Prenatal Care Interventions Research Articles

Prenatal exposure to hypoxic risk conditions in autistic and neurotypical youth: Associated ventricular differences, sleep disturbance, and sensory processing.

There is a growing body of research that suggests conditions during the period of pregnancy and birth can affect how autism spectrum disorder (ASD) presents itself. This study aimed to investigate the incidence of oxygen deprivation during this period known as prenatal and perinatal hypoxic risk (HR) conditions in ASD compared with neurotypical control (NTC) youth. We also examined ventricular morphology variations associated with HR exposure, and to evaluate associations with clinical symptoms. Results from a cohort of 104 youth revealed a higher incidence of exposure to prenatal hypoxic conditions in the ASD group. Additionally, ASD individuals with prenatal hypoxic exposure (ASD + HR) demonstrated larger third ventricle volumes compared with both ASD and NTC individuals without such exposure (ASD-HR and NTC-HR, respectively). Furthermore, associations were identified between prenatal hypoxic exposure, third ventricle volume, sensory dysfunction, and severity of sleep disturbances. These findings suggest exposure to prenatal hypoxic risk conditions may exacerbate or modify the neurodevelopmental trajectory and symptom severity in ASD, emphasizing the need for better prenatal care and specific interventions to reduce these risks.

Pelvic floor status during pregnancy as a predictor of pelvic dysfunction and birth outcome

This literature review presents an analysis of a number of studies that examined the association between pelvic floor health during pregnancy and the development of pelvic dysfunction and birth outcomes. These studies consistently demonstrated that changes in pelvic floor structure and function during pregnancy are associated with an increased risk of developing pelvic disorders such as urinary incontinence and pelvic organ prolapse. Besides, certain pelvic floor characteristics, such as muscle strength, tone, and stretching ability, have been identified as potential predictors of pelvic floor dysfunction during pregnancy and prolonged second-stage labor. The data collected suggest that pelvic floor assessment during pregnancy may provide valuable prognostic information about birth outcomes. Understanding these relationships may lead to improved prenatal care strategies and interventions to optimize pelvic floor function and reduce the incidence of adverse birth outcomes. Further research is required to clarify the specific parameters for evaluating pelvic floor changes that are most indicative of pelvic organ dysfunction and adverse birth outcomes, as well as to assess the efficacy of preventive interventions.

A group prenatal care intervention reduces gestational weight gain and gestational diabetes in American Samoan women.

The objective of this study was to determine the preliminary effectiveness of an intervention to mitigate adverse pregnancy outcomes associated with pre-pregnancy obesity in American Samoa. We enrolled n = 80 low-risk pregnant women at <14 weeks' gestation. A complete case analysis was conducted with randomized group assignment (group prenatal care-delivered intervention vs. one-on-one usual care) as the independent variable. Primary outcomes were gestational weight gain and postpartum weight change. Secondary outcomes included gestational diabetes screening and exclusive breastfeeding at 6 weeks post partum. Other outcomes reported include gestational diabetes incidence, preterm birth, mode of birth, infant birth weight, and macrosomia. Gestational weight gain was lower among group versus usual care participants (mean [SD], 9.46 [7.24] kg vs. 14.40 [8.23] kg; p = 0.10); postpartum weight change did not differ between groups. Although the proportion of women who received adequate gestational diabetes screening (78.4% group; 65.6% usual care) was similar, there were clinically important between-group differences in exclusive breastfeeding (44.4% group; 25% usual care), incidence of gestational diabetes (27.3% group; 40.0% usual care), and macrosomia (8.3% group; 29.0% usual care). It may be possible to address multiple risk factors related to intergenerational transmission of obesity in this high-risk setting using a group care-delivered intervention.

Rheumatoid arthritis and adverse pregnancy outcomes: a bidirectional two-sample mendelian randomization study

BackgroundThere is growing evidence of bidirectional associations between rheumatoid arthritis and adverse pregnancy outcomes (APOs) in observational studies, but little is known about the causal direction of these associations. Therefore, we explored the potential causal relationships between rheumatoid arthritis and APOs using a bidirectional two-sample Mendelian randomization (MR) in European and Asian populations.MethodsWe conducted a bidirectional two-sample Mendelian randomization analysis using available summary statistics from released genome-wide association studies. Summary statistics for instrument–outcome associations were retrieved from two separate databases for rheumatoid arthritis and adverse pregnancy outcomes, respectively. The inverse-variance weighted method was used as the primary MR analysis, and cML-MA-BIC was used as the supplementary analysis. MR-Egger, MR pleiotropy residual sum and outlier (MR-PRESSO), and Cochran Q statistic method were implemented as sensitivity analyses approach to ensure the robustness of the results.ResultsOur study showed that a higher risk of rheumatoid arthritis in the European population was associated with gestational hypertension (OR: 1.04, 95%CI: 1.02–1.06), pre-eclampsia (OR: 1.06, 95%CI: 1.01–1.11), fetal growth restriction (OR: 1.08, 95%CI: 1.04–1.12), preterm delivery (OR:1.04, 95%CI: 1.01–1.07). Furthermore, we found no evidence that APOs had causal effects on rheumatoid arthritis in the reverse MR analysis. No association between rheumatoid arthritis and APOs was found in East Asian population. There was no heterogeneity or horizontal pleiotropy.ConclusionsThis MR analysis provides the positive causal association from rheumatoid arthritis to gestational hypertension, pre-eclampsia, fetal growth restriction and preterm delivery genetically. It highlights the importance of more intensive prenatal care and early intervention among pregnant women with rheumatoid arthritis to prevent potential adverse obstetric outcomes.

Study protocol for the implementation of Centering Patients with Fibroids, a novel group education and empowerment program for patients with symptomatic uterine fibroids.

Black women and people with uteri have utilized collectivistic and relational practices to improve health outcomes in the face of medical racism and discrimination for decades. However, there remains a need for interventions to improve outcomes of uterine fibroids, a condition that disproportionately impacts Black people with uteri. Leveraging personalized approaches alongside evidence that demonstrates the positive impact of social and peer support on health outcomes, we adapted from CenteringPregnancy, an evidence based group prenatal care intervention, for the education and empowerment of patients with uterine fibroids. The present report provides an overview of the study design and planned implementation of CPWF in cohorts at Boston Medical Center and Emory University / Grady Memorial Hospital. After receiving training from the Centering Healthcare Institute (CHI), we adapted the 10-session CenteringPregnancy curriculum to an 8-session hybrid group intervention called Centering Patients with Fibroids (CPWF). The study began in 2022 with planned recruitment of six cohorts of 10-12 participants at each institution. We will conduct a mixed methods evaluation of the program using validated survey tools and qualitative methods, including focus groups and 1:1 interviews. To date, we have successfully recruited 4 cohorts at Boston Medical Center and are actively implementing BMC Cohort 5 and the first cohort at Emory University / Grady Memorial Hospital. Evaluation of the program is forthcoming.

Assessment of knowledge about neonatal danger signs among primiparous women at discharge from healthcare facilities.

This study explores the evaluation of knowledge regarding neonatal danger signs (NDS) among first-time mothers in Pakistan during their discharge from healthcare facilities. The investigation aimed to establish connections between their understanding of NDS and factors such as sociodemographic background, prenatal check-ups, and educational measures. Considering the persistently high neonatal mortality rates in low- and middle-income nations, recognizing maternal NDS awareness becomes crucial for promoting early medical attention and reducing neonatal health risks. Existing research highlights the role of maternal knowledge in shaping neonatal well-being; however, gaps in knowledge remain prevalent, especially among first-time mothers. Using a cross-sectional approach, data were gathered through structured questionnaires, revealing significant relationships among maternal NDS awareness, sociodemographic aspects, prenatal care, and educational interventions. It is noteworthy that first-time mothers demonstrated lower NDS knowledge than mothers with multiple childbirth experiences, while those with higher education displayed greater awareness The effects of educational interventions were diverse, and antenatal visits were linked to enhanced knowledge. This study highlights the significance of focused treatments that target knowledge deficiencies, which can empower women and contribute to the reduction of infant health problems and mortality. encouraging further exploration of effective strategies to augment maternal knowledge and proactive healthcare-seeking behaviors.

Effects of Two Group Prenatal Care Interventions on Mental Health: An RCT

Perinatal depression and anxiety cost the U.S. health system $102 million annually and result in adverse health outcomes. Research supports that cognitive behavioral therapy improves these conditions, but barriers to obtaining cognitive behavioral therapy have prevented its success in pregnant individuals. In this study, the impact of a cognitive behavioral therapy-based intervention on anxiety, depression, stress, healthy lifestyle beliefs, and behaviors in pregnant people was examined. This study used a 2-arm RCT design, embedded in group prenatal care, with one arm receiving a cognitive behavioral therapy-based Creating Opportunities for Personal Empowerment program and the other receiving health promotion content. Black and Hispanic participants (n=299) receiving prenatal care from 2018 to 2022 in New York and Ohio who screened high on 1 of 3 mental health measures were eligible to participate. Participants were randomized into the manualized Creating Opportunities for Personal Empowerment cognitive behavioral therapy-based program, with cognitive behavioral skill-building activities delivered by advanced practice nurses in the obstetrical setting. Outcomes included anxiety, depression, and stress symptoms using valid and reliable tools (Generalized Anxiety Disorder scale, Edinburgh Postnatal Depression Scale, and Perceived Stress Scale). The Healthy Lifestyle Beliefs and Behaviors Scales examined beliefs about maintaining a healthy lifestyle and reported healthy behaviors. There were no statistically significant differences between groups in anxiety, depression, stress, healthy beliefs, and behaviors. There were significant improvements in all measures over time. There were statistically significant decreases in anxiety, depression, and stress from baseline to intervention end, whereas healthy beliefs and behaviors significantly increased. Both cognitive behavioral therapy and health promotion content embedded in group prenatal care with advanced practice nurse delivery improved mental health and healthy lifestyle beliefs and behaviors at a time when perinatal mood generally worsens. This study is registered with clinicaltrials.gov NCT03416010.

Epidemiological Profile of Cleft Lip and Palate Cases in A Libyan Neonatal Unit at Al Wahda Teaching Hospital, Derna: A Comprehensive Analysis

Aim. This study aims to assess the prevalence and associated risk factors of Cleft lip and palate (CLP) among neonates in Derna, Libya, over a six-year period from 2016 to 2021. Methods. This retrospective observational study analysed data from the neonatal unit registry at Al Wahda teaching hospital in Derna, Libya. The study population comprised neonates admitted to the hospital from 2016 to 2021. Inclusion criteria specified Libyan neonates diagnosed with CLP, while exclusion criteria excluded stillbirths and non-Libyan neonates. Data analysis involved calculating incidence rates, descriptive statistics, and subgroup analyses to identify demographic characteristics and associated risk factors. Results. Out of 2,887 neonatal records reviewed, 10 cases of cleft lip ± palate (CL±P) were identified, yielding an overall incidence rate of 0.6 cases per 1000 live births. The majority of cases (50%) presented with both cleft lip and palate, followed by cleft palate only (40%) and cleft lip only (10%). Demographic analysis revealed a higher prevalence among females (60%), full-term neonates (80%), neonates from larger families of more than 6 children (50%), and those with birth weights between 2.5 and 4 kg (70%). Left-sided clefts were more common (90%) than right-sided clefts (10%). Potential risk factors included maternal history of abortion (20%), irregular pregnancy follow-up (90%), and gestational diabetes (10%). Conclusion. This study provides insights into the prevalence and associated risk factors of cleft lip ± palate (CL±P) among neonates in Derna, Libya. The findings underscore the importance of comprehensive prenatal care and public health interventions to address modifiable risk factors and reduce the incidence of cleft lip ± palate in affected populations. Further research is needed to explore additional factors contributing to cleft anomaly occurrence and outcomes.

Understanding cyberchondria in pregnant women: longitudinal assessment of risk factors, triggers, and outcomes

Pregnancy often triggers anxiety and health concerns in women, leading many to search for health information online. Excessive, compulsive, and repetitive online health research, accompanied by heightened anxiety, can result in cyberchondria. This study aimed to explore the risk factors, triggers, and outcomes of cyberchondria in pregnant women. A total of 149 participants completed an online questionnaire longitudinally across three stages of pregnancy: early (14-19 weeks), mid (24-29 weeks), and late pregnancy (34-39 weeks). The findings revealed that health anxiety and the cognitive component of anxiety sensitivity are risk factors for cyberchondria during pregnancy. Pregnancy concerns related to motherhood emerged as triggers for cyberchondria. While a connection between cyberchondria and fear of birth was observed, fear of birth did not appear to be a direct outcome of cyberchondria. These results highlight the importance of addressing health anxiety, cognitive anxiety sensitivity and motherhood concerns in prenatal care and support interventions. Understanding the factors contributing to cyberchondria in pregnant women can assist healthcare professionals in providing targeted support and resources to mitigate excessive online health searching behaviors and alleviate anxiety during pregnancy.

Assessing the association between an early and recommended number of focused antenatal care visits and the number of prenatal care content received before delivery in Ethiopia.

Early and frequent antenatal care (ANC) has been linked to better pregnancy outcomes. This study assessed whether having at least four ANC contacts was associated with increased prenatal care content if the first visit was started in the first trimester in Ethiopia. Data from the 2019 Ethiopia Mini Demographic and Health Survey on 2894 women aged 15-49 who received ANC during their last pregnancy were analyzed. The sum of women's responses to six questions about ANC components (blood pressure taken, urine sample taken, blood sample taken, provided or bought iron tablet, counselling by a health worker on nutrition, and told about pregnancy complications) was used to construct a composite score of routine ANC components. The main predictor was a combination of the timing of the first contact and the number of ANC contacts before birth. We found that 28.7% of women who began ANC early made at least four ANC contacts. More than one-third (36%) received all six components, with blood pressure monitoring being the most common (90.4%). After adjusting for potential confounding factors, women who had at least four contacts and booked early were substantially more likely than their counterparts to get a factor-of-one increase in the number of components received (IRR = 1.08; 95% CI: 1.03, 1.10). We found a strong association between increased prenatal care content and early ANC with at least four contacts. However, less than a third of women in the study setting had at least four contacts, with the first occurring in the first trimester. In addition, less than half of women received essential prenatal care interventions before delivery. The findings suggest that the WHO's new guidelines for ANC frequency and timing may be challenging to implement in some countries, such as Ethiopia, that already have low coverage of four or more contacts. If the recommendations are adopted, effective strategies for increasing early starts and increasing contacts are required.

Mendelian randomization study reveals a causal relationship between rheumatoid arthritis and risk for pre-eclampsia.

Epidemiological observational studies have investigated the relationship between rheumatoid arthritis(RA) and pre-eclampsia, but no consistent conclusions were obtained due to various limitations. Hence, we conducted a two-sample mendelian randomization analysis to evaluate the potential causal effect of RA on pre-eclampsia. Summary-level statistics for RA were derived from a large-scale meta-analysis of datasets of genome-wide association studies(GWAS) which involved 14,361 cases and 43,923 controls. Moreover, summary statistics for pre-eclampsia or eclampsia were sourced from the Finn biobank which contained 3,903 cases and 114,735 controls. The inverse variance weighting (IVW) as well as other four effective methods including MR-Egger, weighted median, weighted mode, and simple mode were applied to deduce the potential causal relationships between RA and pre-eclampsia comprehensively. The two-sample MR analysis suggested a strong causal relationship between RA and pre-eclampsia[OR,1.05;95%CI, 1.01-1.09;p<0.05]. The OR estimates obtained from the weighted mode[OR,1.09;95%CI,1.03-1.15;p<0.01] and weighted median[OR,1.07;95%CI, 1.01-1.14;p<0.05] were similar to those from the IVW method, but there was no significant association observed in MR Egger and simple mode analysis. This MR analysis provides evidence of a positive causal association between RA and pre-eclampsia genetically. Our findings highlight the importance of more intensive prenatal care and early intervention among pregnant women with RA to prevent potential adverse obstetric outcomes. Moreover, our study provides clues for risk factor identification and early prediction of pre-eclampsia.

Covering Undocumented Immigrants: The Effects of a Large-Scale Prenatal Care Intervention

Covering Undocumented Immigrants: The Effects of a Large-Scale Prenatal Care Intervention

Low weight at birth can be an indicative in childhood as a marker of metabolic syndrome and hypertension

As low weight at birth can be a marker for future risk factors for cardiovascular diseases, public school children who had this positive history were studied S to nutritional status, lipids, glucose, uric acid, blood pressure and socioeconomic conditions. The main interest of the investigation is to find statistically significant correlations among data collected from young public school children from a city outside of the capital of Sao Paulo in Brazil. Results: risk factors for metabolic syndrome presented higher impact considering blood pressure and socioeconomic conditions, calling for better prenatal care and surveillance plus intervention in the low weight at birth children.

Pregnancy after bariatric surgery: Effects of personalized nutrition counseling on pregnancy outcomes

Nutritional challenges following bariatric surgery can be intensified during pregnancy and may have crucial effects on the fetus, including lower birth weight. To the best of our knowledge, the effect of nutritional counseling during post-bariatric pregnancy to improve maternal diet quality and eating habits on neonatal outcome has not been evaluated. The aim of this research was to examine the effects of personal nutritional counseling during post-bariatric pregnancy on nutritional intake and neonatal outcomes. We performed a non-randomized, intervention-control clinical trial. Women (n=61) were divided into three groups; two prospective, and one retrospective: 1. An Intervention Bariatric Prospective group 2. A Control Prospective group without surgery, and 3. A Control Bariatric Retrospective group. Patient enrollment was performed from April 2016 to March 2018. The intervention program included biweekly visits with a pregnancy nutrition certified bariatric dietitian. Data collection was performed four times during pregnancy, and included demographic and eating habits questionnaires, 24h dietary recall, and information about delivery outcomes. In the retrospective group delivery outcomes and Food Frequency Questionnaire was collected once, after delivery. There were no differences between groups at baseline except for a higher pre-pregnancy BMI in the post-bariatric groups. In the prospective groups, dietary protein, energy, and iron were found to be consumed in higher amounts in the Control-Prospective group than in the Intervention Bariatric-Prospective group (p<0.05), without the addition of supplements. On the other hand, iron and calcium calculated from diet with supplements, were found to be significantly higher in the Intervention Bariatric Prospective group than in the Control Prospective group. In addition, consumption of saturated fats, oil, and salty snacks was lower in both prospective groups compared to the retrospective group (p<0.05), suggesting better food quality habits for the bariatric group with nutritional counseling. Mean birth weight was significantly lower in the Control Bariatric Retrospective group than in the Control-Prospective group (3074±368g vs. 3396±502g, respectively. p=0.023). In the Intervention Bariatric Prospective group, mean birth weight was 3168±412g, and no significant difference was observed from the Control Prospective group. Birth percentiles were also significantly lower in the Control Bariatric Retrospective group compared to the Control Prospective group (27th vs. 42nd, respectively. p<0.05). In the Intervention Bariatric Prospective group, mean birth percentile was 35th, and no significant difference was observed from the Control Prospective group. As for the weight change of the woman during pregnancy, the highest variability was noted among the Control Bariatric Retrospective group with cases of weight loss up to 37kg, due to conception close to the bariatric operation. Nevertheless, this variable was controlled, and showed no significant impact on birth weight results. Our results suggest that personalized nutritional counseling care during post bariatric pregnancy improved nutrient intake of mothers and may contribute to higher birth weight of offspring. Further research is needed to examine the effects of prenatal nutrition care intervention, in addition to repeating this trial with a larger sample size, to allow for clearer findings. IRB number: 0310-15-RMB. NCT02697981 URL: https://www.nih.gov.

\u201cWhen I think of mental healthcare, I think of no care.\u201d Mental Health Services as a Vital Component of Prenatal Care for Black Women

PurposeBlack people give birth joyously despite disproportionate rates of adverse perinatal outcomes. Given that group prenatal care shows promise in mitigating these inequities, we sought to solicit the opinions of Black peripartum women on how group prenatal care could be tailored to fit their specific needs. In this study, we describe attitudes about a proposed Black group prenatal care in a single focus group of 11 Black women who receive maternal health services from Black Infant Health (BIH, a state and federal funded state-wide program for Black pregnant people with the goal to improve infant and maternal health). These data were used to design a race-conscious group prenatal care curriculum specifically for Black women at UCSF.DescriptionThis study was an analysis of focus group data generated as part of a larger project focused on community involvement in Black maternal health. English speaking pregnant or recently postpartum women age 18 or older who receive services from BIH were recruited to participated in the focus group analyzed in this study. All facilitators of the focus group were Black women in order to facilitate candid conversation about racism in prenatal care.AssessmentThe need for mental health care was common thread underlying all conversations about prenatal health improvements desired by our focus groups. Participants expressed the centrality of mental health access during our discussion of other themes (e.g.: ease of access, inclusion of partners, special classes for teen moms) by discussing them in terms of their relationship to mental health. Our participants’ clear expression of the centrality of mental health care to their prenatal health guided our decision to focus on mental health as a necessary pillar of any group prenatal care intervention designed to mitigate perinatal healthcare disparities in this paper. Three themes related to mental health integration into group prenatal care emerged from thematic analysis of the transcripts. Participants expressed insufficient access and advocacy, and provider distrust.ConclusionEvidence exists supporting group prenatal care as a tool for mitigation of perinatal health disparities among Black women. There is also a large body of data describing the disproportionate burden of mental health needs among Black women. The rich data we present here from Black women on their desire for the integration of these two needs fits well into the parallel conversation occurring in the literature. To our knowledge, this is the first study investigating desires of Black women regarding group prenatal care designed specifically for them. They expressed a strong desire for more access to mental health care providers who are racially conscious and aware of white supremacy, and nuanced opinions on the role of racial concordance in health equity.

Incidence and Risk Factors Associated with Blood Culture Proven Neonatal Sepsis

INTRODUCTION&#x0D; Neonatal sepsis (sepsis neonatorum) is a clinical syndrome resulting from the pathophysiologic effects of local or systemic infection. This is a major cause of morbidity and mortality around the world affecting newborns up to one month of age with clinical symptoms and positive blood cultures. This study aimed at examining the risk factors of neonatal sepsis at pediatric tertiary care hospital.&#x0D; &#x0D; MATERIAL AND METHODS&#x0D; This was a hospital based cross-sectional case control study conducted among 350 neonates admitted within April to September 2015 at the Kanti Children’s Hospital, Kathmandu Nepal. Cases were neonates who had sepsis and controls were neonates who did not have sepsis with their index mothers. CRP screening tests and blood culture was performed. Data were entered using the SPSS (Version 22). Bivariate and multivariate logistic regression was used to determine the risk of neonatal sepsis.&#x0D; &#x0D; RESULTS&#x0D; A total of 59 (17%) neonates who had sepsis (cases) with their index mothers’ and 291 (83%) neonates who had no sepsis (controls) with their index mothers were enrolled. Maternal factors that predicted the occurrence of sepsis among neonates were parity (p&lt;0.027), mode of delivery (p&lt;0.001) and PROM (p&lt;0.001). Neonatal risk factors which predicted the occurrence of sepsis were duration of stay in the facility (p&lt;0.001) and neonatal age on admission (p&lt;0.001).&#x0D; &#x0D; CONCLUSION&#x0D; The study found both maternal and neonatal factors to have a strong association with the risk of developing neonatal sepsis. Encouraging maternal antenatal care utilization would help identify the risk factors during prenatal and postnatal care and appropriate interventions implemented to reduce the likelihood of the neonate developing sepsis.&#x0D;

What is the Impact of Prenatal Counseling on Postnatal Cleft Treatment? Multidisciplinary Pathway for Prenatal Orofacial Cleft Care.

In the pediatric general surgery literature, it has been shown that prenatal diagnosis of a congenital anomaly is an independent predictor of parental psychological distress. Surgical prenatal counseling can decrease parental anxiety by helping families understand the surgical needs and potential outcomes of their infant. In this retrospective analysis (n = 440), the authors sought to present our care pathway for prenatally diagnosed cleft lip and palate (CL/P) and explore the impact of cleft lip and palate-specific prenatal counseling on patient care by comparing the timing of clinical and surgical care between a cohort of patients who received prenatal CL/P consultation and a cohort of patients only seen postnatally. The authors hypothesize that our multidisciplinary prenatal care intervention is associated with earlier postnatal clinic visits and surgical repair. The care of all patients whose mother's presented for prenatal CL/P consultation (prenatal cohort, n = 118) was compared to all new CL/P patients without prenatal consultation at our institution (postnatal cohort, n = 322) from January 2015 through August 2019. 81.4% (n = 96) of the prenatal cohort returned for care postnatally while 2 pregnancies were interrupted, four neonates died, and 15 patients did not return for care. Prenatal consultation was associated with earlier postnatal clinic appointments (P < 0.001) as well as a shorter time to CL repair in patients with CL only (P = 0.002) and CLP (P = 0.047). Our described pre- and postnatal CL/P pathway is a multidisciplinary model associated with high retention rates from the prenatal period through complete surgical repair.

Prenatal methadone exposure and child developmental outcomes in 2-year-old children.

To examine the developmental outcomes of children born to opioid-dependent females enrolled in methadone maintenance and identify pre- and postnatal factors that place these children at developmental risk. Ninety-nine methadone-maintained females and their 100 infants (42 females, 58 males, mean gestational age 38.8wks) were recruited during pregnancy/at birth and studied to age 2years alongside a regionally representative comparison group of 108 non-methadone-maintained females and their 110 infants (62 females, 48 males, mean gestational age 39.2wks). Information about perinatal exposure was collected from medical records, maternal urine and infant meconium toxicological analysis, maternal interviews (at birth and at 18mo), and a home visit (at 18mo). At age 2years, child neuromotor function, cognition, language, and emotional/behavioral dysregulation were assessed. Opioid-exposed children achieved lower motor, cognitive, and language scores and had poorer self, emotional, eating/feeding, and sensory processing regulation than unexposed children. After adjustment for maternal education and other substance use in pregnancy, between-group differences in child motor, cognitive, and overall dysregulation remained. Postnatal parental and family factors explained a further 40% to 52% of between-group differences in child outcomes. These children and families are extremely high-risk and need antenatal and postnatal support. Children exposed to opioids during pregnancy have pervasive developmental difficulties by age 2years. These challenges are largely explained by adverse pregnancy and socio-environmental exposures, emphasizing the importance of specialist prenatal care and postnatal intervention support. What this paper adds Children born to opioid-dependent females are at high risk of pervasive developmental problems. These problems span a range of functional domains, including motor, cognitive, language, and behavioral/emotional dysregulation. Contributing factors include other adverse pregnancy exposures, postnatal environmental factors, and the direct effects of prenatal opioid exposure.

Guideline No. 405: Screening and Counselling for Alcohol Consumption During Pregnancy.

To establish national standards of care for screening and counselling pregnant women and women of child-bearing age about alcohol consumption and possible alcohol use disorder based on current best evidence. Health care providers who care for pregnant women and women of child-bearing age. Pregnant women and women of child-bearing age and their families. Medline, EMBASE, and CENTRAL databases were searched for "alcohol use and pregnancy." The results were filtered for a publication date between 2010 and September 2018. The search terms were developed using Medical Subject Headings terms and keywords, including pre-pregnancy, pregnant, breastfeeding, lactation, female, women, preconception care, prenatal care, fetal alcohol spectrum disorder, prenatal alcohol exposure, drinking behavior, alcohol abstinence, alcohol drinking, binge drinking, alcohol-related disorders, alcoholism, alcohol consumption, alcohol abuse, benzodiazepines, disulfiram, naltrexane, acamprosate, ondansetron, topiramate, cyanamide, calcium carbimide, alcohol deterrents, disease management, detoxification, Alcoholics Anonymous, alcohol counselling, harm reduction, pre-pregnancy care, prenatal care, incidence, prevalence, epidemiological monitoring, and brief intervention. Evidence was included from clinical trials, observational studies, reviews, systematic reviews and meta-analyses, guidelines, and conference consensus. The content and recommendations in this guideline were drafted and agreed upon by the authors. The Board of Directors of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology framework. Implementation of the recommendations in these guidelines using validated screening tools and brief intervention approaches may increase obstetrical care provider recognition of alcohol consumption and problematic alcohol use among women of child-bearing age and those who are pregnant. It is anticipated that health care providers will become confident and competent in managing and supporting these women so they can achieve optimal health and pregnancy outcomes. RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).

Racial Differences in Substance Use Patterns During Pregnancy [23C

INTRODUCTION: Substance use during pregnancy remains a significant public health problem. Studies have reported racial differences in substance use, however this has not been addressed in the pregnant population. This study describes associations between maternal race and substance use patterns in pregnancy. METHODS: A retrospective study of singleton births from August 2013 through December 2014 was conducted using universal urine drug screen (UDS) collected at the initiation of prenatal care. Excluded were multiple gestations and preterm deliveries. The data is shown by frequency of substance use (no use, any use, use of specific substances) and maternal race (Caucasian, African American, Asian). RESULTS: 2,270 patients met study criteria. There were 1,030 (45%) Caucasians, 802 (35%) African Americans, and 117 (5%) Asians identified. Caucasian and African Americans had approximately the same rates of substance use, 30.0% and 32.5% respectively. It is notable that 93.1% of African Americans with a positive UDS were positive for only THC, compared to 63.8% of Caucasians. Polysubstance use was much higher in Caucasians than any other racial group, with 31.7% of Caucasian users positive for opiates, 12.0% for benzos, and 5.8% for cocaine. No Asians had a positive UDS. CONCLUSION: Our study addresses the racial differences of substance use during pregnancy, specifically detailing the substances used. Our study strongly suggests the need for local and state initiatives to better understand the racial trends for substance use in pregnancy in order to tailor prenatal care interventions that optimize pregnancy outcomes.