Postnatal Cohort Research Articles

Perinatal Exposure to Aflatoxins is Associated with a Lower Rate of Weight Gain Among HIV‐Infected Pregnant Women and Reduced Linear Growth of HIV‐Exposed Infants

Aflatoxins (AF) are carcinogens associated with poor linear growth in infants. AF serum levels have been reported to be higher in HIV infected (+) women. However, it is not known if maternal AF exposure affects gestational weight gain (GWG), or if relationship between in utero AF exposure and changes in perinatal anthropometry differs by maternal HIV or infant HIV exposure status. We enrolled 403 pregnant women (33.3% HIV (+), all on anti-retroviral treatment) at the antenatal clinic of Gulu Hospital, northern Uganda. At enrollment and 1 month postpartum, a serum sample was collected from women and stored at −80°C until tested for aflatoxin B1 lysine-adduct levels (AFB1) using HPLC-fluorescence. Women's weight was measured at enrollment and monthly thereafter. 246 dyads were recruited into a postnatal cohort and infant anthropometrics were measured at 1, 3, 6, 9 and 12 months. Indicators of linear growth (height for age, HAZ) were calculated using the 2006 WHO standards. We assessed (1) if gestational AF exposure predicted GWG, and (2) if perinatal AF exposure was related to HAZ growth in 1–12 month old infants. The mean (±SD) enrollment gestational age was 19.4 (±−3.8) weeks. At that time, the mean AFB1 level for HIV (−) women was 6.5 (±13.8) pg/mg albumin vs 37.6 (±82.8) for HIV (+) women (p<0.001). 1 month after birth, AFB1 levels for HIV (−) women were 8.8 (24.3) vs 113.9 (100.6) in HIV (+) women (p<0.001). Using a cut-off of perinatal AFB1=5.47pg/mg of albumin, 59% of early postpartum women met the criteria of being in the high AF category. In bivariate models, the rate of GWG was 308 (±333.6) g/wk for HIV (−) vs 247 (±399) g/wk among HIV (+) women (p=0.003). Adjusting for gestational age, food insecurity, dietary diversity, and asset index, a one log increase in gestational serum AF was associated with 26.1 g/wk less GWG in HIV (+) women (p=0.016). We found no significant association between gestational AF exposure and GWG in the HIV (−) group (Figure 1). Postnatally, adjusting for prenatal food insecurity, dietary diversity, asset index, and infant age and gender, infants of HIV (+)women in the high perinatal AF category had 0.460 lower HAZ scores than infants of HIV (−) women in the low AF exposure category (p=0.006) (Figure 2). Our results suggest that aflatoxin exposure negatively affects maternal nutrition (GWG) and infant linear growth (HAZ) in HIV (+) pregnant women and their HIV-exposed infants. Support or Funding Information This research was funded in part by Cornell University-Weill Medical College Inter-campus Seed Funds, K01 MH098902 from NIMH and USAID Cooperative Agreement AID-OAA-L-10-00006 Figure 1Open in figure viewerPowerPoint Rate of weight gain (kg/week) during pregnancy by women's HIV and Aflatoxin Exposure Status (±1S.E.) Figure 2Open in figure viewerPowerPoint 1- to-12-month-old infant HAZ scores by their mothers HIV and aflatoxin exposure status (±1S.E.)

HIV infection is associated with a lower rate of gestational weight gain and reduced neonatal length

BackgroundAdequate gestational weight gain (GWG) and neonatal growth are important, respectively, for favorable birth outcomes and survival of infants through the first year. In sub‐Saharan Africa, underlying infections, such as HIV, may adversely impact GWG and neonatal growth. We investigated trends in GWG among HIV‐infected and ‐uninfected women in northern Uganda; and, examined growth parameters of their HIV‐exposed and ‐unexposed neonates.Methods403 (133 HIV‐infected and on treatment vs. 270 ‐uninfected) pregnant women were recruited into this study from the antenatal clinic of Gulu Hospital. Women's height and weight were measured at enrollment (mean (±SD) gestational age =19.4 (±−3.8) weeks) and weight was measured at each follow‐up visit. After delivery, a subsample (n=246) of dyads was enrolled into a postnatal cohort. At one month postpartum, length and weight were measured and growth indicators (HAZ, WAZ and WHZ) were evaluated using the 2006 WHO standards. Other important variables were documented at recruitment using a detailed questionnaire. Multivariate regression models were employed to determine whether HIV status was associated with 1) the weekly rate of GWG and 2) neonatal indicators of growth.ResultsAdjusted models indicated a quadratic trend in GWG in both HIV infected and uninfected pregnant women. The rate of GWG among HIV infected women was significantly lower than that of HIV uninfected women (p=0.001). Prenatal HIV exposure was associated with significantly lower HAZ (p=0.013) and a nonsignicant trend towards lower WAZ; but, HIV exposure was not associated with WHZ at one month postpartum. HIV‐exposed neonates were more likely to be stunted (HAZ≤−2) than those who were –unexposed (adjusted odds ratio (aOR) (95%CI): 3.48 (1.29; 9.40).ConclusionThese results provide strong justifications for studies to understand mechanisms that underlay the negative effects of HIV infection or exposure on gestational weight gain and linear growth of HIV exposed neonates in this context.Support or Funding InformationThis research was funded in part by Cornell University Weill Medical College Intercampus Seed Funds, K01 MH098902 from NIMH and USAID Cooperative Agreement AIDOAAL1000006

Effect of antenatal depression on maternal dietary intake and neonatal outcome: a prospective cohort.

BackgroundIn Pakistan, incidence of antenatal depression ranges from 18 to 80 %, which goes undiagnosed, resulting in maternal and neonatal implications. The current study aimed to examine the association of antenatal depression with maternal dietary intake and neonatal outcome.MethodsA hospital-based, prospective cohort study was conducted on 94 middle class antenatal attendees coming to a tertiary care hospital in Lahore, Pakistan at the beginning of second trimester. Participants fulfilling eligibility were enrolled consecutively after taking written informed consent. Exposure group was identified by Edinburgh Postnatal Depression Scale (EPDS) and cohort members were followed till after delivery. Maternal dietary intake was assessed by 24-h Recall and Food Frequency Checklist, while neonatal outcome was identified through patient files before discharge. Data on potential confounders was collected. Loss to follow up was 13 % (82/94). Data was collected from April-September 2013. Results for 82 participants were analyzed using SPSS version 21.ResultsEPDS screened 35/82 (43 %) eligible antenatal attendees as depressed, out of which 16/35 (20 %) were severely depressed and 19/35 (23 %) were moderately depressed. Incidence of poor maternal dietary intake was more in females with antenatal depression. Antenatal depression increased the risk of poor Healthy Eating Index (RR = 2.58, C.I 1.60–5.23, AR = 62 %), carbohydrate <175 gm (RR = 1.188, CI 0.836–1.688, AR = 15 %), protein <71 gm (RR = 1.343, CI 1.059–1.703, AR = 26 %) and fat <55 gm (RR = 2.954, CI 1.612–5.416, AR = 67 %) Incidence of neonatal outcomes included, Fetal Growth Retardation (RR = 2.70, C.I 0.69–3.70, AR = 60 %), preterm birth (RR = 1.60, C.I 0.72–2.45, AR = 54 %), low Apgar score (RR = 2.70, C.I 0.69–3.70, AR = 60 %) and Low Birth Weight (RR = 0.56, C.I 0.93–1.39, AR = −44 %).ConclusionAntenatal women with depression developed poor dietary intake and had increased incidence of Fetal Growth Retardation, preterm birth and low Apgar score, but not of Low Birth Weight.

Factors Associated with Non-disclosure of HIV Status in a Cohort of Childbearing HIV-Positive Women in Ukraine.

Ukraine has one of the largest populations of persons living with HIV in Europe. Data on 2019 HIV-positive married or cohabiting women enrolled in a postnatal cohort from 2007 to 2012 were analysed to investigate prevalence and factors associated with self-reported non-disclosure of HIV status. Median age at enrolment was 27.5 years, with two-thirds diagnosed during their most recent pregnancy. Almost all had received antenatal antiretroviral therapy and 24 % were taking it currently. One-tenth (n = 198) had not disclosed their HIV status to their partner and 1 in 20 (n = 93) had disclosed to no-one. Factors associated with non-disclosure were: unmarried status (AOR 2.99 (95 % CI 1.51-5.92), younger age at leaving full-time education (AOR 0.41 (95 % CI 0.19-0.88) for ≥19 years vs ≤16 years) and lack of knowledge of partner's HIV status (AOR 2.01 (95 % CI 1.09-3.66). Further work is needed to support disclosure in some groups and to explore relationships between disclosure and psychological factors in this setting, including depression, lack of support and perception of stigma.

Exploring risk of experiencing intimate partner violence after HIV infection: a qualitative study among women with HIV attending postnatal services in Swaziland

ObjectiveTo explore risks of experiencing intimate partner violence (IPV) after HIV infection among women with HIV in a postnatal care setting in Swaziland.DesignA qualitative semistructured in-depth interview study, using thematic...

Prenatal Diagnosis and Outcome of Right Aortic Arch without Significant Intracardiac Anomaly

Right aortic arch (RAA) is usually associated with the presence of a significant congenital heart disease, usually a conotruncal defect, which determines the postnatal outcome. In the absence of such cardiac defects, the significance of RAA has not been determined. The aims of this study were to evaluate the significance of recognizing RAA in fetuses with normal or near normal intracardiac anatomy and to determine which associations may be present. A retrospective study was completed of all fetuses diagnosed with RAA with normal or near normal intracardiac anatomy between 1999 and 2011. The aim was to evaluate the presence of RAA with complete ultrasonic evaluation using two-dimensional imaging complemented by the Doppler color flow technique, paying particular attention to the three-vessel and tracheal view. We compared the prenatal findings with the postnatal outcomes and management of this cohort of fetuses. Among 16,450 fetal echocardiograms, 58 fetuses (0.35%) were diagnosed with RAA with normal or near normal intracardiac anatomy. Gestational age at diagnosis ranged from 19 to 34 weeks (mean, 23 weeks). Isolated RAAs were found in 50 fetuses, and double aortic arches (DAAs) were recognized in eight other cases. The postnatal cohort consisted of 44 newborns with RAAs and eight with DAAs (two were lost to follow-up, and four pregnancies were terminated). Postnatal echocardiography confirmed the prenatal diagnosis of RAA in 41 of 45 children, and four were found to have DAAs. Three of seven fetuses diagnosed prenatally as having DAAs were found to have only RAAs. Fourteen fetuses underwent karyotyping; two had 22q11 deletion and two had 47xxy. Eleven infants (21%) had respiratory symptoms, eight with DAAs, one with RAA, mirror-image head and neck vessels, and two with RAAs and aberrant left subclavian arteries. Surgery was indicated in all symptomatic patients except one, whose symptoms resolved. One asymptomatic patient underwent operation for significant compression of the trachea. RAA on fetal ultrasonography may indicate vascular and chromosomal abnormalities that may complicate postnatal management. When RAA is identified, fetal karyotype analysis (including the integrity of chromosome 22) is warranted. RAA may herald an occult DAA and may be a clue to a tight vascular ring. Hence, it seems essential to conduct a careful postnatal evaluation of fetuses with RAAs on prenatal ultrasound.

Effects of schizophrenia risk variation in the NRG1 gene on NRG1-IV splicing during fetal and early postnatal human neocortical development.

Neuregulin 1 (NRG1) is a multifunctional neurotrophin that mediates neurodevelopment and schizophrenia risk. The NRG1 gene undergoes extensive alternative splicing, and association of brain NRG1 type IV isoform expression with the schizophrenia-risk polymorphism rs6994992 is a potential mechanism of risk. Novel splice variants of NRG1-IV (NRG1-IVNV), with predicted unique signaling capabilities, have been cloned in fetal brain tissue. The authors investigated the temporal dynamics of transcription of NRG1-IVNV, compared with the major NRG1 isoforms, across human prenatal and postnatal prefrontal cortical development, and they examined the association of rs6994992 with NRG1-IVNV expression. NRG1 type I-IV and NRG1-IVNV isoforms were evaluated with quantitative real-time polymerase chain reaction in human postmortem prefrontal cortex tissue samples at 14 to 39 weeks gestation and postnatal ages 0-83 years. The association of rs6994992 genotype with NRG1-IVNV expression and the subcellular distribution and proteolytic processing of NRG1-IVNV isoforms were also determined. Expression of NRG1 types I, II, and III was temporally regulated during prenatal and postnatal neocortical development. NRG1-IVNV was expressed from 16 weeks gestation until age 3. Homozygosity for the schizophrenia risk allele (T) of rs6994992 conferred lower cortical NRG1-IVNV levels. Assays showed that NRG1-IVNV is a novel nuclear-enriched, truncated NRG1 protein resistant to proteolytic processing. To the authors' knowledge, this study provides the first quantitative map of NRG1 isoform expression during human neocortical development and aging. It identifies a potential mechanism of early developmental risk for schizophrenia at the NRG1 locus, involving a novel class of NRG1 proteins.

Colonization levels of Streptococcus mutans between mother and infant: a postnatal prospective cohort study.

To investigate the possible association between maternal S. mutans levels and those of the infant during the period between birth and 5 months and evaluate possible risk factors in the S mutans colonization. A prospective cohort study was carried out comprising 62 infants and their mothers, selected at the time of childbirth. For each infant, a sample swab was taken at 0, 15, 30, 90, and 150 days postpartum; on the same days, a sample was obtained from the mothers. TYCSB medium was employed for identifying the microorganism, which was later confirmed by Gram staining, the catalase activity test, and the API strep test. The final total sample consisted of 60 infants, from which S. mutans was detected in only 2 (3%) at the 150th day of oral sample collection. Of the sample of 60 mothers, 54 exhibited colonization levels. In the studied sample pairs up to 150 days, it was not possible to demonstrate the presence of a direct relationship between maternal S. mutans oral levels.

In Utero Closure of Myelomeningocele Does Not Improve Lower Urinary Tract Function

Recent data comparing prenatal to postnatal closure of myelomeningocele showed a decreased need for ventriculoperitoneal shunting and improved lower extremity motor outcomes in patients who underwent closure prenatally. A total of 11 children whose spinal defect was closed in utero were followed at our spina bifida center. We hypothesized that in utero repair of myelomeningocele improves lower urinary tract function compared to postnatal repair. Eleven patients who underwent in utero repair were matched to 22 control patients who underwent postnatal repair according to age, gender and level of spinal defect. Urological outcomes were retrospectively reviewed including urodynamic study data, need for clean intermittent catheterization, use of anticholinergic agents and prophylactic antibiotics, and surgical history. The need for ventriculoperitoneal shunting or spinal cord untethering surgery was also reviewed. Mean followup was 7.2 years for patients who underwent in utero repair and 7.3 years for those who underwent postnatal repair. Mean patient age at compared urodynamic studies was 5.9 years for in utero repair and 6.0 years for postnatal repair. The in utero repair group was comprised of 5 lumbar and 6 sacral level defects with equal matching (1:2) in the postnatal repair cohort. There were no differences between the groups in terms of need for clean intermittent catheterization, incontinence between catheterizations or anticholinergic/antibiotic use. Urodynamic parameters including bladder capacity, detrusor pressure at capacity, detrusor overactivity and the presence of detrusor sphincter dyssynergia were not significantly different between the groups. There was no difference in the rate of ventriculoperitoneal shunting (p = 0.14) or untethering surgery (p = 0.99). While in utero closure of myelomeningocele has been shown to decrease rates of ventriculoperitoneal shunting and improve motor function, it is not associated with any significant improvement in lower urinary tract function compared to repair after birth.

Previous reproductive history and post-natal family planning among HIV-infected women in Ukraine

BACKGROUNDUkraine has the highest antenatal HIV prevalence in Europe. The national prevention of mother-to-child transmission (MTCT) programme has reduced the MTCT rate, but less attention has been given to the prevention of unintended pregnancy among HIV-positive women. Our objectives were to describe the reproductive health, condom use and family planning (FP) practices of HIV-positive childbearing Ukrainian women and to identify factors associated with different methods of post-natal contraception.METHODSHIV-infected childbearing women, diagnosed before or during pregnancy, were enrolled prospectively in a post-natal cohort study in four regional HIV/AIDS centres in Ukraine from December 2007. Logistic regression models were used to identify factors associated with post-natal FP practices.RESULTSData were available for 371 women enrolled by March 2009; 82% (n = 303) were married or cohabiting, 27% (97 of 363) reported a current HIV-negative sexual partner and 69% were diagnosed with HIV during their most recent pregnancy. Overall, 21% (75 of 349) of women were not using contraception post-natally (of whom 80% reported no current sexual activity), 50% (174 of 349) used condoms, 20% (74 of 349) relied solely/partially on coitus interruptus and 4% used hormonal methods or intrauterine device. Among married/cohabiting women, consistent use of condoms in the previous pregnancy [AOR 1.96 (95%CI 1.06–3.62)], having an HIV-positive partner [AOR 0.42 (0.20–0.87)], current sexual activity [AOR 4.53 (1.19–17.3)] and study site were significantly associated with post-natal condom use; 16% of those with HIV-negative partners did not use condoms. Risk factors for non-use of FP were lack of affordability [AOR 6.34 (1.73–23.2)] and inconsistent use of condoms in the previous pregnancy [AOR 7.25 (1.41–37.2)].CONCLUSIONSMore than 40% of HIV-positive women in this population are at risk of unintended pregnancy and the one in six women in HIV-discordant couples not using barrier methods risk transmitting HIV to their partners. Our study results are limited by the observational nature of the data and the potential for both measured and unmeasured confounding.

Bladder and External Urethral Sphincter Function After Prenatal Closure of Myelomeningocele

We compared urodynamic findings in patients who underwent prenatal closure of myelomeningocele with those of patients who underwent postnatal closure, and equivalent lower urinary tract evaluations. Urodynamic studies of 5 patients (2 boys, 3 girls) who underwent prenatal closure of myelomeningocele were compared to those of 88 patients with similar level lesions who underwent repair postnatally between 1979 and 2002. All 5 patients in the prenatally treated cohort had lower lumbosacral lesions on neurological examination. These patients displayed no evidence of electromyographic activity, indicating complete denervation of the external sphincter. In comparison 34 of the 88 patients in the postnatal cohort (39%) lacked sphincter activity at newborn examination, with similar findings noted at 1-year evaluation. In terms of bladder function all 5 patients in the prenatal cohort exhibited detrusor overactivity, compared to 33 of the 88 patients (38%) in the postnatal cohort at the newborn examination, with similar findings at 1-year evaluation. Fetal closure of myelomeningocele is associated with a higher incidence of complete denervation of the external urethral sphincter and detrusor overactivity compared to postnatal closure. Patients who undergo this novel procedure should undergo urodynamic studies in the immediate newborn period and should be under close postnatal surveillance to document possible tethering of the spinal cord, urinary incontinence and increased detrusor pressures.

The significance of the dilated renal pelvis in the nitrofen-exposed rat fetus: Effects on morphology and function

Previously ( R. J. Kavlock, B. F. Rehnberg, and E. H. Rogers, 1987, Teratology 36, 51–58) we reported that gestational exposure of rats to adriamycin induced alterations in development of the fetal renal papilla that persisted postnatally. The morphological effect was associated with functional deficits in neonatal animals as seen by their performance during a test of renal concentrating ability in the second postnatal week. In the present study, we utilized an experimental approach similar to that in the adriamycin study to evaluate the fate of the dilated renal pelvis that is induced in fetal rats following prenatal exposure to nitrofen. Groups of Long-Evans rats were exposed to 0, 6.25, 12.5, or 25 mg/kg of nitrofen on gestation Days 7–16. Renal morphology of the offspring were determined on gestation Day 21 and postnatal Week 5. The postnatal cohort was tested in the second postnatal week for their ability to excrete an osmotically concentrated urine. As was the case with adriamycin, the renal concentrating ability in the neonate was reduced and poor performance in the function test was associated with permanence of the morphological effect. By utilizing a standardized semiquantitative procedure to describe the status of the kidneys and ureters during development in combination with physiological assessment of organ performace, we were able to assess the morphological and functional development of the kidney. In the absence of other anomalies we suggest that offspring be monitored during postnatal development when alterations of the fetal renal papilla are observed in standard teratology bioassays in order to determine whether the effect is transient or permanent.