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Objective: There is uncertainty around the safety of SSRIs for treating depression during pregnancy. Nevertheless, the use of SSRIs has been gradually increasing, especially during the COVID-19 pandemic period. We aimed to (1) characterize maternal depression rate and use of SSRIs in a recent 10-year period, (2) address confounding by indication, as well as socioeconomic and environmental factors, and (3) evaluate associations of the timing of SSRI exposure in pregnancy with risk for preterm birth (PTB), low birthweight (LBW), and small for gestational age (SGA) infants among women with depression before pregnancy. Methods: We conducted propensity score-adjusted regression to calculate odds ratios (ORs) of PTB, LBW, and SGA. We accounted for maternal/pregnancy characteristics, comorbidity, depression severity, time of delivery, social vulnerability, and rural residence. Results: There were 50.3% and 40.3% increases in the prevalence rate of prenatal depression and prenatal SSRI prescription rate during the pandemic. We identified women with depression ≤180 days before pregnancy (n = 8406). Women with no SSRI order during pregnancy (n = 3760) constituted the unexposed group. The late SSRI exposure group consisted of women with an SSRI order after the first trimester (n = 3759). The early-only SSRI exposure group consisted of women with SSRI orders only in the first trimester (n = 887). The late SSRI exposure group had an increased risk of PTB of OR = 1.5 ([1.2,1.8]) and LBW of OR = 1.5 ([1.2,2.0]), relative to the unexposed group. Associations between late SSRI exposure and risk of PTB/LBW were similar among a subsample of patients who delivered during the pandemic. Conclusions: These findings suggest an association between PTB/LBW and SSRI exposure is dependent on exposure timing during pregnancy. Small for gestational age is not associated with SSRI exposure. [ABSTRACT FROM AUTHOR]

Background: According to the World Health Organization, tuberculosis (TB) ranks among the top 10 causes of death worldwide. The significance of TB during pregnancy lies in its symptoms, which can be mistaken for physiological changes associated with pregnancy. This confusion can lead to maternal-perinatal complications. Objective: To evaluate the association between pulmonary TB in pregnancy and adverse neonatal outcomes in two Peruvian hospitals. Methods: This is a retrospective cohort study. The target population consisted of pregnant women with and without pulmonary TB whose deliveries were attended at two public hospitals, located in Lima, Peru. The adverse neonatal outcomes were prematurity, low birth weight (LBW), and being small for gestational age (SGA). Crude and adjusted relative risks (RRa) were calculated with their respective 95% confidence intervals (95%CI). Results: Information from 212 patients was analyzed; 48.1% had TB during pregnancy, and 23.1% had adverse neonatal outcomes (8%, 11.3%, and 12.3% for LBW, prematurity, and SGA, respectively). In the adjusted model, pregnant women with pulmonary TB had a 3.52 times higher risk of having a newborn with at least one of the adverse outcomes than those who were not exposed (aRR, 3.52; 95%CI: 1.93–6.68). Conclusion: Pulmonary TB in pregnancy was jointly and independently associated with adverse neonatal outcomes, including LBW, prematurity, and being SGA.

Abstract Objectives: to evaluate the association between the time to initiate the first skin-to-skin contact (SSC) and the daily practice time with the rates of late-onset sepsis in newborns ≤1,800g. Methods: a multicentric cohort study was carried out at the neonatal units located in three Brazilian geographic regions. The SSC time was recorded in individual files by the hospital staff and the newborn’s parents. Maternal and neonatal data were obtained from medical records and through questionnaires applied to the mothers. Data analysis was carried out using a tree algorithm classification, which divided the data set into mutually exclusive subsets that best described the variable response. Results: 405 newborns participated in the study, with an average of 31.3 ± 2.7 weeks and 1,412g (QR=1,164-1,605g) as a median birth weight. The first SSC was carried out within 137 hours of life (≤5.7 days) was associated with a lower rate of late sepsis (p=0.02) for newborns who underwent daily SSC of 112.5 to 174.7 min/day (1.9 to 2.9h/day), with a reduction in the sepsis rate from 39.3% to 27.5%. Furthermore, the duration of SSC >174.7min/day (>2.9h/day) was relevant (p1,344g, with a reduction in this rate from 24.1% to 6%. Conclusions: SSP has been proven to be significant in reducing late-onset sepsis rates in preterm newborns, especially when carried out in a timely manner (≤5.7 days) and prolonged (>2.9h/day).

Background Gestational diabetes mellitus (GDM) is a common complication during pregnancy. However, the adherence to individualized medical nutrition therapy (IMNT) alone among GDM women is poor and the impact of group cognitive behavioral therapy (GCBT) on their pregnancy outcomes remains unclear. Objective To examine the impact of GCBT on the pregnancy outcomes of women with GDM, and to provide reference for improving pregnancy outcomes and developing effective gestational diabetes management programme. Methods A total of 878 pregnant women with GDM who delivered and received IMNT in our hospital from 2020 to 2021 were retrospectively selected as the study subjects and divided into the observation group including 141 pregnant women with GDM who received GCBT and the control group including 737 pregnant women with GDM who did not receive GCBT. The differences in pregnancy outcomes of pregnant women with GDM between the two groups before and after propensity score matching were analyzed. Results There were 134 pregnant women with GDM in the observation group and 256 pregnant women with GDM in the control group after 1∶2 propensity score matching. The proportion of pregnant women with GDM who gained normal weight in the observation group (50.7%, 68/134) was higher than that in the control group (37.5%, 96/256) (P

ABSTRACT OBJECTIVE To assess risk factors associated with motor development delay at three months of age. METHODS Cross-sectional study with mothers and their three-month-old babies in Southern Brazil. The Bayley-III Scale of Infant and Toddler Development (BSID-III) and the Alberta Infant Motor Scale (AIMS) were used to assess motor development. RESULTS We evaluated 756 mothers and their three-month-old babies. The overall mean motor development assessed by the BSID-III and the AIMS was 104.7 (SD 13.5) and 55.4 (SD 25.4), respectively. When assessed by the BSID-III, the lowest motor development scores were among babies born by cesarean delivery (p = 0.002), prematurely (p < 0.001), and with low birth weight (p < 0.001). When assessed by the AIMS, babies born prematurely (p = 0.002) and with low birth weight (p=0.004) had the lowest motor development means. After a cluster analysis, we found that babies born by cesarean delivery, with low birth weight, and prematurely had more impaired motor development compared with children born without any risk factors. CONCLUSION Identifying risk factors allows the implementation of early interventions to prevent motor development delay and, therefore, reduce the probability of other future problems.

Neonatal tension pneumothorax is life-threatening. A tension pneumothorax on the right side was detected on a newborn boy weighing 2,380 g, who was born at 35 weeks of gestation. Given the unavailability of an on-duty thoracic surgeon and appropriately sized chest tubes in the neonatal intensive care unit, an emergency physician performed closed thoracostomy using two 7-French latex catheters. Immediately after the re-expansion of the right lung, left tension pneumothorax was newly detected. Two more 7-French latex catheters were inserted, relieving the left lesion. We consider that the right pneumothorax occurred due to the mixture of spontaneous rupture of the subpleural blebs and barotrauma during the initial positive pressure ventilation, while the left lesion did due to the high-flow oscillatory ventilation. Despite the limited availability of devices in the present case, a favorable outcome was achieved by the use of alternative catheters, which were chosen by the emergency physician.

ABSTRACT Introduction: Kidney problems may be due to low birth weight alone or may occur in association with other conditions. The objective this study was to evaluate the association between maternal and birth characteristics, anthropometric measurements, and kidney function deficit in low birth weight infants. Methods: Cross-sectional study with children who were born weighing < 2500 grams and were under outpatient follow-up. Maternal factors investigated were prenatal care and presence of hypertension, diabetes, and infection during pregnancy. The children’s variables were sex, gestational age, birth weight, Apgar score, use of nephrotoxic medications, age, body weight at the time of evaluation, height, and serum creatinine and cystatin C dosages. The glomerular filtration rate (GFR) was estimated with the combined Zapittelli equation. Multivariate logistic regression model was used for identification of associated factors, with renal function deficit (GFR < 60 mL/min/1.73 m2) as the dependent variable. Results: Of the 154 children evaluated, 34.42% had kidney function deficit. Most of them had a gestational age > 32 weeks (56.6%), a mean birth weight of 1439.7 grams, and mean estimated GFR of 46.9 ± 9.3 mL/min/1.73 m2. There was a significant association of GFR < 60 mL/min/1.73 m2 with children’s current weight and use of nephrotoxic drugs. Discussion: Children born with low birth weight had a high prevalence of kidney function deficit and current normal weight was a protective factor while the use of nephrotoxic drugs during perinatal period increased the chance of kidney deficit. These findings reinforce the need to evaluate the kidney function in these children, especially those who use nephrotoxic drugs.

Objective: To describe the beginning, duration, location and who makes skin-to-skin contact in Brazilian neonatal units. Methods: This is a descriptive, longitudinal multicenter study, carried out from May 2018 to March 2020, in five reference neonatal units for Kangaroo Mother Care in Brazil, which included newborns weighing up to 1,800 grams. Maternal and newborn characteristics were collected from medical records and interviews. Skin-to-skin contact was recorded on cards attached to the bed, filled in by the team and fathers. Analysis occurred through descriptive statistics. Results: We included 405 newborns, 51.4% male, median gestational age of 31.4 weeks and birth weight of 1,412 grams. Regarding skin-to-skin contact time, the median daily contact frequency was 1.5 times (IQR: 1.2 - 2.4), the time/day was 147 min/day (IQR: 106.7 - 263.0) and the first contact at five days of life (IQR:4.0-8.0). The longest contact time/day was performed by mothers, with a median of 137.8 minutes per day (IQR:95.6-232.1), and the second stage of kangaroo Mother Care, kangaroo Intermediate Care Unit, was the place where contact was performed for the longest time, with a median of 184.4 minutes per day (IQR:124.7-455.4). Conclusion: In the units assessed, skin-to-skin contact is practiced intermittently, a few times a day, predominantly by mothers and with longer exposure time in the second stage. It is necessary to seek ways that allow more encounters between mother/father-child and that gives conditions of greater permanence of fathers in the hospital. [ABSTRACT FROM AUTHOR]

Objective. To estimate the point prevalence and likely ranges of pregnancy-induced hypertension, preeclampsia, gestational diabetes, low birth weight and preterm delivery in Latin America and the Caribbean, and evaluate the heterogeneity of the estimates. Methods. We conducted a systematic review and meta-analysis of observational studies reporting the prevalence of maternal and perinatal adverse outcomes in populations in Latin American and the Caribbean published between 2000 and 2019 in English, Spanish, or Portuguese. We searched PubMed, Embase, and LILACS. We estimated the point prevalence and evaluated overall heterogeneity and, in sub-group analyses, heterogeneity by study design and level of bias. Results. Of 1087 records retrieved, 50 articles were included in the review: two on hypertensive disorders of pregnancy, 14 on pre-eclampsia, six on gestational diabetes, nine on low birth weight and 19 on preterm birth. No meta-analysis for hypertensive disorders of pregnancy could be done because of the small number of studies. Point prevalence estimates and 95% confidence intervals (CIs) for pre-eclampsia, gestational diabetes, low birth weight, and preterm birth were: 6.6% (95% CI: 4.9%, 8.6%), 8.5% (95% CI: 3.9%, 14.7%), 8.5% (95% CI: 7.2%, 9.8%), and 10.0% (95% CI: 8.0%, 12.0%), respectively. We observed substantial heterogeneity overall and by study design. No major differences in estimates were observed by level of bias. Conclusions. The results of this study provide updated estimates of some of the most prevalent adverse pregnancy and perinatal outcomes in Latin America and the Caribbean. They highlight that important heterogeneity exists in prevalence estimates, which may reflect the diversity of populations in the region.

Objective: To evaluate the effectiveness of kangaroo mother care (KMC) in reducing the length of hospital stay of preterm and/or low birth weight infants. Source: Cochrane Library, Pubmed, Embase, LILACS, and Scielo. Randomized clinical trials without time or language limit were included. The intervention was the KMC in preterm and/or low birth weight infants born in health facilities compared to conventional care. The article selection was performed by a pair of reviewers independently. The methodological quality assessment was performed using the tool Risk of Bias 2. Summary of the findings: Eight hundred and sixty-four citations were identified and 12 were selected for data extraction. There was a reduction in the length of hospital stay in days in the KMC group compared to the conventional care group, with a statistically significant difference (MD -1.75, 95% CI -3.22 to -0.28). The subgroup that underwent the intervention for more than six hours daily did not show a statistical difference for the length of hospital stay outcome (MD -0.79, 95% CI -2.52 to 0.90), while the subgroup that underwent the intervention for less than six hours daily showed a reduction in this outcome with a statistically significant difference (MD -4.66, 95% CI -7.15 to -2.17). Conclusions: KMC is a safe and low-cost intervention that has been shown to be effective in reducing the length of hospital stay of preterm and/or low birth weight infants.

Background: The morbidity and mortality rates of neonatal sepsis are high, with significant differences in risk factors and disease burden observed between developing and developed countries., Objective: To provide evidence to support recommendations on improving public health policies using a comparative systematic analysis of the disease burden., Methods: Using data from the Global Burden of Disease Study 2019, the prevalence and incidence of early- and late-onset neonatal sepsis and the disability-adjusted life years (DALYs) due to both countries in both China and the United States of America (USA) were assessed. Furthermore, the DALYs and summary exposure values for the primary risk factors (short gestation and low birthweight) were analysed. Joinpoint regression models were used to analyse temporal trends in epidemiological indicators of neonatal sepsis., Results: Between 1990 and 2019, the incidence and prevalence of neonatal sepsis demonstrated a significant upwards trend in China, whereas both were largely stable in the USA. A decreasing trend in the DALYs due to neonatal sepsis caused by short gestation and low birthweight in both sexes was observed in both countries, whereas a fluctuating increasing trend in years lived with disability was observed in China., Conclusions: The aim of the Chinese public health policy should be to control risk factors, learning from the advanced health policy planning and perinatal management experiences of developed countries.

Background: Homemade peanut oil is widely consumed in rural areas of Southwestern China, which is easily contaminated by aflatoxins (AFs) and associated with adverse birth outcomes., Objective: To identify the effect of exposure to homemade peanut oil consumption on low birth weight (LBW), preterm birth (PB) and other associated factors., Methods: A prospective cohort study was conducted among pregnant women in Guangxi province, Southwestern China. Information of all eligible women on homemade peanut oil consumption and potential factors associated with LBW and PB was collected, and all were followed up until delivery. The effect of homemade peanut oil exposure was analyzed using multiple logistic regression models using the directed acyclic graph (DAG) approach., Results: Of 1611 pregnant women, 1316 (81.7%) had consumed homemade peanut oil, and the rates of LBW and PB were 9.7% and 10.0%, respectively. Increased risks of LBW and PB in women with homemade peanut oil consumption were found with aORs of 1.9 (95% CI 1.1-3.2) and 1.8 (95% CI 1.1-3.0), respectively. Women with a history of PB or LBW were 3-5 times more likely to have higher rates of LBW or PB compared with those without this type of history. The odds of PB were approximately double in those taking medicine during pregnancy. Advanced maternal age, lack of physical exercise during pregnancy, passive smoking, or pregnancy complications were also more likely to have a higher risk of LBW., Conclusions: Homemade peanut oil consumption was a potential risk factor for both LBW and PB, of which health authorities who are responsible for food safety of the country should pay more attention to providing recommendation for oil consumption during pregnancy.

Introduction: Adverse perinatal outcomes (APO) pose a significant global challenge, particularly in low- and middle-income countries (LMICs). This study aims to analyse two cohorts of high-risk pregnant women for APO to comprehend risk factors and improve prediction accuracy., Methods: We considered an LMIC and a high-income country (HIC) population to derive XGBoost classifiers to predict low birth weight (LBW) from a comprehensive set of maternal and fetal characteristics including socio-demographic, past and current pregnancy information, fetal biometry and fetoplacental Doppler measurements. Data were sourced from the FeDoC (Fetal Doppler Collaborative) study (Pakistan, LMIC) and theIMPACT (Improving Mothers for a Better PrenAtal Care Trial) study (Spain, HIC), and included 520 and 746 pregnancies assessed from 28 weeks gestation, respectively. The models were trained on varying subsets of the mentioned characteristics to evaluate their contribution in predicting LBW cases. For external validation, and to highlight potential differential risk factors for LBW, we investigated the generalisation of these models across cohorts. Models' performance was evaluated through the area under the curve (AUC), and their interpretability was assessed using SHapley Additive exPlanations., Results: In FeDoC, Doppler variables demonstrated the highest value at predicting LBW compared with biometry and maternal clinical data (AUC Doppler , 0.67; AUC Clinical , 0.65; AUC Biometry , 0.63), and its combination with maternal clinical data yielded the best prediction (AUC Clinical+Doppler , 0.71). In IMPACT, fetal biometry emerged as the most predictive set (AUC Biometry , 0.75; AUC Doppler , 0.70; AUC Clinical , 0.69) and its combination with Doppler and maternal clinical data achieved the highest accuracy (AUC Clinical+Biometry+Doppler , 0.81). External validation consistently indicated that biometry combined with Doppler data yielded the best prediction., Conclusions: Our findings provide new insights into the predictive role of different clinical and ultrasound descriptors in two populations at high risk for APO, highlighting that different approaches are required for different populations. However, Doppler data improves prediction capabilities in both settings, underscoring the value of standardising ultrasound data acquisition, as practiced in HIC, to enhance LBW prediction in LMIC. This alignment contributes to bridging the health equity gap., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Maternal ambient fine particulate matter (PM 2.5 ) has been linked with fetal low birthweight (LBW), while national causal evidence is limited, particularly in low- and middle-income countries., Methods: We used nationwide registry-based birth records of 3839531 singleton livebirths, with maternal age (MA) between 15 and 49 years, across 31 provinces in Iran from 2013 through 2018. Monthly gridded concentrations of ambient PM 2.5 during entire pregnancy were estimated through validated spatiotemporal models. We adopted traditional logistic/linear regression and double robust model (DRM) based on generalized propensity scores (GPS) to evaluate associations of maternal PM 2.5 exposure with LBW risk and birthweight change. MA-specific exposure-response functions were investigated using restricted cubic splines in both traditional and casual inference models. PM 2.5 -attributable LBW burden were parallelly estimated, under the scenarios of achieving counterfactual exposure levels of multiple WHO interim targets., Results: A total of 228655 LBW births were identified, and mean birthweight of was 3187 g. Both traditional and causal modelling approaches yielded consistently positive associations of maternal PM 2.5 exposure with increased LBW risk and reduced birthweight, but marginally larger effect estimates were seen under GPS-based DRM analyses. Specifically, a 10-μg/m 3 increase in ambient PM 2.5 during the entire pregnancy was associated with the odds of 1.071 (95% confidence interval: 1.066, 1.076) for LBW and reduced birthweight of 8.9 (8.4, 9.4) g in GPS-based DRM analysis. MA-stratified analyses suggested non-linear exposure-response relationships of PM 2.5 exposure with both LBW (P nonlinear <0.001) risk and birthweight change (P nonlinear <0.001) over the exposure range of 17-104 μg/m 3 , with notably steeper slopes at low concentrations (<37.3 μg/m 3 ). According to GPS-based DRM analysis, achieving the interim target level 1-3 of annual PM 2.5 (i.e., 35, 25, and 15 μg/m 3 ) could avoid 5.5%-32.6% of overall LBW infants and birthweight loss of 7.0-57.6 g per livebirth during 2013-2018 in Iran., Conclusions: Our findings provided nationwide evidence of causality for elevated LBW risk and birthweight loss associated with maternal PM 2.5 exposure in Iran. Improving air quality through multisectoral efforts may avoid dramatic LBW burden to promote neonatal health later in life., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Hugely concerning changes to health outcomes have been observed in the UK since the early 2010s, including reductions in life expectancy and widening of inequalities. These have been attributed to UK Government 'austerity' policies which have profoundly affected poorer populations. Studies in mainland Europe have shown associations between austerity and increases in adverse birth outcomes such as low birthweight (LBW). The aim here was to establish whether the period of UK austerity was also associated with higher risks of such outcomes. We analysed all live births in Scotland between 1981 and 2019 (n = 2.3 million), examining outcomes of LBW, preterm birth (PB) and small-for-gestational-age (SGA). Descriptive trend analyses, segmented regression (to identify changes in trends) and logistic regression modelling (to compare risk of outcomes between time periods) were undertaken, stratified by infant sex and quintiles of socioeconomic deprivation. There were marked increases in LBW and PB rates in the austerity period, particularly in the most deprived areas. However, rates of SGA decreased, suggesting prematurity as the main driver of LBW rather than intrauterine growth restriction. The regression analyses confirmed these results: trends in LBW and PB changed within 1-3 years of the period in which austerity was first implemented, and that period was associated with higher risk of such outcomes in adjusted models. The results add to the European evidence base of worsening birth outcomes associated with austerity-related economic adversity. The newly elected UK government needs to understand the causes of these changes, and the future implications for child and adult health., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Public Health Association.)

Background: The mitigation measures implemented to face the healthcare emergency brought by COVID 19 pandemic generated an increase in socioeconomic inequities in the most underprivileged population which is also the most threatened in their human rights. In Uruguay, this population is assisted in the public health care system. To analyze how these measures impacted on these mothers and their neonates we selected outcomes that most contributed to neonatal mortality., Objective: To analyze the incidence of Preterm Birth (PB), Intrauterine Growth Restriction (IUGR) and Low Birth Weight (LBW) in the public health care system in Uruguay, during the period of time in which the strictest measures were adopted to mitigate the COVID 19 pandemic in 2020 (para-pandemic period) compared to the same period in 2019 (pre-pandemic)., Methods: A retrospective, cross sectional, descriptive study was performed to compare PB, IUGR and LBW from 15 March to 30 September 2019 (before COVID 19 pandemic) to the same period of 2020 (when COVID 19 pandemic bloomed), in the public health care subsystem. The analysis was performed with data from the national perinatal database system (SIP)., Results: In 2020, a significative increase in PB, RR: 1.14 (CI 95%: 1.03-1.25), and in LBW, RR: 1.16 (CI 95% 1.02-1.33), was registered compared to 2019 (pre-pandemic period). IUGR also showed an increase, but without statistical significance (4.6% in 2019 vs 5.2% in 2020, RR 1.13 CI 95% 0.98-1.31). The compared groups showed no differences in the distribution of biological confounding variables that could explain the increase in incidence of the main outcomes., Conclusions: In the absence of other factors that could explain the results we consider that social crisis associated to the restrictive measures implemented in the country to dwindle the effect of the pandemic exacerbated the adverse conditions that affect the reproductive process for those underprivileged women assisted in the public sector, increasing PB and LBW. It is important to consider the future impact of these results on neonatal and infant mortality and to implement social measures to reduce the damage as soon as possible.

Objective: To assess the impact of low-dose aspirin (LDA) on obstetrical outcomes through a meta-analysis of placebo-controlled randomized controlled trials (RCTs)., Methods: A systematic search of the PubMed, Cochrane Library, Web of Science and Embase databases from inception to January 2024 was conducted to identify studies exploring the role of aspirin on pregnancy, reporting obstetrical-related outcomes, including preterm birth (PTB, gestational age <37 weeks), small for gestational age (SGA), low birth weight (LBW, birthweight < 2500g), perinatal death (PND), admission to the neonatal intensive care unit (NICU), 5-min Apgar score < 7 and placental abruption. Relative risks (RRs) were estimated for the combined outcomes. Subgroup analyses were performed by risk for preeclampsia (PE), LDA dosage (<100 mg vs. ≥100 mg) and timing of onset (≤20 weeks vs. >20 weeks)., Results: Forty-seven studies involving 59,124 participants were included. Compared with placebo, LDA had a more significant effect on low-risk events such as SGA, PTB and LBW. Specifically, LDA significantly reduced the risk of SGA (RR = 0.91, 95% CI: 0.87-0.95), PTB (RR = 0.93, 95% CI: 0.89-0.97) and LBW (RR = 0.94, 95% CI: 0.89-0.99). For high-risk events, LDA significantly lowered the risk of NICU admission (RR = 0.93, 95% CI: 0.87-0.99). On the other hand, LDA can significantly increase the risk of placental abruption (RR = 1.72, 95% CI: 1.23-2.43). Subgroup analyses showed that LDA significantly reduced the risk of SGA (RR = 0.86, 95% CI: 0.77-0.97), PTB (RR = 0.93, 95% CI: 0.88-0.98) and PND (RR = 0.65, 95% CI: 0.48-0.88) in pregnant women at high risk of PE, whereas in healthy pregnant women LDA did not significantly improve obstetrical outcomes, but instead significantly increased the risk of placental abruption (RR = 5.56, 95% CI: 1.92-16.11). In pregnant women at high risk of PE, LDA administered at doses ≥100 mg significantly reduced the risk of SGA (RR = 0.77, 95% CI: 0.66-0.91) and PTB (RR = 0.56, 95% CI: 0.32-0.97), but did not have a statistically significant effect on reducing the risk of NICU, PND and LBW. LDA started at ≤20 weeks significantly reduced the risk of SGA (RR = 0.76, 95% CI: 0.65-0.89) and PTB (RR = 0.56, 95% CI: 0.32-0.97)., Conclusions: To sum up, LDA significantly improved neonatal outcomes in pregnant women at high risk of PE without elevating the risk of placental abruption. These findings support LDA's clinical application in pregnant women, although further research is needed to refine dosage and timing recommendations.

Aim: This Mendelian randomisation (MR) study endeavoured to delineate the causal relationship between periodontitis and adverse pregnancy outcomes (APOs), encompassing low birthweight (LBW), pre-term birth (PTB), stillbirth, miscarriage, and gestational hypertension (GH)., Methods: Utilising genetic instruments for periodontitis (acute and chronic periodontitis) from the Genome-Wide Association Study (GWAS) database among individuals of European descent, this study explored the causal relationship with adverse pregnancy outcomes, and vice versa. The Inverse Variance Weighted (IVW) method was employed as the primary analytical approach to assess causality, with MR-Egger serving as a sensitivity analysis method., Results: The primary analytical method employed in this study, IVW, did not reveal any impact of periodontitis (acute and chronic periodontitis) on PTB, stillbirth, miscarriage, and gestational hypertension, and vice versa. Heterogeneity testing using the MR-Egger method confirmed the null causal hypothesis, with odds ratios (OR) approximating 1, and P-values exceeding 0.05. Notably, the results from the IVW analysis (OR 1.410, CI 1.039-1.915, P-value 0.028) indicate statistically significant evidence supporting a causal relationship between chronic periodontitis and LBW. However, caution is advised in interpreting the causal relationship, considering the non-significant P-values obtained from other methods., Conclusion: Within the limitations of this MR study, the findings do not support the influence of periodontitis on LBW, PTB, stillbirth, miscarriage, and GH, nor vice versa., Competing Interests: Conflict of interest None disclosed., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background and Aims: Low birth weight (LBW), known as the condition of a newborn weighing less than 2500 g, is a growing concern in the United States (US). Previous studies have identified several contributing factors, but many have analyzed these variables in isolation, limiting their ability to capture the combined influence of multiple factors. Moreover, past research has predominantly focused on maternal health, demographics, and socioeconomic conditions, often neglecting paternal factors such as age, educational level, and ethnicity. Additionally, most studies have utilized localized datasets, which may not reflect the diversity of the US population. To address these gaps, this study leverages machine learning to analyze the 2022 Centers for Disease Control and Prevention's National Natality Dataset, identifying the most significant factors contributing to LBW across the US., Methods: We combined anthropometric, socioeconomic, maternal, and paternal factors to train logistic regression, random forest, XGBoost, conditional inference tree, and attention mechanism models to predict LBW and normal birth weight (NBW) outcomes. These models were interpreted using odds ratio analysis, feature importance, partial dependence plots (PDP), and Shapley Additive Explanations (SHAP) to identify the factors most strongly associated with LBW., Results: Across all five models, the most consistently associated factors with birth weight were maternal height, pre-pregnancy weight, weight gain during pregnancy, and parental ethnicity. Other pregnancy-related factors, such as prenatal visits and avoiding smoking, also significantly influenced birth weight., Conclusion: The relevance of maternal anthropometric factors, pregnancy weight gain, and parental ethnicity can help explain the current differences in LBW and NBW rates among various ethnic groups in the US. Ethnicities with shorter average statures, such as Asians and Hispanics, are more likely to have newborns below the World Health Organization's 2500-gram threshold. Additionally, ethnic groups with historical challenges in accessing nutrition and perinatal care face a higher risk of delivering LBW infants., Competing Interests: Declarations. Ethics approval and consent to participate: All experiments were performed according to relevant guidelines and regulations (such as the Declaration of Helsinki). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Prematurity and low birth weight (LBW) are the main causes of neonatal mortality in South Africa (SA). Home visits by lay health workers (LHWs) may be effective in addressing this., Aim: To inform a national guideline on LHW home visits as part of the Global Evidence, Local Adaptation (GELA) project, we conducted a rapid qualitative evidence synthesis exploring the acceptability, feasibility and equitability of this intervention for preterm and LBW babies., Setting: We included studies conducted in SA., Methods: We searched PubMed and Embase until 15 September 2023 and identified eligible studies independently and in duplicate. We synthesised evidence using thematic analysis, assessed study quality using an adaptation of the Critical Appraisal Skills Programme tool and assessed confidence in the review findings using GRADE-CERQual., Results: The 16 eligible studies included diverse settings and populations in SA. Factors facilitating mothers' acceptance included the knowledge and skills gained, the psychosocial support offered and improved healthcare access and relationships with facility staff. Distrust in LHWs and stigma associated with home visits were barriers to acceptance. Lay health workers' acceptance was facilitated by them feeling empowered. The emotional burden of home visits for LHWs, coupled with insufficient training and support, undermined the feasibility of home visits., Conclusion: A complex range of interacting contextual factors may impact on the implementation of home visit programmes for preterm and LBW infants in SA., Contribution: This country profile provides insights into how home visits for preterm and LBW infants in SA might be contextually tailored to increase local relevance and in turn effectiveness, with potential relevance for other African countries., Competing Interests: Competing interests The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Objectives: We elucidate the impact of the coronavirus disease 2019 (COVID-19) pandemic on assisted reproductive technology (ART) services and birth outcomes and establish an evidence-based framework to maintain the high quality of ART healthcare services and ensure continuous improvement of birth outcomes., Methods: A total of 19,170 pregnant women from Sichuan, Guizhou and Chongqing in Southwest China between 2018 and 2021 were included in this study. The log-binomial regression model was employed to analyse the changes in the probability of adverse birth outcomes, such as low birth weight (LBW), preterm birth (PTB), Apgar score < 7 at 1 min and congenital anomalies (CAs) and their relationship with ART before and after the pandemic. In this analysis, confounding factors such as family annual income, maternal ethnicity, delivery age, subjective prenatal health status, vitamin or mineral supplementation during pregnancy and level of prenatal care provided by the hospital were controlled., Results: ART mothers had the highest probability of giving birth to LBW babies (relative risk (RR): 2.82, 95% confidence interval (CI): 2.32-3.41), experiencing PTB (RR: 2.72, 95% CI: 2.78-3.22) and delivering babies with an Apgar score < 7 at 1 min (RR: 1.73, 95% CI: 1.05-2.69). Before the pandemic, the ART rate increased from 4.42% in 2018 to 6.71% in 2019 (rate difference of 2.29%, P < 0.001). After the pandemic, the ART rate decreased from 6.71% in 2019 to 6.55% in 2020 (rate difference of - 0.16%, P = 0.752). Compared with the pre-pandemic period, the rate difference for LBW decreased from - 0.21% (P = 0.646) in 2018-2019 to an increase of + 0.89% (P = 0.030) in 2019-2020. Similarly, PTB showed an increase in rate difference from + 0.20% (P = 0.623) before the pandemic to + 0.53% (P = 0.256) afterwards. Apgar score < 7 at 1 min had a negative rate difference of - 0.50% (P = 0.012), which changed to a positive value of + 0.20% (P = 0.340). For CAs, the rate difference increased from + 0.34% (P = 0.089) prior to the outbreak to + 0.59% (P = 0.102) at post-outbreak. In 2018 (pre-pandemic), ART was the most significant predictor of LBW, exhibiting an RR of 3.45 (95% CI: 2.57-4.53). Furthermore, in 2020, its RR was 2.49 (95% CI: 1.78-3.42). Prior to the onset of the pandemic (2018), ART (RR: 3.17, 95% CI: 2.42-4.08) was the most robust predictor of PTB. In 2020, its RR was 2.23 (95% CI: 1.65-2.97)., Conclusion: ART services have been significantly impacted by the COVID-19 pandemic, and the resulting delays in ART services have had notable implications for maternal birth outcomes., Competing Interests: Declarations Ethics approval and consent to participate Ethics approval can be seen in the article “Cohort Profile: China Southwest Birth Cohort (CSBC)”. Informed consent was obtained from all participants. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Previous research has proposed that exposure to polycyclic aromatic hydrocarbons (PAHs) during pregnancy could potentially lead to a higher risk of adverse birth anthropometric outcomes. However, the current evidence on this connection remains inconclusive, as various studies have presented conflicting results., Objective: This systematic review and meta-analysis seeks to synthesize the available research on the potential link between maternal PAHs exposure and birth anthropometric outcomes., Methods: A comprehensive search of Scopus, PubMed/MEDLINE, Web of Science, and the Cochrane Library up to July 1, 2024, was conducted to identify studies investigating the impact of maternal PAHs exposure during pregnancy on birth anthropometric measures, including small gestational age (SGA), low birth weight (LBW), birth weight (BW), birth length (BL), birth head circumference (BHC), and birth chest circumference (BCC). Quality assessment was performed using the Newcastle-Ottawa Scale (NOS) and the GRADE framework, and a random-effects meta-analysis was conducted to consolidate association estimates., Results: Out of 5499 articles initially screened, 27 studies were included in the review. The meta-analysis revealed no significant association between maternal PAHs exposure and LBW (OR: 1.02, 95 % CI: 0.96-1.08), with moderate heterogeneity (I²: 25.8 %, P=0.37). Notably, PAHs exposure was significantly associated with BW (β: -9.79 g, 95 % CI: -16.71 to -2.87), along with high heterogeneity (I²: 99.9 %, P<0.001), and shorter BL (β: -0.04 cm, 95 % CI: -0.07 to -0.01), also with high heterogeneity (I²: 84.3 %, P<0.001). Additionally, a borderline significant decrease in BHC was observed (β: -0.01 cm, 95 % CI: -0.02 to -0.00) with no significant heterogeneity among studies. The results SGA were inconsistent across the studies., Conclusion: Maternal exposure to PAHs was associated with adverse birth anthropometric outcomes, particularly lower BW and BL. The borderline significant reduction in BHC suggests a potential impact worth further investigation, although this finding remains inconclusive and not yet actionable. Results for SGA varied significantly among studies, underscoring the complexity of these associations. Collectively, these findings highlight the necessity for additional research to elucidate the effects of specific PAH metabolites on birth anthropometric outcomes and to explore potential interventions aimed at mitigating the identified risks., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Air pollution is a significant global public health concern. However, there is a lack of updated and comprehensive evidence regarding the association between exposure to ambient air pollution and adverse birth outcomes (preterm birth, low birth weight, and stillbirth). Furthermore, the existing evidence is highly inconsistent. Therefore, this study aims to estimate the overall association between ambient air pollution and adverse birth outcomes., Methods: In this study, initially a total of 79,356 articles were identified. Finally, a total of 49 articles were included. We conducted compressive literature searches using various databases, including PubMed, Scientific Direct, HINARI , and Google Scholar. Data extraction was performed using Microsoft Excel, and the data were exported to STATA 17 software for analysis. We used the Joanna Briggs Institute's quality appraisal tool to ensure the quality of the included studies. A random effects model was employed to estimate the pooled prevalence. Publication bias was assessed using funnel plots and Egger's regression test., Results: In this study, the pooled prevalence of at least one adverse birth outcome was 7.69% (95% CI: 6.70-8.69), with high heterogeneity ( I 2  = 100%, p-value  < 0.001). In this meta-analysis, high pooled prevalence was found in preterm birth (6.36%), followed by low birth weights (5.07%) and stillbirth (0.61%). Exposure to PM 2.5 (≤10 μg/m 3 ) throughout the entire pregnancy, PM 2.5 (≤10 μg/m 3 ) in the first trimester, PM 10 (>10 μg/m 3 ) during the entire pregnancy, and O 3 (≤10 μg/m 3 ) during the entire pregnancy increased the risk of preterm birth by 4% (OR = 1.04, 95% CI: 1.03-1.05), 5% (OR = 1.05, 95% CI: 1.01-1.09), 49% (OR = 1.49, 95% CI: 1.41-1.56), and 5% (OR = 1.05, 95% CI: 1.04-1.07), respectively. For low birth weight, exposure to PM 2.5 (≤10 μg/m 3 ) and PM 2.5 (>10 μg/m 3 ) throughout the entire pregnancy was associated with an increased risk of 13% (OR = 1.13, 95% CI: 1.05-1.21) and 28% (OR = 1.28, 95% CI: 1.23-1.33), respectively., Conclusion: This study highlighted a significant association between ambient air pollution and adverse birth outcomes. Therefore, it is crucial to implement a compressive public health intervention., Systematic Review Registration: The review protocol was registered with the record ID of CRD42024578630., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Desye, Berihun, Geto, Berhanu and Daba.)

Background: Antenatal care (ANC) plays a crucial role in ensuring maternal and child safety and reducing adverse delivery outcomes. This study aimed to analyze the association between the quality of ANC and the occurrence of preterm birth and low birth weight in a sample of the population from 16 regions in 8 provinces in China., Methods: Data from all closed cases of pregnant women and newborns reported in the Maternal and Child Health Monitoring System from January 1, 2018, to December 31, 2018, in 16 monitoring regions across 8 provinces in China were collected and included in the analysis, resulting in a total of 49,084 pregnant women and 49,026 newborns., Results: The mean number of ANC visits was 6.95 ± 3.45. By percentage, 78.79% of the women received ANC examinations at least five times. The percentage of normative ANC examinations and the percentage of qualified ANC examinations was 30.98% and 8.0% respectively. The gestational age(χ 2  = 229.305, p<0.001), birth weight (χ 2  = 171.990, p<0.001) and the occurrence of neonatal complications (χ 2  = 53.112, p<0.001) were all significantly related to the number of ANC visits to mothers. There was a correlation between gestational age (χ 2  = 1021.362, p<0.001;χ 2  = 194.931, p<0.001) and birth weight (χ 2  = 259.009, p<0.001; χ 2  = 70.042, p<0.001) with normative ANC and qualified ANC examinations. As the number of ANC examinations increased, the rates of preterm birth and low birth weight decreased. Pregnant women who did not receive normative ANC examinations had a higher risk of preterm birth and neonatal low birth weight compared to those who did; Adjusted Odds Ratio (95%CI) was 23.33(16.97~32.07)and 1.61(1.37~1.90) respectively. Pregnant women who did not receive qualified ANC examinations had a higher risk of preterm birth and neonatal low birth weight compared to those who did; Adjusted Odds Ratio (95%CI) was 15.05(8.45~26.79)and 1.36 (1.02~1.82) respectively., Conclusion: The percentage of women who received normative ANC examination and qualified ANC examination is still low in China, and the quality of antenatal care significantly affects the occurrence of preterm birth and low birth weight in newborns., Competing Interests: Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki and was undertaken following all relevant guidelines and regulations. The study was approved and exempt from informed consent by the Ethics Committee for Human Subjects Studies of the National Center for Women and Children’s Health, Chinese Center for Disease Control and Prevention (FY2015- 007). The informed consent forms were waived because that all the information in the study was collected from Maternal and Child Care Handbook written by doctors in place of collecting data face-to-face with the objects, and the data we used did not identify individuals. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: There is still controversy over the association between newborns with different birth characteristics and colorectal cancer (CRC) in adulthood. We plan to use systematic reviews and meta-analysis to elucidate this relationship., Methods: Pubmed, Web of Science, EBSCO, and Medline databases were searched for published literature on the impact of birth characteristics on the incidence of CRC until Feb 2024, 1065 articles were included in total and necessary data were extracted for systematic reviews and meta-analysis., Results: Ten studies from multiple countries or regions were included. Compared with normal weight, the prevalence of adult CRC in infants with high birth weight (OR = 0.99, 95%CI: 0.92-1.06) and low birth weight (OR = 0.95, 95%CI: 0.89-1.03) did not increase significantly. Infants for every 1 kg increase in birth weight, the incidence of adult CRC increases by 3% (95%CI: -1-8%). For male infants, shorter body length (OR = 1.9, 95%CI: 1.0-3.7) and lighter weight of the placenta (OR = 1.6, 95%CI: 1.0-2.7) indicates that fetal growth restriction is a risk factor for the onset of colorectal cancer. Further epidemiological investigations are needed to verify the association between other birth characteristics and the incidence of colorectal cancer., Conclusion: Babies with abnormal birth length, placental weight, and maternal age often suggest growth restriction, which is related to the incidence of adult CRC., (© 2024. The Author(s).)

Background: The effect of treating periodontal disease (PD) during pregnancy on adverse birth outcomes, such as preterm birth (PTB) and/or low birth weight (LBW), remains unclear. This is partially due to the fact that Randomized Controlled Trials (RCTs) have used different combinations of treatment approaches to test this hypothesis. In this meta-analysis of RCTs, we assessed the impact of treating PD during pregnancy with scaling and root planning (SRP) and mouthwash use on PTB and LBW., Methods: A systematic review with meta-analysis was conducted following PRISMA guidelines. A comprehensive search strategy was employed across electronic databases, including PubMed/Medline, Embase, and Google Scholar. Quality assessment was performed using the Cochrane Risk of Bias 2 Tool. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effect models., Results: Out of 133 initially identified reports, 9 RCTs involving 3,985 pregnant women met the inclusion criteria. Periodontal treatment with SRP and mouthwash use in pregnancy was associated with a lower risk of PTB and LBW in meta-analysis with random effects models (pooled RR for PTB = 0.44, 95% CI: 0.22-0.88) and (pooled RR for LBW = 0.33, 95% CI: 0.13-0.84). Substantial heterogeneity was observed among studies (I 2  = 91% and 90% for PTB and LBW, respectively), with sensitivity analysis suggesting potential sources of heterogeneity. Funnel plot assessment for publication bias showed evidence of asymmetry., Conclusion: SRP with mouthwash use during pregnancy were associated with significantly lower risks of PTB and LBW. Larger, well-conducted RCTs are warranted to address this issue, as existing trials are small and exhibit methodological and statistical heterogeneity., (© 2024. The Author(s).)

Background: Aflatoxins are various poisonous carcinogens and mutagens produced by Aspergillus species. Exposure to aflatoxins during pregnancy results in adverse birth outcomes. This meta-analysis was carried out to determine the estimates of how much aflatoxin is harmful to the pregnancy and its outcome, including birthweight, birth length, low birthweight (LBW), small for gestational age (SGA), stunting, poverty, food insecurity, income, pesticides and stillbirth, in an African context., Methods: Both published and unpublished studies in Africa were searched on MEDLINE, PubMed, Embase, SCOPUS, Web of Science and Google Scholar. Stata version 18.2 software was used for cleaning and analysis. The prevalence with a 95% confidence interval (CI) was estimated using the random effects model and a forest plot was used to present the findings. In addition, the heterogeneity of the study was assessed using Cochrane I2 statistics and publication bias was assessed using Egger's intercept and funnel plot., Results: This review included 28 studies with a total of 6283 pregnant women and newborns. The analysis showed the overall level of exposure to aflatoxins was 64% (95% CI 48 to 78, τ2=0.66, I2=99.34%, p=0.001). In the subgroup analysis by publication year, the highest level of exposure to aflatoxins (82% [95% CI 69 to 92]) was observed among studies published from 2020 to 2023. This study also found that exposure to aflatoxins during pregnancy had an association with prematurity, LBW, SGA and stillbirth., Conclusions: The data analysed in this study indicated that three of every five pregnant women had exposure to aflatoxins in Africa. Moreover, pregnant women exposed to aflatoxins had a higher likelihood of having a LBW and SGA newborn. Thus governments and all stakeholders should initiate policies that mitigate the toxicity of aflatoxins in pregnant women, foetuses and newborns., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Astronomical Society of Japan.)

Objectives: To compare complications in neonates who had umbilical venous catheter (UVC) versus peripherally inserted central catheter (PICC), percentage of non-elective removal of central catheters, and to compare complications of PICC in the upper limb compared with the lower limb., Design: A prospective cross-sectional cohort study., Setting: Neonatal intensive care unit (NICU) in Prince Sultan Military Medical City in Riyadh, Saudi Arabia., Participants: All infants who are admitted to the unit requiring central catheter insertion were included in the study., Primary Outcome Measure: Complications of central catheters in infants admitted to the NICU., Results: A total of 415 central catheters were involved in this study (206 UVCs and 209 PICCs (85 in the lower limb, 99 in the upper limb and 25 in the head and neck). The median birth weight of the neonates was 1470 grams (1000-2215). Low birth weight was the most common reason for central catheter insertion, which accounted for 59.8%. Neonatologists were the main insertor for the majority of the cases. The median dwell days for the study sample were 11.00 (7.00-16.50) days. Complications were more common across PICC cases compared with UVC cases (p=0.001). There was non-elective removal of PICC (32.1%) compared with UVC (22.8%) (p=0.035). Phlebitis, occlusion, local infiltrate and leakage were more common in PICC compared with UVC (p<0.05). However, malposition was more commonly associated with the use of UVC (mainly to the liver) (p<0.01). Central line-associated bloodstream infection (CLABSI) rate in 1000.00 dwell days was higher in the upper limb 4.6 compared with the lower limb 2.72 but was not statistically significant (p=0.63), and there was no statistically significant difference in the proportion of other complications between the upper limb and the lower limb (p>0.05)., Conclusion: Close monitoring during extended dwell times is crucial. Our findings underscore the importance of raising awareness of CLABSI risk factors and adhering to best practices for central catheter maintenance. Healthcare professionals should be vigilant about the differences in complication rates between PICC and UVC, tailoring their approach accordingly., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Racially minoritized populations experience higher rates of adverse birth outcomes than White populations in the U.S. We estimated the mediating effect of neighborhood social and physical environments on disparities in adverse birth outcomes in California., Method: We used birthing parent's residential address for California live birth records from 2019 to estimate census block group Area Deprivation Index and census tract level measures of ambient fine particulate matter (PM2.5), drinking water contamination, tree canopy coverage, as a measure of greenspace, potential heat vulnerability, and noise. We performed mediation analysis to assess whether neighborhood factors explain racial/ethnic disparities in preterm birth (PTB) and term-birth low birth weight (TLBW) comparing Black, Latinx, and Asian with White births after controlling for individual-level factors., Results: Black, Latinx, and Asian parents had PTB rates that were 67%, 36%, and 11% higher, and TLBW rates that were 150%, 38%, and 81% higher than Whites. Neighborhood deprivation contributed 7% (95% CI: 3%, 11%) to the Black-White and 9% (95% CI: 6%, 12%) to the Latinx-White disparity in PTB, and 8% (95% CI: 3%, 12%) of the Black-White and 9% (95% CI: 5%, 15%) of the Latinx-White disparity in TLBW. Drinking water contamination contributed 2% (95% CI: 1%, 4%) to the Latinx-White disparity in PTB. Lack of greenspace accounted for 7% (95% CI: 2%, 10%) of the Latinx-White PTB disparity and 7% (95% CI: 3%, 12%) of the Asian-White PTB disparity. PM2.5 contributed 11% (95% CI: 5%, 18%), drinking water contamination contributed 3% (95% CI: 1%, 7%), and potential heat vulnerability contributed 2% (95% CI: 1%, 3%) to the Latinx-White TLBW disparity. Lack of green space contributed 3% (95% CI: 1%, 6%) to the Asian-White TLBW disparity., Conclusions: Our study suggests social environments explain portions of Black/Latinx-White disparities while physical environments explain Latinx/Asian-White disparities in PTB and TLBW., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

SARS-CoV-2 utilizes the angiotensin-converting enzyme 2 (ACE2) receptors located on membranes to enter host cells. Nevertheless, the ACE2 gene primarily encodes for a zinc metalloproteinase, which is a part of the renin-angiotensin system (RAS). ACE2 downregulation results in the deregulation of RAS in favor of pro-fibrosis, pro-apoptosis, oxidative stress, pro-inflammation, aldosterone production and release, and blood vessel contraction axis. ACE2 is highly expressed in the placenta. There are both axes of the RAS system in the placenta. This study aims to assess the perinatal outcomes with ACE2 receptor polymorphisms in pregnant women infected with SARS-CoV-2 during pregnancy. The case-control study was conducted to determine the association of ACE2 single-nucleotide polymorphisms in 171 COVID-19-positive pregnant subjects and 112 control subjects. The recessive mutations of rs2158082 and rs4830974 were associated with an increased risk of low birthweight and preterm birth, whereas the dominant mutation of rs2285666 (CT + TT) was associated with decreased odds of low birthweight. COVID-19 was not a significant factor contributing to the adverse perinatal outcomes in our sampling. These findings may help to clarify the controversy regarding the increased risk of adverse perinatal outcomes observed during COVID-19 as well as provide new perspectives for research on the genetic factors associated with a higher risk of adverse perinatal outcomes.

Background: Despite progress in reducing maternal and child mortality worldwide, adverse birth outcomes such as preterm birth, low birth weight (LBW), small for gestational age (SGA), and stillbirth continue to be a major global health challenge. Developing a prediction model for adverse birth outcomes allows for early risk detection and prevention strategies. In this systematic review, we aimed to assess the performance of existing prediction models for adverse birth outcomes and provide a comprehensive summary of their findings., Methods: We used the Population, Index prediction model, Comparator, Outcome, Timing, and Setting (PICOTS) approach to retrieve published studies from PubMed/MEDLINE, Scopus, CINAHL, Web of Science, African Journals Online, EMBASE, and Cochrane Library. We used WorldCat, Google, and Google Scholar to find the grey literature. We retrieved data before 1 March 2022. Data were extracted using CHecklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies. We assessed the risk of bias with the Prediction Model Risk of Bias Assessment tool. We descriptively reported the results in tables and graphs., Results: We included 115 prediction models with the following outcomes: composite adverse birth outcomes (n = 6), LBW (n = 17), SGA (n = 23), preterm birth (n = 71), and stillbirth (n = 9). The sample sizes ranged from composite adverse birth outcomes (n = 32-549), LBW (n = 97-27 233), SGA (n = 41-116 070), preterm birth (n = 31-15 883 784), and stillbirth (n = 180-76 629). Only nine studies were conducted on low- and middle-income countries. 10 studies were externally validated. Risk of bias varied across studies, in which high risk of bias was reported on prediction models for SGA (26.1%), stillbirth (77.8%), preterm birth (31%), LBW (23.5%), and composite adverse birth outcome (33.3%). The area under the receiver operating characteristics curve (AUROC) was the most used metric to describe model performance. The AUROC ranged from 0.51 to 0.83 in studies that reported predictive performance for preterm birth. The AUROC for predicting SGA, LBW, and stillbirth varied from 0.54 to 0.81, 0.60 to 0.84, and 0.65 to 0.72, respectively. Maternal clinical features were the most utilised prognostic markers for preterm and LBW prediction, while uterine artery pulsatility index was used for stillbirth and SGA prediction., Conclusions: A varied prognostic factors and heterogeneity between studies were found to predict adverse birth outcomes. Prediction models using consistent prognostic factors, external validation, and adaptation of future risk prediction models for adverse birth outcomes was recommended at different settings., Registration: PROSPERO CRD42021281725., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

Background: Maternal and child health is an important measure of national well-being. This study further explored the individual and combined effects of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on adverse birth weight-related outcomes., Methods: A retrospective study was carried out at a maternal and child health hospital from 2018 to 2021, and a total of 17,506 eligible women were invited to participate. The associations of pre-pregnancy BMI and GWG with adverse birth outcomes were examined by using restricted cubic spline regression and binary logistic regression., Results: Pre-pregnancy BMI and GWG had non-linear associations with low birth weight and macrosomia. They were associated with an increased risk of macrosomia (Pre-pregnancy BMI for OR = 1.170, 95%CI:1.144 to 1.197, P < 0.001, and GWG for OR = 1.071, 95%CI:1.054 to 1.089, P < 0.001) and large for gestational age infant (LGA) (Pre-pregnancy BMI for OR = 1.125, 95%CI:1.111 to 1.141, P < 0.001, and GWG for OR = 1.045, 95%CI:1.036 to 1.054, P < 0.001). The high risk of low birth weight and preterm birth was observed among the group of women with inadequate GWG. The risks of macrosomia and LGA increased with pre-pregnancy BMI from low weight to overweight and obesity, and GWG from inadequate to overabundance, while small for gestational age infant was more prevalent in the low pre-pregnancy BMI group., Conclusions: Pre-pregnancy BMI and GWG exhibited non-linear associations with low birth weight and macrosomia. The various combinations of pre-pregnancy BMI and GWG had different effects on adverse birth weight-related outcomes., (© 2024. The Author(s).)

Background and Aims: The birth weight of a newborn is a crucial factor that affects their overall health and future well-being. Low birth weight (LBW) is a widespread global issue, which the World Health Organization defines as weighing less than 2,500 g. LBW can have severe negative consequences on an individual's health, including neonatal mortality and various health concerns throughout their life. To address this problem, this study has been conducted using BDHS 2017-2018 data to uncover important aspects of LBW using a variety of machine learning (ML) approaches and to determine the best feature selection technique and best predictive ML model., Methods: To pick out the key features, the Boruta algorithm and wrapper method were used. Logistic Regression (LR) used as traditional method and several machine learning classifiers were then used, including, DT (Decision Tree), SVM (Support Vector Machine), NB (Naïve Bayes), RF (Random Forest), XGBoost (eXtreme Gradient Boosting), and AdaBoost (Adaptive Boosting), to determine the best model for predicting LBW. The model's performance was evaluated based on the specificity, sensitivity, accuracy, F1 score and AUC value., Results: Result shows, Boruta algorithm identifies eleven significant features including respondent's age, highest education level, educational attainment, wealth index, age at first birth, weight, height, BMI, age at first sexual intercourse, birth order number, and whether the child is a twin. Incorporating Boruta algorithm's significant features, the performance of traditional LR and ML methods including DT, SVM, NB, RF, XGBoost, and AB were evaluated where LR, had a specificity, sensitivity, accuracy and F1 score of 0.85, 0.5, 85.15% and 0.915. While the ML methods DT, SVM, NB, RF, XGBoost, and AB model's respective accuracy values were 85.35%, 85.15%, 84.54%, 81.18%, and 84.41%. Based on the specificity, sensitivity, accuracy, F1 score and AUC, RF (specificity = 0.99, sensitivity = 0.58, accuracy = 85.86%, F1 score = 0.9243, AUC = 0.549) outperformed the other methods. Both the classical (LR) and machine learning (ML) models' performance has improved dramatically when important characteristics are extracted using the wrapper method. The LR method identified five significant features with a specificity, sensitivity, accuracy and F1 score of 0.87, 0.33, 87.12% and 0.9309. The region, whether the infant is a twin, and cesarean delivery were the three key features discovered by the DT and RF models, which were implemented using the wrapper technique. All three models had the identical F1 score of 0.9318. However, "child is twin" was recognized as a significant feature by the SVM, NB, and AB models, with an F1 score of 0.9315. Ultimately, with an F1 score of 0.9315, the XGBoost model recognized "child is twin" and "age at first sex" as relevant features. Random Forest again beat the other approaches in this instance., Conclusions: The study reveals Wrapper method as the optimal feature selection technique. The ML method outperforms traditional methods, with Random Forest (RF) being the most effective predictive model for Low-Birth-Weight prediction. The study suggests that policymakers in Bangladesh can mitigate low birth weight newborns by considering identified risk factors., (© 2024. The Author(s).)

Background: Globally, every year, 20 million neonates are born with weights below 2500 g and are considered low birth weight (LBW). About 90% of these births occur in low- and middle-income countries. Information regarding the geographical variation, socioeconomic inequalities of LBW neonates, and the relationship between maternal inadequate dietary diversity and LBW is limited in rural areas of Bangladesh. We aimed to explore the geographical disparities and socioeconomic inequalities in the prevalence of LBW and its association with inadequate maternal dietary diversity., Methods: We extracted data from a large-scale evaluation programme conducted as a part of the maternal infant and young child nutrition phase two in Bangladesh, implemented by BRAC. We used the concentration index (CIX) to measure the socioeconomic inequalities of LBW. We performed a cluster-adjusted multiple logistic regression analysis to determine the association between LBW and maternal dietary diversity., Results: A total of 4651 children aged <5 years with their mother's information were included. The overall prevalence of LBW was 13.5%. About 16% of mothers living in the poorest wealth quintile gave birth to LBW babies, whereas 10% of mothers living in the richest households gave birth to LBW babies. The CIX exhibited LBW babies were more prevalent among the socioeconomically worst-off (poorest) group (CIX = -0.08), indicating mothers of the poorest households are vulnerable to giving birth to normal-weight babies. An adjusted multiple logistic regression model indicated that mothers with inadequate dietary diversity had higher odds (adjusted odds ratio (AOR) = 1.27; 95% confidence interval (CI) = 1.04, 1.54) of giving birth to LBW babies. Notably, in the interaction of mothers' age and dietary diversity, we found that adolescent mothers (aged ≤ 19 years) with inadequate dietary diversity had 2.56 times (AOR = 2.56; 95% CI = 1.14, 5.76) higher odds of giving birth to LBW babies compared to adult mothers (aged >19 years) who consumed diversified foods., Conclusions: Intervention strategies for reducing LBW prevalence should target the poorest households. Also, interventions for improving the dietary diversity of adolescent pregnant mothers are expected to reduce the number of LBW babies from the rural areas of Bangladesh., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

Aim: To explore the risk factors for low-birth-weight infants born to pregnant women with GDM to develop a prediction model and to construct a prediction nomogram for the risk of low birth weight infants born to pregnant women with GDM., Methods: The clinical data of singleton infants diagnosed with gestational diabetes mellitus in Southeast China in 2019 were retrospectively reviewed. Gestational conditions and neonatal weight were assessed., Results: A total of 386 diabetic mothers and infants were enrolled, including 193 in the low birth weight group and 193 in the normal birth weight group. The statistically significant factors were age over 36 years (OR = 1.916, 95% CI 1.048-3.505), junior high school education (OR = 4.454, 95% CI 1.882-10.543), history of fetal distress (OR = 0.120, 95% CI 0.016-0.925), gestational hypertension (OR = 3.681, 95% CI 1.357-9.986), preeclampsia (OR = 24.652, 95% CI 5.956-102.036), threatened preterm birth (OR = 18.393, 95% CI 8.457-39.999), triglycerides (OR = 0.642, 95% CI 0.485-0.850), and inadequate gestational weight gain (OR = 1.997, 95% CI 1.162-3.432). The area under the receiver operating characteristic curve (AUC) was 0.834 (95% CI: 0.794-0.874, p  < 0.001), and the sensitivity and specificity were 82.38 and 87.56%, respectively. The goodness-of-fit test likelihood ratio 2 was 2.089 ( p  = 0.978). The comprehensive nomogram model showed that the discrimination and mean absolute error were 0.834 and 0.015, respectively. The calibration curves showed acceptable agreement between the predictions of the column line plots and the observations. The DCA curves showed good positive net yields in the prediction model., Discussion: This study established a prediction model and risk score for low birth weight in pregnant women with GDM. It helps pregnancy clinics to identify the risk of low birth weight in newborns promptly, in addition to glycemic control and weight management for pregnant women with GDM, and should improve the appropriate treatment plan for pregnant women with higher risk, to provide personalized and precise treatment for pregnant women with GDM and improve infant outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Pan, Huang and Jiang.)

Background: Quality caregiver-infant interaction is crucial for infant growth, health, and development. Traditional methods for evaluating the quality of caregiver-infant interaction have predominantly relied on rating scales or observational techniques. However, rating scales are prone to inaccuracies, while observational techniques are resource-intensive. The utilization of easily collected medical records in conjunction with machine learning techniques offers a promising and viable strategy for accurate and efficient assessment of caregiver-infant interaction quality., Methods: This study was conducted at a follow-up outpatient clinic at two tertiary maternal and infant health centers located in Shanghai, China. 68 caregivers and their 3-15-month-old infants were videotaped for 3-5 min during playing interactions in non-threatening environment. Two trained experts utilized the Infant CARE-Index (ICI) procedure to assess whether the caregivers were sensitive or not in a dyadic context. This served as the gold standard. Predictors were collected through Health Information Systems (HIS) and questionnaires, which included accessible features such as demographic information, parental coping ability, infant neuropsychological development, maternal depression, parent-infant interaction, and infant temperament. Four classification models with fivefold cross-validation and grid search hyperparameter tuning techniques were employed to yield prediction metrics. Interpretable analyses were conducted to explain the results., Results: The score of sensitive caregiver-infant interaction was 6.34 ± 2.62. The Random Forest model gave the best accuracy (83.85%±6.93%). Convergent findings identified infant age, care skills of infants, mother age, infant temperament-regulatory capacity, birth weight, positive coping, health-care-knowledge-of-infants, type of caregiver, MABIS-bonding issues, ASQ-Fine Motor as the strongest predictors of interaction sensitivity between infants and their caregiver., Conclusions: The proposed method presents a promising and efficient approach that synergistically combines rating scales and artificial technology to detect important features of caregiver-infant interactions. This novel approach holds several implications for the development of automatic computational assessment tools in the field of nursing studies., (© 2024. The Author(s).)

Stunting continues to be a significant health issue, particularly in developing nations, with Indonesia ranking third in prevalence in Southeast Asia. This research examined the risk of stunting and influencing factors in Indonesia by implementing various Bayesian spatial conditional autoregressive (CAR) models that include covariates. A total of 750 models were run, including five different Bayesian spatial CAR models (Besag-York-Mollie (BYM), CAR Leroux and three forms of localised CAR), with 30 covariate combinations and five different hyperprior combinations for each model. The Poisson distribution was employed to model the counts of stunting cases. After a comprehensive evaluation of all model selection criteria utilized, the Bayesian localised CAR model with three covariates were preferred, either allowing up to 2 clusters with a variance hyperprior of inverse-gamma (1, 0.1) or allowing 3 clusters with a variance hyperprior of inverse-gamma (1, 0.01). Poverty and recent low birth weight (LBW) births are significantly associated with an increased risk of stunting, whereas child diet diversity is inversely related to the risk of stunting. Model results indicated that Sulawesi Barat Province has the highest risk of stunting, with DKI Jakarta Province the lowest. These areas with high stunting require interventions to reduce poverty, LBW births and increase child diet diversity.

Objective: Hospital-based labor and delivery units are closing at increasing rates in the rural US, significantly impacting maternal and newborn health. The objective of this study to determine if rurality-measured as distance from the hospital-and socioeconomic status-measured as insurance payor-impact both spontaneous and medically indicated preterm birth incidence at a single rural academic institution., Methods: This was a retrospective cohort study using electronic medical records of patients with singleton pregnancies delivering at a single rural academic institution between 2016-2018. The primary outcome was preterm delivery (PTD) and secondary outcomes included low birth weight (LBW) and intensive care nursery (ICN) admission. The primary exposures included (1) travel time from a patient's address to the hospital and (2) insurance carrier as a proxy for socioeconomic status. Bivariate analyses indicated that travel time, insurance status, race, ethnicity, marital status, number of prenatal visits, gravida and para, and smoking status were significant predictors of all outcomes (LBW, ICN admission, and PTD). Therefore, these predictors were included in the multivariable logistic models., Results: Within the multivariable logistic model, patients traveling 1-1.5 hours had approximately twice the odds of PTD (Odds Ratio, OR: 2.08, 95% Confidence Interval CI, 1.32, 3.29, p = .002), birth of a LBW neonate (OR: 2.15; 95% CI: 1.29-3.58, p = .005), and infant admission to the ICN (OR 1.83, 95% CI: 1.22-2.76, p = .004) compared to patients traveling under 30 minutes,. Insurance carrier status was not associated with increased odds of PTD, LBW, or ICN admission., Conclusion: Patients living 1-to-1.5 hours from the hospital had an increased risk for LBW, ICN admission, and PTD, despite living in zip codes with less social deprivation than zip codes further away from the hospital., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Darivemula et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Risk of preterm birth (PTB) and low birth weight (LBW) due to hydraulic fracturing (HF) exposure is a growing concern. Regional studies have demonstrated links, but results are often contradictory among studies., Objectives: This is the first US national study to our knowledge linking fracturing fluid ingredients to the human hormone pathways targeted-estrogen, testosterone, or other hormones (e.g., thyroid hormone)-to assess the effect of HF ingredients on rates of PTB and LBW., Methods: We constructed generalized linear regression models of the impact of HF well density and hormone targeting chemicals in HF fluids (2001-2018) on the county-level average period prevalence rates of PTB and LBW (2015-2018) with each outcome measured in separate models. Our data sources consisted of publicly available datasets, including the WellExplorer database, which uses data from FracFocus, the March of Dimes Peristats, the US Census Bureau, the US Department of Agriculture, and the Centers for Disease Control and Prevention. We conducted additional stratified analyses to address issues of confounding. We used stratification to address issues regarding outcomes in rural vs. urban communities by assessing whether our models achieved similar results in nonmetro counties, as well as farming and mining counties. We also stratified by the year of the HF data to include HF data that was closer to the time of the birth outcomes. We also added covariate adjustment to address other important factors linked to adverse birth outcomes, including the proportion of the population belonging to various racial and ethnic minority populations (each modeled as a separate variable); education (bachelor's degree and high school); use of fertilizers, herbicides, and insecticides, acres of agricultural land per square mile; poverty; insurance status; marital status; population per square mile; maternal care deserts; and drug deaths per 100,000 people., Results: We found that the density of HF wells in a county was significantly associated with both PTB and LBW rates (percentage of live births) in our fully adjusted models. We report the results from our more restrictive stratified analysis with a subset including only the 2014-2018 data, because this resulted in the most meaningful time frame for comparison. Across all models, the magnitude of effect was highest for wells with ingredients that include estrogen targeting chemicals (ETCs), testosterone targeting chemicals (TTCs) and other hormone targeting chemicals (OHTCs), and, finally, all wells grouped regardless of chemical type. For every unit increase in well density per square mile of wells that use chemicals that include an ETC, we observed a 3.789-higher PTB rate (95% CI: 1.83, 5.74) compared with counties with no ETC wells from 2014 to 2018 and likewise, we observed a 1.964-higher LBW rate (95% CI: 0.41, 3.52). Similarly, for every unit increase in well density per square mile of wells that use TTC, we observed a 3.192-higher PTB rate (95% CI: 1.62, 4.77) compared with counties with no TTC wells. Likewise, for LBW, we found a 1.619-higher LBW rate (95% CI: 0.37, 2.87). We also found that an increase in well density per square mile among wells that use chemicals that include an OHTC resulting in a 2.276-higher PTB rate (95% CI: 1.25, 3.30) compared with counties with no OHTC wells, and for LBW, we found a 1.244-higher LBW rate (95% CI: 0.43, 2.06). We also explored the role of HF well exposure in general (regardless of the chemicals used) and found that an increase in total well density (grouped regardless of hormonal targeting status of the chemicals used) resulted in a 1.228-higher PTB rate (95% CI: 0.66, 1.80) compared with counties with no wells, and for LBW, we found a 0.602-higher LBW rate (95% CI: 0.15, 1.05) compared with counties with no wells. We found similar results in our primary analysis that used all data without any exclusions and the statistical significance did not change., Discussion: Our findings reinforce previously identified regional associations between HF and PTB and LBW, but on a national scale. Our findings point to dysregulation of hormonal pathways underpinning HF exposure risk on birth outcomes, which warrants further exploration. Future research must consider the specific ingredients used in HF fluids to properly understand the differential effects of exposure. https://doi.org/10.1289/EHP12628.

Low birth weight (LBW) is a global health concern. While it is commonly associated with maternal health and behavior, exposure to ambient air pollution, can also play a role in contributing to LBW. In Brazil, where diverse environmental conditions and regional disparities exist, assessing the impact of ambient air pollution on LBW becomes particularly pertinent. To our knowledge, there is a gap in the existing literature, as no previous study has specifically investigated the relationship between ambient air pollution and LBW nationwide in Brazil. This study aims to fill this gap by examining the association between ambient air pollution and LBW in each trimester of pregnancy across the Brazilian states. In this work, birth data from January 1, 2001, to December 31, 2018 has been used. We utilized logistic regression models to estimate the odds ratio (OR) for low birth weight (LBW) associated with ambient air pollution (PM 2.5 , NO 2 , and O 3 ) during each trimester of pregnancy (1st to 3rd trimester) across all 27 Brazilian states in our nationwide case-control study. We adjusted our model for several variables, including ambient temperature, relative humidity, and socioeconomic status (SES) variables at the individual level. We also conducted effect modification analyses by infant sex, mother's age, and the number of prenatal visits. Our study comprises over 10,213,144 birth records nationwide. Of these, 479,204 (4.92%) infants were included as cases of LBW. Our results indicate positive associations between PM 2.5 and LBW, mainly in the Southern region. For example, in the state of Santa Catarina (South region), ORs were 1.003 (95% CI: 1.002, 1.004), 1.003 (95% CI: 1.002, 1.004), and 1.005 (95% CI: 1.003, 1.007) for the 1st, 2nd, and 3rd trimesters of exposure, respectively. NO 2 had a robust association with LBW in the Northern and Northeastern states, including the state of Amapá (North region, where the Amazon Forest is located) with ORs of 1.377 (95% CI: 1.010, 1.878), 1.390 (95% CI: 1.020, 1.894), and 1.747 (95% CI: 1.297, 2.352) for the 1st, 2nd, and 3rd trimesters of exposure, respectively. Similarly, O 3 had a robust association in the North and Midwest states, as observed in the state of Amapá with ORs of 1.033 (95% CI: 1.012, 1.054), and 1.033 (95% CI: 1.013, 1.053) for the 2nd, and 3rd trimesters, respectively. In the stratified analysis, boys were more vulnerable than girls, and the lower number of prenatal visits was associated with higher OR. Our findings are essential to the development of guidelines to prevent maternal exposure and protection of newborns in Brazil. This study provides valuable insights for region-specific strategies to improve maternal and neonatal health., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Weeberb J Requia reports financial support was provided by National Council for Scientific and Technological Development., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Complications of prematurity are the leading cause of under-5 mortality globally and 80% of newborn deaths are of low birth weight (LBW) babies. Early identification of LBW and preterm infants is crucial to initiate timely interventions., Objective: To evaluate the feasibility and diagnostic accuracy of alternative neonatal anthropometric measurements in identifying LBW and preterm infants in Africa., Methods: In this systematic review and meta-analysis, we evaluated the diagnostic performance of infant foot length, mid-upper arm circumference (MUAC), head and chest circumferences against birth weight and gestational age. Pooled correlation between the index and the reference methods was estimated. Multiple anthropometric thresholds were considered in estimating the pooled sensitivity, specificity and area under receiver operating characteristic curve (AUC)., Results: 21 studies from 8 African countries met the inclusion criteria. Correlation coefficients with birth weight were 0.79 (95% CI 0.70 to 0.85) for chest circumference, 0.71 (95% CI 0.62 to 0.78) for MUAC and 0.66 (95% CI 0.59 to 0.73) for foot length. Foot length measured by rigid ruler showed a higher correlation than tape measurement. Chest circumference with 28.8 cm cut-off detects LBW babies with AUC value of 0.92 (95% CI 0.71 to 0.97). Foot length identified preterm infants, with 82% sensitivity, 89% specificity and AUC of 0.91 (95% CI 0.69 to 0.98) at a 7.2 cm optimal cut-off point. MUAC had an AUC of 0.83 (95% CI 0.47 to 0.95) for preterm detection. In identifying LBW babies, foot length and MUAC have AUC values of 0.89 (95% CI 0.70 to 0.96) and 0.91 (95% CI 0.73 to 0.97) at 7.3 cm and 9.8 cm optimal cut-off points, respectively. Foot length and MUAC are relatively simple and minimise the risk of exposing infants to cold., Conclusion: Newborn foot length, MUAC, head and chest circumferences have comparable diagnostic accuracy in identifying LBW and preterm babies. Using foot length and MUAC in low-resource settings are the most feasible proxy measures for screening where weighing scales are not available., Prospero Registration Number: CRD42023454497., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

OBJECTIVE: To find out the effect of Lipid based nutritional supplement (LNS) on body composition, hematological findings, maternal, birth and infant outcomes in underweight primi-gravidas. METHODS: This single-blinded randomized controlled clinical trial was executed in the tertiary care hospitals of Khyber Pakhtunkhwa province, Pakistan from April 2018 to August 2019. Forty primi-gravidas recruited in the study were randomized into LNS and placebo groups. LNS group received 75 gms of high energy nutritional supplement, named “MAAMTA”, on daily basis from their first antenatal visit till delivery in addition to their conventional antenatal treatment. Fasting blood samples were taken and body composition was measured at baseline visit, 16th week of gestation and post-natally. For the measurement of hematological parameters neonates cord blood was obtained. Data of 36 participants (LNS group n=19; placebo group n=17) were available for final analysis. RESULTS: Majority (n=33/36; 91.7%) had normal vaginal deliveries (n=18/19 in LNS group & n=15/17 in placebo group). Frequency of Cesarean section was 1/19 (5.3%) in LNS group and 2/17 (11.8%) in placebo group. No case of abortion was reported. Mean crown heel length (CHL) was 47.11±2.747 cm in LNS group and 44.24±2.359 cm in placebo group (p=0.002). Mean fronto-occipital circumference was 35.11±1.663 cm and 32.41±7.859 cm in the LNS and placebo groups respectively (p=0.153). No difference was observed between the groups in maternal gestational weight gain per visit, prevalence of maternal anemia, maternal mortality & neonatal birth weight. CONCLUSION: The prenatal use of LNS increases the CHL of the neonates of underweight primi-gravidas.

Purpose Kangaroo mother care (KMC) was introduced in Indonesia 30 years ago, but the extent of its use has not been fully documented. Therefore, this study aimed to examine the use of KMC and evaluate the characteristics of infants who received KMC at Koja District Hospital in North Jakarta, Indonesia. This retrospective cohort study recorded the characteristics of infants with birthweights less than or equal to 2,200 g at the above-mentioned hospital. Methods Data collected from infant registers included gestational age, birthweight, Apgar score, number of complications, history of neonatal intensive care unit treatment, and KMC status. Cox regression analysis was conducted. Results This study found that 57.7% of infants received KMC. Infants with birthweights over 1,500 g were 2.16 times (95% CI: 1.20-3.89) more likely to receive KMC. Conclusion Efforts to promote KMC are recommended, specifically for infants with birthweights greater than 1,500 g. KMC for infants with other conditions can also be considered based on the infants' stability.

Studies have shown that mercury (Hg) exposure during pregnancy is associated with adverse birth outcomes (ABO) in infants, but the association between the two has not been systematically summarized. Therefore, we conducted a systematic review and meta-analysis of existing observational studies on the association between maternal Hg exposure (MHE) during pregnancy and ABO in infants to evaluate the association between them. We comprehensively searched all relevant literature published in three electronic databases (Web of Science, PubMed, Embase) from 2004 to June 2024. According to the heterogeneity, fixed effect model (I 2  ≤ 50 %) or random effect model (I 2  > 50 %) was used to pool the associated effect values. The results showed a positive association between MHE and low birth weight (LBW) (OR = 1.079, 95 % CI: 1.032-1.128) and no statistically significant association between and preterm birth (PTB) (OR = 1.044, 95 % CI: 0.956-1.140) and small-for-gestational-age (SGA) (OR = 1.006, 95 % CI: 0.983-1.030). In addition, each 10-fold increase in MHE during pregnancy was associated with abnormal Birth Anthropometrics. These findings suggest that MHE is a risk factor for LBW and is associated with abnormal anthropometric measurements at birth. However, there is insufficient evidence for Hg exposure and SGA, PTB. Further population-based studies are warranted to investigate these associations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To perform a systematic review in order to verify the association between full-term birth of small for gestational age (SGA) children and the outcomes in the development of oral language. Data source: Articles from MEDLINE/PubMed, Web of Science, Embase, Lilacs, SciELO and Cochrane Library databases were identified, selected and critically evaluated by two independent reviewers and a judge, blindly, without language restriction and publication period. The PRISMA tool was used, and original studies with a theme involving children born full-term and SGA were included, outcome related to aspects of oral language development, as well as the use of tests, scales and/or specific questionnaires for the investigation, whose methodology was described in full, with children as the target population. Data synthesis: The researchers included nine articles based on the eligibility criteria. Studies have shown that being born SGA can interfere in aspects related to language and reported greater chances of under performance in SGA children when compared to children with appropriate size for gestational age. It was observed that the different studies did not have a uniform design, and the objectives were quite diverse. Furthermore, few of them had as focus issues related to the assessment of language, as well as the variability of instruments used to investigate this domain. Conclusions: The effects of low weight for gestation age in full-term infants continue beyond the neonatal period and may impact on children's performance, mainly with regard to oral language development. [ABSTRACT FROM AUTHOR]

Background: Low birth weight (LBW) is a major public health issue associated with increased neonatal morbidity and mortality. This study aimed to examine the association between household food insecurity and LBW in Mashhad, Iran. Study Design: A population-based case-control study., Methods: This study involved 6294 mothers (3247 cases and 3247 controls) who visited healthcare centers affiliated with Mashhad University of Medical Sciences for term births between March 2019 and March 2022. Cases included women who delivered neonates weighing<2500 g, while controls delivered babies≥2500 g. Food security was measured using the validated Household Food Insecurity Access Scale. Logistic regression models examined the associations between food insecurity and LBW. Geographic information system techniques mapped LBW distribution in Mashhad., Results: Household food insecurity was significantly associated with higher odds of LBW (adjusted odds ratio [AOR]=1.25, 95% confidence interval [CI]: 1.03, 1.53). Other risk factors included younger maternal age (AOR=1.03, 95% CI: 1.01, 1.04), lower maternal education (AOR=0.55, 95% CI: 0.43, 0.71), cesarean delivery (AOR=1.70, 95% CI: 1.40, 2.06), and exposure to secondhand smoke (AOR=1.68, 95% CI: 1.02, 2.75). Gestational diabetes demonstrated a protective effect (AOR=0.37, 95% CI: 0.15, 0.91). Geographic mapping revealed that regions with higher food insecurity had elevated LBW prevalence., Conclusion: These findings underscore the importance of addressing food insecurity among pregnant women to reduce the risk of LBW and improve newborn outcomes., (© 2024 The Author(s); Published by Hamadan University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: Prenatal drug use may cause toxicity to bone health in newborns. We aimed to examine whether birth outcomes mediate the association between medication use and neonatal metabolic bone disease (MBD)., Methods: A prospective cohort of 10,801 pregnant women (17-49 years) and their infants followed at a single center from 1 January 2012 to 31 December 2021 were included. Based on four single drugs, comprehensive medication use was determined and categorized into three groups using latent-class analysis: group 1 included antibiotics and furosemide or less than two drugs except for MgSO 4 ; group 2 included MgSO 4 without antibiotics or furosemide; and group 3 encompassed dexamethasone and antibiotics. Mediation analysis was conducted to assess the mediating effects of prematurity, low birth weight (LBW), and small for gestational age (SGA)., Results: There were 138 (1.3%) infants with MBD; 2,701 (25%) were born preterm, 1717 (15.9%) had LBW, and 303 (2.8%) were SGA. Pregnant women in groups 2 and 3 were 2.52 to 14.66 times more likely to deliver an infant with MBD than those in group 1. Only LBW showed a significant mediating effect on the association between comprehensive medication use and MBD, with a mediation proportion of 51.8% (45.0-64.1%, p  < 0.001)., Conclusion: Comprehensive medication use during pregnancy was associated with an increased risk of neonatal MBD, largely mediated by LBW. Early antepartum monitoring and prevention targeting adverse birth outcomes are necessary to mitigate the risk of MBD., Competing Interests: HL and JY were employed by the company Aigora technology PTE. LTD, TRIVEX. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Jiang, Guo, Li, Li, Du, Canavese, Xie, Li, Yang, Ying and Hua.)

Background: A major challenge in epidemiology is knowing when an exposure effect is large enough to be clinically important, in particular how to interpret a difference in mean outcome in unexposed/exposed groups. Where it can be calculated, the proportion/percentage beyond a suitable cut-point is useful in defining individuals at high risk to give a more meaningful outcome. In this simulation study we compute differences in outcome means and proportions that arise from hypothetical small effects in vulnerable sub-populations., Methods: Data from over 28,000 mother/child pairs belonging to the Environmental influences on Child Health Outcomes Program were used to examine the impact of hypothetical environmental exposures on mean birthweight, and low birthweight (LBW) (birthweight < 2500g). We computed mean birthweight in unexposed/exposed groups by sociodemographic categories (maternal education, health insurance, race, ethnicity) using a range of hypothetical exposure effect sizes. We compared the difference in mean birthweight and the percentage LBW, calculated using a distributional approach., Results: When the hypothetical mean exposure effect was fixed (at 50, 125, 167 or 250g), the absolute difference in % LBW (risk difference) was not constant but varied by socioeconomic categories. The risk differences were greater in sub-populations with the highest baseline percentages LBW: ranging from 3.1-5.3 percentage points for exposure effect of 125g. Similar patterns were seen for other mean exposure sizes simulated., Conclusions: Vulnerable sub-populations with greater baseline percentages at high risk fare worse when exposed to a small insult compared to the general population. This illustrates another facet of health disparity in vulnerable individuals., (© 2024. The Author(s).)