levels of pre-treatment support are associated with children’s self-reported trauma-related symptoms among 165 treatment-seeking children (M=10.85, SD=3.09) and their non-offending mothers. Levels of maternal emotional support corresponded with few of children’s outcomes, and when relationships were observed, emotional support was related to higher levels of symptoms. Maternal levels of blame and doubt were only associated with dissociative symptoms. Maternal support therefore appears to be an ineffective predictor of children’s post-disclosure trajectories and raises the possibility that maternal support is linked with poorer functioning.

Quantification of ethyl glucuronide, ethyl sulfate, nicotine, and its metabolites in human fetal liver and placenta

Tobacco and alcohol use during pregnancy is serious public health concerns and result in adverse developmental outcomes. Identifying in utero exposure is often achieved through meconium analysis or via maternal self-report. In this study, we analyzed fetal liver and placenta to examine second trimester alcohol and smoking exposure. A validated liquid chromatography–tandem mass spectrometry method for simultaneous analysis of nicotine and its metabolites and alcohol markers (ethyl glucuronide: EtG and ethyl sulfate: EtS) was employed to analyze 193 fetal liver and 48 placenta (n = 47 paired) samples from electively terminated pregnancies. EtG, EtS, and nicotine markers’ limits of detection were 0.7–20 ng/g in fetal samples. Ninety-eight fetal liver and 23 placenta samples were EtG/EtS-positive, while 137 liver and 25 placenta samples were positive for tobacco exposure. When both alcohol markers were present in samples, EtG/EtS ratios were 1.6–11.1 in 17 livers and 2.5–31.1 in 10 placentas. Median (range) summed tobacco marker concentrations were 422 (1.0–2776) and 154 (1.6–1621) ng/g in livers and placentas, respectively. Median EtG and nicotine marker concentrations were higher in liver than placenta in paired samples. Strong evidence of exposure occurred in 11 and 22 pairs, respectively, when both samples were positive for alcohol and/or tobacco markers. These paired fetal liver and placenta alcohol and tobacco data provided a unique means for examining the effects of in utero exposure, a critical first step in selecting fetal samples for proteomic and RNA sequencing studies that could provide mechanisms for adverse developmental outcomes.

Maternal report of fever from cold or flu during early pregnancy and the risk for noncardiac birth defects, National Birth Defects Prevention Study, 1997-2011.

As maternal fever affects approximately 6-8% of early pregnancies, it is important to expand upon previous observations of an association between maternal fever and birth defects. We analyzed data from the National Birth Defects Prevention Study, a multistate, case-control study of major structural birth defects. Telephone interviews were completed by mothers of cases (n = 17,162) and controls (n = 10,127). Using multivariable logistic regression, we assessed the association between maternal self-report of cold or flu with fever and cold or flu without fever during early pregnancy and 30 categories of non-cardiac birth defects. Maternal report of cold or flu with fever was significantly associated with 8 birth defects (anencephaly, spina bifida, encephalocele, cleft lip with or without cleft palate, colonic atresia/stenosis, bilateral renal agenesis/hypoplasia, limb reduction defects, and gastroschisis) with elevated adjusted odds ratios ranging from 1.2 to 3.7. Maternal report of cold or flu without fever was not associated with any of the birth defects studied. This study adds to the evidence that maternal fever during early pregnancy is associated with an increased risk for selected birth defects. Elevated associations were limited to mothers who reported a fever, suggesting that it is fever that contributes to the excess risk rather than illnesses associated with it. However, fever may also serve as a marker for more severe infections.

A Model-Based Cluster Analysis of Maternal Emotion Regulation and Relations to Parenting Behavior.

In a diverse community sample of mothers (N=108) and their preschool-aged children (Mage =3.50years), this study conducted person-oriented analyses of maternal emotion regulation (ER) based on a multimethod assessment incorporating physiological, observational, and self-report indicators. A model-based cluster analysis was applied to five indicators of maternal ER: maternal self-report, observed negative affect in a parent-child interaction, baseline respiratory sinus arrhythmia (RSA), and RSA suppression across two laboratory tasks. Model-based cluster analyses revealed four maternal ER profiles, including a group of mothers with average ER functioning, characterized by socioeconomic advantage and more positive parenting behavior. A dysregulated cluster demonstrated the greatest challenges with parenting and dyadic interactions. Two clusters of intermediate dysregulation were also identified. Implications for assessment and applications to parenting interventions are discussed.

Effects of prenatal alcohol consumption on cognitive development and ADHD-related behaviour in primary-school age: a multilevel study based on meconium ethyl glucuronide.

Alcohol intake during pregnancy is considered to be a risk factor for child development. Child biomarkers of intrauterine alcohol exposure have been rarely studied. We investigated whether a meconium alcohol metabolite (ethyl glucuronide, EtG) was associated with cognitive development, ADHD-related behaviour and neurophysiological markers of attention and executive control of children at primary-school age. Mothers provided self-report on prenatal alcohol consumption during their 3rd trimester. Meconium samples were collected at birth. A total of 44 children with a meconium EtG above the detection limit (≥10ng/g) and 44 nonexposed matched controls were compared. A second threshold (≥154ng/g) was applied to study the dose effects. When children reached primary-school age, mothers rated ADHD-related behaviour, child cognitive development was measured using an IQ test battery, and event-related potentials were recorded during a cued go/nogo task. Children in both EtG-positive groups allocated fewer attentional resources than controls to the go/nogo task (reduced P3 component in go-trials). Children with a meconium EtG above 154ng/g were also found to have an IQ that was six points lower than the other groups. Within the EtG≥154ng/g group, there was a positive correlation between EtG value and ADHD-related behaviour. These significant effects were not observed in relation to the maternal self-report data. Associations between EtG and cognitive deficits, attentional resource capacity and ADHD-related behaviour could be documented with effects that were partially dose-dependent. In addition to maternal self-reports, this biomarker of intrauterine alcohol exposure may be considered as a predictor of child development.