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Objective In 1991, the Medical Research Council (MRC) Vitamin Study demonstrated that folic acid taken before pregnancy and in early pregnancy reduced the risk of a neural tube defect (NTD). We aimed to estimate the number of NTD pregnancies that would have been prevented if flour had been fortified with folic acid in the UK from 1998 as it had been in the USA. Design Estimates of NTD prevalence, the preventive effect of folic acid and the proportion of women taking folic acid supplements before pregnancy were used to predict the number of NTD pregnancies that would have been prevented if folic acid fortification had been implemented. Setting Eight congenital anomaly registers in England and Wales. Main outcome measures The prevalence of pregnancies with an NTD in the UK and the number of these pregnancies that would have been prevented if folic acid fortification had been implemented. Results From 1991 to 2012, the prevalence of NTD pregnancies was 1.28 (95% CI 1.24 to 1.31) per 1000 total births (19% live births, 81% terminations and 0.5% stillbirths and fetal deaths =20 weeks' gestation). If the USA levels of folic acid fortification from 1998 onwards had been adopted in the UK, an estimated 2014 fewer NTD pregnancies would have occurred. Conclusions Failure to implement folic acid fortification in the UK has caused, and continues to cause, avoidable terminations of pregnancy, stillbirths, neonatal deaths and permanent serious disability in surviving children. [ABSTRACT FROM AUTHOR]

Background When examining the association between prenatal alcohol exposure and fetal effects, the timing and intensity of exposure have been ignored in epidemiological studies. The effect of using dose, pattern and timing of consumption ("composite" method) was investigated in this study, to examine the association between prenatal alcohol exposure and fetal effects. Methods The composite method resulted in six categories of exposure (abstinent, low, moderate, binge

Objectives: To identify a national, population-based cohort of women with acute fatty liver of pregnancy (AFLP), to evaluate proposed diagnostic criteria and to document accurately the incidence, management and outcomes of the condition. Subjects and methods: This was a population-based descriptive study using the UK Obstetric Surveillance System, carried out in all 229 hospitals with consultant-led maternity units in the UK. The participants comprised 57 women in the UK diagnosed with AFLP between February 2005 and August 2006 in an estimated cohort of 1 132 964 maternities (women delivering). Results: The estimated incidence of AFLP was 5.0 cases per 100 000 maternities (95% Cl 3.8 to 6.5 per 100 000). Fifty-five cases (90%) were confirmed by diagnostic criteria and clinical assessment, two (3%) by clinical assessment alone, representing 97% agreement (kappa statistic = 0.78). 18% of women had twin pregnancies and 20% were underweight (body mass index )BMI) <20). 60% of women were admitted to intensive care and 15% to a specialist liver unit. One woman received a liver transplant. One woman died (case fatality rate 1.8%, 95% CI 0% to 9.4%). There were seven deaths among 67 infants (perinatal mortality rate 104 per 1000 births, 95% Cl 43 to 203). Conclusions: The largest population-based cohort of women with AFLP to date has been identified. Diagnostic criteria previously proposed agree substantially with clinical diagnosis. The incidence estimate from this study is lower than documented by earlier hospital-based studies, but maternal and neonatal outcomes are better than previously reported, possibly related to improved ascertainment. Women with twin pregnancies appear to be at higher risk, but further studies are needed to investigate the risk associated with low BMI. [ABSTRACT FROM AUTHOR]

Background and objectives: Deviations in birth weight from an optimum, thought to be just above average for gestational age, are known to increase both the risk of developing cerebral palsy and the risk of developing cerebral palsy of a more severe form. Influences on survival of such deviations from average birth weight for gestational age are not known. Methods: Using a well-established, well-defined and large UK cohort of children and adults with cerebral palsy, followed from birth for nearly 25 years, we investigate the influence of deviations from average birth weight for gestational age, on survival duration, after allowing for severity of impairments. Results: A total of 3946 cases, born between 1980 and 1996 were included. For those born much lighter than average for gestational age, more than 30% (n = 313) had a severe motor or cognitive impairment, rising to as much as 40% (n = 239) for extremely low weights. For female infants, the proportions severely impaired increased to as much as 35% (n = 49) among those born much heavier than average; no such increase was observed for heavier than average male infants. For those with four severe impairments and a birth weight close to average for gestational age, around 60% (n = 140) survived to age 15 years, compared with less than 40% (n = 9) of those born much heavier than average for gestational age. A 2-year-old child with four severe impairments and born heavy for gestational age has a predicted median life expectancy of 79% (95% CI 70% to 88%) of the average. Conclusions: Infants with a birth weight lighter than average for gestational age have an increased likelihood of developing a more severe form of cerebral palsy. Surprisingly, among the infants who are very severely impaired, those born much lighter than average for gestational age have the longest life expectancy, and those born much heavier than average for gestational age have the shortest life expectancy. [ABSTRACT FROM AUTHOR]

Aim: To determine the reliability of family assessment for the Gross Motor Function Classification System (GMFCS) for children with cerebral palsy in the UK. Methods: Families of a complete geographically defined population of children with cerebral palsy between 6 and 12 years old were identified from the 4Child epidemiological database. Postal surveys were conducted with the families and any of the child's health professionals that were nominated by the families. Results: Families of 129/314 eligible children took part in the study (41%). The indices of agreement and reliability between families and professionals were also equivalent to those observed between the professionals (κ = 0.5, ICC ⩾0.9). Reliability coefficients were higher when more of the professionals classified children using direct observation rather than only reviewing their clinical records. Conclusions: Despite excellent reliability, families and professionals did not always agree exactly on a child's GMFCS level. Classifications may differ due to children's varying performance in different environments, in which case families will almost certainly know their children's ability in a broader range of settings. The indices of reliability of family assessment for the GMFCS meet the recommended criteria for use with individuals and groups, indicating that the method is suitable for use in research studies and clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: To assess the quality of care and timing of possible asphyxial events for infants with neonatal encephalopathy; to compare the quality of care findings with those relating to the deaths from the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI); and to assess whether the confidential enquiry method is a useful clinical governance tool for investigating morbidity. Design: Independent, anonymised, multidisciplinary case reviews. Selling: Trent Health Region, UK. Patients: All cases of grade II and III neonatal encephalopathy born in 1 997, excluding those due to congenital malformation, inborn error of metabolism, or infection. All CESDI deaths thought to have resulted from intrapartum asphyxia in 1996 and 1997. Main measures: Quality of care provided, timing of possible asphyxia1 episodes, and the source and timing of episodes of suboptimal care. Results: Significant or major episodes of suboptimal care were identified for 64% of the encephalopathy cases and 75% of the deaths. An average of 2.8 and 2.5 episodes of suboptimal care were identified for the deaths and encephalopathy cases respectively. Over 90% of episodes involved the care provided by health professionals. Results were fed directly back to the units concerned on request and changes in practice have been reported. Conclusions: The findings were very similar for the encephalopathy cases and the deaths. We have demonstrated that with minor adaptations the CESDI process can be applied to serious cases of morbidity. However, explicit quality standards, control data, and a more formal mechanism for the implementation of findings would strengthen the confidential enquiry process as part of clinical governance. [ABSTRACT FROM AUTHOR]

An abstract of the article "Effect of pregnancy planning and fertility treatment on cognitive outcomes in children at ages 3 and 5: longitudinal cohort study," by C. Carson, Y. Kelly, J. J. Kurinczuk, A. Sacker, M. Redshaw, and M. A. Quigley is presented.

Objective To examine the effects of pregnancy planning, time to conception and assisted reproductive treatment on expressive language ability at 3 years. Design Population-based cohort (Sweeps 1 and 2 of the UK Millennium Cohort Study). Setting UK. Participants 11 790 English-speaking singletons born 2000–2001. Exposure measure Mothers reported whether the pregnancy was planned, and their feelings when first pregnant. Women who planned their pregnancy provided time to conception (TTC) and details of any assisted reproductive treatment (ART). The population was divided into “unintended” pregnancies (unplanned and unhappy about pregnancy), “unplanned” pregnancies (unplanned but happy), “planned” (planned and TTC≤12 months), “subfertile” (planned and TTC>12 months), “ovulation stimulated (OS)” (received clomiphene citrate) and “ART” (in vitro fertilisation or intracytoplasmic sperm injection). Outcome measure Expressive language ability was assessed using the Naming Vocabulary component of the British Ability Scale. There is evidence that expressive language skills predict cognitive ability. Results 15% of pregnancies were unintended and a further 26% were unplanned. 53% were planned; 4% subfertile; 2% used OS and 1% ART to help them conceive. The mean BAS naming vocabulary score was 76.5 in the planned group and was not significantly different in the OS or subfertile groups. In the unadjusted analysis the mean score was lower among the unintended and unplanned groups (difference in mean score was −4.8 (95% CI −6.0 to 3.7) and −2.8 (95% CI −3.4 to −1.51) respectively) and higher in the ART group (3.8 (95% CI −0.2 to 7.85)). This equates to a 3.8 month cognitive delay in the unintended group, and to a 3.0 month advantage in the ART group, compared to the planned group. These effects almost entirely disappear once the models are adjusted for sociodemographic factors (parent's income, qualifications, mother's age, whether the baby is her first child and alcohol in pregnancy). Compared to the fertile group, the difference in means becomes −0.9 (95% CI −1.9 to 0.2) in the unintended group, −0.4 (95% CI −1.2 to 0.4) in the planned group and 1.2 (95% CI −2.0 to 4.4) in the ART group. Further adjustment for lifecourse mediating factors (birthweight, parent-child relationship, and parental involvement) makes little difference to the final results. Conclusions We find no evidence that pregnancy planning, subfertility or ART adversely affects children's expressive language ability at 3 years of age. The effects observed in the crude analyses are almost entirely explained by confounding by socio-economic factors, indicating that maternal education and poverty are strong influences on children's cognitive tests in early childhood. [ABSTRACT FROM AUTHOR]

Objective To systematically evaluate the effectiveness of interventions to increase the early initiation of comprehensive antenatal care in socially disadvantaged and vulnerable women. Design Systematic review. Data Sources Major bibliographic databases (Medline, Cinahl, Embase, PsycINFO, HMIC, CENTRAL) and other online libraries and resources were searched to identify relevant English language journal articles published 1990–2009. We included comparative studies (experimental or observational) evaluating the effectiveness of an intervention on the proportion of women initiating antenatal care by any defined cut-off point ≤20 weeks in a disadvantaged or vulnerable population. In order to focus on interventions relevant in the context of the UK National Health Service, we excluded studies from low-income countries and those relating to financial interventions such as extension of health insurance coverage or similar. Review Methods Two reviewers independently extracted data for eligible studies; assessed internal validity using the GATE checklist and considered whether the studies provided evidence of a beneficial effect. Results Over 3000 citations were screened. Sixteen eligible studies were identified; 14 conducted in the USA, one in Australia and one in the UK. All were observational evaluations. Twelve studies evaluated interventions targeted at specific disadvantaged or vulnerable subgroups of the population (predominantly ethnic minority women or teenagers); the remaining studies evaluated interventions in more generally socioeconomically disadvantaged populations. Eleven studies evaluated interventions that involved outreach or other community-based services, and five evaluated interventions that involved alternative models of clinic-based antenatal care. Overall, the quality of evidence was poor. Only one study, which evaluated a US home visiting intervention delivered by paraprofessional women to pregnant adolescents, was considered to have adequate internal validity. The reviewers considered the evidence relating to this intervention to be inconclusive but consistent with a possible beneficial effect of the intervention on timing of initiation of antenatal care. Conclusion We found insufficient evidence of adequate quality to reliably conclude that any of the interventions considered were effective at increasing the early initiation of antenatal care in socially disadvantaged and vulnerable women. There was weak evidence of effectiveness relating to one intervention based on home visiting for pregnant adolescents. Findings were inconclusive for all other included interventions, although we identified several strategies that might warrant further consideration and possibly more robust evaluation. The results of this review highlight the paucity of evidence and the need for further high quality research to ensure that future service innovations are evidence based. [ABSTRACT FROM AUTHOR]

Introduction: Exposure to SARS-CoV-2 during pregnancy or in the neonatal period may impact fetal or neonatal brain development either through direct central nervous system infection or indirectly through the adverse effects of viral infection-related inflammation in the mother or newborn infant. This study aims to determine whether there are early neurodevelopmental effects of SARS-CoV-2 infection., Methods and Analysis: We will conduct a prospective national population-based cohort study of children aged 21-24 months who were born at term (≥37 weeks' gestation) between 1 March 2020 and 28 February 2021 and were either antenatally exposed, neonatally exposed or unexposed (comparison cohort) to SARS-CoV-2. Nationally, hospitals will identify and approach parents of children eligible for inclusion in the antenatally and neonatally exposed cohorts using information from the UK Obstetric Surveillance System (UKOSS) and British Paediatric Surveillance Unit (BPSU) national surveillance studies and will identify and approach eligible children for the comparison cohort through routine birth records. Parents will be asked to complete questionnaires to assess their child's development at 21-24 months of age. Outcome measures comprise the Ages and Stages Questionnaire, Third Edition (ASQ-3), Ages and Stages Questionnaire Social-Emotional, Second Edition (ASQ-SE-2), Liverpool respiratory symptoms questionnaire and questionnaire items to elicit information about healthcare usage. With parental consent, study data will be linked to routine health and education records for future follow-up. Regression models will compare ASQ-3 and ASQ-SE-2 scores and proportions, frequency of respiratory symptoms and healthcare usage between the exposed and comparison cohorts, adjusting for potential confounders., Ethics and Dissemination: Ethics approval was obtained from the London-Westminster Research Ethics Committee. Findings will be disseminated in scientific conference presentations and peer-reviewed publications., Isrctn Registration Number: ISRCTN99910769., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)