Smaller Head Circumference Research Articles

Functional and structural evaluation in the lungs of children with repaired congenital diaphragmatic hernia

BackgroundTo evaluate the long-term functional and structural pulmonary development in children with repaired congenital diaphragmatic hernia (CDH) and to identify the associated perinatal-neonatal risk factors.MethodsChildren with repaired CDH through corrective surgery who were born at gestational age ≥ 35 weeks were included in this analysis. Those who were followed for at least 5 years were subjected to spirometry and chest computed tomography for evaluation of their functional and structural growth. Main bronchus diameters and lung volumes (total, left/right) were measured. According to total lung volume (TLV) relative to body surface area, children were grouped into TLV ≥ 50 group and TLV < 50 group and the associations with perinatal-neonatal factors were analyzed.ResultsOf the 28 children (mean age, 6.2 ± 0.2 years) with left-sided CDH, 7 (25%) had abnormal pulmonary function, of whom 6 (87%) showed restrictive patterns. All pulmonary functions except FEF25–75% were worse than those in matched healthy control group. Worse pulmonary function was significantly associated with small head and abdominal circumferences at birth. The mean TLV was 1339.1 ± 363.9 mL and LLV/TLV was 47.9 ± 2.5 mL. Children with abnormal pulmonary function were more likely to have smaller lung volumes. In multivariate analysis, abdominal circumference at birth was significantly associated with abnormal lung volume.ConclusionsA quarter of children with repaired CDH showed abnormal pulmonary function. Small abdominal circumference at birth was associated with abnormal pulmonary function and lower TLV.

Maternal phthalate urine concentrations, fetal growth and adverse birth outcomes. A population-based prospective cohort study

ImportanceExposure to phthalates may affect fetal growth, but previous studies are inconsistent and have not explored the trimester-specific effects of phthalates on repeated measures of fetal growth. ObjectiveTo assess the associations of maternal phthalate metabolites urine concentrations with fetal growth measures and birth outcomes and identify potential windows of vulnerability to exposure. DesignPopulation-based prospective cohort study, the Generation R Study (2002–2006). Data analysis was performed from November 2019 to June 2020. SettingRotterdam, the Netherlands. Participants1379 pregnant women. ExposuresMaternal phthalate metabolites urine concentrations in first, second and third trimester. Main outcomes and measuresFetal head circumference, length and weight measured in the second and third trimester by ultrasound and at birth and preterm birth and small size for gestational age at birth. ResultsHigher pregnancy-averaged phthalic acid, low molecular weight phthalate (LMWP), high molecular weight phthalate (HMWP) and di-2-ethylhexylphthalate (DEHP) concentrations tended to be associated with lower fetal weight SDS across gestation. The associations of phthalic acid and LMWP with fetal weight became stronger as pregnancy progressed (differences −0.08 (95% CI −0.14 to −0.02) SDS and −0.09 (95% CI −0.16 to −0.02) SDS at 40 weeks per interquartile range increase in phthalic acid and LMWP, respectively). Higher concentrations of specific LMWP, HMWP and DEHP metabolites were also associated with smaller head circumference and lower length SDS at birth and an increased risk of preterm birth and small size for gestational age at birth (p-values < 0.05). We observed differences by timing of exposure in these associations. Conclusions and relevanceHigher maternal phthalate metabolites urine concentrations seem to be related with fetal growth restriction and preterm birth. Phthalates may have trimester specific effects on fetal growth and birth outcomes. Further studies are needed to explore the underlying mechanisms and long-term consequences.

636 Prenatal methadone exposure is associated with smaller fetal and neonatal cranial measurements compared to buprenorphine

Limited information about differential effects of methadone (mthdn) vs. buprenorphine (bup) on fetal and neonatal outcomes exists. Objectives of this study were to compare fetal measurements, including unique ultrasound measures of fetal brain, and neonatal outcomes in women who receive mthdn or bup in pregnancy. Data were obtained from the ENRICH prospective cohort study; 60 women receiving mthdn and 86 receiving bup. Ultrasound measurements were obtained for 127 women in the 2nd trimester (18-22 weeks) and 132 in the 3rd trimester (28-32 weeks). Fetal measurements included standard biometric parameters as well as frontal lobe width and length, fronto-thalamic distance, and caval-calvarial distance (CCD). Neonatal measurements included birth weight, length, and head circumference (HC). Group comparisons used Wilcoxon rank sum, Fisher’s exact, or Chi-square tests as appropriate. Ultrasound measures were compared using analysis of variance models (non-percentile measures adjusted for gestational age). Least-square means±standard error are reported. Methadone-exposure was associated with smaller cranial measurements beginning in the 2nd trimester and persisting to birth compared to buprenorphine-exposure. Second trimester ultrasound demonstrated significantly lower HC percentile (29.2±2.7 vs. 38.6±2.3), CCD (21.8±0.3 vs. 23.1±0.3mm), and occipitofrontal diameter (OFD) (63.4±0.3 vs. 65.0±0.3mm) in the mthdn compared to bup group (all p’s<0.05). These differences persisted in the 3rd trimester (HC percentile 27.3±4.2 vs. 42.1±3.6; OFD 95.3±1.5 vs. 101.3±1.3mm). Differences were also observed at birth between mthdn and bup treated groups (HC percentile: 28.3±2.9 vs. 49.5±3.5; p<0.01; length percentile: 34.0±3.5 vs. 45.6±3.4; p=0.04). Buprenorphine-exposed infants had shorter hospital stays (14.5±5.2 vs 18.6±1.8 days; p<0.01) and were less likely to require withdrawal treatment (31.4% vs 58.3%; p<0.01). Prenatal methadone exposure was associated with smaller head circumference and body length measurements and longer neonatal hospital stays due to withdrawal treatment.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Evolution of the Physical Phenotype of Fetal Alcohol Spectrum Disorders from Childhood through Adolescence.

This paper reports findings from the first longitudinal study on the evolution of the physical phenotypes of fetal alcohol syndrome (FAS) and partial FAS (PFAS) from early childhood through adolescence. The sample consisted of 155 children (78 males and 77 females) born to women recruited at an antenatal clinic serving a Cape Coloured (mixed ancestry) population in Cape Town, South Africa. Two expert FASD dysmorphologists, blind regarding prenatal alcohol exposure, independently evaluated each child's growth and dysmorphology at 4 clinics conducted over an 11-year period. Case conferences were held to reach consensus regarding which children had FAS or PFAS growth and physical features using the Revised Institute of Medicine (2005) guidelines. The prevalence of the physical phenotype was stable across the 4 ages for about half of the children with FAS and about one-third of those with PFAS but more variable for the others. Test-retest reliability was substantial for the FAS phenotype, but poorer for PFAS. Two distinct patterns were seen: a "strong phenotype" that was consistently identified and a less consistent one in which dysmorphic features and/or anthropometric deficits fluctuated or diminished with age. The physical phenotype was most apparent during early childhood and least apparent during puberty, due to differences in timing of the growth spurt and the evolving adult face. Short palpebral features and small head circumference diminished with age, flat philtrum fluctuated, while thin vermilion and weight and height restriction were stable. Key facial features that characterize FASD in early childhood diminish or evolve in some individuals, making diagnostic examinations that rely on these characteristics most sensitive during early childhood and school age. Moreover, puberty poses classification problems due to variability in timing of the growth spurt. Given that several features and small head circumference diminished with age, many individuals would be misdiagnosed if only examined at a later age.

Association between gestational phthalate exposure and newborn head circumference; impacts by race and sex

Observational and experimental studies report associations between gestational phthalate exposure and fetal development, yet few data exist to characterize phthalate effects on head circumference (HC) or to estimate the impact of race or sex. To address this data gap, we enrolled 152 African American and 158 white mothers with uncomplicated singleton pregnancies from the Charleston, South Carolina (USA) metropolitan area in a prospective birth cohort. Study participants provided up to two urine specimens during mid and late gestation, completed a study questionnaire, and allowed access to hospital birth records. We measured eight phthalate monoester metabolites using liquid chromatography with tandem mass spectrometry, and calculated molar sums of phthalate parent diesters. After specific gravity correction, we tested for associations between phthalates and neonatal HC (cm) and cephalization index (cm/g) using multiple informant linear regression with inverse probability weighting to account for selection bias between repeated urine sampling, adjusted for maternal race, age, body mass index, education, and smoking. We explored interactions by maternal race and infant sex. A doubling of urinary monoethyl phthalate (MEP) concentration was associated with a −0.49% (95%CI: -0.95%, −0.02%) smaller head circumference, although seven other phthalate metabolites were null. There were no statistically significant associations with cephalization index. HC was larger for whites than African American newborns (p < 0.0001) but similar for males and females (p = 0.16). We detected interactions for maternal race with urinary monobutyl phthalate (MBP; p = 0.03), monobenzyl phthalate (MBzP; p = 0.01), monoethylhexyl phthalate (MEHP; p = 0.05), monomethyl phthalate (MMP; p = 0.02), and the sum of dibutyl phthalate metabolites (∑DBP; p = 0.05), in which reduced HC circumference associations were stronger among whites than African Americans, and interactions for sex with MBP (p = 0.08) and MiBP (p = 0.03), in which associations were stronger for females than males. Our results suggest that gestational phthalate exposure is associated with smaller neonatal HC and that white mothers and female newborns have greater susceptibility.

Relationship of Low Maternal Vitamin D3 Level and Adverse Early Neonatal Outcomes

Background: Low serum vitamin D [25 (OH) D] levels have been shown to have multiple health-relatedimplications in females at childbearing age, during pregnancy, as well as in their children. Aim of thestudy: To assess the inverse relationship between vitamin D3 level and adverse neonatal outcomes usingparameters such as fetal birth weight, head circumference, Apgar scores, fetal respiratory distress syndrome,and rate of neonatal admission.Materials and methods: A prospective study was conducted on 100 early- and full-term pregnant women atAl-Elwiya Maternity Teaching Hospital in Baghdad from 1st of April 2017 to 31st of March 2018. Maternalvitamin D deficiency was confirmed based on levels <20 ng/mL.Results: The vitamin D3 levels in the studied pregnant women were categorized as follows: normal (45%),insufficiency (31%) and deficiency (24%). The significant adverse neonatal outcomes associated withvitamin D3 deficiency were low Apgar score (54.2%), low birth weight (91.7%), small head circumference(91.7%), respiratory distress syndrome (66.7%), and neonatal intensive care unit admission (66.7%).Conclusions: vitamin D3 deficiency among pregnant women is associated with prominent adverse neonataloutcomes.

Cranial findings detected by second-trimester ultrasound in fetuses with myelomeningocele: a systematic review.

BackgroundAbnormal intracranial findings are often detected at mid‐trimester ultrasound (US) in fetuses with myelomeningocele (MMC). It is unclear whether these findings constitute a spectrum of the disease or are an independent finding, which should contraindicate fetal surgery.ObjectiveTo ascertain the spectrum and frequency of US‐detected cranial findings in fetuses with MMC.Search strategyMEDLINE, Embase, Web of Science and CENTRAL were searched from January 2000 to June 2020.Selection criteriaStudy reporting incidence of cranial US findings in consecutive cases of second‐trimester fetuses with MMC.Data collection and analysisPublication quality was assessed by Newcastle–Ottawa Scale (NOS) and modified NOS. Meta‐analysis could not be performed as a result of high clinical diversity and study heterogeneity.Main resultsFourteen cranial US findings were reported in 15 studies. Findings in classic Chiari II malformation (CIIM) spectrum included posterior fossa funnelling (96%), small transcerebellar diameter (82–96%), ‘banana’ sign (50–100%), beaked tectum (65%) and ‘lemon’ sign (53–100%). Additional cranial findings were small biparietal diameter (BPD) and head circumference (HC) (<5th centile; 53 and 71%, respectively), ventriculomegaly (45–89%), abnormal pointed shape of the occipital horn (77–78%), thinning of the posterior cerebrum, perinodular heterotopia (11%), abnormal gyration (3%), corpus callosum disorders (60%) and midline interhemispheric cyst (42%).ConclusionsWe identified 14 cranial findings by second‐trimester US in fetuses with MMC. The relatively high incidence of these findings and their unclear prognostic significance might not contraindicate fetal surgery in the case of normal fetal genetic testing. Some cranial findings may independently affect postnatal outcome, however. Long‐term detailed follow‐up is required to investigate this.Tweetable abstractA high rate of cranial abnormalities found on second‐trimester ultrasound in fetuses with myelomeningocele.

Shunt failure clusters: an analysis of multiple, frequent shunt failures.

Repeated failure of ventriculoperitoneal shunts (VPSs) is a problem familiar to pediatric neurosurgeons and patients. While there have been many studies to determine what factors are associated with the first shunt failure, studies of subsequent failures are much less common. The purpose of this study was to identify the prevalence and associated risk factors of clustered shunt failures (defined as 3 or more VPS operations within 3 months). The authors reviewed prospectively collected records from all patients who underwent VPS surgery from 2008 to 2017 at their institution and included only those children who had received all of their hydrocephalus care at that institution. Demographics, etiology of hydrocephalus, history of endoscopic third ventriculostomy or temporizing procedure, initial valve type, age at shunt placement, and other factors were analyzed. Logistic regression was used to test for the association of each variable with a history of shunt failure cluster. Of the 465 included children, 28 (6.0%) had experienced at least one cluster of shunt failures. Among time-independent variables, etiology of hydrocephalus (OR 0.27 for non-intraventricular hemorrhage [IVH], nonmyelomeningocele, nonaqueductal stenosis etiology vs IVH, 95% CI 0.11-0.65; p = 0.003), younger gestational age at birth (OR 0.91, 95% CI 0.85-0.97; p = 0.003), history of a temporizing procedure (OR 2.77, 95% CI 1.12-6.85; p = 0.028), and smaller head circumference at time of initial shunt placement (OR 0.91, 95% CI 0.84-0.99; p = 0.044) showed significant association with shunt failure cluster on univariate analysis. None of these variables maintained significance in a multivariate model. Among children with a history of a shunt failure cluster, 21 (75%) had a shunt infection either prior to or during the shunt failure cluster. A comparison of the infecting organism between these children and 62 children with a history of infection but without a shunt failure cluster showed an association of cluster with gram-negative rod species. Six percent of children in this institutional sample had at least one shunt failure cluster. These children accounted for 30% of the total shunt revisions in the sample. Shunt infection is an important factor associated with shunt failure cluster. Children with a history of prematurity and IVH may have a higher risk for failure cluster.

Pregnancy outcomes in women with preexisting thyroid diseases: a French cohort study.

Women with thyroid diseases at the beginning of pregnancy may have suboptimal thyroid hormone levels because of potential difficulties in compensating for the physiological thyroid hormone changes occurring in pregnancy. Our objective was to study the association between preexisting thyroid diseases, pregnancy complications, and neonatal anthropometry. In total, 16,395 women from the ELFE French longitudinal birth cohort were included, and 273 declared pre-pregnancy thyroid diseases. Associations were investigated with multivariable regression models, with adjustment for relevant potential confounders. Body mass index (BMI) was additionally adjusted for in a second stage. As compared with other women, women with pre-pregnancy thyroid diseases were more frequently obese (19.6% vs. 9.8%) and had greater odds of gestational diabetes development (odds ratio [OR] = 1.58 [95% confidence interval [CI] 1.08, 2.30]) or had undergone treatment for infertility (OR = 1.57 [95% CI 1.07, 2.31]). After adjustment for BMI, the association with gestational diabetes was no longer significant (OR = 1.27 [95% CI 0.86, 1.88]). After excluding women with another medical history, those with pre-pregnancy thyroid diseases had increased odds of premature rupture of membranes (OR = 1.51 [95% CI 1.01, 2.25]). Children born from mothers with hypothyroidism before conception due to a disease or as a potential side effect of treatment had a smaller head circumference at birth than other children (β = -0.23 [95% CI -0.44, -0.01] cm). In conclusion, pre-pregnancy thyroid diseases were associated with risk of infertility treatment, gestational diabetes, and premature rupture of membranes. The association between history of hypothyroidism and moderate adverse effects on fetal head circumference growth needs replication.

Timing of Antenatal Steroid Administration and Effects on the Newborn Infant: A Retrospective Study.

The timing of antenatal steroids (ANS) on short- and long-term effects on newborn infants was evaluated. This study was conducted at the University of Cincinnati Medical Center Level-III Neonatal Intensive Care Unit by reviewing the medical records of all women with history of ANS exposure from January 2015 to December 2018. We compared outcomes of newborns delivered within the ideal therapeutic window of 24 hours to 7 days (within window [WW]) after administration to those exposed and delivered outside the therapeutic window (outside window primary group [OWP]). Outcomes included anthropometrics, blood sugars, thyroid hormone profile, and neonatal morbidities. A total of 669 patients were identified as having received at least two doses of ANS. Two-thirds of them delivered within the ideal therapeutic window. Significant differences were found in anthroprometrics including lower birth weight, shorter length, and smaller head circumferences in those born within the window compared with those outside the window. Derangements in glucose homeostasis requiring treatment and elevations of thyroid stimulating hormone (TSH) were seen in infants born outside the ideal therapeutic window compared with those born within the therapeutic window. No differences were found in neonatal morbidities including severe intraventricular hemorrhage (sIVH), necrotizing enterocolitis (NEC), need for resuscitation, exogenous surfactant administration, continuous positive airway pressure (CPAP), mechanical ventilation, bronchopulmonary dysplasia (BPD), or periventricular leukomalacia (PVL). After controlling for selected covariates, only birth length was different between the groups. Effects on anthropometrics, glucose homeostasis, and thyroid function support the need to develop new or refine existing risk stratification systems to time the administration of antenatal steroids. Better targeting of women and fetuses may confer the benefits of systemic corticosteroids while mitigating the risks of adverse effects. · The timing of antenatal steroids on short and long-term effects on newborn infants was evaluated.. · Differences were found in anthroprometrics, glucoses, and thyroid function.. · No differences were found in neonatal morbidities..

Fetal growth, fetal development, and placental features in women with polycystic ovary syndrome: analysis based on fetal and placental magnetic resonance imaging.

Polycystic ovary syndrome (PCOS), a common endocrine-metabolic dysfunction in reproductive-aged women, may be involved in compromised pregnancy and offspring outcomes. This study aimed to investigate whether maternal PCOS affects fetal growth, fetal development, and placental features. This retrospective case-control study included 60 pregnant women with PCOS (PCOS group) and 120 healthy pregnant women without PCOS (control group). Fetal magnetic resonance imaging (MRI) was performed followed by an ultrasound examination and indications for imaging, including known or suspected fetal pathology, history of fetal abnormality in previous pregnancy or in a family member, and concern for placenta accreta. Fetal MRI images were analyzed for head circumference (HC), abdomen circumference (AC), lung-to-liver signal intensity ratio (LLSIR, a prenatal marker of fetal lung maturity), lengths of liver and kidney diameters in fetuses, and placental relative signal intensity on T2-weighted single-shot fast spin echo (SSFSE) imaging (rSISSFSE), and placental relative apparent diffusion coefficient value (rADC). Data on height and weight of offspring were collected through telephone follow-up. Compared to the control group, the PCOS group showed the following characteristics: (1) smaller biparietal diameter and femur length in fetuses (P=0.026 and P=0.005, respectively), (2) smaller HC in fetuses (evident after 32 weeks; P=0.044), (3) lower LLSIR and smaller dorsoventral length of liver in fetuses (evident before 32 weeks; P=0.005 and P=0.019, respectively), and (4) smaller placental thickness (evident before 32 weeks; P=0.017). No significant differences in placental rSISSFSE or rADC were observed between the groups (all P>0.05). No significant differences in height and weight of offspring during childhood existed between the groups (all P>0.05). There exist alterations of fetal growth, fetal development, and placental features from women with PCOS.

Abstract 16738: Association Between First and Second Trimester Maternal Screening Biochemistry, Ultrasound, and Fetal Brain Growth in Presence of Fetal or Maternal Congenital Heart Disease

Introduction: Newer research has highlighted significant neurological impairments in children and adults with congenital heart disease (CHD). The more severe the heart defect, the higher the neurologic impairment. Pregnancies complicated by fetal or maternal CHD carry a higher risk of placental abnormalities. We studied the association between pregnancy hormonal levels and fetal head and body growth. Hypothesis: Placental dysfunction in pregnancies with fetal or maternal CHD alters pregnancy hormonal levels affecting fetal brain and somatic growth. Methods: We performed a retrospective case-control study on pregnant women (year 2010-2019) at the University of Iowa. Only women with first and/or second trimester prenatal screening (ultrasound and blood test) were included. Pregnancies with fetal chromosomal abnormalities, multiple gestation, maternal diabetes, smoking, or hypertension were excluded. Pregnancies were either healthy controls (n=36), women with CHD (MCHD; n=26), or fetus with CHD (FCHD; n=23). Pregnancy hormonal levels, ultrasound findings, and fetal/neonatal growth percentiles and/or z-scores data were analyzed. Results: Women with CHD were younger (p=0.004) with increased fetal nuchal translucency (p=0.003) compared to controls. Women in MCHD (p=0.02) and FCHD (p=0.02) group delivered earlier than controls. FCHD had significantly lower pregnancy associated plasma protein-A (PAPP-A) levels than controls (p=0.04). The groups had no difference in the second trimester fetal head circumference (HC) and femur length. FCHD group had significantly smaller HC percentile (p=0.03) and z-scores (p=0.03) at birth than controls. Both FCHD and MCHD had smaller birth weight and length compared to controls. However, only FCHD group demonstrated significantly lower HC to birth weight ratio (p=0.01). The controls had a positive correlation between human chorionic gonadotropin level and head circumference z-score at birth (r=0.34;p=0.053). Conclusions: Pregnant women with CHD have increased fetal nuchal translucency and deliver at earlier gestational age. Women with fetal CHD have smaller neonatal head and body size at birth with associated low PAPP-A level early in their pregnancy probably related to placental dysfunction.

Sedentary behaviour and physical activity across pregnancy and birth outcomes.

Shorter gestation or smaller birth size are indicators of a suboptimal fetal environment and negatively impact short- and long-term offspring health. Understanding how modifiable maternal behaviours, such as moderate-to-vigorous intensity physical activity (MVPA) or sedentary behaviour (SED), improve fetal outcomes could inform strategies to improve health across the lifespan. The objective of this study was to examine the association of MVPA and SED across pregnancy trimesters on gestational age at delivery and newborn anthropometrics. The MoM Health Study measured SED (thigh-mounted activPAL3 micro) and MVPA (waist-worn Actigraph GTX3) in each trimester of pregnancy. Birth outcomes (gestational age at delivery, birthweight, birth length, and head circumference) were abstracted from medical records and used to calculate ponderal index (grams*100/cm3 ) and size-for-gestational age percentiles. Associations of group-based trajectories and trimester-specific SED and MVPA with birth outcomes were analysed using regression models. Low, medium, and high trajectory groups were generated SED and MVPA in 103 and 99 pregnant women, respectively. High vs low SED trajectory was associated with earlier gestational age at delivery (β -1.03weeks, 95% CI -2.01, -0.06), larger head circumference (β 0.83cm, 95% CI 0.24, 1.63), longer birth length (β 1.37cm, 95% CI 0.09, 2.64), and lower ponderal index (β -0.24g*100/cm3 , 95% CI -0.42, -0.06), after adjustment for demographics, pre-pregnancy BMI, and (for newborn anthropometric outcomes) gestational age. The association of high SED with lower ponderal index was the most robust across progressively adjusted models (β -0.25g*100/cm3 , 95% CI -0.44, -0.07). SED trajectory was not associated with birthweight or size-for-gestational age. High vs low MVPA trajectory was only associated with smaller head circumference (β -0.86cm, 95% CI -1.70, -0.02). Higher SED during pregnancy may result in shorter gestation and inhibited fetal growth. Further research evaluating the effect of reducing SED during pregnancy on birth outcomes is warranted.

The Companion Status and Anxiety on Third Trimester Pregnancy Mother

Anxiety in pregnant women can have an impact on low birth weight and smaller head circumference in babies born and can interfere with cognitive performance during infancy and decrease brain volume in areas associated with learning and memory in children aged 6-8 years. The purpose of this study was to determine the relationship between companion status during pregnancy and third trimester pregnant women anxiety. This research design method is quantitative analytic with cross sectional approach. research subjects for trimester III pregnant women numbering 40 respondents at the Bangetayu Health Center in Semarang City from July-August 2019. The sampling technique used was purposive sampling with research instruments in the form of a questionnaire with Kruskal wallis test. There is a relationship between the companion status during pregnancy to the anxiety of pregnant women third trimester.

VP26.01: Small head circumference at fetal ultrasound: when should we counsel for microcephaly?

VP26.01: Small head circumference at fetal ultrasound: when should we counsel for microcephaly?

Long-term outcomes for children with disability and severe acute malnutrition in Malawi

IntroductionSevere acute malnutrition (SAM) and disability are major global health issues. Although they can cause and influence each other, data on their co-existence are sparse. We aimed to describe the...

Fetal brain age estimation and anomaly detection using attention-based deep ensembles with uncertainty

MRI-based brain age prediction has been widely used to characterize normal brain development, and deviations from the typical developmental trajectory are indications of brain abnormalities. Age prediction of the fetal brain remains unexplored, although it can be of broad interest to prenatal examination given the limited diagnostic tools available for assessment of the fetal brain. In this work, we built an attention-based deep residual network based on routine clinical T2-weighted MR images of 659 fetal brains, which achieved an overall mean absolute error of 0.767 weeks and R2 of 0.920 in fetal brain age prediction. The predictive uncertainty and estimation confidence were simultaneously quantified from the network as markers for detecting fetal brain anomalies using an ensemble method. The novel markers overcame the limitations in conventional brain age estimation and demonstrated promising diagnostic power in differentiating several types of fetal abnormalities, including small head circumference, malformations and ventriculomegaly with the area under the curve of 0.90, 0.90 and 0.67, respectively. In addition, attention maps were derived from the network, which revealed regional features that contributed to fetal age estimation at each gestational stage. The proposed attention-based deep ensembles demonstrated superior performance in fetal brain age estimation and fetal anomaly detection, which has the potential to be translated to prenatal diagnosis in clinical practice.

In utero opioid exposure and birth outcomes: a systematic review and meta-analysis

Abstract Background The nonmedical use of opioids during pregnancy, either those prescribed or obtained illegally, is a worldwide public health issue. Opioids pass through the placental barrier, which can expose the fetus to maternal opioid use; opioid-exposed babies may experience Neonatal Abstinence Syndrome (or Neonatal Opioid Withdrawal). We conducted a systematic review and meta-analysis to investigate how maternal opioid use during pregnancy may impact infants' birth outcomes. Methods We searched PubMed, Embase, PsycInfo, and the Web of Science, and identified 90 articles that met our inclusion criteria. Cohort, case-control and cross-sectional studies comparing birth outcomes of any opioid-exposed group (prescribed or obtained illegally) and a non-exposed comparison group were eligible for our systematic review. An adapted version of the Newcastle-Ottawa-Scale was used for quality assessment of the studies. Due to high heterogeneity between studies, we used random effects models to estimate pooled effects. Results In meta-analyses, opioid-exposed infants had lower birthweight (mean difference (MD):-405.9 grams, 95%CI: -472.26,-339.54, N = 37 studies), smaller head circumference (MD:-1.19 cm, 95%CI:-1.41, -0.96,N=22 studies), shorter gestational age (MD:-0.93 weeks, 95%CI: -1.20, -0.66,N= 34 studies), and shorter birth length (MD:-0.97 cm, 95%CI: -1.20, -0.74, N = 15 studies). The pooled relative risk of fatal outcomes was higher among the exposed infants: (RR:2.64, 95%CI: 1.06,6.59). Almost half of the studies were rated as poor, based on the Newcastle Ottawa Scale. Conclusions Our meta-analysis provides evidence of a link between opioid use during pregnancy and multiple adverse infant birth outcomes. Efforts should focus on increasing awareness about risks associated with opioid use and provide access to harm reduction measures for people who use opioids preconceptionally and in pregnancy. Key messages This meta-analysis provides insight into the magnitude of effects of in-utero opioid exposure on birth outcomes among the included studies. The findings highlight the importance of access to harm reduction measures in the periconceptional period and during pregnancy for people who use opioids.

Child HIV Exposure and CMV Seroprevalence in Botswana: No Associations With 24-Month Growth and Neurodevelopment.

BackgroundWe sought to identify predictors of child cytomegalovirus (CMV) infection overall and by maternal HIV status and to assess associations of child CMV status with growth and neurodevelopmental outcomes at 24 months of age in Botswana.MethodsData and samples were used from the Botswana-based observational Tshipidi study (2010–2014), enrolling pregnant women living with and without HIV and following their infants through 2 years of age. Child plasma samples were tested at 18 months of age for anti-CMV immunoglobulin G (IgG). Associations were assessed between detectable anti-CMV IgG and growth (using the World Health Organization Child Growth Standards) and neurodevelopment (using the Bayley Scales of Infant and Toddler Development III and the Developmental Milestones Checklist) at 24 months of age.ResultsOf 317 children, 215 (68%) had detectable anti-CMV IgG at 18 months of age. Comparatively, 83% (n = 178) of HIV-unexposed uninfected (HUU) children had positive CMV serology vs 47% (n = 139) of HIV-exposed uninfected (HEU) children (P < .01); 100% of HUU vs 10.5% of HEU children breastfed. Child CMV infection was not associated with weight-for-age, weight-for-length, or length-for-age z-scores at 24 months. In HUU children, CMV infection was associated with smaller head circumference (P < .01). No difference was observed by child CMV status in any neurodevelopmental domain at 24 months.ConclusionsWe observed high CMV seropositivity in 18-month-old children in Botswana, with higher seropositivity among breastfed (HUU) children. Positive CMV serostatus was not associated with 24-month child growth or neurodevelopmental outcomes, with the exception of smaller head circumference among HUU CMV-positive children.

The effect of non-organophosphate household pesticides exposure during pregnancy on infants birth sizes and growth rate: a cohort study

BackgroundTo date, there is limited evidence on the effect of antenatal exposure to non-organophosphate household pesticides on infant health. Our hypothesis is that antenatal exposure to non-organophosphate household pesticides will be associated with birth sizes and infant growth rate.MethodsIn this prospective cohort study, 284 mother-infant pairs were studied. Mothers were recruited at the third trimester in two primary care centers and one private hospital in Jakarta, Indonesia. Mothers filled out questionnaires about exposure to non-organophosphate household pesticides at the 3rd trimester of pregnancy. Birth weight and length were measured at birth. Afterwards, the weight, height, and head circumference (HC) were measured at 7 days, 1, 2, 4, and 6 months of age. Linear mixed modeling and linear regression was performed to calculate growth rate of each infant. Multivariable linear regression adjusted for confounders was used to assess the association between household pesticides exposure and birth sizes and infant growth rate.ResultsBased on self-report questionnaires, 133 (46.8%) mothers were exposed to household pesticides during pregnancy. The mean HC at day 7 in the exposed group was − 7.1 mm (95%CI -13.1;-1.2) lower than in the non-exposed group. The difference was more prominent in the non-mosquito pesticide group (linear regression coefficient: − 22.1 mm, 95%CI -36.5;-7.6). No material associations were found between antenatal exposure to household pesticides with other growth measures, including weight gain, length gain, HC increment and weight-to-length gain rates. No modification of effects by breastfeeding was found.ConclusionsOur findings suggest that antenatal exposure to household non-organophosphate pesticides is associated with smaller head circumference at birth.