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Objective  Nicotine is an established neuroteratogen, and prenatal tobacco exposure alters the structure of the developing nervous system. An association between prenatal tobacco exposure and impaired neurologic function is less well established. We examine the association between prenatal tobacco exposure and childhood neurodevelopment among infants born preterm. Study Design  Secondary analysis of a multicenter randomized controlled trial assessing the benefits of magnesium sulfate for the prevention of cerebral palsy in preterm infants. Women were included if they delivered a singleton and nonanomalous infant before 37 weeks. Exposure was any self-reported prenatal tobacco use. Primary outcome was the original trial composite outcome of moderate or severe cerebral palsy at 2 years of age, or stillbirth, or infant death by 1 year of age. Secondary outcomes included components of the composite and mild cerebral palsy at 2 years, Bayley Scales of Infant Development II motor and mental scores, death before two years, and use of auditory aids or corrective lenses. Multivariable logistic regression models were performed to estimate adjusted odds ratios (aOR) with 95% confidence intervals. Results  Of 1,826 women included, 503 (27.5%) used tobacco. Tobacco users were more likely to be older, unmarried, and white; have a prior preterm birth; have received no prenatal care; and to use illicit drugs or alcohol. Gestational age at delivery, betamethasone exposure, and magnesium exposure were not different between groups. There were no differences in the composite primary outcome or in rates of cerebral palsy by tobacco use. Moderate developmental delay was more common among tobacco exposed in bivariate but not adjusted analysis (20.5 vs. 15.9%, p  = 0.035). In adjusted analysis, tobacco exposure was associated with increased use of corrective lenses (5.0 vs. 2.9%, aOR: 2.28, 95% confidence interval: 1.28–4.07). Conclusion  Prenatal tobacco exposure is not associated with neurodevelopmental impairment in infants born preterm. However, tobacco exposure may be associated with impaired vision. Key Points Tobacco exposure is not associated with impaired neurodevelopment in this preterm population. Prenatal tobacco exposure is associated with increased need for corrective lenses. Tobacco use in pregnancy may be a risk factor for poorer visual acuity in children. [ABSTRACT FROM AUTHOR]

Moderate state abortion legislation was associated with lower rates of maternal, fetal, and infant mortality but not lower all-cause mortality in reproductive-aged females, compared with restrictive laws. OBJECTIVE: To estimate the association between state-level abortion legislation and all-cause mortality among all females of reproductive age and maternal, fetal, and infant mortality. METHODS: We conducted a retrospective cohort study using the Centers for Disease Control and Prevention's WONDER (Wide-ranging ONline Data for Epidemiologic Research) database. Generalized estimating equations were used to estimate the association between supportive, moderate, and restrictive state abortion regulations and all-cause mortality in reproductive-aged females. Secondary outcomes included maternal, fetal, and infant mortality. The association of the number and type of laws on mortality were estimated. RESULTS: Moderate and supportive states were not associated with a significant decrease in all-cause mortality compared with restrictive states. Maternal mortality (per 100,000 live births) was significantly lower in moderate (−5.79, 95% CI −9.88 to −1.70) compared with restrictive states, but not supportive states (−2.51, 95% CI −6.75 to 1.72). Infant mortality (per 1,000 live births) was significantly lower in both moderate (−0.56, 95% CI −1.09 to −0.04) and supportive (−1.10, 95% CI −1.56 to −0.64) states. Fetal mortality was lower in moderate states (−0.69, 95% CI −1.18 to −0.20) but not in supportive states (−0.64, 95% CI −1.14 to 0.13). Each additional abortion regulation was associated with an increase in maternal mortality (1.09/100,000 live births, 95% CI 0.36–1.82) and infant mortality (0.20/1,000 live births, 95% CI 0.12–0.26). CONCLUSION: Moderate state abortion legislation was associated with lower rates of maternal, fetal, and infant mortality but not lower all-cause mortality in reproductive-aged females compared with restrictive laws. An increasing number of laws restricting abortion was associated with increased maternal and infant mortality. [ABSTRACT FROM AUTHOR]

Objective Studies have suggested an association between prenatal care (PNC) and preterm birth (PTB). We evaluated trends in PTB and association of PNC and PTB. Study Design This was a retrospective cohort study of singleton, viable nonanomalous deliveries from 1991 to 2018. PNC utilization was defined by World Health Organization using number of visits: adequate (≥8), suboptimal (5–7), and inadequate (<5). Primary outcome was PTB. Tests of trend were used to assess changes in PTB over time. Baseline characteristics and outcomes were compared. Logistic regression estimated the association of PNC and PTB. We evaluated for effect modification by year of birth. Results Of 92,294 patients, 14,057 (15%) had PTB. Inadequate and suboptimal PNC were associated with higher odds of PTB compared to adequate PNC (adjusted odds ratios = [aOR 6.21], 95% confidence interval [CI]: 5.84–6.60; aOR = 3.57, 95% CI: 3.36–3.79). Inadequate PNC was associated with higher odds of PTB over time (effect modification p < 0.0001). Inadequate PNC was associated with 5.4 times higher odds of PTB in 1998, 7.0 times in 2008, and 9.1 times in 2018. Conclusion Despite an increase in adequate PNC, there was a rise in PTB associated with inadequate and suboptimal PNC. PNC utilization was a stronger risk factor in recent years with higher PTB in patients who attended more than five PNC visits. Key Points PNC utilization is associated with the risk of PTB. Despite an increase in PNC utilization, PTB rates have increased. There is an even stronger association between PNC utilization and PTB over time. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the efficacy of occipital nerve block compared with standard care, defined as acetaminophen with caffeine, for treatment of acute headache in pregnancy. METHODS: We conducted a single-center, unblinded, parallel, randomized controlled trial of pregnant patients with headache and pain score higher than 3 on the visual rating scale. Patients with secondary headache, preeclampsia, or allergy or contraindication to study medications were excluded. Participants were randomized to occipital nerve block or standard care (oral 650 mg acetaminophen and 200 mg caffeine). Crossover treatment was given at 2 hours and second-line treatment at 4 hours to those with worsening visual rating scale score or visual rating scale score higher than 3. The primary outcome was headache improvement to a visual rating scale score of 3 or lower within 2 hours of initial therapy. Secondary outcomes included serial visual rating scale scores, receipt of crossover or second-line therapy, patient satisfaction, and perinatal outcomes. Outcomes were assessed in an intention-to-treat analysis. We estimated that a sample of 62 would provide 80% power to detect a difference from 85% to 50% between groups. RESULTS: From February 2020 to May 2022, 62 participants were randomized to occipital nerve block (n531) or standard care (n531). Groups were similar except payer status. The primary outcome, headache improvement to visual rating scale score of 3 or lower, was not significantly different between groups (64.5% vs 51.6%, P5.30). The occipital nerve block group experienced lower median [interquartile range] visual rating scale scores at 1 hour (2 [0-5] vs 6 [2-7], P5.014), and more patients in the occipital nerve block group had visual rating scale scores of 3 or lower at 1 hour. Among patients receiving crossover treatment at 2 hours, the standard care group had a significantly lower visual rating scale score 1 hour after crossover to occipital nerve block than the occipital nerve block group receiving crossover to standard care (P5.028). There were no significant differences in second-line treatment, refractory headache, satisfaction, or complications. Patients receiving occipital nerve block delivered earlier (36.6 weeks vs 37.8 weeks), but preterm birth did not differ between groups. CONCLUSION: Occipital nerve block is an effective and quick-acting treatment option for acute headache in pregnancy. [ABSTRACT FROM AUTHOR]

• After a year of closed schools in Mexico, youth aged 12 to 18 are spending overall 30 percent less time on their studies than pre pandemic. • Reduction of 14 percentage points in the probability of studying during previous week, potentially a predictor of more permanent dropout. • Effects of the pandemic on reducing time on studies are seen nationwide and occur for girls, boys, and youth in more urban and less urban areas. • General decrease in the probability of working outside the home with the pandemic but some small increases in work inside the home. • This is concerning as evidence shows the longer the time out of school the larger the reduction on learning. Studying how the pandemic affects the education and work of adolescents is a critical question with long lasting implications for well-being of the next generation, particularly in the developing world. The Covid-19 pandemic by mid-March 2020 had led to the closing of most educational institutions in Latin America and the Caribbean, and the region has been one of the worst hit by the pandemic (Sanmarchi et al., 2021). This paper uses the Mexican National Occupation and Employment Survey (ENOE) to provide evidence on the pandemic's effects on school and work of youth. We measure changes in the time use of adolescents comparing patterns just before the pandemic (January to March 2020) with those at the beginning of the following school year (September 2020), controlling for pre pandemic trends and potential seasonality. Our study finds a sharp reduction in the probability of being engaged in studies during the previous week for youth age 12 to 18 during the pandemic, as well as a reduction of about 30 percent in total hours spent on studies for those who report spending at least one hour on studies in the previous week. Time in work in general shows fewer changes than in time dedicated to studies, with some reductions in the probability of working outside the home for older youth, and a small increase in the number of hours dedicated to work inside the household. Our results overall are suggestive of an important decrease in youth who are engaged with school, who may be at particular risk for abandoning school permanently. It also suggests that even for those who remain engaged, there is a reduction on time spent studying likely to lead to a decrease in learning. Policies to combat potential dropout and negative effects on learning of the pandemic are urgently needed. [ABSTRACT FROM AUTHOR]