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Prenatal maternal exposure to air pollution may cause adverse health effects in offspring, potentially through altered immune responses. Maternal psychosocial distress can also alter immune function and may increase gestational vulnerability to air pollution exposure. We investigated whether prenatal exposure to air pollution is associated with altered immune responses in cord blood mononuclear cells (CBMCs) and potential modification by maternal depression in 463 women recruited in early pregnancy (1999–2001) into the Project Viva longitudinal cohort. We estimated black carbon (BC), fine particulate matter (PM2.5), residential proximity to major roadways, and near-residence traffic density, averaged over pregnancy. Women reported depressive symptoms in mid-pregnancy (Edinburgh Postnatal Depression Scale) and depression history by questionnaire. Immune responses were assayed by concentrations of three cytokines (IL-6, IL-10, and TNF-α), in unstimulated or stimulated (phytohemagglutinin (PHA), cockroach extract (Bla g 2), house dust mite extract (Der f 1)) CBMCs. Using multivariable linear or Tobit regression analyses, we found that CBMCs production of IL-6, TNF-a, and IL-10 were all lower in mothers exposed to higher levels of PM2.5 during pregnancy. A suggestive but not statistically significant pattern of lower cord blood cytokine concentrations from ever (versus never) depressed women exposed to PM2.5, BC, or traffic was also observed and warrants further study.

Background Little is known about the quality of life of parents and families of preterm infants after discharge from the neonatal intensive care unit (NICU). Our aims were (1) to describe the impact of preterm birth on parents and families and (2) and to identify potentially modifiable determinants of parent and family impact. Methods We surveyed 196 parents of preterm infants

Objective Identification and refinement of psychometric properties of the Reproductive Coercion Scale (RCS) for use in survey research and clinical practice. Study design Young women aged 16–29 years seeking services in 24 Pennsylvania and 5 California family planning clinics completed questionnaires. Data were pooled for analysis (n=4674), and underlying domains were assessed using Horn's Parallel Analysis and Exploratory Factor Analysis. Multidimensional Item Response Theory was used to refine the scale and assess reliability and validity of a short-form RCS. Results The full, nine-item RCS had two underlying domains: pregnancy coercion and condom manipulation. Five items were retained in the short form: three about pregnancy coercion (e.g., “told you not to use birth control…”) and two for condom manipulation (e.g., “taken off the condom while you were having sex…”; one of these items is the combination of two original items on damaging the condom that were combined because of similar statistical properties and face validity and a third item on removing the condom was retained on its own). Recent reproductive coercion was reported by 6.7% and 6.3% of the sample with the full and short-form RCS, respectively. Characteristics of women reporting reproductive coercion were similar with both forms. Conclusion Findings indicate that reproductive coercion includes pregnancy coercion and deliberate manipulation of condoms to promote pregnancy. Moreover, women experience reproductive coercion across a continuum of severity. We selected items that varied in RC severity and discrimination to generate a five-item short-form RCS for survey research and clinical practice. Implications This study assesses the psychometric properties of the RCS, identifying pregnancy coercion and condom manipulation as underlying domains of reproductive coercion. Recommendations for using the RCS in research and clinical practice are discussed.

Access to good intensive care blunts the effects of deprivation In the linked prospective cohort study (doi:10.1136/bmj.b4702), Smith and colleagues assessed socioeconomic inequalities in survival and neonatal care provision among very preterm infants.1 A cohort of 7449 infants born during a 10 year period (1998-2007) at between 22+0 and 32+6 weeks’ gestation were followed up until discharge from neonatal care. What do the findings suggest about equity of neonatal care provision? Preterm birth is a leading cause of infant mortality worldwide and a substantial cause of childhood disability in survivors. The risks of death are highest in babies born before 33 weeks’ gestation—the very preterm group. Furthermore, both preterm birth and infant mortality are associated with socioeconomic position, with the risks being highest in those from the most deprived socioeconomic groups.2 3 As might be expected, the most striking socioeconomic inequalities in neonatal survival are seen from a global perspective, with 98% of neonatal deaths occurring in less developed countries.4 However, even in high income …

The objective of this study is to investigate prenatal and perinatal determinants of school age blood pressure (BP) in former preterm, low birth weight infants.We studied 694 participants in the Infant Health and Development Program, an eight-center longitudinal study of children born ≤ 37 weeks and ≤ 2500 g. We obtained information about prenatal and perinatal factors by interview and medical record review, and measured BP three times at age 6.5 years.Adjusting for sex, age, sociodemographic variables and height Z-score; for each Z-score birth weight for gestational age-which represents fetal growth-systolic BP at 6.5 years was 0.7 mm Hg higher (95% confidence interval -0.1, 1.6). Maternal age, pre-pregnancy weight, gestational weight gain, smoking, preeclampsia, gestational diabetes, and child gestational age and neonatal complications were also not associated with BP.In contrast to full-term infants, slower fetal growth was not associated with higher BP in former preterm, low birth weight infants.

Healthy diet, physical activity and appropriate weight gain during pregnancy contribute to healthy birth outcomes. The Institute of Medicine recommends that women receive counseling about diet and exercise during preconception, pregnancy and postpartum periods. We sought to determine how often healthcare providers report counseling women of childbearing age about diet or exercise and if such rates vary by pregnancy, overweight/obesity status or physician specialty. We combined the 2005–2010 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to obtain nationally representative estimates of outpatient preventive care visits for women of child-bearing age (15–44 years). Accounting for survey design, we compared proportions of preventive visits that included diet/exercise counseling for pregnant women versus non-pregnant women and performed multivariable logistic regression models to estimate odds ratios. Providers reported counseling pregnant women about diet/exercise during 17.9 % of preventive care visits compared to 22.6 % of visits for non-pregnant women (P < 0.01, adj. OR 0.8, 95 % CI 0.7, 1.0). Overweight/obese pregnant (vs. non-pregnant) women were significantly less likely to receive diet/exercise counseling (adj. OR 0.7, CI 0.5, 0.9) as were women seen by OB/GYNs versus non-OB/GYNs (adj. OR 0.4, CI 0.3, 0.5). Our findings suggest that provider-reported diet/exercise counseling rates during preventive care visits for women of childbearing age vary by overweight/obesity and pregnancy statuses, as well as by provider specialty. Our data suggest that there may be missed opportunities to provide diet/exercise counseling and that increasing rates of counseling could result in improved maternal and infant health outcomes.

The National Children’s Study 2014: Commentary on a Recent National Research Council/Institute of Medicine Report Marie C. McCormick, MD, ScD; Dean B. Baker, MD, MPH; Paul P. Biemer, PhD; Barbara Lepidus Carlson, MA; Ana V. Diez Roux, MD, MPH; Virginia M. Lesser, DrPH; Sara S. McLanahan, PhD; George R. Saade, MD; S. Lynne Stokes, PhD; Leonardo Trasande, MD, MPP; Greg J. Duncan, PhD From the Harvard School of Public Health, Boston, Mass (Dr McCormick); School of Medicine, University of California, Irvine, Calif (Dr Baker); RTI International, Research Triangle Park, NC (Dr Biemer); Mathematica Policy Inc, Boston, Mass (Ms Lepidus Carlson); Drexel University School of Public Health, Philadelphia, Pa (Dr Diez Roux); Oregon State University, Corvallis, Ore (Dr Lesser); Princeton University, Princeton, NJ (Dr McLanahan); University of Texas Medical Branch at Galveston, Galveston, Tex (Dr Saade); Southern Methodist University, Dallas, Tex (Dr Stokes); School of Medicine, New York University, New York, NY (Dr Trasande); and University of California, Irvine, Calif (Dr Duncan) Much of this commentary is drawn from NRC/IOM (2014). Conflict of Interest: The authors declare that they have no conflict of interest. Address correspondence to Marie C. McCormick, MD, ScD, Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115 (e-mail: mmccormi@hsph.harvard.edu). Received for publication August 22, 2014; accepted August 24, 2014. A CADEMIC P EDIATRICS 2014;14:545–546 T HE NATIONAL CHILDREN’S Study (NCS) was autho- NICHD specified that the panel’s review should cover such aspects of the Main Study design as the national prob- ability sample’s overall sample size and design; the use of hospitals and birthing centers as the primary sampling unit; the relative size of the prenatal and birth strata in the prob- ability sample; the size of the supplemental convenience samples; optimal use of sibling births; use of health care providers to refer prospective participants; the proposed study visit schedule, with emphasis on more frequent data collection in pregnancy and early childhood; the proposed approach to assess health and developmental phenotypes; and the proposed approach to define and char- acterize health disparities. The panel concluded that to meet its charge of evaluating the scientific merit of the Main Study, the NCS program office would need to provide specific documentation on the sampling design, the sample frame, the data collection protocols, and the study instruments, rather than just describe the conceptual framework, strategies, and antici- pated processes to design the Main Study. The panel re- viewed what the NCS program office provided by way of documentation and responses to several sets of written questions from the panel. The panel also listened to public comments during open meetings that included the NICHD staff. In addition, the panel engaged consultants to provide an expert cost analysis to support comparison of various design alternatives. rized by the Children’s Health Act of 2000 (Public Law 106-310) and is being implemented by a dedicated pro- gram office in the Eunice Kennedy Shriver National Insti- tute of Child Health and Human Development (NICHD). In the words of the program office, the NCS is planned to be a “longitudinal observational birth cohort study to eval- uate the effects of chronic and intermittent exposures on child health and human development in US children.” 1 The NCS would be the first US study to collect a broad range of environmental exposure measures for a national probability sample of about 100,000 children followed from birth or before birth to age 21. Detailed plans for the NCS were developed by 2007 and reviewed by an outside panel. 2 At that time, sample recruit- ment for the NCS Main Study was scheduled to begin in 2009 and to be completed within about 5 years. However, results from the initial 7 Vanguard Study (pilot) locations, which recruited sample cases in 2009–2010, indicated that the proposed household-based recruitment approach would be more costly and time-consuming than planned. In response, the program office conducted additional pilot tests in 2011–2013 to evaluate alternative recruitment methods. Based on these results, the study design was revised in early 2013, and a tentative 2015 start date was set for the Main Study. In March 2013, Congress requested a review of the revised study design by a panel of the National Research Council and Institute of Medicine. Congress stated the panel should “conduct a comprehensive review and issue a report regarding proposed methodologies for the NCS Main Study, including whether such methodologies are likely to produce scientifically sound results that are gener- alizable to the United States population and appropriate subpopulations.” 2 A CADEMIC P EDIATRICS Copyright a 2014 by Academic Pediatric Association O VERALL A SSESSMENT The National Research Council and Institute of Medi- cine released the panel’s report, The National Children’s Study 2014: An Assessment (NRC/IOM, 2014), on June 16, 2014. 3 The panel concluded that the National Chil- dren’s Study has the potential to add immeasurably to Volume 14, Number 6 November–December 2014

This study investigated the developmental course of autistic traits in a nationally representative sample of subjects 7 to 13 years of age.The parents of 6,539 children in the Avon Longitudinal Study of Parents and Children completed the Social and Communication Disorders Checklist at ages 7, 10, and 13. The phenotypic progression of autistic traits was assessed in the full sample and in high-scoring individuals (e.g., top 10%, 5%). Gender, IQ, and overall behavior difficulties were examined as potentially relevant influences on autistic trait trajectories.Autistic traits were highly stable in the general population overall and in the high-scoring groups. In the full sample, there was no change in mean Social and Communication Disorders Checklist scores for female subjects ages 7 to 13 (p = .43). Scores for male subjects decreased slightly, but significantly, on the order of 0.1 standard deviations (p.001). There was no mean change in parent-rated autistic traits within any of the high-scoring groups. IQ was not related to phenotypic progression; high parent-rated behavior problems predicted slight improvement in Social and Communication Disorders Checklist scores over the course of the study period in high-scoring individuals (p.01).These findings suggest that autistic traits are highly stable in the general population, even in individuals with the highest concentrations of autism-like behaviors. Phenotypic stability is consistent with expectations for individuals with autism spectrum disorders, providing further support for a phenomenologic continuum across the clinical threshold. Moreover, the gap between female and male risk for autistic symptomology is consistent over time.

OBJECTIVES: More rapid infant weight gain may be associated with better neurodevelopment but also with higher blood pressure (BP). The objective of this study was to determine the extent to which infant weight gain is associated with systolic BP (SBP) and IQ at school age in former preterm, low birth weight infants. METHODS: We studied 911 participants in the Infant Health and Development Program, an 8-center longitudinal study of children born at ≤37 weeks' gestation and ≤2500 g. Study staff weighed participants at term and at 4 and 12 months' corrected ages; measured BP 3 times at 6.5 years; and administered the Wechsler Intelligence Scale for Children, Third Edition (WISC-III), an IQ test, at 8 years. In linear regression, we modeled our exposure “infant weight gain” as the 12-month weight z score adjusted for the term weight z score. RESULTS: Median (interquartile range) weight z score was −0.7 (−1.5 to −0.0) at 12 months. Mean ± SD SBP at 6.5 years was 104.2 ± 8.4 mmHg, and mean ± SD WISC-III total score at 8 years was 91 ± 18. Adjusting for child gender, age, and race and maternal education, income, age, IQ, and smoking, for each z score additional weight gain from term to 12 months, SBP was 0.7 mmHg higher and WISC-III total score was 1.9 points higher. CONCLUSIONS: In preterm infants, there seem to be modest neurodevelopmental advantages of more rapid weight gain in the first year of life and only small BP-related effects.

Objectives: Few studies have examined factors associated with compliance with a postpartum visit (PPV). The identification of such factors is of particular importance in populations with high rates of unintended pregnancies and medical complications of pregnancy. This study seeks to determine factors associated with compliance with a PPV among low-income women in the population served by fourteen Healthy Start sites. Methods: Data from the Healthy Start Survey of Postpartum Women were reviewed to identify variables associated with compliance with a PPV at or beyond 6 weeks. Multiple logistic regression models were created, based on a sociobehavioral model of health services use, to examine which types of factors (demographic, social, enabling or need) are most strongly associated with the use of a PPV. Results: The study population consisted of survey respondents interviewed six weeks or more following delivery. Eighty-five percent of respondents had had a PPV at time of interview. In a multiple regression analysis, enabling factors such as multiple moves (OR (95% CI) = 0.34 (0.18, 0.67)), trouble understanding the provider (OR (95 % CI) = 0.65 (0.43, 0.99)) and appointment reminders (OR (95% CI) = 2.37 (1.40, 4.02)) were most strongly associated with a PPV. Conclusions: This work finds that women with unstable housing, transportation barriers, and difficulties communicating with providers are at risk for not receiving a PPV. This suggests that access to postpartum health services in the Healthy Start communities studied may not be entirely equitable. Policies aimed at improving interconception care will need to address these barriers to accessing health services.

As part of a smoke detector give-away program, 388 adults were surveyed to characterize smoke detector ownership in a low-income population and to identify those who would acquire a free smoke detector following their child's visit to the hospital. Factors associated with smoke detector ownership included higher education, home ownership (vs public housing), knowledge of the city smoke detector law, and the practice of other injury prevention measures. Regardless of ownership, the great majority of parents (82 per cent) acquired a free smoke detector, but those previously without a smoke detector were more likely to do so. These characteristics of smoke detector usage and acquisition should be considered in targeting future intervention strategies.