Search

Objective To determine whether prenatal risk factors (RFs) that predict cord blood iron status in term newborns also predict iron status of premature newborns. Study design Cord blood iron indices from 80 preterm newborns were compared with historical and demographic RFs for developing iron deficiency if born at term. Result The presence of multiple RFs did not incrementally interfere with cord iron status in preterm newborns. Poorer iron status accompanied being small for gestational age in prematurity, but other RFs, including diabetes, had relatively little impact. Conclusion Growth-restricted preterm newborns are at risk for poor iron endowment, likely due to uteroplacental insufficiency. Other RFs were less impactful on iron status of premature newborns than in term newborns, likely reflecting that disruptive effects of RFs are more impactful in the third trimester. Understanding RFs for poor iron endowment is important for clinical recognition and treatment of premature babies.

Parents' representations of their infants consist of parents' subjective experiences of how they perceive their infants. They provide important information about the quality of the parent-infant relationship and are closely related to parenting behavior and infant attachment. Previous studies have shown that parents' representations emerge during pregnancy. However, little is known about prenatal (risk) factors that are related to parents' representations. In a prospective study, 308 mothers and 243 fathers were followed during pregnancy and postpartum. Prenatal risk factors were assessed with an adapted version of the Dunedin Family Services Indicator (T.G. Egan et al., ; R.C. Muir et al., ). At 26 weeks' gestation and 6 months' postpartum, parents' representations of their children were assessed with the Working Model of the Child Interview (C.H. Zeanah, D. Benoit, L. Hirshberg, M.L. Barton, & C. Regan). Results showed stability between pre- and postnatal representations, with fathers having more disengaged representations than did mothers. In addition, prenatal risk factors of parenting problems were associated with the quality of parents' prenatal (only in mothers) and postnatal representations. This study provides valuable information concerning parents at risk of developing nonbalanced representations of their children. In clinical practice, these families could be monitored more intensively and may be supported in developing a more optimal parent-infant relationship.

Early maternal resolution with preterm birth was assessed at one month corrected age (CA), and potential maternal and infant characteristics that may be associated with early resolution were examined. Fifty-five mothers of preterm infants (≤34 weeks) participated. Data regarding pregnancy, prenatal risk, delivery, infant's medical risk, maternal well-being status, and infant's early developmental status were collected. Resolution was examined using the Reaction to Diagnosis Interview (RDI). A total of 38.2% of the mothers were classified as resolved. Only completion of antenatal corticosteroids (ACS) treatment and high prenatal risk significantly predicted maternal resolution. Early maternal resolution of preterm birth is associated with early knowledge regarding the preterm birth.

Dynamic systems methods offer invaluable insight into the nuances of the early parent–child relationship. This prospective study aimed to highlight the characteristics of mother–infant dyadic behavior at 12 weeks post-partum using state space grid analysis (total n = 322). We also examined whether maternal prenatal depressive symptoms and perceived stress were associated with reduced non-negative engagement in exchange for more negativity and unengagement, and contrasted them with global observational methods. Non-negative engagement (NNE) was an attractor for dyads during a teaching task, with a range of flexibility and entropy across dyads. Further, dyads with mothers reporting higher prenatal depressive symptoms demonstrated less 12-week NNE dyadic behavior and more dyadic negativity. Prenatal maternal perceived stress was associated with reduced negativity and reduced flexibility in NNE states. However, maternal distress of any kind was not associated with entropy of behavior. Finally, direct comparisons with global perspectives of dyadic behavior indicated strong external validity relating to concepts of dyadic affect and engagement, and dynamic approaches remained uniquely related to prenatal distress above and beyond global observations of behavior. Findings lend support to the utility and necessity of dynamic systems approaches for identifying mechanisms of prenatal risk and emerging parent–child social–emotional functioning. Copyright © 2015 John Wiley & Sons, Ltd.

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

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

To evaluate the status of congenital diaphragmatic hernia (CDH) management in France and to assess predictors of adverse outcomes.We reviewed the first-year outcome of all cases of CDH reported to the French National Register in 2011.A total of 158 cases were included. Of these, 83% (131) were prenatally diagnosed, with a mortality rate of 39% (44 of 112) for live born infants with a known outcome at hospital discharge. Mortality increased to 47% (60 of 128) including those with termination of pregnancy and fetal loss. This contrasts with the 7% (2 of 27) mortality rate of the patients diagnosed postnatally (P = .002). Mortality worsened with 1 prenatal marker of CDH severity (OR 3.38 [1.30-8.83] P = .013) and worsened further with 2 markers (OR 20.64 [5.29-80.62] P .001). Classic postnatal risk factors of mortality such as side of hernia (nonleft P = .001), prematurity (P .001), low birth weight (P = .002), and size of the defect (P .001) were confirmed. Of the 141 live births (114 prenatal and 27 postnatal diagnosis) with known outcomes, 93 (67%) survived to hospital discharge, 68 (60%) with a prenatal diagnosis and 25 (93%) with a postnatal diagnosis. The median time to hospital discharge was 34 days (IQR, 19.25-62). Of these survivors, 71 (76%) were followed up for 1 year.Despite advances in management of CDH, mortality was high and associated with prenatal risk factors. Postnatally, severe persistent pulmonary hypertension was difficult to predict and presented persistent challenges in management.

Current professional and policy debate over the use of prenatal testing emphasizes the need for informed choice making and for services that provide prospective parents with what is referred to as ‘non-directive counseling’. On the basis of an ethnography of prenatal decision making in the context of first trimester prenatal risk assessment (FTPRA) in Denmark, the chapter challenges the representational view of knowledge production and the liberal notion of human action underlying these ideals. The paper develops an account of prenatal decision making as a process of knowledge production and illustrates how this approach allows us to study processes of decision making as an effect of an assemblage of multiple forms of actors involved in the process of prenatal decision making (such as human actors, technologies, standards, policies and non-verbal aspects of knowledge production). I argue that framing the problems and solutions about prenatal testing only through the lens of choice tends to collapse ethical questions on prenatal testing into questions about the possibility of autonomous decision making. Ethical consideration express an ethics of being locally accountable for the ways in which programs of prenatal testing intervene in pregnant women’s lives and of taking responsibility for the entities and phenomena that emerge through such knowledge production.

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

Psychological aggression has been shown to have harmful effects on both partners, sometimes above and beyond the effects of physical aggression. However, very little is known about psychological aggression during the transition to parenthood. The transition to parenthood is a time where relationship satisfaction often declines and stress increases, which may put the couples at higher risk for psychological aggression. The purpose of this study was to examine if prenatal risk factors related to interpersonal style (specifically, emotional flooding and hostility) predict changes in psychological aggression from pregnancy to 2 years postpartum. Ninety eight couples took part in this study. The couples completed self-report questionnaires during pregnancy, 1 year postpartum, and 2 years postpartum. Both partners were asked about perpetrating and experiencing psychological aggression in their current relationship. Two level Hierarchical Linear Models (HLMs) were used to examine longitudinal associations between hostility, flooding, and psychological aggression. For women, hostility during pregnancy was a significant longitudinal predictor of psychological aggression. For men, flooding was a significant longitudinal predictor of psychological aggression. For both men and women, relationship satisfaction partially mediated the relationship between flooding/hostility and psychological aggression, indicating that women's hostile attitudes and men's tendency to be flooded tend to erode relationship quality, leading to increases in psychological aggression. This may represent a classic demand-withdraw dynamic in couples. The results indicate hostility for women and flooding for men are potential prenatal risk factors for future psychological aggression. Implications and future research directions are discussed. Aggr. Behav. 42:134-148, 2015. © 2014 Wiley Periodicals, Inc.

Physeal injuries occurring secondary to neonatal birth-related trauma are rare entities. Most reported cases of physeal injury involve the distal humerus with only a few published case reports of proximal femoral involvement. So far, we have found only one reported case of neonatal distal femoral epiphysiolysis following Caesarean section. We hereby report a unique case of distal femoral physeal injury with at least partial epiphyseal separation following an uneventful, spontaneous vaginal delivery. Given the uneventful delivery and no known prenatal risk factors, the imaging findings were initially not recognized as being secondary to birth-related injury. Nonaccidental trauma and infection were considered among the possible etiologies for the clinical and imaging findings and a detailed workup for both these entities was performed. Distal femoral physeal injury was considered as a diagnosis of exclusion only after both initial differential considerations were excluded. The authors hope that a knowledge of this entity will facilitate a more accurate differential in cases of thigh swelling and hypomobility in the newborn.

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

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

Objective The objective of this study was to use two-dimensional (2D) ultrasound (US) during routine prenatal surveillance to develop normative estimated placental volume (EPV) growth curves. Study Design Patients ≥ 18 years old with singleton pregnancies were prospectively followed from 11 weeks gestational age (GA) until delivery. At routine US visits, placental width, height, and thickness were measured and EPV calculated using a validated mathematical model. Results In this study, 423 patients were scanned between 9.7 and 39.3 weeks GA to generate a total of 627 EPV calculations. Readings were clustered at 12 and 20 weeks, times of routine scanning. The mean EPV was 73 ± 47 cc at 12.5 ± 1.5 weeks (n = 444) and 276 ± 106 cc at 20 ± 2 weeks (n = 151). The data best fit a parabolic function as follows: EPV = (0.384GA – 0.00366GA2)3. Tenth and 90th percentile lines were generated with ± 1.28 SE offset. EPV readings below the 10th or above the 90th percentiles tended to be associated with either small or large newborns, respectively. Conclusion Routine 2D US created EPV growth curves, which may be useful for stratifying patients into prenatal risk groups.

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

The Fetal medicine foundation (FMF) has developed a new algorithm called Prenatal Risk Calculation (PRC) to evaluate Down syndrome screening based on free hCGβ, PAPP-A and nuchal translucency. The peculiarity of this algorithm is to use the degree of extremeness (DoE) instead of the multiple of the median (MoM). The biologists measuring maternal seric markers on Kryptor™ machines (Thermo Fisher Scientific) use Fast Screen pre I plus software for the prenatal risk calculation. This software integrates the PRC algorithm. Our study evaluates the data of 2.092 patient files of which 19 show a fœtal abnormality. These files have been first evaluated with the ViewPoint software based on MoM. The link between DoE and MoM has been analyzed and the different calculated risks compared. The study shows that Fast Screen pre I plus software gives the same risk results as ViewPoint software, but yields significantly fewer false positive results.

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

OBJECTIVE: Congenital anomalies of the kidney and urinary tract (CAKUT) are the leading cause of chronic renal disease in childhood. Abnormal intrauterine conditions as well as genetic disorders play role in CAKUT development. We evaluated antenatal factors in CAKUT.

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

Objective To evaluate the population parameters applied to the calculation of risk for Down syndrome (DS) in the first trimester screening (FTS) and the comparison of performance obtained including or excluding maternal age from the mathematical algorithm. Methods Three different calculation engines for prenatal risk of DS were developed on the basis of the population parameters from the Serum, Urine and Ultrasound Screening Study, the Fetal Medicine Foundation, and a combination of both of them. These calculators were evaluated in 14 645 first trimester pregnant women, including 59 DS affected fetuses, comparing their performance with that obtained by our commercial software Elipse® (Perkin Elmer Life and Analytical Sciences, Turku, Finland). Advanced first trimester screening (AFS) strategy was also analyzed, and a hybrid strategy (FTS + AFS) was evaluated. Results By selecting population parameters from the Serum, Urine and Ultrasound Screening Study, the detection rate increased from 76% (Elipse) to 86% with a small increase in the false positive rate (FPR), from 3.3% to 3.7%, respectively. DS screening performance significantly improved by using the hybrid strategy (AFS in pregnant women under 35 years and FTS in pregnant women over 35 years), with a 92% detection rate (FPR: 3.9%). Conclusions In the present study, a new hybrid screening strategy has been proposed to achieve DS detection rates higher than 90%, for a convenient

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

Objective: To identify potential risk factors for low umbilical cord artery pH in term, singleton pregnancies. Methods: Retrospective case-control study. Cases were deliveries characterized by umbilical cord artery \(pH \le 7.05\). Controls were with no sign of hypoxia. Results: In the database of 10637 deliveries, collected between 2014 and 2015 at the University Hospital in Brno delivery ward, we identified 99 cases. Univariate analysis of clinical features was performed. The following risk-factors were associated with low pH: the length of the first stage (odds ratio (OR) 1.40 (95 % CI 1.04–1.89)) and the length of the second stage of labor (OR 2.86 (95 % CI 1.70–4.81)), primipara (OR 2.99 (1.90–4.71)) and meconium stained fluid (OR 1.60 (1.07–2.38)). Conclusion: Among the risk factors that increase the chance of low umbilical cord artery pH at term, we identified: excessive length of the first and second stage of labour, parity, and meconium stained fluid.

International adoption research has been called a natural experiment by many child development researchers. How do studies of severe early deprivation inform us about risk factors experienced by many of these children and their impact on developmental outcomes? Three longitudinal studies conducted by British and American researchers in the 1990s are reviewed. Each year, over 20,000 children are adopted from overseas, and a significant number are now entering adolescence; the impact of their prenatal risk factors, early institutionalization, and ameliorative postadoptive environments is also reviewed. The feasibility of generalizing findings to other children in foster care is also addressed.

Objective: Triple test with measured maternal serum α-fetoprotein, human chorionic gonadotropin, and unconjugated estriol combination as a routine procedure for fetal Down's syndrome, trisomy 18 and neural tube defect screening has some intrinsic problems, such as precision. The aim of this study was to evaluate the effect of analytical variation of triple test on prenatal risk estimation. Method: Five different serum pools were prepared and triple test was performed seven times for within run and five times for between run precision determination. Result: Within run and between run, precision values of risk estimations by measuring the same sample for Triple test were calculated to be 7.9–21.4% and 14.1–31.0% for trisomy 21, 13.2–23.7% and 14.2–15.1% for trisomy 18, 47.2 and 42.0 % for neural tube defect, respectively. Conclusion: These results demonstrated that analytical variations have great impact on second trimester risk estimation procedures; therefore, triple test analyses should be carried out in laboratories using strict internal and external quality control programs. Moreover, triple test results should always be interpreted by considering analytical and biological variations.

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

To identify the main prenatal risk factors for cerebral palsy in very preterm singletons and twins.The data were from the Epipage study, which included all very preterm children (33 weeks) born in 1997 in 9 regions of France. The analysis included 1,954 children for whom a medical questionnaire was completed at the age of 2 years (83% of the surviving children). The risk factors studied were pregnancy complications and specific factors in twins (type of placenta and death of cotwin). Logistic regression analysis was carried out for singletons and generalized estimating equation models used for twins.The proportion of cerebral palsy was 8% in singletons and 9% in twins. For singletons, spontaneous preterm labor (adjusted odds ratio [OR] 3.4, 95% confidence interval [CI] 1.7-6.7), preterm premature rupture of membranes (PPROM) with short latency (adjusted OR 4.9, 95% CI 2.0-11.8), and prolonged PPROM (adjusted OR 2.7, 95% CI 1.4-5.3) were associated with a higher risk of cerebral palsy than was hypertension. No such link was found between these pregnancy complications and cerebral palsy in twins. For twins, a monochorionic placenta (OR 1.9, 95% CI 1.0-3.6) increased the risk of cerebral palsy, but the OR became nonsignificant after adjustment (OR 1.7, 95% CI 0.8-3.4).In very preterm singletons, spontaneous preterm labor and PPROM increased the risk of cerebral palsy compared with hypertension.

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

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

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

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

The purpose of this study was to assess the effectiveness of a practical antenatal screen used at the Royal Women's Hospital, Brisbane, to identify women at risk for postnatal depression. It was a prospective, hospital-based, cohort study of 901 women (600 with and 301 without prenatal risk factors for postnatal depression). Depression was measured 16 weeks after the birth using the Edinburgh Postnatal Depression Scale. More of the women with a prenatal risk factor for depression (25.9%)scored above 12 on the Edinburgh Postnatal Depression Scale than those without any risk (10.9%) (p less than or equal to 0.001). Low social support (p less than or equal to 0.001), a personal history of mood disorder (p less than or equal to 0.001) and a past history of postnatal depression(p = 0.002) were all strongly associated with postnatal depression in this sample. Results indicate that an objective, psychosocial assessment during pregnancy improves recognition of women at risk for postnatal depression.

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

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

The present research provides empirical evidence of whether communicating the prenatal risk of chromosomal anomalies using comparison scenarios influences women’s ability to distinguish between different risk levels. In 2 experiments, participants read a description of a hypothetical woman who was learning of the risk of chromosomal anomaly as a result of a prenatal screening test. Both experiments used a 3 (risk level) × 3 (scenario) full between-subjects design. In accordance with the experimental condition, participants were presented with a low (e.g., 1 in 5390), a medium (e.g., 1 in 770), or a high risk value (e.g., 1 in 110). Such risk values were presented either on their own or along with additional information illustrating a comparison scenario that provided 2 numerical comparison points. Participants were asked to evaluate the risk of chromosomal anomaly. In Experiment 2, participants’ numeracy skills were also assessed. Results showed that the use of comparison scenarios results in significant differences in perceived risk across risk levels whereas such differences are not significant without the comparison scenario, but such a technique has differential effects according to participants’ capacity to deal with numbers. Although the technique is beneficial for high-numerate participants, it has no effect on low-numerate participants.