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Background: Florida's Healthy Start Program is a statewide prenatal screening program that aims to identify pregnant women at risk of adverse birth outcomes. However, the effectiveness of this legislatively mandated prenatal risk screening tool in predicting poor birth outcomes is unknown. This study aimed to evaluate associations between risk factors self-reported on this screening tool and adverse birth outcomes. Materials and Methods: A 1-year retrospective birth cohort at a large academic referral center was created. Risk factors reported on the tool by mothers who had a preterm or low-birthweight (LBW) infant were compared with those reported by mothers who delivered full-term non-LBW infants in bivariate and multivariate analyses. All data were extracted from maternal or infant electronic health records. Results: The Mother/Infant Dyad Screening cohort consisted of 528 dyads. We identified two items on the screening tool that significantly associated with adverse birth outcomes, but which do not currently contribute to the total risk score used to identify women for referral to preventive social services. These items were feeling alone and thinking it was not a good time to be pregnant. Conclusions: Comprehensive prenatal risk screening is an underutilized strategy in medicine. Florida's mandatory self-reported, prenatal survey can identify women at risk for poor neonatal outcomes. A more nuanced understanding how women are interpreting survey items and a re-evaluation of scoring practices may allow the tool to better serve as a model for other programs seeking to identify pregnant women at risk of poor birth outcomes.

Because aggressive behavior during early childhood has been related to negative developmental outcomes, a further understanding of the underlying mechanisms of aggression during the first years of life is essential. Although the factors prenatal risk, parenting behavior, temperament and cognitive functions have consistently been related to externalizing behavior during preschool and school age, research focusing on their interplay in relation to aggressive behavior earlier in life is scarce. The aim of the current dissertation was to gain more insight into these associations during infancy and toddlerhood. Our studies indicated that impairments in children’s early cognitive regulation abilities play a role in the development of aggressive behavior. It can also be concluded that both adverse pre- and postnatal environmental influences have an impact on child aggression: higher prenatal risk and adverse parenting behavior were directly or indirectly (via poor cognitive functioning) related to higher levels of aggression. In addition, it was found that poor cognitive skills increased the risk of aggression in case of high prenatal risk or a highly reactive temperament during early development. These results suggest that early intervention programs to prevent aggression should focus on prenatal risk, parenting behavior and cognitive development during the first years of life.

Advanced maternal age was the be all and end all of prenatal risk assessment for aneuploidy for nearly half a century. In virtually all countries, women a given age cutoff were regarded as being at high enough risk of aneuploidy to warrant the costs, hazards of performing an invasive, diagnostic procedure. Since alpha-fetoprotein (AFP) was already widely being used to screen for neural tube defects, at 16 to 18 weeks of gestation, it was relatively simple to include aneuploidy. Maternal serum AFP screening for aneuploidy was widely adopted, had the potential to increase the detection rate, but it was inefficient. While the diagnosis of Mendelian disorders may be possible by fetal cells or cell-free DNA, it is very likely that aneuploidy detection will be seen as a screening test to modify risk as a predicate for invasive diagnostic procedures. Considerable work in the mid-1990s focused on the development of ultrasound markers to be used to modify the risk of aneuploidy.

\n Otizm spektrum bozuklugu, sosyal etkilesim ve iletisim bozuklugu ile kisitli ve tekrarlayici davranislarla karakterize norogelisimsel bozukluklardan biridir. Otizm yaklasik 68 cocukta 1 gorulmektedir. Son yillarda yapilan calismalarda gorulme sikliginin arttigi bildirilmekte olup bu artisin bilgi ve farkindaligin artmasi ve tani olcutlerinin degismesinden kaynaklandigi iddia edilmekle birlikte yapilan calismalarda cevresel faktorler ve bunlarin henuz bilinmeyen genetik bir takim etkenlerle iliskisinin de bu artisa katki sagladigi dusunulmektedir. Norogelisimsel olarak onemli ve kirilgan bir donem olan prenatal donemde cocugun maruz kaldigi cevresel faktorlerin otizm spektrum bozuklugu gelismesi acisindan risk etkeni olup olmadiginin degerlendirilmesi onemlidir. Gebelik doneminde ozellikle valproik asit, terbutalin, selektif serotonin geri alim inhibitorleri gibi ilaclarla otizm spektrum bozuklugu arasinda bir iliski oldugu, bu donemde agir metal ve pestisite maruz kalmanin otizm spektrum bozuklugu riskini arttirdigi, yogun sigara, alkol ve madde kullaniminin norogelisimsel sureci sekteye ugrattigi, gebelik doneminde gecirilen gestasyonel diyabet, otoimmun hastaliklar, enfeksiyonlar ve uzamis atesin inflamatuar surecler araciligiyla otizm spektrum bozuklugu riskini artirabilecegi bildirilmektedir. Goc, mevsimler ve gebelik doneminde maruz kalinan hava kirliligininde risk artisina etkisi oldugu bildirilmis ve daha fazla epidemiyolojik calismaya ihtiyac oldugu vurgulanmistir. otizm spektrum bozuklugu ile iliskili cevresel etkenlerin taninmasi, anne adaylarinin bu risk etkenleri ile ilgili bilgilendirilmesinin saglanarak bu etkenlerden uzak durmalari veya bu etkenlerin elimine edilmesi ile otizm spektrum bozuklugu riskinin azaltilmasina yardimci olabileceginden bu alanda yapilan calismalarin derlenmesi ve risklerin ortaya konulmasi ozellikle onemlidir. Bu gozden gecirmede son donemde sayisi artan prenatal etkenler ile ilgili yapilan calismalarin derlenerek butuncul olarak ele almasinin kolaylastirilmasi hedeflemektedir. \n

Though the etiology of autism spectrum disorder (ASD) remains largely unknown, recent findings suggest that hormone dysregulation within the prenatal environment, in conjunction with genetic factors, may alter fetal neurodevelopment. Early emphasis has been placed on the potential role of in utero exposure to androgens, particularly testosterone, to theorize ASD as the manifestation of an “extreme male brain.” The relationship between autism risk and obstetric conditions associated with inflammation and steroid dysregulation merits a much broader understanding of the in utero steroid environment and its potential influence on fetal neuroendocrine development. The exploration of hormone dysregulation in the prenatal environment and ASD development builds upon prior research publishing associations with obstetric conditions and ASD risk. The insight gained may be applied to the development of chronic adult metabolic diseases that share prenatal risk factors with ASD. Future research directions will also be discussed.

INTRODUCCION: La tetralogia de Fallot representa la cardiopatia congenita cianogena mas frecuente despues del primer ano de vida, ocurre aproximadamente en 1 de cada 3 500 nacimientos y representa el 7 al 10% de todas las Enfermedades Cardiacas Congenitas. Su variante extrema que se acompana de atresia pulmonar representa el 1 a 2% de las cardiopatias congenitas. Presentamos una Tetralogia de Fallot Extrema Ductus Dependiente de manejo complejo.CASO CLINICO: Se trata de un neonato a termino de 12 dias de vida, adecuado para la edad gestacional, sin factores de riesgo prenatales, ni antecedentes patologicos familiares, el cual es diagnosticado de Tetralogia de Fallot Extrema por ecocardiograma.EVOLUCION: Paciente inicialmente tratado con infusion de prostaglandina E1. Posteriormente mediante fistula Blalock-Taussig izquierda.CONCLUSIONES: Para mejorar el pronostico y sobrevida de un paciente con Tetralogia de Fallot Extrema el diagnostico prenatal oportuno y el tratamiento apropiado es de vital importancia, sin embargo el tratamiento definitivo con derivaciones pulmonares sistemicas representan complicaciones con riesgo de mortalidad. El presente caso tuvo un desenlace desfavorable.ABSTRACT BACKGROUND: The Tetralogy of Fallot represents the most common cyanogenic heart disease after the first year of life. It occurs in 1 of 3 500 live births and accounts as 7 to 10% of all Congenital Heart Diseases. Its extreme variant is accompanied by pulmonary atresia and accounts 1 to 2% of the Congenital Heart Diseases. We present an Extreme Tetralogy of Fallot– Ductus Dependent of complex management.CLINICAL CASE: A full term 12 day neonate, adequate for gestational age, without prenatal risk factors or pathologic family antecedents, is diagnosed with Extreme Tetralogy of Fallot by echocardiogram.EVOLUTION: The patient was treated initially with an infusion of prostaglandin E1. Then, a left Blalock-Taussig shunt was performed.CONCLUSIONS: To improve the prognosis and survival rates of patients with Extreme Tetralogy of Fallot , a timely diagnosis and treatment are of vital importance. Definitive treatment with systemic pulmonary shunts carries high risk complications. The present case had an unfavorable evolution.

BACKGROUND/OBJECTIVES: Specific maternal risk factors have recently been identified in the development of infantile hemangiomas (IH), including gestational diabetes (GDM), maternal anti-hypertensive medication use and/or gestational hypertension (GHTN), maternal progesterone use, and artificial reproductive technologies (ART). We sought to explore the change in incidence of these risk factors over time, and determine their association with the increased incidence of hemangiomas over 35 years, as previously reported. METHODS: The charts of 869 mother and infant pairs (infants previously diagnosed with IH between January 1, 1976 and December 31, 2010) were reviewed for prenatal complications. Rates of the prenatal complications over the 35-year period in birth mothers of infants diagnosed with IH were determined, and evaluated by year of diagnosis (1976–1990, 1991–2000 and 2001–2010). RESULTS: Over the 35-year period in which the incidence of IH was previously examined, maternal age at delivery, pre-pregnancy body mass index (BMI), use of ART, maternal progesterone use, placental abnormalities, and GDM also increased. CONCLUSIONS: GDM, ART, and maternal progesterone use increased over the past 35 years, mirroring the previously reported trend of increasing incidence of IH. Maternal age and BMI also increased in mothers of infants with IH. Further exploration of this association may direct future research in the pathogenesis of infantile hemangiomas.

Background: Various neuro-developmental impairment (NDI) among very low birth weight babies (VLBW) and extremely low birth weight (ELBW) babies are common in Indian scenario. This study was designed to assess the impact between prenatal risk factors and neuro-developmental outcomes of premature infants.Methods: This descriptive study was conducted on 143 VLBW and ELBW babies admitted in SNCU of North Bengal Medical College, Darjeeling, West Bengal and discharged babies were followed up.Results: Total 143 neonates were studied among male 82 (57.3%) and female 61 (42.7%) and AGA: SGA ratio was 1.97. Birth weight ranged from 500 to 1500grams with mean was 1199.6±244.14 and the median was 1240 gm. The mean gestational age (Mean± SD) was 29.65±2.032 weeks with range 24-32 weeks and the median was 30 weeks. 28 (19.6%) had PIH, 39 (27.3%) had multiple gestation, 18 (12.6%) had perinatal infection and 25 (17.5%) had birth asphyxia. CRIB II score ranged from 3-18 with mean was 8.021±3.883 and median was 7. 73.4% (105/143) were discharged alive. Significant positive correlations were found among birth weight, gestational age, perinatal infection (p

Introduction: Cerebral Palsy is a disease that is less recognized by the public due to the lack of information related to CP in Indonesia. Aims to analyze prenatal risk factors that influence the evidence of CP RSIA Bunda Jakarta.Methods: This study was conducted in April 2021 at RSIA Bunda Jakarta, an analytical study with a case control design. The sample in this study were 124 respondents from mothers of children who underwent outpatient treatment at the RSIA Bunda Jakartaas cases and controls. each taken by simple random sampling technique. Data were analyzed using the test chi-square to analyze the relationship between variables.Results: The results of statistical analysis showed that the risk factors associated with the incidence of CP were maternal age (p= 0.00; OR= 13.25; 95% CI= 2.93-59.93), preeclampsia (p= 0.00; OR= 2,06; 95% CI= 1,71-2,48), TORCH (p= 0.00; OR= 2.40; 95% CI= 1.92-3.01), and antenatal care (p= 0.00; OR= 41.2; 95% CI= 5.45-317.0). Conclusion: Risk factors affecting the occurrence of CP in children include age

Background: The mental health of pregnant women, particularly those with elevated risks, has been an issue of global concern. Thus far, few studies have addressed mental health of pregnant women with threatened preterm labour (TPL). In the present study, we investigated self-perceived burden (SPB) and postpartum depression (PPD) among hospitalized pregnant women with TPL, exploring the association of SPB with PPD, and identifying other potential risk factors of early PPD. Methods: A self- reported survey conducted in the Obstetrics Department of Anhui Provincial Hospital, People’s Republic of China. Women hospitalized with TPL were approached one week after delivery. One hundred fifty women were recruited from January 2017 to December 2017. Self-Perceived Burden Scale (SPBS), Edinburgh Postnatal Depression Scale (EPDS), and Multidimensional Scale of Perceived Social Support (MSPSS) were the main measures. Descriptive statistics, Spearman's correlation, and multiple logistic regression were employed for data analysis.Results: SPB and PPD were commonly experienced by women hospitalized with TPL, and SPB was positively and significantly correlated with PPD. A multiple logistic regression analysis revealed that, for the women hospitalized with TPL during pregnancy, the emotional aspect of SPB (OR = 1.473, 95% CI = 1.141–1.903, p = 0.003), age (OR = 1.178, 95%CI = 1.056–1.314, p = 0.003), occupation (OR = 0.282, 95%CI = 0.095–0.023, p = 0.023), history of scarred uterus (OR = 0.163, 95%CI = 0.034–0.769, p = 0.022), delivery mode (OR = 5.974, 95%CI = 1.750–20.396, p = 0.004), and family support to women hospitalized with TPL during pregnancy (OR = 0.665, 95% CI = 0.498–0.887, p = 0.006) were the significant factors predicting early signs of PPD. Conclusion: This study indicated that SPB and PPD were prevalent mental issues among hospitalized women with TPL, and SPB, especially perceived emotional burden, is a strong predictor of PPD. Our study suggests the necessity of paying attention to mental health issues—especially SPB and PPD—among hospitalized women with TPL, as well as providing appropriate interventions at the prenatal stage to prevent adverse consequences. Perceiving support from family during pregnancy with high risk can help women in reducing the risk of PPD.

Prenatal risk, temperamental negative affect, and specific cognitive abilities have all individually been identified as predictors of behavior problems during early childhood, but less is known about their interplay in relation to aggression during toddlerhood. This study examined the main and interaction effects of prenatal risk, negative affect, inhibitory control, attention, and vocabulary in the prediction of aggression in 150 children (75 boys). During pregnancy, a cumulative risk index was calculated based on the presence of 10 well-established maternal risk factors, such as prenatal substance use, maternal psychiatric disorder, and financial problems. Negative affect was measured at 6 and 20 months using maternal report. Child cognition was examined at 30 months using laboratory tasks for inhibitory control and attention, and a questionnaire was administered to assess vocabulary. In addition, mothers reported on their children's aggressive behavior at 30 months. Higher prenatal risk and negative affect at 20 months and, to a lesser extent, at 6 months were related to more aggression at 30 months. Poorer inhibitory control and, to a lesser extent, vocabulary at 30 months also predicted higher levels of aggressive behavior. Two-way interaction effects were found for cumulative risk and inhibitory control, negative affect (at 20 months) and inhibitory control, and negative affect (at 6 months) and vocabulary: aggressive behavior was most pronounced when combinations of high prenatal risk, high negative affect, and poor cognition were present. These results suggest that the impact of prenatal risk and child temperament depends in part on child's cognitive development during toddlerhood.

Given the importance of early prevention and intervention strategies for children exposed to trauma, detection of early risk factors for exposure to traumatic events in childhood is critical. The present study examined associations between three known prenatal risk factors that characterize environmental instability in utero-prenatal substance exposure, prenatal violence victimization, and unintended pregnancy-and child exposure to interparental violence and other adverse experiences in a sample of 198 mother-child dyads (M child age = 44.48 months) referred to a hospital clinic for treatment following exposure to trauma. Prenatal substance and violence exposure were associated with child trauma exposure, and prenatal violence victimization was also associated with maternal severity ratings of traumatic exposures. Unintended pregnancy was not associated with child trauma exposure or severity. These findings expand our understanding of prenatal risk factors for trauma exposure in childhood and, specifically, highlight prenatal substance exposure and violence victimization as risk factors for subsequent exposure to trauma in early childhood. Results suggest that prenatal prevention and intervention programs should target reducing maternal substance use and in-utero exposure to violence.Dada la importancia de las estrategias de prevención e intervención tempranas para niños expuestos al trauma, el detectar los tempranos factores de riesgo en el caso de estar expuesto a eventos traumáticos en la niñez es crítico. El presente estudio examinó las asociaciones entre tres conocidos factores de riesgo prenatales que caracterizan la inestabilidad ambiental en el útero -el haber estado expuesto a sustancias prenatalmente, la victimización de la violencia prenatal, y el embarazo no intencional -y el que el niño esté expuesto a la violencia entre progenitores (IPV) y otras experiencias adversas en un grupo muestra de 198 díadas madre-niño (edad promedio del niño = 44.48 meses) que habían sido referidas a una clínica hospital para el tratamiento que seguía al haber estado expuestos al trauma. El haber estado expuesto a sustancia y violencia prenatal se asoció con el hecho de que el niño había estado expuesto a trauma, y la victimización de la violencia prenatal también se asoció con la severidad maternal de clasificación de la exposición traumática. El embarazo no intencional no se asoció con la exposición del niño al trauma o la severidad. Estos resultados amplían nuestra comprensión de los factores de riesgo prenatales en cuanto al haber estado expuesto al trauma en la niñez y, específicamente, subrayan el haber estado expuesto a sustancias prenatalmente y la victimización de la violencia como subsecuentes factores de riesgo para estar expuesto al trauma en la temprana niñez. Los resultados sugieren que los programas de prevención e intervención prenatales deber enfocarse en reducir el uso de sustancias por parte de la madre y el estar expuesto dentro del útero a la violencia.Vu l'importance des stratégies de prévention précoce et d'intervention pour les enfants exposés au trauma, la détection de facteurs de risque précoce pour l'exposition à des événements traumatiques s'avère critique. Cette étude a examiné les liens entre trois facteurs de risque prénatals connus qui caractérisent l'instabilité environnementale in utero - l'exposition prénatale à des substances toxiques, la victimisation liée à la violence prénatale, et la grossesse involontaire - ainsi que l'exposition à la violence conjugale et d'autres expériences adverses chez un échantillon de 198 dyades mère-enfant (moyenne d’âge de l'enfant = 44,48 mois) envoyées consulter en clinique hospitalière pour un traitement suivant une exposition à un trauma. L'exposition à la toxicomanie et l'exposition à la violence étaient liées à l'exposition de l'enfant au trauma et la victimisation liée à la violence prénatale était également liée à la sévérité des scores maternels d'expositions traumatiques. La grossesse involontaire n’était pas liée à l'exposition au trauma de l'enfant ou à la sévérité. Ces résultats élargissent notre compréhension des facteurs prénatals d'exposition au trauma dans l'enfance et mettent en lumière plus spécifiquement l'exposition à la toxicomanie prénatale et la victimisation liée à la violence en tant que facteurs de risque d'exposition ultérieure au trauma durant la petite enfance. Les résultats suggèrent que la prévention prénatale et les programmes d'intervention devraient cibler la réduction d'utilisation toxicomane maternelle et l'exposition à la violence in-utero.Zusammenhänge zwischen pränataler Drogen- bzw. Gewaltexposition, ungewollter Schwangerschaft und Traumatisierung in der Kindheit in einem klinischen Setting Angesichts der Bedeutung früher Präventions- und Interventionsstrategien bei traumatisierten Kindern, ist die Aufdeckung potenzieller Risikofaktoren für Traumatisierung entscheidend. Die vorliegende Studie überprüft Zusammenhänge zwischen drei bekannten, eine Umgebungsinstabilität in utero charakterisierenden, pränatalen Risikofaktoren (pränatale Drogen- bzw. Gewaltexposition und ungewollte Schwangerschaft) und kindlicher Belastung durch zwischenelterliche Gewalt (interparental violence; IPV) sowie anderen widrigen Erfahrungen. Die Stichprobe bestand aus 198 Mutter-Kind Dyaden (mittleres Alter der Kinder = 44.48 Monate), die sich aufgrund traumatischer Erfahrungen in Behandlung begeben haben. Pränatale Drogen- bzw. Gewaltexposition wiesen Zusammenhänge zu kindlicher Traumatisierung auf. Des Weiteren wies pränatale Gewaltexposition auch einen Zusammenhang zu den mütterlichen Ratings der Traumaschwere auf. Ungewollte Schwangerschaft war nicht mit kindlicher Traumatisierung oder Traumaschwere assoziiert. Diese Ergebnisse ermöglichen es uns, pränatale Risikofaktoren für kindliche Traumatisierung besser zu verstehen. Insbesondere werden pränatale Drogen- und Gewaltexposition als Risikofaktoren für eine darauffolgende Traumatisierung in der frühen Kindheit hervorgehoben. Die Ergebnisse legen nahe, dass pränatale Präventions- und Interventionsprogramme darauf abzielen sollten, mütterlichen Drogenkonsum und Gewalterfahrungen in utero zu minimieren.胎児期の薬物暴露・胎児期の暴力虐待・予期せぬ妊娠と、臨床現場における小児期のトラウマ暴露の関連 トラウマに曝された子どもへの早期予防と介入の方法の重要性を考えると、小児期にトラウマとなる出来事に暴露される初期の危険因子を検出することは必須である。本研究は、トラウマに曝され治療のために病院の外来に紹介された198 組の母子 (子どもの平均年齢 44.48 ヶ月) において、胎内の環境不安定性を特徴づける３つの既知の出生前リスク因子−胎児期の薬物暴露、胎児期の暴力虐待、予期せぬ妊娠―と、パートナー間の暴力 (IPV) やその他の逆境体験に子どもが曝されること、との関連性を検討した。胎児期の薬物と暴力への暴露は、子どものトラウマ暴露と関連し、胎児期の暴力虐待は母親のトラウマ暴露の深刻さの評価とも関連した。予期せぬ妊娠は子どものトラウマ暴露や深刻さに関連していなかった。これらの結果から小児期のトラウマ暴露に関連する胎児期のリスク因子への我々の理解が広まり、特に胎児期の薬物暴露と暴力虐待は早期小児期のトラウマ暴露に引き続くリスク因子であると強調する。出生前の予防と介入プログラムは、母親の薬物使用と胎児期に暴力に晒されることを減らすことをターゲットにすべきであると、この結果から提案する。.產前物質使用丶產前暴力受害丶意外懷孕和兒童創傷在臨床環境中的關係 鑑於經歷過創傷的兒童早期預防和干預策略的重要性, 檢測兒童受創事件的早期風險因素至關重要。本研究在受創傷後轉診到醫院診所接受治療的 198 個母親-兒童二元組樣本中 (平均兒童年齡 = 44.48 個月), 探討三種已知的產前風險因素 - 產前使用物質丶產前暴力受害丶及意外懷孕 - 做成的不穩定環境與兒童經歷過父母間暴力 (IPV) 和其他不良經歷的關聯。母親產前物質使用和暴力經歷與兒童創傷有關, 產前暴力受害也與母親創傷的評分相關。意外懷孕與兒童創傷或嚴重程度無關。這些研究結果擴展了我們對兒童創傷的產前風險因素的理解, 特別強調產前物質使用和暴力受害, 是隨後兒童早期創傷的風險因素。結果表明, 產前預防和干預計劃的目標, 應該是減少母體物質使用和產前暴力經歷。.العلاقة بين التعرض للمواد المخدرة قبل الولادة، وإيذاء العنف قبل الولادة، والحمل غير المقصود، والتعرض للصدمات النفسية في مرحلة الطفولة في سياق إكلينيكي بالنظر إلى أهمية استراتيجيات الوقاية والتدخل المبكرة للأطفال المعرضين للصدمات النفسية، فإن الكشف عن عوامل الخطر المبكرة للتعرض للأحداث الصادمة في مرحلة الطفولة أمر بالغ الأهمية. تناولت هذه الدراسة الارتباطات بين ثلاثة عوامل خطر معروفة قبل الولادة تميز عدم الاستقرار البيئي في التعرض للمواد داخل الرحم قبل الولادة، والإيذاء أثناء الولادة، والحمل غير المقصود - وتعرض الأطفال للعنف بين الوالدين وغيره من التجارب السلبية في عينة من 198 من ثنائيات الأم والطفل (متوسط عمر الطفل = 44.48 شهراً) الذين تم إحالتهم إلى عيادة لتلقي العلاج بعد التعرض للصدمات. وترتبط المواد السابقة للولادة والتعرض للعنف بالتعرض لصدمات الأطفال، كما يرتبط الإيذاء الناجم عن العنف قبل الولادة بتقديرات الأم بشدة الصدمات. ولا يرتبط الحمل غير المقصود بالتعرض لصدمات الأطفال أو شدتها. وتوسع هذه النتائج فهمنا لعوامل الخطر قبل الولادة للتعرض للصدمات في مرحلة الطفولة، وعلى وجه التحديد، تسليط الضوء على التعرض لمواد ما قبل الولادة والإيذاء الناجم عن العنف كعوامل خطر للتعرض اللاحق للصدمات في مرحلة الطفولة المبكرة. وتشير النتائج إلى أن برامج الوقاية والتدخل قبل الولادة ينبغي أن تستهدف الحد من تعاطي المواد أثناء الحمل والتعرض للعنف داخل الرحم.

Prenatal risk and a lack of inhibitory control have consistently been related to the development of physical aggression in older children. This study examined whether inhibitory control mediated the relation between prenatal risk and aggression in infants and toddlers. The role of gender in this mediation model was also examined. The sample consisted of 161 mother-child dyads (83 boys). A prenatal cumulative risk score was created from a number of well-established risk factors including maternal psychopathology, substance use, and social and socioeconomic disadvantages. At 12 months, children performed an inhibitory control task. Physical aggression was assessed through maternal reports at 12 and 20 months of age. Results showed that higher prenatal risk was associated with more physical aggression. Inhibitory control mediated this association at both 12 and 20 months: higher prenatal risk was related to lower inhibitory control, which in turn led to higher aggression. At 20 months, gender moderated the mediation effect: the mediating role of inhibitory control was only found for girls. These results suggest that even before 2 years of age, inhibitory control is an important construct involved in the relation between prenatal risk and physical aggression.

Little research has considered whether prenatal experience contributes to executive function (EF) development above and beyond postnatal experience. This study tests direct, mediated, and moderated associations between prenatal risk factors and preschool EF and IQ in a longitudinal sample of 1,292 children from the Family Life Project. A composite of prenatal risk factors (i.e., low birth weight, prematurity, maternal emotional problems, maternal prepregnancy obesity, and obstetric complications) significantly predicted EF and IQ at age 3, above quality of the postnatal environment. This relationship was indirect, mediated through infant general cognitive abilities. Quality of the postnatal home and child-care environments did not moderate the cascade model. These findings highlight the role of prenatal experience as a contributor to individual differences in cognitive development.

Background: Preterm infants are still at an increased risk for suboptimal neurodevelopmental outcomes when compared with term born infants. The development of a child born preterm can be jeopardized by suboptimal conditions during pregnancy, in addition to the suboptimal growth environment postnatally compared to the normal in utero environment. This review summarizes the literature on the role of chorioamnionitis, placental insufficiency, and maternal smoking on the developmental outcomes of preterm infants. Methods: A systematic database search was performed to identify all original articles published on or before September 12, 2018 that evaluated the impact of clinical or histological chorioamnionitis, abnormal prenatal fetal and placental blood flow, and prenatal smoking exposure on the neuropsychological and cognitive outcomes of preterm infants. We identified a total of 54 studies. Thirty five original articles evaluated the effects of clinical or histological chorioamnionitis; 15 studies evaluated the effects of abnormal blood flow patterns; and four studies evaluated the effects of maternal smoking during pregnancy. Results: The studies on prenatal risk factors showed conflicting results about the impact on the neurodevelopment of preterm infants. The majority of the studies did not show that chorioamnionitis poses a direct risk to the development of preterm infants. The role of abnormal prenatal placental and fetal blood flow on the development of preterm infants remained inconclusive because the sample sizes were often small and methodological problems complicated the interpretation of the data. Maternal smoking during pregnancy was assessed only in one cohort which showed that maternal smoking is a risk for suboptimal cognitive and neuropsychological development in preterm infants. Conclusions: This review summarizes the data on several prenatal risk factors which play a role in the developmental outcomes of preterm infants. To optimize the developmental outcomes, we need to first optimize the fetal wellbeing before birth. More research that extends from the fetal life to long-term developmental outcomes is needed.

Objetive: To describe the clinical and electroencephalographic features in a sample of patients diagnosed with Lennox-Gastaut syndrome. The patients were part of the epilepsy program at the University of Antioquia in Medellin between 2007 and 2012. Materials and methods: This was completed with an observational, descriptive and retrospective method. The data used was taken from the records of all patients diagnosed with Lennox-Gastaut syndrome included in the epilepsy program at the University of Antioquia and who were evaluated by EEG video monitoring. Clinical and electroencephalographic variables were analyzed. For the analysis we used SPSS. Resualts: We reviewed 18 video EEG. The average age of the patients was 19,89 years, with the gender being equally being balanced. Half of the patients had a prenatal risk. The average age of the first seizure was at 4,67 years and the average number of attacks per week was 31,17. The most frequent were atypical absence seizures in 17 patients (94,4%). The most commonly used drug was valproic acid. All patients experienced mental retardation and characteristic electroencephalographic findings of the syndrome, during both times of wakefulness and sleep. Most abnormalities were observed during superficial sleep. Conclusions: The Lennox-Gastaut syndrome is one of the most severe epileptic encephalopathies with onset during childhood and with large social and economic costs and poor prognosis due to its associated morbid conditions.

Objective The Changing Childbirth in British Columbia study explored women’s preferences and experiences of maternity care, including women’s role in decision-making. Methods Following content validation by community members, we administered a cross-sectional online survey exploring novel topics, including drivers for interventions, and experiences of autonomy, respect, or mistreatment during maternity care. Using the Mothers Autonomy in Decision-Making (MADM) scale as an outcome measure in a mixed-effects analysis, we examined differential experiences by socio-demographic and prenatal risk profile, type of care provider, interventions received, and nature of communication with care providers. Results A geographically representative sample of Canadian women (n = 2051) reported on 3400 pregnancies. Most women (95.2%) preferred to be the lead decision-maker during care. Patients of physicians had significantly lower autonomy (MADM) scores than midwifery clients as did women who felt pressured to accept interventions. Women who had a difference in opinion with their provider, and those who felt their provider seemed rushed reported the lowest MADM scores. Conclusion Women’s autonomy is significantly altered by model of maternity care, the nature of interactions with care providers, and women’s ability for self-determination. Practice Implications If health professionals acquire skills in person-centred decision-making experience of autonomy among pregnant women may improve.

espanolIntroduccion: las alteraciones auditivas en el recien nacido prematuro impactan en su desarrollo y lenguaje y por ende a la calidad de vida. Se conocen varios factores de riesgo asociados a estas alteraciones, pero poco sobre los aspectos socioeconomicos, nutricionales y de inseguridad alimentaria. Objetivo: analizar la asociacion con la inseguridad alimentaria y los factores de riesgo prenatales en prematuros con problemas de audicion. Material y metodos: estudio de 35 casos y 105 controles, en prematuros de 30 a 37 SDG de un hospital publico, realizado a traves de una encuesta donde se recopilaron datos del expediente materno y del recien nacido (antropometria), asi como factores de riesgo para alteracion auditiva, aspectos sociodemograficos, seguridad alimentaria con sus respectivas clasificaciones y tipo de alimentacion. Resultados: el principal factor de riego perinatal asociado a las alteraciones auditivas fue la administracion de gentamicina (antibiotico ototoxico) en 18,1% de los casos (OR: 5,61 [IC = 1,29-24,50]). La inseguridad alimentaria severa se asocio con las alteraciones auditivas, en 27,2% de casos y en 2,8% de controles (OR: 12,75 [IC = 2,89-56,16]). Ademas, se encontraron diferencias entre los grupos para el nivel de escolaridad (casos: 50% de las madres tuvieron primaria terminada o incompleta vs. controles con 19%; Ji2 = 0,008) y Las variables antropometricas presentaron diferencias en peso, longitud y perimetro cefalico (p Conclusion: la inseguridad alimentaria severa, exposicion a gentamicina, el nivel de escolaridad de la madre, tuvieron una asociacion significativa con las alteraciones auditivas en el prematuro. Variables como el peso, longitud y perimetro cefalico al nacimiento presentaron valores inferiores en el grupo casos. Estos primeros hallazgos, reflejan riesgos ambientales como la inseguridad alimentaria en las alteraciones auditivas ademas de las ya conocidas. EnglishBackground: hearing disorders in the premature newborns impact on their development and language and therefore, on their quality of life. Several risk factors have been associated to these conditions, but little is known about socioeconomic, nutrition factors and food security. Objective: to analyze the association between food security and prenatal risk factors in newborns with hearing disorders. Material and methods: study of 35 cases and 105 controls in premature newborns from 30 to 37 weeks of gestation (WG) in a public hospital. The working tool was a questionnaire to collect data about the maternal medical record and the anthropometry of the newborn, as well as the risk factors for the auditory function, sociodemographic aspects, and food security with its respective classification and food habits. Results: the principal perinatal risk factor associated to hearing impairment was the use of gentamycin (ototoxic drug) in 18.1% of the total (OR: 5.61 [1.29-24.50]). Severe food insecurity was associated with auditory disfunctions in 27.2% of cases and in 2.8% of controls (OR: 12.75 [2.89-56.16]). There were differences between the groups regarding the education level (cases: 50% of the mothers finished or interrupted primary education level vs controls with 19%; Ji2 = 0.008). The anthropomorphic variables showed differences in weight, length and cephalic perimeter for the newborns (p Conclusion: severe food insecurity, exposure to gentamycin and low education level of the mother had a significant association with auditory impairments in preterm children. For these newborns, variables like weight, length and cephalic perimeter at the moment of birth were lower than in controls. These initial findings point to the important role that environmental risks, like food insecurity, have in auditory impairments in addition to those previously described.

Exposure to prenatal adversity is associated with aggression later in life. Individual differences in autonomic nervous system (ANS) functioning, specifically nonreciprocal activation of the parasympathetic (PNS) and sympathetic (SNS) nervous systems, increase susceptibility to aggression, especially in the context of adversity. Previous work examining interactions between early adversity and ANS functioning in infancy is scarce and has not examined interaction between PNS and SNS. This study examined whether the PNS and SNS moderate the relation between cumulative prenatal risk and early physical aggression in 124 children (57% male). Cumulative risk (e.g., maternal psychiatric disorder, substance (ab)use, and social adversity) was assessed during pregnancy. Parasympathetic respiratory sinus arrhythmia (RSA) and sympathetic pre-ejection period (PEP) at baseline, in response to and during recovery from emotional challenge were measured at 6 months. Physical aggression and non-physical aggression/oppositional behavior were measured at 30 months. The results showed that cumulative prenatal risk predicted elevated physical aggression and non-physical aggression/oppositional behavior in toddlerhood; however, the effects on physical aggression were moderated by PNS and SNS functioning. Specifically, the effects of cumulative risk on physical aggression were particularly evident in children characterized by low baseline PNS activity and/or by nonreciprocal activity of the PNS and SNS, characterized by decreased activity (i.e., coinhibition) or increased activity (i.e., coactivation) of both systems at baseline and/or in response to emotional challenge. These findings extend our understanding of the interaction between perinatal risk and infant ANS functioning on developmental outcome. Electronic supplementary material The online version of this article (doi:10.1007/s10802-017-0337-y) contains supplementary material, which is available to authorized users.

Pathways from maternal tobacco, marijuana, stress, and anger in pregnancy to infant reactivity and regulation (RR) at 9 months of infant age were examined in a low-income, diverse sample beginning in the first trimester of pregnancy, with fetal growth and postnatal stress/anger as potential mediators, and infant sex as a moderator. Participants were 247 dyads (173 substance-exposed infants). There were no direct effects of prenatal risk on RR and no moderation by sex. However, there were significant indirect effects on RR via poor fetal growth and higher postnatal anger. The study adds to the sparse literature on joint effects of tobacco and marijuana, and highlights the role of fetal growth and maternal anger as important pathways from prenatal risk to infant RR.

Background: Advancement of skill, technology and perinatal medicine has led to improve survival of low birth weight babies during the last few decades but they have reported high incidence of growth failure during infancy and early childhood. The objective of the study was to find out the influence of perinatal risk factors on anthropometric outcome.Methods: A prospective cohort study conducted on 143 ELBW and VLBW babies admitted in Sick Newborn Care Unit (SNCU and PICU) of North Bengal Medical College and Hospital (NBMC), Darjeeling, West Bengal from 2016 to 2017 and discharged babies were followed up.Results: Total 143 neonates were studied at NBMC among male 82(57.3%) and female 61(42.7%), 95 were AGA and 48 were SGA babies. Significant positive correlations were found among birth weight, gestational age, perinatal infection (p

The cause of PHACE syndrome is unknown. In a study of 218 patients, we examined potential prenatal risk factors for PHACE syndrome. Rates of pre-eclampsia and placenta previa in affected individuals were significantly greater than in the general population. No significant risk factor differences were detected between male and female subjects.

Nonreciprocal action of the parasympathetic (PNS) and sympathetic (SNS) nervous systems, increases susceptibility to emotional and behavioral problems in children exposed to adversity. Little is known about the PNS and SNS in interaction with early adversity during infancy. Yet this is when the physiological systems involved in emotion regulation are emerging and presumably most responsive to environmental influences. We examined whether parasympathetic respiratory sinus arrhythmia (RSA) and sympathetic pre-ejection period (PEP) response and recovery at six months, moderate the association between cumulative prenatal risk and physical aggression at 20 months (N = 113). Prenatal risk predicted physical aggression, but only in infants exhibiting coactivation of PNS and SNS (i.e., increase in RSA and decrease in PEP) in response to stress. These findings indicate that coactivation of the PNS and SNS in combination with prenatal risk is a biological marker for the development of aggression.

Physicians should provide women considering abortion after Down syndrome screening with unbiased information and not attempt to influence their decision.

The study addresses risk factors and cause of pediatric sensory over-responsivity (SOR) in a large sample of twins. At age 2 years, (a) the association of temperamental traits with concurrent SOR; (b) the association of prenatal complications with SOR; (c) the association of having a male cotwin with female SOR; and (d) the common and unique genetic causes of temperament and SOR symptoms are examined.The sample included 1026 twin pairs (mean age = 2 years 2 months) from a population-based longitudinal study. Auditory and tactile SOR symptom domains were partially independent and thus were examined separately.Temperamental negative affect and fear were moderately correlated with auditory and tactile SOR symptoms. Prenatal complications significantly predicted tactile symptoms after controlling for child characteristics. In addition, females with a male cotwin showed greater SOR at age 2 years than same-sex female dizygotic twins, suggesting a possible risk associated with in utero testosterone exposure. Both auditory and tactile SOR domains were heritable. Bivariate genetic analyses showed that each SOR domain had a similar genetic relationship with fear and negative affect.The findings suggest partially nonoverlapping causes and risk factors for tactile versus auditory SOR and indicate that prenatal factors warrant further investigation.

Clinicians may wish to use the T-ACE, a screening instrument for prenatal risk drinking, for their infertile patients. Twenty-eight T-ACE negative and 23 T-ACE positive women presenting to an academic infertility clinic completed two interviews about their drinking. The 23 T-ACE positive participants were also randomized to receive a brief intervention. The T-ACE distinguished between heavier and lighter patterns of alcohol use in this sample. Moreover, it appeared that although the average quantity of alcohol consumed per drinking day was unchanged, the overall mean percentage of days drinking declined significantly from the time of enrollment to follow-up in all groups.

To identify prenatal risk factors for postpartum diabetes among pregnant women with gestational diabetes mellitus (GDM).In a retrospective study, baseline characteristics and data from a postpartum 75-g glucose tolerance test (GTT) were reviewed for patients with GDM who had delivered in four Korean tertiary institutions from 2006 to 2012. Clinical characteristics were compared between women with and those without postpartum diabetes. Cutoffs to predict postpartum diabetes and diagnostic values were calculated from receiver operating characteristic (ROC) curves.Of 1637 patients with GDM, 498 (30.4%) underwent a postpartum 75-g GTT. Postpartum diabetes was diagnosed in 40 (8.0%) patients and impaired glucose intolerance in 157 (31.5%). Women with postpartum diabetes had higher glycated hemoglobin (HbA1c) levels at GDM diagnosis (P=0.008) and higher 100-g GTT values (P0.05 for all). In ROC curve analysis, optimal cutoffs for predicting postpartum diabetes were 0.058 for HbA1c level and 5.3 mmol/L (fasting), 10.9 mmol/L (1h), 10.2 mmol/L (2h), and 8.6 mmol/L (3h) for 100-g GTT. The highest sensitivity was observed for 3-h 100-g GTT (76.9%) and the highest positive predictive value was for HbA1c at diagnosis (15.2%).HbA1c level at GDM diagnosis and 100-g GTT values could be used to identify patients at high risk of postpartum diabetes who should undergo postpartum screening.

Socially disinhibited or indiscriminate behavior (IB) has traditionally been investigated using caregiver reports. More recently, an observational measure based on the Strange Situation Procedure (M. Ainsworth, M. Blehar, E. Waters, & S. Wall, 1978), the Rating of Infant and Stranger Engagement (RISE; C. Riley, A. Atlas-Corbett, & K. Lyons-Ruth, 2005), was validated in home-reared at-risk children. The present study aimed to validate the RISE in an institutionally reared sample using the caregiver report, to assess whether IB assessed with the RISE was elevated among the institutionalized children, and to explore potential risk factors associated with IB. The study was conducted among 74 institutionalized toddlers aged 11 to 30 months. Sociodemographic questionnaires were used to assess pre-admission experiences, and aspects of institutional placement were coded from the children's files in the institution and staff's report. Institutionalized children displayed high frequencies of IB as assessed on the RISE, and this instrument was validated against caregiver report. Pre-admission experiences of the institutionalized children in their biological families-namely, prenatal risk and maternal emotional neglect risk-predicted IB. Results suggest that the RISE is adequate to use among institutionally reared toddlers and point to aspects of the early familial environment that may be implicated in IB.

This article highlights major research findings that indicate a relation between prenatal environmental factors and the risk of adult schizophrenia. Evidence suggests that schizophrenia may have its origins in early maldevelopment of the brain. However, the factors responsible for this devastating disorder remain unknown. While genes clearly play a causal role, there is likely an environmental contribution as well. We discuss the evidence for several candidate environmental exposures that occur during prenatal life and that may modify the risk for developing schizophrenia. The main challenge of this type of research, termed risk-factor epidemiology, is to generate and test such exposures in subjects with schizophrenia, in order to develop preventive strategies and better understand the mechanisms that lead to this illness.

Exposure to adverse experiences in early life increases the risk of depression during adulthood. Recent findings have highlighted that exposure of a fetus to an adverse intrauterine environment may also have implications for later offspring depression. This review considers the status of the evidence for these associations and the potential mechanisms underlying prenatal developmental risks for later depression, addressing the challenging possibility that environmental predisposition to depression may begin before birth.

Research suggests that genetic, prenatal, endocrine, and parenting influences across development individually contribute to internalizing and externalizing problems in children. The present study tests the combined contributions of genetic risk for psychopathology, prenatal environments (maternal drug use and internalizing symptoms), child cortisol at age 4.5 years, and overreactive parenting influences across childhood on 6-year-old children’s internalizing and externalizing problems. We used data from an adoption design that included 361 domestically adopted children and their biological and adopted parents prospectively followed from birth. Only parenting influences contributed (independently) to externalizing problems. However, genetic influences were indirectly associated with internalizing problems (through increased prenatal risk and subsequent morning cortisol), and parenting factors were both directly and indirectly associated with internalizing problems (through morning cortisol). Results suggest that prenatal maternal drug use/symptoms and children’s morning cortisol levels are mechanisms of genetic and environmental influences on internalizing problems, but not externalizing problems, in childhood.

Pregnancy is a major factor that modifies psychosocial aspects of the adolescents. A study with 120 pregnant adolescents aged 12 to 18 years, without regarding gestational age, was carried out at Prenatal Risk Program in the Secretaria Estadual de Saúde, Belém-Pará, from 10/1991 to 04/1992. At the first encounter, it was made an approach of psychosocial and sexual subjects, with the following results: onset of menarche primarily between 12-13 years old (median 12.2 years old); beginning of sexual practice at 14 years old in 50.9% of the adolescents. 56.6% were pregnant at 16 years old. Most of the adolescents (98.4%) first had sexual intercourse with their boy friends and by their own wish (72.5%). In one year of loving affair, 67.5% of the adolescents have already begun sexual activities, this attitude more prevalent among the younger(79.4%). Adolescents had learned about sexuality mainly from mates (65.1%). Although 55.9% of the adolescents were aware of some contraceptive method, just 13.3% of them used one. The majority of the pregnant adolescents (96.7%) were financially supported by their families. Respectively, 30.3% and 32.1% of these girls left school before or during pregnancy. The risk factors that may contribute to an early and unintended pregnancy among adolescents, specially the younger ones, were pointed out: little information about sex and contraceptive methods, limited practice on their use and a high rate of precocious sexual activities.