Maternal Tobacco Use Research Articles

Maternal tobacco use and risk for congenital anomalies

Background: Over a period of decades non genetic causes are controlled and mortality and morbidity is considerable reduced due to malformation. Although 50% of causes for malformation are unknown origin, but, with primary prevention 50% of birth defects could be prevented. Research for finding the risk factors are continuous and such results would help to implement preventive strategies to improve maternal and child health.Methods: This is cross sectional; hospital based study, conducted in Krishna Hospital Karad, included all the Pregnant Mother diagnosed to have congenital birth defected foetus through antenatal examinations, delivered baby with diagnoses of congenital malformation, who were admitted at tertiary care hospital Karad.Results: Total 283 cases were diagnosed with birth defects. Parent’s history for tobacco use states that 16 (5.7%) mothers and 149 (53%) of fathers of malformed babies used tobacco. Among these 16 (5%) tobacco user mothers, maximum babies 5 (1.7 %) babies had born with neural tube defect and among fathers 149 (53%) maximum babies 41 (14%) circulatory system defect.Conclusions: There is a need to make the rural women aware about hazardous effects of use of mishri through health education sessions to wean them out of this addiction, which is passed from one generation to the next as a tradition at an early age.

Exposure to group B Streptococcal antibiotic prophylaxis and early childhood body mass index in a vaginal birth cohort

Purpose: Perinatal antibiotic exposure may be associated with changes in both early infancy gut microbiota and later childhood obesity. Our objective was to evaluate if group B Streptococcus (GBS) antibiotic prophylaxis is associated with higher body mass index (BMI) in early childhood.Materials and methods: This is a retrospective cohort study of mother/child dyads in a single hospital system over a 6-year period. All women with term, singleton, vertex, vaginal deliveries who received no antibiotics or received antibiotics only for GBS prophylaxis and whose children had BMIs available at 2–5 years of age were included. Children were divided into three groups for comparison: children born to GBS positive mothers that received antibiotics solely for GBS prophylaxis, children born to GBS negative women that received no antibiotics (healthy controls), and children born to GBS positive mothers who received no antibiotics. The primary outcome was the earliest available child BMI Z-score at 2–5 years of age. Multivariable linear regression was used to estimate differences in child BMI Z-scores between groups, adjusted for maternal BMI, age, race, parity, tobacco use, and child birthweight.Results: Of 4825 women, 786 (16.3%) were GBS positive and received prophylactic antibiotics, 3916 (81.2%) were GBS negative and received no antibiotics, and 123 (2.5%) were GBS positive but received no antibiotics. Childhood BMI Z-scores were similar between children exposed to intrapartum GBS prophylaxis and healthy controls who were unexposed in both unadjusted (mean (SE), 0.04 (0.04) versus −0.3 (0.02), p = .11) and adjusted (0.01 (0.05) versus −0.04 (0.03), p = .3) models.Conclusions: Exposure to intrapartum antibiotic prophylaxis for GBS was not associated with higher early childhood BMI Z-scores compared to healthy controls.

Group B Streptococcus (GBS) Colonization and Disease among Pregnant Women: A Historical Cohort Study.

Background Maternal GBS colonization is associated with early-onset neonatal sepsis and extensive efforts are directed to preventing this complication. Less is known about maternal risks of GBS colonization. We seek to provide a modern estimate of the incidence and impact of maternal GBS colonization and invasive GBS disease. Methods A single center historical cohort study of all births between 2003 and 2015 was performed. Data was collected via electronic health record abstraction using an institutional specific tool. Descriptive statistics were performed regarding GBS status. Inferential statistics were performed comparing risk of adverse pregnancy outcomes in cohorts with and without GBS colonization as well as cohorts with GBS colonization and invasive GBS disease. Results A total of 60,029 deliveries were included for analysis. Overall, 21.6% of the population was GBS colonized and 0.1% had invasive GBS disease. GBS colonization was associated with younger maternal age, Black race, non-Hispanic ethnicity, chronic hypertension, preexisting diabetes, and tobacco use (p<0.01). In the adjusted analyses, there was an increased risk of gestational diabetes (aRR 1.21, 95% CI 1.11-1.32) in colonized pregnancies and a decreased incidence of short cervix (aRR 0.64, 95% CI 0.52-0.79), chorioamnionitis (aRR 0.76, 95% CI 0.66-0.87), wound infection (aRR 0.75, 95% CI 0.64-0.88), and operative delivery (aRR 0.85, 95% CI 0.83-0.88). Conclusions This modern-day large cohort of all births over a 12-year period demonstrates a GBS colonization rate of 21.6%. This data reflects a need to assess maternal and perinatal outcomes in addition to neonatal GBS sepsis rates to inform decisions regarding the utility of maternal vaccination.

Are environmental risk factors for current wheeze in the International Study of Asthma and Allergies in Childhood (ISAAC) phase three due to reverse causation?

BackgroundPhase Three of the International Study of Asthma and Allergies in Childhood (ISAAC) measured the global prevalence of symptoms of asthma in children. We undertook comprehensive analyses addressing risk factors for asthma symptoms in combination, at both the individual and the school level, to explore the potential role of reverse causation due to selective avoidance or confounding by indication.ObjectiveTo explore the role of reverse causation in risk factors of asthma symptoms.MethodsWe compared two sets of multilevel logistic regression analyses, using (a) individual level exposure data and (b) school level average exposure (ie prevalence), in two different age groups. In individual level analyses, reverse causation is a possible concern if individual level exposure statuses were changed as a result of asthma symptoms or diagnosis. School level analyses may suffer from ecologic confounding, but reverse causation is less of a concern because individual changes in exposure status as a result of asthma symptoms would only have a small effect on overall school exposure levels.ResultsThere were 131 924 children aged 6‐7 years (2428 schools, 25 countries) with complete exposure, outcome and confounder data. The strongest associations in individual level analyses (fully adjusted) were for current paracetamol use (odds ratio = 2.06; 95% confidence interval 1.97‐2.16), early life antibiotic use (1.65; 1.58‐1.73) and open fire cooking (1.44; 1.26‐1.65). In school level analyses, these risk factors again showed increased risks.There were 238 586 adolescents aged 13‐14 years (2072 schools, 42 countries) with complete exposure, outcome and confounder data. The strongest associations in individual level analyses (fully adjusted) were for current paracetamol use (1.80; 1.75‐1.86), cooking on an open fire (1.32; 1.22‐1.43) and maternal tobacco use (1.23; 1.18‐1.27). In school level analyses, these risk factors again showed increased risks.Conclusions & clinical relevanceThese analyses strengthen the potentially causal interpretation of previously reported individual level findings, by providing evidence against reverse causation.

Early Paternal Support Behaviors Moderate Consonant Smoking Among Unmarried Parents

Unmarried mothers have high rates of smoking, including during late pregnancy and after pregnancy, thus increasing their children's risk for negative health outcomes associated with maternal tobacco use. Few studies have examined whether partners' smoking exacerbates or attenuates maternal smoking risk. The current study examines how fathers' behaviors during the third trimester of pregnancy and after pregnancy influence maternal smoking across the first 9 years of a child's life. Unmarried parents (N = 2,580 pairs) from the Fragile Families and Child Wellbeing Study were measured four times. Paternal and maternal tobacco use during the third trimester was assessed via retrospective report at baseline (the time of the child's birth). Parents also reported tobacco use 1 year, 5 years, and 9 years later. Paternal supportive behaviors were self-reported at baseline. Paternal tobacco use predicted maternal tobacco use. This association was moderated by paternal supportive behaviors as reported by fathers (b = 0.51, 95% CI [0.22, 0.81], p = .001; adjusted odds ratio = 1.67, 95% CI [1.24, 2.25]). Paternal smoking predicted maternal smoking for fathers who reported both high and low levels of supportive behaviors, but this relationship was stronger for fathers who engaged in the highest levels of support. Unmarried fathers' smoking had a stronger relationship to maternal smoking during late pregnancy and postpartum when fathers engaged in more support behaviors. The results of this study suggest that targeting fathers' smoking cessation may help improve the effectiveness of tobacco cessation programs for at-risk unmarried mothers.

Maternal Tobacco use during Pregnancy in South Africa: Results from a National Population-based Survey.

Background:Tobacco use in pregnancy is linked with various negative health effects. The aim of this study was to examine the prevalence of maternal tobacco use during pregnancy and sociodemographic and health correlates.Methods:Data of ever pregnant women from the cross-sectional “South African National Health and Nutrition Examination Survey (SANHANES-1) 2011-12” were analyzed. The sample included 5089 adolescents and adult women aged 15–55 years. They responded to questions on tobacco use, sociodemographic and health indicators.Results:Results indicate that 5.0% [95% confidence interval (CI) = 4.3, 5.9] of South African women had engaged in tobacco use during their pregnancy. In adjusted analysis, being Colored and White population groups, poor self-rated health status, and having chronic medical conditions were associated with tobacco use during pregnancy.Conclusions:Findings suggest links between sociodemographic and health variables and prenatal tobacco use, which may have public health policy implications.

569: Maternal risk factors for stillbirth: does obesity play a role?

Despite efforts to decrease the rate of stillbirth including the use of antepartum fetal surveillance, stillbirth rates remain high in the United States. We aimed to estimate the incidence of stillbirth and to identify modifiable maternal risk factors associated with stillbirth. This retrospective cohort study included all singleton pregnancies with a normal anatomic survey at a single, academic tertiary care center between 17 and 23 weeks gestation from March 2010 to June 2017. Our primary outcome was the incidence of stillbirth, defined as fetal death in utero after 20 weeks gestation. Univariate analyses were used to identify potential maternal risk factors for stillbirth. Logistic regression was used to adjust for confounders. Of 24,711 pregnancies meeting inclusion criteria, stillbirth occurred in 262 pregnancies (1.1%, 95% CI 0.9-1.2%). In unadjusted analyses, maternal factors significantly associated with increased risk of stillbirth included body mass index (BMI), nulliparity, African-American race, lower education status and unmarried status. Notably, advanced maternal age, tobacco use, and alcohol use were not associated with stillbirth (Table 1). After controlling for confounders, maternal obesity continued to be associated with increased odds of stillbirth (aOR 1.52, 95% CI 1.15-2.00), with a dose-dependent relationship between increasing maternal BMI and risk of stillbirth (Table 2). Notably, women with a BMI ≥ 45 kg/m2 had a more than two-fold increased odds of stillbirth (aOR 2.17, 95% CI 1.16-4.03). After excluding women with medical comorbidities, including hypertensive disease and diabetes, maternal obesity remained a significant risk factor for stillbirth in a dose-dependent fashion. Obesity is an independent risk factor for stillbirth with a dose-dependent relationship between increasing maternal BMI and rate of stillbirth. Obese women should be counseled on this risk, and future studies should investigate the mechanisms of stillbirth in this population and evaluate the utility of antepartum fetal surveillance in this high-risk population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Prenatal exposure to organochlorine pesticides and early childhood communication development in British girls

BackgroundThe developing brain is susceptible to exposure to neurodevelopmental toxicants such as pesticides. AimsWe explored associations of prenatal serum concentrations of hexachlorobenzene (HCB), beta-Hexachlorocyclohexane (β-HCH), 2,2-Bis(4-chlorophenyl)-1,1-dichloroethene (p,p’-DDE) and 2,2-Bis(4-chlorophenyl-1,1,1-trichloroethane (p,p’-DDT) with maternal-reported measures of verbal and non-verbal communication in young girls. Study design and methodsWe studied a sample of 400 singleton girls and their mothers participating in the Avon Longitudinal Study of Parents and Children (ALSPAC) using multivariable linear regression models adjusting for parity, Home Observation Measurement of the Environment (HOME) score, maternal age and education status, and maternal tobacco use during the first trimester of pregnancy. Exposure and outcome measuresMaternal serum samples (collected at median 15 wks. gestation [IQR 10, 28]) were assessed for selected organochlorine pesticide levels. Communication was assessed at 15 and 38 months, using adapted versions of the MacArthur Bates Communicative Development Inventories for Infants and Toddlers (MCDI). ResultsAt 15 months, girls born to mothers with prenatal concentrations of HCB in the highest tertile had vocabulary comprehension and production scores approximately 16% (p = 0.007) lower than girls born to mothers with concentrations in the lowest tertile. This association varied by maternal parity in that the evidence was stronger for daughters of nulliparous mothers. At 38 months, girls born to mothers with prenatal concentrations of HCB in the highest tertile had mean adjusted intelligibility scores that were 3% (p = 0.03) lower than those born to mothers with concentrations in the lowest tertile; however, results did not vary significantly by parity. Maternal concentrations of β-HCH and p,p’-DDE were not significantly associated with MCDI scores at 15 or 36 months. p,p’-DDT had an inconsistent pattern of association; a significant positive association was observed between p,p’-DDT with verbal comprehension scores at 15 months; however, at 38 months a significant inverse association was observed for p,p’-DDT with communicative scores. This inverse association for p,p’-DDT among older girls tended to be stronger among daughters of mothers who had lower depression scores. ConclusionsOrganochlorine pesticide exposure in utero may affect communication development.

Striving to Meet Healthy People 2020 Objectives: Trend Analysis of Maternal Smoking.

We examined trends in prevalence rates of smoking and smoking cessation during pregnancy among women in the United States to assess achievement of Healthy People 2020 prevention targets. We assessed the smoking habits of 30 667 mothers whose children were born between 1985 and 2014 and who were sampled by the National Health and Nutrition Examination Survey, 1999-2014. Sampled participants were children aged 0-15 at the time of interview; however, an adult proxy-usually the biological mother-responded on the child's behalf and reported information about maternal tobacco use during pregnancy. We calculated prevalence rates, adjusted odds ratios (aORs), and predicted annual increase or decrease of smoking and quitting smoking during pregnancy, adjusting for mother's age at delivery and income level and child's race/ethnicity and sex. The average annual prevalence of smoking at any time during pregnancy decreased from 25.7% (95% confidence interval [CI], 15.3%-36.0%) in 1985 to 10.1% (95% CI, 7.1%-13.0%) in 2014 ( P < .001), and quitting smoking at any time during the index pregnancy increased from 36.6% (95% CI, 20.3%-52.9%) in 1985 to 54.9% (95% CI, 44.4%-65.4%) in 2008 ( P = .002). The adjusted annual risk of smoking during pregnancy decreased significantly by 3% (aOR = 0.97; 95% CI, 0.95-0.98; P < .001). The prevalence rate of smoking in the year 2020 extrapolated from the current trend would be 6.1%. Smoking during pregnancy in the United States is declining. However, renewed public health measures are needed to achieve the Healthy People 2020 objectives of preventing smoking among pregnant women in the United States.

Preconception and prenatal cannabis use and the risk of behavioural and emotional problems in the offspring; a multi-informant prospective longitudinal study.

Studies of the long-term consequences of maternal cannabis use on child development beyond the neonatal period are sparse. In the current study, we use a multi-information approach to assess the association of prenatal cannabis exposure and child behavioural and emotional functioning. To explore the possible causal nature of the association, we investigated whether maternal tobacco and paternal cannabis use during pregnancy were also associated with child problems. The study population included children of a population-based birth cohort in The Netherlands (n = 5903). Information on parental cannabis use was collected using questionnaires; urine of mothers was analysed for the presence of cannabis metabolites. Child behavioural and emotional problems at approximately 7-10 years were measured using validated teacher-, child- and mother-reports. Our findings show associations of maternal cannabis use during pregnancy with offspring externalising problems (B = 0.53; 95% CI: 0.29-0.77), but not with internalising problems (B = -0.10; 95% CI: -0.31-0.11). However, maternal cannabis use before pregnancy was also associated with offspring externalising problems (B = 0.27; 95% CI: 0.02-0.52). Further, cannabis use by the father was associated with child externalising problems (B = 0.36; 95% CI: 0.22-0.49) but not internalising problems. Prenatal exposure to maternal cannabis use is specifically associated with offspring behavioural problems, but not emotional problems. This association is probably not due to an effect of intrauterine cannabis exposure on fetal development, because both maternal and paternal cannabis exposure during pregnancy were related to offspring externalising problems. Our findings suggest that the association can be explained through residual confounding, most likely through shared genetic vulnerabilities for parental cannabis use and offspring behavioural problems.

Educational Disabilities Among Children Born With Neonatal Abstinence Syndrome.

Neonatal abstinence syndrome (NAS) is a postnatal drug withdrawal syndrome that can occur after intrauterine opioid exposure. Adverse neurobehavioral outcomes have been documented in infants with NAS; however, educational outcomes have not been thoroughly examined. We analyzed Tennessee data to understand the need for special educational services among infants who are born with NAS. By using Tennessee Medicaid and birth certificate data, infants who were born in Tennessee between 2008 and 2011 with a history of NAS were matched (1:3) to infants who were born during the same period without a history of NAS. Groups were matched on the basis of sex, race and/or ethnicity, age, birth region of residence, and Medicaid enrollment status. Data were linked to Tennessee Department of Education special education data during early childhood (3-8 years of age). Conditional multivariable logistic regression was used to assess associations between NAS and selected special education outcomes. A total of 1815 children with a history of NAS and 5441 children without NAS were assessed. Children with NAS were significantly more likely to be referred for a disability evaluation (351 of 1815 [19.3%] vs 745 of 5441 [13.7%]; P < .0001), to meet criteria for a disability (284 of 1815 [15.6%] vs 634 of 5441 [11.7%]; P < .0001), and to require classroom therapies or services (278 of 1815 [15.3%] vs 620 of 5441 [11.4%]; P < .0001). These findings were sustained in a multivariable analysis, with multiple models controlling for maternal tobacco use, maternal education status, birth weight, gestational age, and/or NICU admission. Results of this novel analysis linking health and education data revealed that children with a history of NAS were significantly more likely to have a subsequent educational disability.

Maternal smoking during pregnancy and long-term neurological morbidity of the offspring

ObjectiveTo evaluate the long-term pediatric neurological morbidity of children born to mothers who reported smoking during pregnancy as compared with children born to non-smoking mothers. Study designA population-based cohort analysis was performed comparing all deliveries of mothers who reported smoking during pregnancy and non-smoking mothers between 1991 and 2014 at a single tertiary medical center. Hospitalizations of the offspring up to the age of 18 years involving neurological morbidities were evaluated according to a predefined set of ICD-9 codes, including autism, development and movement disorders, cerebral palsy and more. A Kaplan-Meier survival curve was used to compare cumulative hospitalization rate in exposed and unexposed offspring and a Cox proportional hazards model was used to control for confounders. ResultsDuring the study period, 242,342 deliveries met the inclusion criteria. Of them, 2861 (1.2%) were children of smoking mothers. Neurological-related hospitalizations were significantly higher in children born to smoking mothers, as compared with the non-smoking group (5.3% vs. 3.1%, p < 0.01). Specifically, these children had higher rates of movement, eating and developmental disorders as well as attention deficit hyperactive disorder. The Kaplan-Meier survival curve demonstrated a significant higher cumulative incidence of neurological-related hospitalizations in the smoking group (log rank p < 0.01). Using a Cox proportional hazards model, controlling for potential confounders, maternal tobacco use was found to be independently associated with long-term neurological morbidity of the offspring (adjusted HR = 1.58, CI 1.33–1.89, p value < 0.01). ConclusionMaternal smoking during pregnancy is an independent risk factor for long-term neurological morbidity of the offspring.

Co-use of tobacco and marijuana during pregnancy: Pathways to externalizing behavior problems in early childhood

Use and co-use of tobacco and marijuana during pregnancy are associated with the development of social, cognitive, and behavioral problems for infants and children. However, less is known about the potential developmental impact of the use of tobacco and marijuana in tandem. The present study examined an etiological model for the development of externalizing behavior problems (EBP) in early childhood in a high risk sample (N = 247) of mother-infant dyads with prospective data from pregnancy to 36 months of child age. Co-use during pregnancy and continued maternal tobacco and marijuana use from infancy through early childhood were investigated. Although direct pathways from exposure during pregnancy to EBP were not significant, there was a significant indirect pathway from prenatal tobacco use to EBP via lower breastfeeding duration to lower maternal warmth/sensitivity to EBP, and a pathway from higher maternal affective dysregulation to higher EBP. These results highlight the importance of considering cascading effects of substance use during pregnancy on parental processes within the context of developmental risk and protection.

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.

Developing health communication messaging for a social marketing campaign to reduce tobacco use in pregnancy among Alaska native women

ABSTRACTBackground: Despite the high prevalence of tobacco use during pregnancy among Alaska Native and American Indian (AI/AN) women, few efforts have focused on developing tobacco cessation interventions for this group. This paper describes development of messaging for a social media campaign targeting the entire community to reduce tobacco use in pregnancy (cigarette smoking and smokeless tobacco use including a homemade product known as Iqmik) among AN women, as part of a multi-component intervention.Method: The study (clinical trial registration #NCT02083081) used mixed methods with two rounds of assessments to develop and refine culturally relevant message appeals. Round 1 used qualitative focus groups and individual interviews (n = 60), and Round 2 used quantitative survey interviews (n = 52). Each round purposively sampled adult AN pregnant women, family/friends, and Elders in Western Alaska, and included tobacco users and non-users. Round 1 also assessed reasons for tobacco use in pregnancy.Results: Qualitative findings generally converged with quantitative results to indicate that many participants preferred factual, loss-framed, visual concepts on how maternal tobacco use harms the fetus, newborn, and child in contrast to spiritual or emotional appeals, or gain-framed messaging. Stress was indicated as a major reason for tobacco use in pregnancy and strategies to manage stress along with other health pregnancy targets (e.g. prenatal care) were suggested.Conclusions: This preliminary study suggests campaign messages targeting the entire community to reduce tobacco use in pregnancy among rural AN women should include factual messaging for being tobacco-free as well as focus on reducing stress and other healthy pregnancy targets.

Longitudinal Changes in Amino Acid (AA) Turnover in Pregnancy in Women with Normal Glucose Tolerance (NGT) and GDM—Relationship to Fetal Growth

GDM have decreased glucose insulin sensitivity vs. NGT. However, there are less data on the impact of GDM on AA metabolism or relationship to fetal growth. Ten NGT and 8 GDM (≥ 1 abnormal value, 3 hour OGTT) were evaluated at 18-22 and 32-36 weeks for 2 potent amino acid secretogogues, Phenylalanine (PHE) and Leucine (LEU). PHE and LEU turnover was estimated (D5 PHE and 13C LEU) under basal and euglycemic hyperinsulinemic clamp conditions. Neonatal body composition was estimated using anthropometrics. There were no significant difference in maternal age, race, education, tobacco use, weight or body composition between GDM and NGT at 18-22 weeks. The was a higher family hx of diabetes in GDM (p=0.05). Basal LEU but not PHE turnover increased over time and was greater in GDM, Table. Glucose disposal decreased over time and was lower in GDM. During the clamp LEU but not PHE turnover increased over time and was greater in GDM. Clamp PHE turnover (µmol/kg/hour) at 18-22 weeks correlated with neonatal lean mass (r=0.48, p=0.048) and there was a trend for fat mass (r=0.47, p=0.058). Omitting 1 outlier there remained a trend for PHE turnover and neonatal lean mass (r=0.43, p=0.09). Leu turnover increased over time and was greater in GDM vs. NGT. In contrast, there were no significant changes in PHE turnover over time or between groups but PHE turnover in early pregnancy was related to fetal lean mass.Metabolic ResultsNGT (n=10)GDM (n=8)ANOVABasal Leucine turnover (umol/kg*ffm/hr)12-16 weeks129.8 ± 19.8155.6 ± 20.1p=0.00532-36 weeks134.1 ± 20.8157.0 ± 22.9pgroup = 0.001Leucine turnover (umol/kg*ffm/hr)12-16 weeks108.5 ± 18.5126.8 ± 20.8p=0.0232-36 weeks123.0 ± 19.8136.2 ± 21.8pgroup = 0.03mean ± SDpgroup difference between NGT &amp; GDM Disclosure P. Catalano: None. L. Presley: None. S. Hauguel de Mouzon: None. S. Kalhan: None.

Case 2: The Well-Appearing Cyanotic Infant

A term male infant is born via spontaneous vaginal delivery at 40 2/7 weeks’ gestational age to a gravida 2 para 2 mother. Her pregnancy was complicated by maternal tobacco use and inadequately treated group B Streptococcus colonization. The infant is vigorous at birth with Apgar scores of 7 and 9 at 1 and 5 minutes, respectively. The infant has growth parameters appropriate for gestational age and examination in the delivery room reveals bilateral clubfeet, but is otherwise normal. At 11 hours of age, the infant is noted to have cyanosis with breastfeeding and is found to have an oxygen saturation of 83% measured in the right upper extremity with pulse oximetry. His breathing is unlabored and lung sounds are clear to auscultation. Heart rate and rhythm are normal and no murmurs are appreciated. Blood pressures in all 4 limbs, peripheral pulses, and perfusion are also all appropriate. The infant receives oxygen supplementation via nasal cannula, which is subsequently escalated to nasal continuous positive airway pressure (CPAP) of 6 cm H2O with a fraction of inspired oxygen (Fio2) of 1.00. Despite these interventions, his pulse oximetry saturations remain between 70% and 80%. Chest radiography reveals a normal cardiac size and silhouette, with clear bilateral lung fields. A complete blood cell count with differential and blood glucose concentrations is also unremarkable. Blood culture specimens are obtained and the infant starts broad-spectrum antibiotics for empirical treatment of possible early-onset neonatal sepsis. Given the concern for congenital cyanotic heart disease, the infant is transported via air ambulance to our tertiary care children’s hospital. Echocardiography performed on admission at 16 hours of age reveals normal ventricular size and function, as well as an expected patent ductus arteriosus and foramen ovale with …

205: Maternal smoking and long-term neurological morbidity of the offspring

Tobacco use is a worldwide epidemic and is a risk factor for adult neurological morbidity. Smoking during pregnancy has been associated with various pregnancy complications and adverse perinatal outcomes. This study was aimed to evaluate the long-term pediatric neurological morbidity of children born to mothers who reported tobacco use during pregnancy as compared with children born to mothers who negated smoking during pregnancy. A population-based cohort analysis was performed comparing all deliveries of mothers who reported smoking during pregnancy and non-smoking mothers between 1991-2014 at a single tertiary medical center. Hospitalizations of the offspring up to the age of 18 years involving neurological morbidities were evaluated according to a predefined set of ICD-9 codes, including autistic, eating, sleeping and movement disorders, cerebral palsy, developmental disorders, and more. A Kaplan-Meier survival curve was used to compare cumulative hospitalization rate in exposed and unexposed offspring and a Cox proportional hazards model was used to control for confounders. During the study period, 242,342 deliveries met the inclusion criteria. Of them, 2,861 (1.2%) were children of mothers reported smoking during pregnancy. Hospitalizations involving neurological morbidities were significantly higher in children born to smoking mothers, as compared with those born to non-smoking mothers (5.3% vs. 3.1%, p<0.01, Table). Specifically, these children had higher rates of movement, eating and developmental disorders as well as attention deficit disorder. The Kaplan-Meier survival curve demonstrated a significant higher cumulative incidence of neurological-related hospitalizations in the smoking group (Figure, log rank p<0.01). Using a Cox proportional hazards model, controlling for maternal age, gestational age, maternal diabetes and hypertensive disorders of pregnancy, maternal tobacco use was found to be independently associated with long-term neurological morbidity of the offspring (adjusted HR=1.8, 95% CI 1.53-2.11, p<0.01). Maternal tobacco use during pregnancy is an independent risk factor for long-term neurological morbidity of the offspring.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Central Hematocrit Levels in Fetal Malnourished Term Infants.

Fetal malnutrition is especially important for common chronic diseases in adult life. They could potentially be prevented by achieving optimal fetal nutrition. The aim of this study was to investigate hematocrit levels of malnourished, term, appropriate for gestational age (AGA) neonates. A total of 80 AGA neonates (between 10% and 90% percentiles interval according to birth week), born with spontaneous vaginal delivery between 37 and 42 weeks of gestation, detected by both last menstrual period and ultrasonography measurements, were included in the study. Neonates with fetal malnutrition constituted the study group and the control group consisted of well-nourished neonates. We analyzed central venous hematocrit levels obtained 4 hours after birth and maternal risk factors for both groups. Although there were no differences in gestational age, head circumference, maternal factors (gravidity, parity, abortions and curettage counts, maternal tobacco use, preeclampsia, hypertension, diabetes mellitus, gestational diabetes mellitus, and history of urinary tract infections), first minute APGAR scores, and sex, Clinical Assessment of Nutritional Status score was lower (29.91±2.87 vs. 21.25±1.65) and hematocrit levels were higher (51.33±2.740 vs. 59.53±5.094) in the fetal malnutrition group (P<0.0001). Central hematocrit levels in malnourished term AGA neonates were found significantly higher than well-nourished term AGA newborns.

Morbidly Adherent Placenta in Mid Trimester Abortion - A Case Report

Morbidly adherent placenta (MAP) occurs when there is abnormally firm attachment of placental villi to the uterine wall with the absence of the normal intervening decidua basalis and nitabuch’s layer. There are several risk factors of this condition including previous uterine surgery like myomectomy, dilatation and curettage operation, placenta praevia following previous caesarean section, advanced maternal age, multiparity and tobacco use. A diagnosis of MAP can be confirmed with tissue histology; however, medical imaging can be effective diagnostic tool. USG can detect the presence of accreta (80% sensitivity) and absence of accreta (95% specificity). This condition is presented here as a 20 weeks pregnancy with missed abortion with morbid adherent placenta (MAP).Bangladesh J Obstet Gynaecol, 2016; Vol. 31(1) : 50-53