Stages Questionnaire Research Articles

Parental stress and child stimulation practices: examining associations with child developmental outcomes over time in Kenya and Zambia

BackgroundParental stress often arises when parenting demands exceed the expected and actual resources available for parents to succeed in the parenting role. Parental stress is an important contributor to parent-child relationships. This, in turn, affects opportunities to engage their children in stimulating activities which could improve their development outcomes. However, limited evidence exists from sub-Saharan Africa (SSA) on the association between parental stress, caregiving practices, and child developmental outcomes.MethodsThe findings reported in this paper were derived from data collected through previous longitudinal work on nurturing care evaluation studies in Kisumu and Nairobi Counties in Kenya, and Chisamba District in Zambia. A total of 341 caregivers and their children who participated in the three rounds of data collection were included in this study. The children’s mean age was 9.3 (SD = 8.2) months pre-intervention, 25.5 (SD = 8.6) months in mid-intervention, and 36 (SD = 10.0) months post-intervention. The Ages and Stages Questionnaire (ASQ), Parental Stress Scale (PSS), and caregiving tools were used to assess children’s developmental outcomes, parental stress, and stimulation practices, respectively. A Random Intercept Cross-Lagged Panel model (RI-CLPM) was used to determine the association between caregivers’ parenting stress, child stimulation practices, and child developmental outcomes.ResultsThe findings showed that caregiver stimulation practices were positively associated with developmental outcomes. Findings on the associations between parental stress and caregivers’ stimulation practices and children’s developmental outcomes were not universally supported.ConclusionThe findings show that improved caregiver stimulation practices are likely to improve children’s developmental outcomes. The policy implications of the findings from this study focus on improving parenting practices by addressing the predictors of parental stress. This includes subsidising childcare services to reduce costs.Trial registrationPan African Clinical Trials Registry (https://pactr.samrc.ac.za/) database (ID number: PACTR20180774832663 Date: 26/July/2018.

Validity and Reliability Study of the Turkish Version of Focus on the Outcomes of Communication Under Six-34.

Speech and language disorders can negatively affect preschool children's communicative participation skills. Focus on the Outcomes of Communication Under Six-34 (FOCUS-34) is a valid and reliable scale that evaluates communicative participation in preschool children with speech and language disorders. This study aimed to establish the Turkish version of FOCUS-34 (FOCUS-34-TR) and investigate its validity and reliability. A total of 175 children with language disorders, speech sound disorders, and fluency disorders (aged 20-72 months) and their parents were included in the study. Parents were asked to complete the demographic information form, the FOCUS-34-TR scale, and the Ages and Stages Questionnaires: Social-Emotional (ASQ-SE) Turkish version. The construct validity, convergent and divergent validity, internal consistency, and test-retest reliability of the scale were investigated. The FOCUS-34-TR had high values for internal consistency (α = .97) and test-retest reliability (r = .95). The correlations between the FOCUS-34-TR total score and its subscales were between .77 and .90. A moderately significant negative correlation was found between the FOCUS-34-TR scale and the ASQ-SE. The Turkish version of FOCUS-34 is a valid and reliable scale that can be used in clinics and for research purposes to evaluate the communicative participation skills of Turkish-speaking preschool children with speech and language disorders.

In Utero Exposure to Maternal COVID-19 Vaccination and Offspring Neurodevelopment at 12 and 18 Months

Uptake of COVID-19 vaccines among pregnant individuals was hampered by safety concerns around potential risks to unborn children. Data clarifying early neurodevelopmental outcomes of offspring exposed to COVID-19 vaccination in utero are lacking. To determine whether in utero exposure to maternal COVID-19 vaccination was associated with differences in scores on the Ages and Stages Questionnaire, third edition (ASQ-3), at 12 and 18 months of age. This prospective cohort study, Assessing the Safety of Pregnancy During the Coronavirus Pandemic (ASPIRE), enrolled pregnant participants from May 2020 to August 2021; follow-up of children from these pregnancies is ongoing. Participants, which included pregnant individuals and their offspring from all 50 states, self-enrolled online. Study activities were performed remotely. In utero exposure of the fetus to maternal COVID-19 vaccination during pregnancy was compared with those unexposed. Neurodevelopmental scores on validated ASQ-3, completed by birth mothers at 12 and 18 months. A score below the established cutoff in any of 5 subdomains (communication, gross motor, fine motor, problem solving, social skills) constituted an abnormal screen for developmental delay. A total of 2487 pregnant individuals (mean [SD] age, 33.3 [4.2] years) enrolled at less than 10 weeks' gestation and completed research activities, yielding a total of 2261 and 1940 infants aged 12 and 18 months, respectively, with neurodevelopmental assessments. In crude analyses, 471 of 1541 exposed infants (30.6%) screened abnormally for developmental delay at 12 months vs 203 of 720 unexposed infants (28.2%; χ2 = 1.32; P = .25); the corresponding prevalences at 18 months were 262 of 1301 (20.1%) vs 148 of 639 (23.2%), respectively (χ2 = 2.35; P = .13). In multivariable mixed-effects logistic regression models adjusting for maternal age, race, ethnicity, education, income, maternal depression, and anxiety, no difference in risk for abnormal ASQ-3 screens was observed at either time point (12 months: adjusted risk ratio [aRR], 1.14; 95% CI, 0.97-1.33; 18 months: aRR, 0.88; 95% CI, 0.72-1.07). Further adjustment for preterm birth and infant sex did not affect results (12 months: aRR, 1.16; 95% CI, 0.98-1.36; 18 months: aRR, 0.87; 95% CI, 0.71-1.07). Results of this cohort study suggest that COVID-19 vaccination was safe during pregnancy from the perspective of infant neurodevelopment to 18 months of age. Additional longer-term research should be conducted to corroborate these findings and buttress clinical guidance with a strong evidence base.

Place-Based Child Opportunity at Birth and Child Development from Infancy to Age 4

ObjectiveTo evaluate whether the children’s neighborhood quality, as a measure of place-based social determinants of health, is associated with the odds of developmental delay and developmental performance up to age 4 years. Study DesignMothers of 5702 children from the Upstate KIDS Study, a longitudinal population-based cohort of children born from 2008 through 2010, provided questionnaire data and a subset of 573 children participated in a clinic visit. The Child Opportunity Index 2.0 (COI) was linked to home census tract at birth. Probable developmental delays were assessed by the Ages and Stages Questionnaire© up to 7 times between 4 and 36 months, and developmental performance was assessed via the Battelle Developmental Inventory at age 4 years. ResultsIn unadjusted models, higher neighborhood opportunity was protective against developmental delays and was associated with slightly higher development scores at age 4. After adjusting for family-level confounding variables, ten-point higher COI (on a 100-point scale) remained associated with a lower odds of any developmental delay (OR = .966, 95%CI = .940-.992), and specifically delays in the personal-social domain (OR = .921, 95%CI = .886-.958), as well as better development performance in motor (B = 0.79, 95%CI = 0.11-1.48), personal-social (B = 0.64, 95%CI = 0.003-1.28), and adaptive (B = 0.69, 95%CI = 0.04-1.34) domains at age 4. ConclusionsCommunity-level opportunities are associated with some aspects of child development prior to school entry. A greater understanding of neighborhood quality may be helpful to pediatric providers to inform targeted developmental screening.

Do parent media habits contribute to child global development?

Parents of preschoolers' report using screen media frequently. More frequent screen use by parents may undermine child development by displacing time for foundational parent-child interactions. The objective of the present study is to examine the extent to which parent screen use contributes to child global development 1 year later. Data are from a cohort of 315 preschoolers from Nova Scotia, Canada and their parents during the COVID-19 pandemic. Parents reported the number of hours per day they spent using screens, as well as child screen time and sex, and parent educational attainment. Our outcome is child global development scores, which combine assessments of communication, cognitive, personal-social, and motor skills measured at 4.5 using the Ages and Stages Questionnaire (ASQ) (N = 249, 79% retained). Parents in our sample spent on average 6.35 h per day using screen media outside of work (SD = 3.07) and children spent on average 3.43 h per/day using screens. Multivariate linear regression indicated that each 1-h increase in parents daily screen media use, corresponded to a 1.25 decrease in child global development scores, B = -1.25 p < 0.05, 95% CI between -2.37 and -0.13. Our results indicate that parent screen use may represent a key component of children's media ecology. Given the importance of global development in early childhood for later health and achievement, the present results suggest that interventions should include parent screen use habits in media wellness interventions.

Developmental Risk for Infants with Cleft Lip with or Without Cleft Palate Based on Caregiver-Proxy Reports.

(1) Assess caregiver-reported development in infants born with cleft lip ± alveolus (CL ± A) and cleft lip and palate (CLP); (2) determine factors associated with increased developmental risk; and (3) determine consistency of developmental risk before and after surgery for cleft lip. Prospective, longitudinal assessment of development. Time (T) 1, prior to lip closure; T2, 2 months post lip closure. Three US craniofacial teams and online parent support groups. 123 total caregivers (96% mothers); 100 at T1, 92 at T2, and 69 at both T1 and T2. Ages and Stages Questionnaire-3 (ASQ-3): Communication, Gross Motor, Fine Motor, Problem Solving, Personal Social Domains. At T1 47%; at T2 42% passed all 5 Domains; 36% of infants pass all 5 Domains at both T1 and T2. Infants with CLP were at greatest risk on Communication [B = 1.449 (CI = .149-20.079), p = .038; Odds Ratio (OR) = 4.3 (CI = .923-19.650)] and Gross Motor Domains [B = 1.753 (CI = .316-20.605), p = .034; OR = 5.8 (CI = 1.162-28.671)]. Male infants were at greatest risk on Fine Motor [B = 1.542 (CI = .495-20.005), p = .009; OR = 4.7 (CI = 1.278-17.101)] and Problem Solving Domains [B = 1.200 (CI = .118-19.708), p = .044; OR = 3.3 (CI = .896-12.285)]. Based on caregiver report, infants with CL ± A and CLP meet referral criteria at a high rate. Infants with CLP and male infants were at greatest risk. Regular developmental screening is recommended.

Association of gestational cardiovascular health with infant neurodevelopment: A prospective study in Hefei of Anhui, China

We investigate the prospective the association of gestational cardiovascular health (CVH) with infant neurodevelopment, and whether such relation was mediated by cord blood metabolites. The data come from the prospective birth cohort study in Hefei of Anhui, China. A total of 1714 mother-infant pairs are included from March 2018 and June 2021. CVH was evaluated at 24 to 28 gestational weeks by the combination of five metrics: body mass index, blood pressure, total cholesterol, glucose, and smoking. Cord blood samples were collected at delivery for the detection of related indicators. Infant neurodevelopment at 12 months was assessed by the Ages and Stages Questionnaire Edition 3 (ASQ-3). We stratified the status of CVH into three levels, ideal, intermediate, and poor. Compared with the ideal CVH, poor CVH was associated with infant communication domain failure (RR = 2.06; 95 %CI, 1.24–3.42) and cord blood C-peptide levels (β = 0.09; 95 %CI, 0.06–0.13) were higher. Cord blood C-peptide level with infant communication domain failure risk increased (RR = 3.43, 95 %CI: 2.11–5.58). Mediation analysis showed that cord blood C-peptide mediated 13.9 % of the effect. Key findings indicated that maternal poor CVH at 24 to 28 weeks gestation was associated with an increased risk of infant neurodevelopment at ASQ-3 failure in the communication domain, and cord blood C-peptide might mediate this association. The findings, if confirmed by replications, specific nursing cares among pregnant women with poor CVH, might have implications for the offspring neurodevelopment prevention strategies targeting.

Interpregnancy interval and early infant neurodevelopment: the role of maternal-fetal glucose metabolism.

Interpregnancy interval (IPI) is associated with a variety of adverse maternal and infant outcomes. However, reports of its associations with early infant neurodevelopment are limited and the mechanisms of this association have not been elucidated. Maternal-fetal glucose metabolism has been shown to be associated with infant neurodevelopmental. The objective of this study was to determine whether this metabolism plays a role in the relationship between IPI and neurodevelopment. This prospective birth cohort study included 2599 mother-infant pairs. The IPI was calculated by subtracting the gestational age of the current pregnancy from the interval at the end of the previous pregnancy. Neurodevelopmental outcomes at 12months in infants were assessed by the Ages and Stages Questionnaire Edition 3 (ASQ-3). Maternal fasting venous blood was collected at 24-28weeks and cord blood was collected at delivery. The association between IPI and neurodevelopment was determined by logistic regression. Mediation and sensitivity analyses were also conducted. In our cohort, 14.0% had an IPI < 12months. IPI < 12months increased the failure of the communication domain, fine motor domain, and personal social domain of the ASQ (relative risks (RRs) with 95% confidence interval (CI): 1.73 [1.11,2.70]; 1.73 [1.10,2.72]; 1.51 [1.00,2.29]). Maternal homeostasis model assessment of insulin resistance (HOMA-IR) and cord blood C-peptide was significantly associated with failure in the communication domain [RRs with 95% CI: 1.15 (1.02, 1.31); 2.15 (1.26, 3.67)]. The proportion of the association between IPI and failure of the communication domain risk mediated by maternal HOMA-IR and cord blood C-peptide was 14.4%. IPI < 12months was associated with failing the communication domain in infants. Maternal-fetal glucose metabolism abnormality may partially explain the risk of neurodevelopmental delay caused by short IPI.

The association between maternal social support levels during pregnancy and child development at three years of age: the Japan Environment and Children's Study.

Social relationships are essential in maintaining the physical and mental health of mothers and their children. However, there is limited evidence on how social support provided to the mother during pregnancy could impact child development. Herein, we examined whether maternal social support levels during pregnancy was associated with the risk of developmental delay in 3-year-old children. Overall, 68,442 mother-child pairs completed questionnaires on maternal social support during pregnancy and development delay in 3-year-old children. The maternal social support level was evaluated using four items. The risk of development delay was evaluated using the Japanese version of the Ages and Stages Questionnaire-3 (ASQ-3) with five domains of communication, gross motor, fine motor, problem-solving, and personal-social. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression according to the quintiles of maternal social support levels after adjusting for potential confounding factors. Social support during pregnancy was associated with a lower risk of development delay at 3 years of age. Beneficial effects were detected in all domains of the ASQ-3 (p for trend <0.001). Multivariable ORs (95% CIs) for the highest versus lowest quartiles of maternal social support level were 0.57 (0.50-0.65) for communication, 0.49 (0.43-0.55) for gross motor delay, 0.58 (0.53-0.64) for fine motor delay, 0.56 (0.51-0.62) for problem-solving delay, and 0.52 (0.45-0.60) for personal social delay. The associations remained unchanged when stratified by maternal education level, paternal education level, living with children, household income, and postpartum depression. Maternal social support during pregnancy was inversely associated with the risk of developmental delay at 3 years of age.

Evaluation of Developmental Delay in Term Babies on Ventilator Support: A Cross-sectional Study

Introduction: Developmental limitation in two or more developmental domains that affects children under the age of five is termed as developmental delay. Due to various reasons such as drug-induced toxicity and maternal variables like a history of drinking, smoking, or infections during pregnancy (e.g., rubella), neonates may require admission to the Neonatal Intensive Care Unit (NICU). Although NICU admission improves survival rates, the extended stay and the use of different types of equipment in the NICU may lead to developmental delay. Aim: To identify the developmental delays in critically ill fullterm babies on ventilator support, using the Ages and Stages Questionnaire-3 (ASQ-3) scale. Materials and Methods: A cross-sectional study was designed to evaluate developmental delays in term babies receiving ventilator support. A total of 35 babies who met the inclusion criteria were included in the study. Once the babies reached 17 to 18 months of age, parents were given ASQ-3 to complete. The data were analysed and expressed as mean, standard deviation, frequency, and percentage. Results: Out of the 35 full-term babies on ventilator support, 22 babies (62.9%) showed lower values in gross motor function, 12 (34.3%) in fine motor function, and 12 (34.3%) in problem-solving skills compared to communication and other components, according to ASQ-3. Conclusion: The findings of this research suggest that critically ill full-term infants on ventilator support exhibit significant developmental delays, particularly in gross motor, fine motor, and problem-solving skills.

The impact of gestational diabetes on infants’ neurodevelopmental status: a cohort study

Objective: The prevalence of gestational diabetes is increasing worldwide. Several studies have indicated that gestational diabetes can cause neurodevelopmental disorders in children. None of them has examined all areas of neurodevelopment. We conducted this pilot study to compare the neurodevelopmental status in infants of mothers with and without gestational diabetes. Materials and Methods: Forty infants of mothers with gestational diabetes and 40 infants of healthy mothers were included and followed up at 6 and 12 months old of age. The primary data of the study were extracted from a cohort study (PERSIAN Birth Cohort) done in Yazd province, Iran. Ages and Stages Questionnaire (ASQ) was used as a standard test to assess all domains of neurodevelopment. Finally, the data obtained from the questionnaire were statistically analyzed using SPSS software. Results: Data analysis showed a significant relationship between gestational diabetes and neurodevelopment in the area of problem solving at one year old, but its relationship with other domains was not significant. In the case group, there was a significant relationship between the type of treatment (insulin therapy) and neurodevelopment in the area of gross motor skills at one year of age. Conclusion: Based on this study, it seems that infants' neurodevelopment in the area of problem solving has been affected by gestational diabetes. Thus, the role of physicians in follow up of the neurodevelopmental progress of infants of diabetic mothers is significant

Cultural adaptation, validation, and standardization of a developmental screening tool (ASQ-3) in Iranian children.

This study aimed at culturally adapting, validating, and standardizing the Ages and Stages Questionnaire, third edition (ASQ-3) by implementing a nation-wide cross-sectional methodological study in order to provide a valid and reliable tool for determining the developmental status of Iranian children. This cross-sectional and methodological study was conducted on Iranian children between 1-66 months. The ASQ-3 tool was translated; following that, its face and content validity, as well as the cross-cultural adaptation were assessed by 51 specialists and experts in the field of pediatrics and child development. In order to determine the reliability of the ASQ-3 (using Cronbach's alpha), and cut-off points. All statistical analyses were performed using STATA software. This study was enrolled in 2 phases. The face and content validity, as well as the cultural relevance of the Persian version of ASQ-3 was confirmed using panel of specialists views then researchers investigated 11,740 children aged 1-66 months in order to evaluate the reliability of the tool. The Cronbach's alpha coefficients (reliability) determined for the ASQ-3 and the cut-off points for the ASQ-3 of different age groups and domains were determined by calculating one and two SDs below the mean; the latter represents the main cut-off point, and the interval between the two represents the monitoring zone according to the ASQ-3 technical manual. The results of this study showed that the Iranian version of ASQ-3 is valid and reliable; moreover, the cut-off points designated for it can be implemented in the Iranian children community to assess their developmental status.

The reliability and validity of the isixhosa version of the euroqol toddler and infant populations (EQ-TIPS) health related quality of life instrument.

Considering the high burden of disease in young children measurement of Health-Related Quality of Life is needed to evaluate the burden of morbidity. This study aims to report on the validity and reliability of the isiXhosa EuroQol Toddler and Infant Populations (EQ-TIPS) measure for South Africa. A sample of 181 caregivers of children 0-36 months were recruited from a hospital in-patient (inpt) and outpatient (outpt) facility and crèches. The EQ-TIPS, Ages and Stages Questionnaire (ASQ), Faces, Leg, Activity, Cry, Consolability (FLACC) and dietary information were administered at baseline. EQ-TIPS was administered one week later in crèche children for test-retest reliability. Known groups showed significant differences for pain (X2=37.21, p<0.001), and EQ-TIPS level sum score (KWH=25.9, p<0.001) between health groups. The Visual Analogue Scale was unable to discriminate general health between groups (KW-H=3.92, p=0.141). Concurrent validity was weak to moderate and significant for all dimensions hypothesised to correlate. There was significant fair to moderate test-retest reliability for EQ-TIPS dimensions of movement, play, pain and eating. The isiXhosa EQ-TIPS is valid and reliable for very young children in South Africa and we suggest that it be included in the assessment of children with health conditions within this context.

Socioemotional Development of Infants and Toddlers During the COVID-19 Pandemic

Understanding the impact of the COVID-19 pandemic on children's socioemotional development is critical to plan for ongoing needs in the early intervention and education systems. To determine if Ages and Stages Questionnaire, Third Edition (ASQ-3) and Ages and Stages Questionnaire Social-Emotional, Second Edition (ASQ:SE-2) scores changed during the COVID-19 pandemic among families served by a nurse-visiting program. This retrospective, cohort study took place from 2015 through 2021 and included 4 cohorts (prepandemic, pandemic 1, pandemic 2, and pandemic 3) with differing pandemic exposure at the time of screening. Analysis was conducted from July 2022 through October 2023. Data from the Nurse-Family Partnership (NFP), a national nurse-visiting program enrolling birthing people during pregnancy and continuing through age 2 years, were used. A total of 60 171 families with a singleton birth at 37 weeks' gestation or longer and at least 1 valid ASQ-3 and/or ASQ:SE-2 screening in the NFP from January 1, 2015, through December 31, 2021, were enrolled. COVID-19 pandemic. Outcomes were a positive screening, defined as scores in the refer area on the ASQ-3 at 10 months and 18 months of age and in the ASQ:SE-2 at 12 months and 18 months of age. Multivariable mixed-effects logistic regression models were used to calculate odds ratios (ORs) for positive screening in pandemic cohorts compared with the prepandemic cohort. Covariates included parent age, race and ethnicity, marital status, income, child's biological sex, and multiparity. Of 60 171 families enrolled, pandemic cohorts had fewer teenagers, were more likely to be married, and were multiparous. Compared with the prepandemic cohort, all pandemic cohorts had higher odds of positive screening on the ASQ-SE at 12 months (pandemic 1: OR, 1.35; 95% CI, 1.09-1.66; pandemic 2: OR, 1.60; 95% CI, 1.30-1.96; and pandemic 3: OR, 1.94; 95% CI, 1.61-2.33) and pandemic 2 and 3 had higher odds of a positive screening at 18 months (pandemic 2: OR, 1.61; 95% CI, 1.29-2.00 and pandemic 3: OR, 1.87; 95% CI, 1.50-2.32). On the ASQ-3, pandemic cohorts 2 and 3 were more likely than the prepandemic cohort to screen positive on the communication subscale at 18 months (pandemic 2: OR, 1.39; 95% CI, 1.17-1.64 and pandemic 3: OR, 1.28; 95% CI, 1.07-1.53). In this study, exposure to the COVID-19 pandemic, especially during the first year of life, was associated with higher odds of positive ASQ:SE-2 screening, even when adjusting for demographics and family risks. These findings suggest that unmeasured community, family, and child factors that changed as a result of the pandemic contributed to delays in young children's socio-emotional development.

Parental Material and Time Investment as Mediators Between Family SES and Toddlers’ Development: Evidence from Rural China

ABSTRACT Research Findings: This study investigated the sequential mediating effects of parental material investment (MI) and time investment (TI) upon the correlation between family socioeconomic status (SES) and toddlers’ development (TD). Data derived from a 2016 data set, including a sample of 1,316 toddlers based in 117 villages across 22 counties within northwestern China, were utilized. Parents completed the Bayley Scales of Infant and Toddler Development III (BSID-III) and Ages & Stages Questionnaires: Social-Emotional (ASQ: SE). The mediation analysis revealed: (1) a significant positive correlation among family SES, parental material investment, time investment, and the development of toddlers aged 0–3 years; (2) family SES indirectly impacted toddlers’ development through the singular mediating pathway of material investment significantly, and the single mediating path of time investment was found to be insignificant; and (3) both material investment and time investment were recognized as the sequential mediators between family SES and toddler development. Practice or Policy: The study’s findings underscore the aspects of parental material and time investment that optimally support toddlers’ development. These results may also guide the structure and implementation of family interventions and policies designed to reduce the developmental disparity among toddlers from families of differing SES.

Gross motor development in children with epidermolysis bullosa.

Epidermolysis bullosa (EB) is a group of rare, congenital skin disorders, characterized by skin fragility and formation of blisters. The gross motor outcomes of children with EB are not known. The primary objective of the study was to measure the proportion of gross motor delay in children with EB. The secondary objectives were to measure the difference in gross motor outcomes between EB sub-types and change in gross motor outcomes over time. Children with EB, aged between one month and five and a half years of age, attending the Sydney Children's Hospital, Epidermolysis Bullosa Clinic, were eligible. Carers completed Ages and Stages Questionnaires, Third Edition, on behalf of their children. Questionnaires were scored, and outcomes were compared to age-expected norms. There were 24 participants to complete a questionnaire. Eleven participants completed additional questionnaires over the 24 month study duration. The proportion of children with EB with gross motor delay was greater than age-expected norms (29.17% vs. 2.5%). The delay occurred in children with recessive dystrophic (80%) and epidermolysis bullosa simplex (33.33%) sub-types, but not dominant dystrophic (0%). No children with Junctional EB or Kindler EB joined this study. This study demonstrates a difference in gross motor outcomes in children with EB. Children with recessive dystrophic and epidermolysis bullosa simplex should be prioritized for monitoring of, and intervention for, gross motor outcomes through multidisciplinary care. Further research investigating long-term outcomes for children with EB and the effectiveness of interventions would be beneficial.

Prenatal exposures to organophosphate ester metabolites and early motor development in the MADRES cohort

Organophosphate esters (OPEs) are increasingly considered neurotoxicants which may impact gross and fine motor development. We evaluated associations between prenatal OPE exposures and infant motor development. Third trimester urinary concentrations of nine OPE metabolites were measured in 329 mother-infant dyads participating in the Maternal And Developmental Risks from Environmental and Social Stressors (MADRES) cohort. Child gross and fine motor development at 6, 9, 12, and 18-months were assessed with the Ages and Stages Questionnaire-3 (ASQ-3) and operationalized in models using dichotomous instrument-specific cutoffs for typical motor development. Five OPE metabolites with >60% detection were specific-gravity-adjusted, natural log-transformed, and modeled continuously, while four metabolites with <60% detection were modeled dichotomously (detected/not-detected). We fit mixed effects logistic regression between OPE metabolites and fine/gross motor development and assessed sex-specific effects using a statistical interaction term and sex-stratified models. Among children, 31% and 23% had gross and fine motor scores, respectively, below the ASQ-3 at-risk cutoffs at least once across infancy. A doubling in prenatal diphenyl phosphate (DPHP) exposure was associated with 26% increased odds of potential fine motor delays (ORfine = 1.26, 95% CI: 1.02, 1.57, p = 0.04). We also observed significant interactions by infant sex for associations of detected dipropyl phosphate (DPRP) with gross motor development (pinteraction = 0.048) and detected bis(1-chloro-2-propyl) phosphate (BCIPP) with fine motor development (pinteraction = 0.02). Females had greater odds of potential motor delays for both detected DPRP (females vs males ORgross (95% CI) = 1.48 (0.71, 3.09), p = 0.30 vs 0.27 (0.06, 1.29), p = 0.10) and detected BCIPP (females vs males ORfine (95% CI) = 2.72 (1.27, 5.85), p = 0.01 vs 0.76 (0.31, 1.90), p = 0.56). There were no other significant associations between other metabolites and motor development, despite similar patterns. We found evidence of adverse effects of prenatal OPE exposures on infant motor development with greater adverse effects among female infants with some OPE metabolites.

Developmental impairment in children exposed during pregnancy to maternal SARS-COV2: A Brazilian cohort study

ObjectivesTo determine the effects of in-utero exposure to maternal SARS-CoV-2 infection on offspring's neurodevelopment during the first year of life. MethodsWe performed a prospective cohort of babies exposed to SARS-CoV-2 during pregnancy, and a control group (CG) of unexposed babies in a low-income area in Brazil. Children's neurodevelopment was assessed using the guide for Monitoring Child Development in the Integrated Management of Childhood Illness context for both groups (at 1,2,3,4,5,6, 9, and 12 months), and the Ages & Stages Questionnaire (ASQ-3) for the exposed group (EG) (at 4, 6 and 12 months). ResultsWe followed 137 children for 1 year, 69 in the COVID-19-EG, and 68 in the CG. All mothers were unvaccinated at the time of cohort inclusion, and maternal demographics were similar in the two groups. 20.3% of EG children and 5.9% of the CG received a diagnosis of neurodevelopmental delay within 12 months of life (P = 0.013, relative risk = 3.44; 95% confidence interval, 1.19- 9.95). For the EG, the prevalence of neurodevelopment impairment using Ages & Stages Questionnaire was 35.7% at 4 months, 7% at 6 months, and 32.1% at 12 months. ConclusionSARS-CoV-2 exposure was associated with neurodevelopmental impairment, and specific guidelines are needed for the follow-up of these high-risk children to mitigate the long-term effects on children's health.

Association between frequency of breakfast intake before and during pregnancy and developmental delays in children: the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study

BackgroundAlthough an association between maternal nutritional intake and developmental delays in children has been demonstrated, the association of the timing of meal intake and development delays remains unclear. We examined the association between breakfast intake frequency before and during pregnancy and developmental delay in children.MethodsOf the pregnant women who participated in the Tohoku Medical Megabank Project Three-Generation Cohort Study, 7491 answered the required questions and were analyzed. The frequency of breakfast intake from pre- to early pregnancy and from early to mid-pregnancy was classified into four groups: daily, and 5–6, 3–4, and 0–2 times/week. Child developmental delays at age 2 and 3.5 years were assessed using the Ages & Stages Questionnaire, Third Edition. Logistic regression models were constructed to examine the association between breakfast intake frequency in pregnant women and developmental delays in children aged 2 and 3.5 years.ResultsThe proportion of pregnant women who had breakfast daily was 78.1% in pre- to early pregnancy, and 82.2% in early to mid-pregnancy. The proportion of children with developmental delays was 14.7% and 13.4% at age 2 and 3.5 years, respectively. Compared with the risk in children of women who had breakfast daily from pre- to early pregnancy, children of women who had breakfast 0–2 times/week had a higher risk of developmental delays at 2 years of age: odds ratio (OR) 1.30, (95% confidence interval [CI], 1.02–1.66). The risk of developmental delays at age 2 years increased in the children of women who had breakfast 0–2 times/week in early to mid- pregnancy: OR 1.75 (95% CI, 1.32–2.32). The risk of developmental delays at age 3.5 years did not increase in the children of women who had breakfast 0–2 times/week from pre- to early and early to mid-pregnancy: OR 1.06 (95% CI, 0.81–1.39 and OR 1.15 (95% CI 0.84–1.57), respectively.ConclusionFor women with a low frequency of breakfast intake from pre- to mid-pregnancy there was an association with developmental delays in their children at age 2, but not at 3.5 years.

Neurodevelopmental assessment of normocephalic children born to Zika virus exposed and unexposed pregnant people.

Studies examining the association between in utero Zika virus (ZIKV) exposure and child neurodevelopmental outcomes have produced varied results. We aimed to assess neurodevelopmental outcomes among normocephalic children born from pregnant people enrolled in the Zika in Pregnancy in Honduras (ZIPH) cohort study, July-December 2016. Enrollment occurred during the first prenatal visit. Exposure was defined as prenatal ZIKV IgM and/or ZIKV RNA result at enrollment. Normocephalic children, >6 months old, were selected for longitudinal follow-up using the Bayley Scales of Infant and Toddler Development (BSID-III) and the Ages & Stages Questionnaires: Social-Emotional (ASQ:SE-2). One hundred fifty-two children were assessed; after exclusion, 60 were exposed and 72 were unexposed to ZIKV during pregnancy. Twenty children in the exposed group and 21 children in the unexposed group had a composite score <85 in any of the BSID-III domains. Although exposed children had lower cognitive and language scores, differences were not statistically significant. For ASQ:SE-2 assessment, there were not statistically significant differences between groups. This study found no statistically significant differences in the neurodevelopment of normocephalic children between in utero ZIKV exposed and unexposed. Nevertheless, long-term monitoring of children with in utero ZIKV exposure is warranted. This study found no statistically significant differences in the neurodevelopment in normocephalic children with in utero Zika virus exposure compared to unexposed children, although the exposed group showed lower cognitive and language scores that persisted after adjustment by maternal age and education and after excluding children born preterm and low birth weight from the analysis. Children with prenatal Zika virus exposure, including those normocephalic and have no evidence of abnormalities at birth, should be monitored for neurodevelopmental delays. Follow-up is important to be able to detect developmental abnormalities that might not be detected earlier in life.