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(1) Background: Attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are common cognitive and behavioral disorders. Antibiotics are widely used in pregnant women and their newborns. The objective of this study was to examine the potential association between prenatal exposure to antibiotics and the risk of ADHD and ASD in childhood from a nationwide perspective. (2) Methods: The Taiwan National Health Insurance Research Database (NHIRD) was used as the primary data source. This nationwide cohort study included only first-time pregnancies. A total of 906,942 infants were enrolled. All infants were followed up for at least 6 years. The Cox regression model was applied for covariate control. (3) Results: Prenatal exposure to antibiotics was found to significantly increase the cumulative incidence of ADHD while having only a borderline effect on the cumulative incidence of ASD. Exposure to antibiotics during any of the three different gestational age ranges significantly increased the cumulative risk. However, only exposure after 34 weeks of gestation had a significant impact on the occurrence of ASD. The study also revealed a dose-dependent effect on the occurrence of ADHD but no effect on the occurrence of ASD. (4) Conclusions: This study suggests that prenatal exposure to antibiotics may increase the risk of developing ADHD and ASD later in life. [ABSTRACT FROM AUTHOR]

Home visiting programs can provide critical support to mothers in recovery from substance use disorders (SUDs) and young children prenatally exposed to substances. However, families impacted by maternal SUDs may not benefit from traditional child‐focused developmental home visiting services as much as families not impacted by SUDs, suggesting the need to adjust service provision for this population. Given the need to implement tailored services within home visiting programs for families impacted by SUDs, we sought to investigate the implementation barriers and facilitators to inform future integration of a relationship‐based parenting intervention developed specifically for parents with SUDs (Mothering from the Inside Out) into home visiting programs. We conducted nine interviews and five focus groups with a racially diverse sample (N = 38) of parents and providers delivering services for families affected by SUDs in the USA. Qualitative content analysis yielded three most prominent themes related to separate implementation domains and their associated barriers and facilitators: (1) engagement, (2) training, and (3) sustainability. We concluded that the home visiting setting may mitigate the logistical barriers to access for families affected by SUDs, whereas relationship‐based services may mitigate the emotional barriers that parents with SUDs experience when referred to home visiting programs. [ABSTRACT FROM AUTHOR]

Methamphetamine (MA) is the second most commonly used illicit drug in the world, after cannabis. There are limited data on the outcomes of pregnant MA users but there is rapidly emerging evidence to suggest that they are more vulnerable, marginalized and impoverished compared with other drug‐using mothers. MA use during pregnancy is associated with worse pregnancy outcomes and significantly higher rates of co‐existing health and psychosocial problems. Newborn infants exposed to MA are at increased risk of perinatal complications, present differently at birth to infants exposed to other drugs of dependency such as opioids and have poorer neurological adaptation and feeding difficulties. Sparse literature from neuroimaging and cohort studies suggests that the neurocognitive deficits in MA exposed children persist, even into adulthood. Current clinical practice guidelines for the care of substance exposed pregnant women are opioid‐centric with little attention paid to the consequences of prenatal MA exposure. [ABSTRACT FROM AUTHOR]

As the United States faces the repercussions of the current opioid epidemic, it is important for social workers to be able to identify risks for poor birth outcomes in infants with neonatal abstinence syndrome (NAS). Although some studies have identified single risk factors, no studies have tested associations between total amount of risk (that is, cumulative risk) and birth outcomes in infants with NAS. Authors examined 318 mothers who used opioids during pregnancy and their infants' birthweight, length, head circumference, and Apgar scores (which measure overall infant health after birth). All infants were admitted to a neonatal intensive care unit in Appalachia and were diagnosed with NAS. Authors found that high cumulative risk during pregnancy was associated with lower birthweight and Apgar scores one and five minutes after birth as well as shorter length and smaller head circumference at birth. Social workers are encouraged to assess for the quantity of prenatal adversity experienced by the mothers they serve and to consider multicomponent, comprehensive community-based interventions to reduce cumulative risk. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 36-year-old woman was admitted for labor and delivery of her fourth child including the dynamic changes in the U.S. legal landscape and greater social acceptance have likely contributed to higher rates of marijuana use.

Introduction: The dual impact of prenatal substance exposure (i.e. alcohol/drugs) and adverse postnatal caregiving environment on offspring secondary education completion is an understudied research area. The aim was to investigate the influence of childhood adversities, out-of-home care, and offspring's mental and/or behavioural disorders on secondary education completion among prenatally exposed offspring in comparison to matched unexposed offspring.Methods: This is a longitudinal register-based matched cohort study in Finland including offspring with a history of prenatal substance exposure and a matched unexposed cohort. The study sample included 283 exposed and 820 unexposed offspring aged 18-23 years.Results: The results showed a time lag in secondary education completion and lower educational attainment overall among exposed compared with unexposed (37.8% vs. 51.0%, respectively). The results from the multivariate logistic regression models showed that the differences in the secondary education completion between exposed and unexposed were diminished in the presence of covariates. A cumulative childhood adversity score and out-of-home care were not associated with secondary education completion in the multivariate models, whereas the different domains of offspring's mental and/or behavioural disorders including psychiatric disorders (AOR 0.65, 95% CI 0.45-0.96), neuropsychological disorders (AOR 0.35, 95% CI 0.23-0.54) and dual psychiatric and neuropsychological disorder (AOR 0.29, 95% CI 0.18-0.48) showed an independent negative effect on secondary education completion.Conclusions: Inferior educational outcomes may not be directly linked with prenatal substance exposure but may rather reflect the extent of evolving offspring's mental and/or behavioural disorders over time influenced by childhood adversities. [ABSTRACT FROM AUTHOR]

Prenatal substance exposure is a serious public health concern given that such exposure is associated with deficits across various neurodevelopmental domains. Mothercraft's Breaking the Cycle (BTC) is a child maltreatment prevention and early intervention program in Canada for pregnant and parenting women who use substances and their children (0–6 years). Case studies of three substance-exposed sibling groups that received services at BTC are described to depict the spectrum of clinical progress that can be observed. The purpose of this study was to use our clinically and theoretically grounded, cross-domain cumulative risk and protection framework, previously developed for quantitative analyses, to qualitatively describe cumulative risk and protection. Using this framework within a qualitative case study approach yields insights into how contexts of risk and protection contribute to clinical progress. This study offers direction for future research to enhance understanding of the spectrum of clinical progress in substance-exposed families accessing early intervention. We discuss the clinical utility of this qualitative framework for case formulation and treatment planning. Understanding the balance between contexts of risk and protection qualitatively, and the link with neurodevelopment and clinical progress, can inform evidence-based, multisystemic early interventions that target key risk factors and promote salient protective factors. [ABSTRACT FROM AUTHOR]

Background: Marijuana is the most‐used illicit substance during pregnancy in the USA, but only two cohort studies, begun over 30 years ago, were specifically established to assess the association of pregnancy use with childhood outcomes. They found use to be associated with specific deficits in executive function at 8+ years, but did not focus on these outcomes earlier in life when intervention may be more successful. Two general purpose cohorts found increased aggression in exposed female toddlers and increased behavioural problems and tic disorders in exposed school‐age children. Objectives: The Lifestyle and Early Achievement in Families (LEAF) study assesses the association of in utero marijuana exposure, documented prospectively by biomarker, self‐report, and medical records, with executive function and aggression at age 3½‐7 years. Methods: This ambidirectional cohort (historical cohort with continued follow‐up) includes women enrolled in the Perinatal Research Repository during prenatal care at Ohio State University Wexner Medical Center and their children, recontacted 3½‐7 years post‐birth. Children complete 1‐2 study visits including cognitive testing, behavioural observation, and maternal and teacher report of behaviour. Family and social environmental factors are assessed. Results: Child follow‐up began in September 2016; visits continue through August 2020. There are 362 eligible children; 32% had mothers who used marijuana during pregnancy, 10% of mothers completed college, and 23% did not complete high school. Mean maternal age at study registration in pregnancy was 26.4 years, and 63% of mothers were African American. To date, 268 children have completed at least 1 study visit. Conclusions: The LEAF Study will document the association of prenatal marijuana exposure with development and behaviour in the current era when marijuana is more potent than when previous cohorts were studied. The results may inform policy and interventions to counsel reproductive‐aged women about the risks of use during pregnancy and guide prevention and treatment of adverse effects among children. [ABSTRACT FROM AUTHOR]

Importance: Recent evidence suggests that cannabis use during pregnancy is increasing, although population-based data about perinatal outcomes following in utero exposure remain limited.Objective: To assess whether there are associations between self-reported prenatal cannabis use and adverse maternal and perinatal outcomes.Design, Setting, and Participants: Population-based retrospective cohort study covering live births and stillbirths among women aged 15 years and older in Ontario, Canada, between April 2012 and December 2017.Exposures: Self-reported cannabis exposure in pregnancy was ascertained through routine perinatal care.Main Outcomes and Measures: The primary outcome was preterm birth before 37 weeks' gestation. Indicators were defined for birth occurring at 34 to 36 6/7 weeks' gestation (late preterm), 32 to 33 6/7 weeks' gestation, 28 to 31 6/7 weeks' gestation, and less than 28 weeks' gestation (very preterm birth). Ten secondary outcomes were examined including small for gestational age, placental abruption, transfer to neonatal intensive care, and 5-minute Apgar score. Coarsened exact matching techniques and Poisson regression models were used to estimate the risk difference (RD) and relative risk (RR) of outcomes associated with cannabis exposure and control for confounding.Results: In a cohort of 661 617 women, the mean gestational age was 39.3 weeks and 51% of infants were male. Mothers had a mean age of 30.4 years and 9427 (1.4%) reported cannabis use during pregnancy. Imbalance in measured maternal obstetrical and sociodemographic characteristics between reported cannabis users and nonusers was attenuated using matching, yielding a sample of 5639 reported users and 92 873 nonusers. The crude rate of preterm birth less than 37 weeks' gestation was 6.1% among women who did not report cannabis use and 12.0% among those reporting use in the unmatched cohort (RD, 5.88% [95% CI, 5.22%-6.54%]). In the matched cohort, reported cannabis exposure was significantly associated with an RD of 2.98% (95% CI, 2.63%-3.34%) and an RR of 1.41 (95% CI, 1.36-1.47) for preterm birth. Compared with no reported use, cannabis exposure was significantly associated with greater frequency of small for gestational age (third percentile, 6.1% vs 4.0%; RR, 1.53 [95% CI, 1.45-1.61]), placental abruption (1.6% vs 0.9%; RR, 1.72 [95% CI, 1.54-1.92]), transfer to neonatal intensive care (19.3% vs 13.8%; RR, 1.40 [95% CI, 1.36-1.44]), and 5-minute Apgar score less than 4 (1.1% vs 0.9%; RR, 1.28 [95% CI, 1.13-1.45]).Conclusions and Relevance: Among pregnant women in Ontario, Canada, reported cannabis use was significantly associated with an increased risk of preterm birth. Findings may be limited by residual confounding. [ABSTRACT FROM AUTHOR]

Background and Aims: Our understanding of the long‐term safety of prenatal exposure to opioid maintenance treatment (OMT) is insufficient. We compared childhood morbidity (0–3 years) between OMT‐exposed and relevant comparison groups. Design Nation‐wide, registry‐based cohort study. Registries on reproductive health, addiction treatment, hospitalization and death were linked using identification numbers. Setting: The Czech Republic (2000–14). Participants: Children with different prenatal exposure: (i) mother in OMT during pregnancy (OMT; n = 218), (ii) mother discontinued OMT before pregnancy (OMT‐D; n = 55), (iii) mother with opioid use disorder, but not in OMT during pregnancy (OUD; n = 85) and (iv) mother in the general population (GP) (n = 1 238 452) Measurements Episodes of hospitalization were observed as outcomes. Information on in‐patient contacts, length of stay and diagnoses (International Classification of Diseases version 10) were assessed. Binary logistic regressions were conducted to estimate the associations between OMT exposure and the outcomes, crude and adjusted for the socio‐economic status and smoking. Findings No significant differences were found in the overall proportion of hospitalization among OMT‐exposed children, children of OMT‐D and children of women with OUD [54.1%, 95% confidence interval (CI) = 47.3–60.1%; 47.3%, 95% CI = 33.9–61.1%; 51.8%, 95% CI = 40.7%–62.6%], while the proportion was significantly lower (35.8%, 95% CI = 35.7–35.8%) in the GP. There were no significant differences in risk of specific diagnoses between OMT‐exposed children, children of OMT‐D and children of women with OUD. In the adjusted analyses, differences between OMT‐exposed and children in the GP were still present for infections and parasitic diseases (OR = 2.0, 95% CI = 1.4–2.7), diseases of the digestive system (OR = 1.7, 95% CI = 1.2–2.6) and diseases of the skin and subcutaneous tissue (OR = 1.9, 95% CI = 1.2–3.2). Conclusion: This study did not find clear evidence for an increase in risk of morbidity during the first 3 years of life in children with prenatal opioid maintenance treatment exposure compared with children of women who discontinued such treatment before pregnancy or suffered from opioid use disorder without this treatment. Compared the general population, there appears to be an increased risk of hospitalizations for infectious, gastrointestinal and skin diseases. [ABSTRACT FROM AUTHOR]

Background and aims: Hazardous drinking (i.e. alcohol consumption that places drinkers at risk for adverse health outcomes) during pregnancy is associated with adverse child outcomes. To address whether the associations are causal, we aimed to estimate the effect of maternal hazardous drinking during the first trimester on offspring emotional and behavioural problems throughout the pre‐school age. We adjusted for: (1) measured confounding (e.g. smoking), (2) familial risk factors by sibling control design and (3) non‐shared environmental risk factors by using hazardous drinking the 3 months before pregnancy as an instrumental variable. Design Prospective cohort study. Participants were recruited between 1999 and 2009 at ultrasound examination offered to all pregnant women in Norway. Data were collected during the 17th and the 30th weeks of gestation, and when the children were aged 1.5, 3 and 5 years. Setting Norway, 1999–2015. Participants: The sample consisted of 14 639 mothers with 25 744 offspring siblings from the Norwegian Mother and Child Cohort Study. Measurements Respondents self‐reported on: alcohol consumption, children's emotional problems (i.e. emotional reactive, anxiety/depression, somatic complaints) and children's behavioural problems (i.e. attention and aggressive behaviour) throughout pre‐school age. We used longitudinal latent growth curve models to estimate the effect of maternal drinking during the first trimester on offspring emotional and behavioural problems. Findings Most associations were strongly reduced after controlling for both familial and measured environmental risk factors. After adjustment, exposed children were more emotionally reactive [β = 2.33; 95% confidence interval (CI) = 0.13–4.53] and had more somatic complaints (β = 1.93; 95% CI = 0.09–3.77) at age 3, but not at age 5. Exposed children were less aggressive than unexposed siblings at age 5 (β = −2.27; 95% CI = –4.02 to –0.52). Conclusions: Children exposed to their mothers' hazardous drinking during the first trimester appear to be more emotionally reactive and have more somatic complaints at age 3, but not at age 5, and are less aggressive at age 5 compared with unexposed siblings. [ABSTRACT FROM AUTHOR]

Although most medications can be taken safely during breastfeeding, potential risks of infant toxicity do exist because all medications will be excreted into the breast milk to some extent. The amount of medication excreted in the milk depends mainly on (i) within‐drug variation, such as dosing; (ii) between‐drug variation including chemical characteristics of the medication; and (iii) host factors, such as maternal pharmacokinetics (PK), including variations of pregnancy‐associated changes and their post‐partum recovery. Neonatal drug exposure is usually assessed by calculating an expected total infant daily dose through breast milk and comparing it to the normal therapeutic dose. However, clinical PK studies in this population are challenging to conduct. Recently, research methods using population PK analyses and physiologically‐based PK modeling and simulation techniques have been recognized as a complementary approach to the conventional PK studies in this field. These efforts are important for rational risk assessment balancing the toxicity risk against the benefits of human milk. Health benefits of lactation for both mother and child are significant and a decision to withhold from this should not be taken lightly. In case limited information is present, additional expertise from pharmacists or clinical pharmacologist with expertise in this area should be sought. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To describe the prevalence of risk factors for abuse and newborns' risks for physical abuse hospitalizations during early infancy. METHODS: We created a nationally representative US birth cohort using the 2013 and 2014 Nationwide Readmissions Databases. Newborns were characterized by demographics, prematurity or low birth weight (LBW), intrauterine drug exposure, and medical complexity (including birth defects). Newborns were tracked for 6 months from their birth hospitalization, and subsequent abuse hospitalizations were identified by using International Classification of Diseases, Ninth Revision codes. We calculated adjusted relative risks (aRRs) with multiple logistic regression, and we used classification and regression trees to identify newborns with the greatest risk for abuse on the basis of combinations of multiple risk factors. RESULTS: There were 3 740 582 newborns in the cohort. Among them, 1247 (0.03%) were subsequently hospitalized for abuse within 6 months. Among infants who were abused, 20.4% were premature or LBW, and 4.1% were drug exposed. Premature or LBW newborns (aRR 2.16 [95% confidence interval (CI): 1.87-2.49]) and newborns who were drug exposed (aRR 2.86 [95% CI: 2.15-3.80]) were independently at an increased risk for an abuse hospitalization, but newborns with medical complexity or noncardiac birth defects were not. Publicly insured preterm or LBW newborns from rural counties had the greatest risk for abuse hospitalizations (aRR 9.54 [95% CI: 6.88-13.23]). Publicly insured newborns who were also preterm, LBW, or drug exposed constituted 5.2% of all newborns, yet they constituted 18.5% of all infants who were abused. CONCLUSIONS: Preterm or LBW newborns and newborns who were drug exposed, particularly those with public insurance and residing in rural counties, were at the highest risk for abuse hospitalizations. Effective prevention directed at these highest-risk newborns may prevent a disproportionate amount of abuse. [ABSTRACT FROM AUTHOR]

Background: Small for gestational age (SGA) infants are less likely to develop respiratory distress syndrome (RDS), but more likely to develop bronchopulmonary dysplasia (BPD) and have a higher mortality. Our aim was to focus on outcomes of those with a birth weight less than or equal to 750 g. Methods: The mortality, BPD severity, necrotising enterocolitis (NEC), home oxygen requirement and length of hospital stay were determined according to SGA status of all eligible infants in a 5-year period admitted within the first 24 h after birth. Results: The outcomes of 84 infants were assessed, and 35 (42%) were SGA. The SGA infants were more mature (P<0.001), had a lower birth weight centile (P<0.001) and a greater proportion exposed to antenatal corticosteroids (P=0.022). Adjusted for gestational age (GA), there was no significant difference in mortality between the two groups (P=0.242), but a greater proportion of the SGA infants developed severe BPD (P=0.025). The SGA infants had a lower weight z-score at discharge (−3.64 vs. −1.66) (P=0.001), but a decrease in z-score from birth to discharge was observed in both groups (median −1.53 vs. −1.07, P=0.256). Conclusion: Despite being more mature, the SGA infants had a similar mortality rate and a greater proportion developed severe BPD. [ABSTRACT FROM AUTHOR]

Here, we review the case of a 26 1/7 weeks' gestation premature female infant born to a mother who intentionally ingested a large quantity of Tylenol, aspirin, quetiapine, and prenatal vitamins. The neonate subsequently had markedly elevated levels of both Tylenol and aspirin when checked on the first day of life. While overall clinically stable, the neonate did demonstrate coagulopathy as evidenced by abnormal coagulation studies. Both poison control and a pediatric gastroenterologist/hepatologist were consulted. She successfully tolerated a course of N-acetylcysteine; her subsequent Tylenol level was markedly decreased and the neonate exhibited no further effects of toxicity. The salicylate level decreased on its own accord. To our knowledge, this is the first report of a neonate at 26 weeks' gestation that has been successfully managed for supratherapeutic concentrations of acetaminophen and acetylsalicylic acid secondary to maternal ingestion. While rare, this case may serve as a reference for the effectiveness of N-acetylcysteine in premature infants in such instances. [ABSTRACT FROM AUTHOR]

Children with prenatal substance exposure are at increased risk for externalizing behavior problems and violence. However, the contribution of early life experiences for placing these individuals at risk is not well understood. Utilizing a sample of 1,388 children with prenatal substance exposure from the Maternal Lifestyle Study, we attempt to shed light on these contributing factors by examining the impact of infant temperament, maternal sensitivity, and early life stress on the expression of violent behavior at ages 12 through 14 years. Males may be more at risk for increases in violent behavior in early adolescence through a number of early life experiences, such as variability in responses to maternal flexibility and engagement related to individual differences in temperament, as well as exposure to early adversity. Comparing two prevailing developmental theoretical frameworks, deficit models and differential susceptibility, we aim to understand the developmental origins of violent behavior in males by identifying children who may be most susceptible to early caregiving experiences. [ABSTRACT FROM AUTHOR]

Objectives To assess paediatricians' use of genetic testing for children with global developmental delay (GDD). Study Design We developed and piloted a questionnaire assessing the use of genetic tests in children with GDD and awareness of relevant guidelines. All practicing Quebec paediatricians were contacted. Paediatricians who did not evaluate children with GDD in their practice were excluded. Descriptive and statistical analyses were performed with SPSS. Results Of the 651 paediatricians, 225 answered (34.5%) and 141 were eligible. Only 31.9% were familiar with at least one guideline about genetic tests for the investigation of children with GDD, but 93.6% had ordered genetic testing for children with GDD (Fragile X testing [92.9%], karyotype [87.2%] and chromosomal microarray [63.8%]). Based on vignettes, 20.6% of participants would order genetic tests for isolated GDD and 95.0% for GDD with dysmorphic features and microcephaly. Only 56.7% ordered Fragile X testing for a girl with GDD and a known family history of Fragile X syndrome. Use of tests for isolated GDD was increased in presence of maternal pregnancy, compared with absence of pregnancy (44.7% and 27.7%, respectively). More participants would order genetic tests for a child with GDD and fetal exposure to alcohol (69.5%) than isolated GDD (20.6%). Conclusions Even though paediatricians often order genetic testing for children with GDD, practices and knowledge regarding testing are not optimal. As new and more complex genetic tests are developed, up-to-date training about the use of genetic tests for children with GDD needs to be integrated into paediatrics residency programs and continuous medical education. [ABSTRACT FROM AUTHOR]

Abstract: Background and Aims: In‐utero exposure to opioids including buprenorphine (BUP) has been shown to affect fetal activity, specifically heart‐rate variability (FHRV) and fetal movement (FM). Our objective was to extract simultaneous recordings of fetal cardiac and brain‐related activity in BUP‐maintained and non‐opioid exposed pregnant women using a novel non‐invasive biomagnetic technique. Design: A pilot study was conducted, recording and analyzing biomagnetic data from fetuses of BUP‐maintained and non‐opioid exposed pregnant women. Signals were acquired with the non‐invasive 151‐channel SARA (SQUID‐Array for Reproductive Assessment) system. Advanced signal‐processing techniques were applied to extract fetal heart and brain activity. Setting: University of Arkansas for Medical Sciences (UAMS, Little Rock, Arkansas, USA). Participants: Eight BUP‐maintained pregnant women from UAMS Women's Mental Health Program between gestational ages (GA) of 29–37 weeks who were treated with 8–24 mg of BUP daily. Sixteen pregnant women with no known opioid exposure in the same GA range were also included. Measurements: Outcome measures from the fetal heart and brain signals included: heart rate (FHR), FM, FHR accelerations, FHR–FM coupling, FHRV, fetal behavioral states (FBS) and power spectral density (PSD) of spontaneous brain activity. These measures were analyzed at three GA intervals. Findings: Fetal heart and brain activity parameters were extracted and quantified successfully from 18 non‐opioid and 16 BUP recordings. Overall analysis in both groups show that: FHR and FM ranged from 131 to 141 beats per minute (b.p.m.) and 5 to 11 counts, respectively. In the 35–37 weeks GA, the coupling duration (~9 s) was the shortest, while three of the FHRV parameters were the highest. The PSD of brain activity revealed highest power in 0.5‐4 Hz bandwidth. Transitions in FBS from quiet to active sleep were > 50% of sessions. Conclusions: This pilot study showed that a novel biomagnetic technique allows simultaneous quantification of cardiac and brain activities of a group of buprenorphine‐exposed and non‐exposed fetuses in the third trimester. [ABSTRACT FROM AUTHOR]

The article focuses on the risk and benefits of antidepressant use in breastfeeding women. Topics discussed include mental health disorders that occur during postpartum period, symptoms of the condition, and factors to consider before treating breastfeeding women. Information about antidepressant medication for breastfeeding women with low adverse reactions including selective serotonin reuptake inhibitors (SSRIs), Citalopram, and serotonin norepinephrine reuptake inhibitors (SNRIs) is noted.

Objective To evaluate the association of magnesium sulfate (MgSO4) exposure and candidate gene polymorphisms with adverse neurodevelopmental outcomes following preterm birth. Study Design We performed a nested case-control analysis of a randomized trial of maternal MgSO4 before anticipated preterm birth for the prevention of cerebral palsy (CP). Cases were children who died within 1 year of life or were survivors with abnormal neurodevelopment at age 2 years. Controls were race- and sex-matched survivors with normal neurodevelopment. We analyzed 45 candidate gene polymorphisms in inflammation, coagulation, and vascular regulation pathways and their association with (1) psychomotor delay, (2) mental delay, (3) CP, and (4) combined outcome of death/CP. Logistic regression analyses, conditional on maternal race and child sex, and adjusted for treatment group, gestational age at birth and maternal education, were performed. Results Four hundred and six subjects, 211 cases and 195 controls, were analyzed. The strongest association was for IL6R (rs 4601580) in which each additional copy of the minor allele was associated with an increased risk of psychomotor delay (adjusted odds ratio 3.3; 95% confidence interval, 1.7-6.5; p < 0.001). Conclusion Candidate gene polymorphisms are associated with death and adverse neurodevelopmental outcomes following preterm birth. MgSO4 may abrogate this genotype association for some loci. [ABSTRACT FROM AUTHOR]

Prenatal alcohol exposure (PAE) is associated with a constellation of physical, neurocognitive, and behavioral abnormalities in offspring. The presence of internalizing (e.g., anxiety, mood disorders) and externalizing (e.g., oppositional defiant and conduct disorders) behavior problems has devastating and often long-lasting impacts on children, adolescents, and their families. The present meta-analysis explored the strength of the association between PAE and behavior problems, as well as factors that increase or mitigate risk. The current meta-analysis included 65 studies comparing children and adolescents with PAE to non- or light-exposed controls and attention-deficit/hyperactivity disorder (ADHD) samples, on a variety of internalizing and externalizing behavior outcomes. Results indicated that individuals with PAE are at increased risk for internalizing (d = 0.71, medium effect) and externalizing (d = 0.90, large effect) problems compared to control samples. The occurrence of total behavior problems was similar to that seen in ADHD samples. The strength of the association between internalizing and externalizing behavior problems and PAE was significantly moderated by several distinct sample characteristics, such as sample age, socioeconomic status, severity of exposure, and type of behavior problem. These findings further our understanding of the behavior problems experienced by children and adolescents with PAE. [ABSTRACT FROM AUTHOR]

In brief: Review finds widely held belief regarding omega 3 fats to be largely wrong Effect of maternal nicotine replacement therapies in mothers on sudden infant death syndrome Eating the final meal of the day earlier is associated with lower risk of breast and prostate cancer [ABSTRACT FROM AUTHOR]

Background and Aims: Opioid maintenance treatment (OMT) is recommended to opioid‐dependent females during pregnancy. However, it is not clear which medication should be preferred. We aimed to compare neonatal outcomes after prenatal exposure to methadone (M) and buprenorphine (B) in two European countries. Design: Nation‐wide register‐based cohort study using personalized IDs assigned to all citizens for data linkage. Setting: The Czech Republic (2000–14) and Norway (2004–13). [Correction added after online publication on 26 April 2018: The Czech Republic (2000–04) corrected to (2000–14).] Participants: Opioid‐dependent pregnant Czech (n = 333) and Norwegian (n = 235) women in OMT who received either B or M during pregnancy and their newborns. Measurements: We linked data from health registries to identify the neonatal outcomes: gestational age, preterm birth, birth weight, length and head circumference, small for gestational age, miscarriages and stillbirth, neonatal abstinence syndrome (NAS) and Apgar score. We performed multivariate linear regression and binary logistic regression to explore the associations between M and B exposure and outcomes. Regression coefficient (β) and odds ratio (OR) were computed. Findings: Most neonatal outcomes were more favourable after exposure to B compared with M, but none of the differences was statistically significant. For instance, in the multivariate analysis, birth weight was β = 111.6 g [95% confidence interval (CI) = −10.5 to 233.6 and β = 83.1 g, 95% CI = −100.8 to 267.0] higher after B exposure in the Czech Republic and Norway, respectively. Adjusted OR of NAS for B compared with M was 0.94 (95% CI = 0.46–1.92) in the Norwegian cohort. Conclusions: Two national cohorts of women receiving opioid maintenance treatment during pregnancy showed small but not statistically significant differences in neonatal outcomes in favour of buprenorphine compared with methadone. [ABSTRACT FROM AUTHOR]

The symbiotic relationship between microbes and human is fundamental for a physiological development and health. The microbiome of the newborn undergoes to dramatic changes during the process of birth and in the first thousand days of life. Mother Nature provided us with the best possible start to achieve eubiosis: vaginal delivery to receive our mother’s microbiome and breast milk that favours the establishment of beneficial bacteria. Infants deprived of one or both of these evolutionary gifts undergo to important modification of the microbial communities leading to a state of dysbiosis enhancing the chance of the emergence of a variety of immune, inflammatory and metabolic disorders. Are we able to imitate nature? Is there any intervention for dysbiosis in children born by cesarean section? In this review we will try to answer to this intriguing question on the basis of the most recent scientific evidences. [ABSTRACT FROM AUTHOR]

Background: We recently demonstrated the acceptability and feasibility of a randomized, double‐blind choline supplementation intervention for heavy drinking women during pregnancy. In this study, we report our results relating to the efficacy of this intervention in mitigating adverse effects of prenatal alcohol exposure (PAE) on infant growth and cognitive function. Methods: Sixty‐nine Cape Coloured (mixed ancestry) heavy drinkers in Cape Town, South Africa, recruited in mid‐pregnancy, were randomly assigned to receive a daily oral dose of either 2 g of choline or placebo from time of enrollment until delivery. Each dose consisted of an individually wrapped packet of powder that, when mixed with water, produced a sweet tasting grape‐flavored drink. The primary outcome, eyeblink conditioning (EBC), was assessed at 6.5 months. Somatic growth was measured at birth, 6.5, and 12 months, recognition memory and processing speed on the Fagan Test of Infant Intelligence, at 6.5 and 12 months. Results: Infants born to choline‐treated mothers were more likely to meet criterion for conditioning on EBC than the placebo group. Moreover, within the choline arm, degree of maternal adherence to the supplementation protocol strongly predicted EBC performance. Both groups were small at birth, but choline‐treated infants showed considerable catch‐up growth in weight and head circumference at 6.5 and 12 months. At 12 months, the infants in the choline treatment arm had higher novelty preference scores, indicating better visual recognition memory. Conclusions: This exploratory study is the first to provide evidence that a high dose of choline administered early in pregnancy can mitigate adverse effects of heavy PAE on EBC, postnatal growth, and cognition in human infants. These findings are consistent with studies of alcohol‐exposed animals that have demonstrated beneficial effects of choline supplementation on classical conditioning, learning, and memory. [ABSTRACT FROM AUTHOR]

Objective: The aim of this research was to assess psychosocial history and psychological functioning in women who use drugs during pregnancy and determine how drug exposure affects child development. Methods: Pregnant women using marijuana (n = 38) and cocaine (n = 35) and receiving methadone maintenance (n = 24), along with a control (n = 49) group of pregnant women, were enrolled and followed every six months through 18–24 months postnatally. Results: There was a significantly higher incidence of mental illness among mothers in the drug-using groups. Prenatal stress and late-term drug severity scores were significantly higher in the mothers who used cocaine and methadone, who were also more likely to have abuse and incarceration histories. At 12 months, there were significantly higher rates of drug use in the marijuana group. Anxiety scores were highest in the methadone group. At 18 to 24 months, the methadone group reported significantly more stress, and methadone and marijuana groups had significantly higher anxiety and depression scores. At birth, neonates from the methadone and marijuana groups had significantly smaller head circumferences, with the smallest values in the methadone group. At one year, children in the cocaine group had significantly lower Bayley Scales of Infant Development–Third Edition (Bayley-III) cognitive and motor scores. At 18 to 24 months, children in the methadone group had significantly smaller head circumferences and Bayley-III cognitive scores. Children in the methadone and cocaine groups had a significantly higher incidence of atypical neurological examinations at 6 to 9 and 18 to 24 months. Conclusions: Mothers in the methadone and cocaine groups presented with more severe prenatal drug use and psychosocial risk factors relative to women who used primarily marijuana. Children in the cocaine and methadone groups were neurologically atypical relative to others at study end. Mothers in the marijuana group reported chronic drug use as well as anxiety and depression at follow-up. At birth, children in the marijuana group were smaller, but this resolved with time. Similarly, children in the cocaine group had motor and cognitive delays that resolved by age two. Children in the methadone group had persistent growth and cognitive deficits. Their mothers demonstrated more anxiety, depression, and stress, the combination of which left these women and children liable to face ongoing psychosocial struggle and psychological distress. Dual interventions for mother and child should be considered in attempting to optimize outcome. [ABSTRACT FROM AUTHOR]

This article describes results from a state-wide survey of social services professionals (n = 259) regarding knowledge of the Child Abuse Prevention and Treatment Act Reauthorization of 2010 (CAPTA), clinically based markers of prenatal substance exposure (PSE), and appropriate child protection responses following a PSE referral. Few respondents were aware of CAPTA, and knowledge of clinical markers of PSE and appropriate child protective services responses to prenatal exposure varied according to substance type (alcohol or drugs). Regression models revealed that fewer years in practice and fewer annual drug referrals predicted more drug-exposure knowledge. Fewer years in practice and awareness of CAPTA predicted more alcohol-exposure knowledge. Policy implementation strategies are needed to increase the likelihood that CAPTA achieves its desired intent, particularly with professionals who have been in the field longer and may be less open to changing practice behaviors. [ABSTRACT FROM AUTHOR]

Confounding may account for the apparently improved infant outcomes after prenatal exposure to buprenorphine versus methadone. We used Massachusetts Medicaid Analytic eXtract (MAX) data to identify a cohort of opioid-dependent mother-infant pairs (2006-2011), supplemented with confounder data from an external Boston, Massachusetts, cohort (2015-2016). Associations between prenatal buprenorphine exposure versus methadone exposure and infant outcomes in the MAX cohort were adjusted for measured MAX confounders and were additionally adjusted for unmeasured confounders with bias analysis using external cohort data. A total of 477 women in MAX were treated with methadone and 543 with buprenorphine. More buprenorphine users than methadone users were white and used psychotropic medications. After adjustment forMAX confounders, risk ratios among infants exposed to buprenorphine versus those exposed tomethadone were 0.45 (95% confidence interval (CI): 0.34, 0.61) for preterm birth (birth at <37 weeks) and 0.75 (95%CI: 0.51, 1.11) for low birth weight for gestational age. The mean difference in infant hospitalization was -7.35 days (95% CI: -9.16, -5.55). After further adjustment with bias analysis, the risk ratios were 0.53 (95%CI: 0.39, 0.71) for preterm birth and 1.14 (95%CI: 0.77, 1.69) for low birth weight for gestational age, and the mean difference in infant hospitalization was -3.66 days (95% CI:-5.46,-1.87). External confounder data can be used to adjust for unmeasured confounding in studies of prenatal outcomes among women on opioid agonist therapy based on administrative databases. [ABSTRACT FROM AUTHOR]

Abstract: Background and Aims: Research on Neonatal Abstinence Syndrome has prompted discussion over how to ensure best outcomes for pregnant women who use drugs and for drug‐dependent newborns. Before Neonatal Abstinence Syndrome and the 1980s panic of “crack babies,” turn‐of‐the‐century American medical journals discussed infants born to drug‐using mothers. This paper aimed to determine whether women who used drugs while pregnant in early twentieth‐century America were subject to the stigma many face today. Methods: Records from early twentieth century medical journals, narcotic maintenance clinics, prisons that held drug users, and conferences on narcotics were examined. Dr. Charles Terry's outspokenness on drug addiction and pregnancy merited closer examination of his work, particularly The Opium Problem. Results: Some physicians saw drug‐dependent newborns as scientific proof that addiction was a physiological disease and not subject to questions of morality. This theory was discarded in the 1920s. In that decade, beliefs that children born to drug‐using parents threatened national well‐being proliferated. Following formal medicine's retreat from addiction treatment, research on drug addiction and pregnancy fell into obscurity until decades later. Conclusions: The precedent that women who use drugs while pregnant deserve humane treatment extends to the early twentieth century in the US. From 1910 to 1930, perceptions of infants of drug‐using women changed from hopeful to fearful. [ABSTRACT FROM AUTHOR]

Opioid use in pregnancy and the postpartum period increases the vulnerability of the newborn in many ways. No single system can appropriately meet all the needs of this population. Due to the variety of systems that are involved, there are multiple opportunities for gaps in care. Thus, the systems of care must collaborate, communicate, and share information in an effective manner in order to provide optimal care. This article uses the metaphor of driving on a long journey with many twists and turns to illustrate the various aspects of opioid use in pregnancy, the challenges to intervention, and how to effectively support children and families in recovery. [ABSTRACT FROM AUTHOR]

Evidence suggests multiple anesthetics in early childhood may increase risk for neurodevelopmental injury. We evaluated proportions of children undergoing circumcision and myringotomy, concomitantly with or prior to circumcision, and compared costs between groups. The Pediatric Health Information System was queried for males aged 6 to 36 months who underwent circumcision in 2009-2014. Relative to circumcision, the proportion who underwent myringotomy previously, concomitantly, or both, was calculated. Of 29  789 patients who underwent circumcision, 822 also underwent myringotomy; 342 (41.6%) underwent myringotomy on a previous day, and 480 (58.4%) underwent myringotomy at time of circumcision. Total hospital costs were lower for concomitant procedures (median $2994 vs $4609, P < .001. In total, 58.4% of patients who underwent circumcision and myringotomy did so concomitantly. Combined procedures resulted in significantly reduced costs and potentially minimized neurocognitive risk. Ideally, both referring pediatricians and surgical specialists should inquire about other surgical needs to optimize the availability of concomitant procedures. [ABSTRACT FROM AUTHOR]

This study used the National Poison Data System database to retrospectively analyze the characteristics and medical outcomes of exposures to antipyretic medications involving children younger than 6 years in the United States. From 2000 through 2015, United States Poison Control Centers recorded an average of 74 387 antipyretic exposures annually among children younger than 6 years. Most exposures involved ibuprofen (55.1%) or acetaminophen (40.1%). From 2000 to 2009, the number of exposures increased by 73.0%, followed by a 25.2% decrease from 2009 to 2015. Children exposed to acetaminophen had 1.98 times higher odds of a serious medical outcome compared with those exposed to ibuprofen. Although generally safe at the correct dosage, antipyretic exposures continue to cause pediatric morbidity and, in rare cases, death. Prevention efforts should focus on reducing child access; educating caregivers about the potential dangers of antipyretics; and discouraging their use, except when needed to improve a child’s comfort. [ABSTRACT FROM AUTHOR]

The incidence of opioid abuse and subsequent drug withdrawal is exponentially on the rise in the United States for many populations including newborns who are born to drug-addicted mothers. These newborns often exhibit symptoms of neonatal abstinence syndrome (NAS) within 24 to 72 hours of birth. Treatment of NAS includes monitoring of withdrawal symptoms, managing physiological parameters, and the use of supportive and pharmacologic treatments. Although a few randomized controlled trials exist, studies on supportive intervention are generally limited by small sample sizes, case study reports, expert opinions, and descriptive design. Few studies address the safety of Reiki for newborns at risk for NAS using neonatal parameters. This pilot study addresses feasibility and demonstrates that Reiki is safe when administered to this high-risk population. Considerations for future studies are discussed. [ABSTRACT FROM AUTHOR]

Aim: To examine whether exposure to increased alcohol availability in utero is associated with later alcohol-related health problems. Method: Register-linked population-based longitudinal study using data from a natural experiment setting, including 363 286 children born 1965–71. An experimental alcohol policy change was piloted in two regions of Sweden in 1967–68, where access to strong beer increased for 16–20 year old. Children exposed in utero to the policy change were compared to children born elsewhere in Sweden (excluding a border area), and to children born before and after the policy change. The outcome was obtained from the National Hospital Discharge Register using the Swedish index of alcohol-related inpatient care. Hazard ratios (HR) with 95% confidence intervals (CI) were estimated by Cox regression analysis. Results: The results suggest that children conceived by young mothers prior to the policy change but exposed to it in utero had a slightly increased risk of alcohol-related health problems later in life (HR 1.26, 95% CI 0.94-1.68). A tendency towards an inverse association was found among children conceived by older mothers (HR 0.88, 95% CI 0.74-1.06). Conclusion: Results obtained from a natural experiment setting found no consistent evidence of long-term health consequences among children exposed in utero to an alcohol policy change. Some evidence however suggested an increased risk of alcohol-related health problems among the exposed children of young mothers. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine factors associated with behaviors of mothers that expose their infants to endocrine disruptors. The PROCEED model was used as a theoretical basis for the study. Methods: This correlational study included 120 mothers with infants between the ages of 1 month to 36 months. Participants were recruited through the maternal community web-site of mothers of infants in W city. Results: There was a significant negative correlation among experience of mothers who had participated in environmentally friendly activities, the health status of the infants perceived by the mother, and behaviors of mothers that exposed infants to endocrine disruptors. The factors based on PROCEED model explained 15.3% of the behaviors by mothers that exposed infants to endocrine disruptors. Conclusion: It is necessary to develop and provide educational programs that include detailed information on relationship of endocrine disruptors to children's health. [ABSTRACT FROM AUTHOR]

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Objectives Determine trends in incidence and expenditure for perinatal drug exposure and neonatal abstinence syndrome (NAS) among Louisiana's Medicaid population. We also describe the maternal characteristics of NAS affected infants. Methods Retrospective cohort analysis using linked Medicaid and vital records data from 2003 to 2013. Conducted incidence and cost trends for drug exposed infants with and without NAS. Also performed comparison statistics among drug exposed infants with and without NAS and those not drug exposed. Results As rate of perinatal drug exposure increased, NAS rate per 1000 live Medicaid births also increased, from 2.1 (2003) to 3.6 (2007) to 8.0 (2013) (P for trend <0.0001). Total medical cost paid by Medicaid also increased from $1.3 million to $3.6 million to $8.7 million (P for trend <0.0001). Compared with drug exposed infants without NAS and those not drug exposed, infants with NAS were more likely to be white, have feeding difficulties, respiratory distress syndrome, sepsis, and seizures, all of which had an association at P < 0.0001. Over one-third (33.2%) of the mothers of infants with NAS had an opioid dependency in combination with a mental illness; with depression being most common. Conclusions for Practice Over an 11-year period, NAS rate among Louisiana's Medicaid infants quadrupled and the cost for caring for the affected infants increased six-fold. Medicaid, as the predominant payer for pregnant women and children affected by substance use disorders, must play a more active role in expanding access to comprehensive substance abuse treatment programs. [ABSTRACT FROM AUTHOR]

Foetal alcohol spectrum disorder (FASD) is a non-diagnostic umbrella term encompassing a spectrum of disorders caused by prenatal alcohol exposure. This article reports on a qualitative research project undertaken in three Indigenous communities in the West Kimberley region of Western Australia, intended to develop diversionary pathways for Indigenous young people with FASD at risk of enmeshment in the justice system. Rates of FASD in some parts of the West Kimberley are comparable to the highest identified internationally. A diagnosis of FASD amplifies the chances of Indigenous youth being caught up in the justice system in Western Australia, including indefinite detention in prison if found unfit to stand trial. A fresh diversionary paradigm is required. Employing a postcolonial perspective, we explore issues surrounding law and justice intervention – and non-intervention – in the lives of Indigenous children and their families. The FASD problem cannot be uncoupled from the history of colonial settlement and the multiple traumas resulting from dispossession, nor can solving the problem be isolated from the broader task of decolonizing relationships between Indigenous people and the settler mainstream. The decolonizing process involves expanding the role of Indigenous owned and place-based processes and services embedded in Indigenous knowledge. [ABSTRACT FROM AUTHOR]

Recent studies indicate that the immune system adaptation during pregnancy could play a significant role in the pathophysiology of perinatal depression. The aim of this study was to investigate if inflammation markers in a late pregnancy plasma sample can predict the presence of depressive symptoms at eight weeks postpartum. Blood samples from 291 pregnant women (median and IQR for days to delivery, 13 and 7–23 days respectively) comprising 63 individuals with postpartum depressive symptoms, as assessed by the Edinburgh postnatal depression scale (EPDS ≥ 12) and/or the Mini International Neuropsychiatric Interview (M.I.N.I.) and 228 controls were analyzed with an inflammation protein panel using multiplex proximity extension assay technology, comprising of 92 inflammation-associated markers. A summary inflammation variable was also calculated. Logistic regression, LASSO and Elastic net analyses were implemented. Forty markers were lower in late pregnancy among women with depressive symptoms postpartum. The difference remained statistically significant for STAM-BP (or otherwise AMSH), AXIN-1, ADA, ST1A1 and IL-10, after Bonferroni correction. The summary inflammation variable was ranked as the second best variable, following personal history of depression, in predicting depressive symptoms postpartum. The protein-level findings for STAM-BP and ST1A1 were validated in relation to methylation status of loci in the respective genes in a different population, using openly available data. This explorative approach revealed differences in late pregnancy levels of inflammation markers between women presenting with depressive symptoms postpartum and controls, previously not described in the literature. Despite the fact that the results do not support the use of a single inflammation marker in late pregnancy for assessing risk of postpartum depression, the use of STAM-BP or the novel notion of a summary inflammation variable developed in this work might be used in combination with other biological markers in the future. [ABSTRACT FROM AUTHOR]

Background and aims The relationship between gestational age at delivery and the severity of neonatal abstinence syndrome (NAS) is poorly understood. Our objective was to compare the length of pharmacotherapy and hospital stay among opioid-exposed infants born during the late pre-term, early term, full term and late term periods. Design Retrospective cohort study of infants affected by NAS. Setting MetroHealth Medical Center in Cleveland, OH, USA: an urban tertiary care hospital serving as the referral center for opioid dependency in pregnancy with a level III neonatal intensive care unit. Participants All deliveries complicated by maternal opioid exposure from January 2000 to October 2014; 403 were eligible to be included [ n = 102 late pre-term, 34-36 weeks (LP), n = 158 early term, 37-38 weeks (ET), n = 122 full term, 39-40 weeks (FT), n = 21 late term, ≥41 weeks (LT)]. Measurements NAS requiring pharmacotherapy with opioids and hospital stay duration were compared between gestational age cohorts. Interaction by type of maternal medication was evaluated. Findings The necessity for pharmacotherapy for NAS was similar in all gestational age groups [LP n = 45/102 (44%), ET n = 65/158 (41%), FT n = 55/122 (45%), LT n = 9/21 (43%); P = 0.92]. However, the median duration of pharmacotherapy for NAS was significantly different between the groups [LP =16.0 median (interquartile range: IQR = 10.0-24.0) days, ET = 22.5 (IQR = 15.0-40.0), FT = 23.0 (IQR = 6.0-38.0), LT = 22.0 (IQR = 6.0-28.0); P = 0.02]. Neonatal intensive care unit admission for NAS ( P = 0.07) and total length of stay ( P = 0.27), which includes observation for NAS not requiring medication, were not different. There was no significant interaction between gestational age cohorts and maternal medication assisted treatment therapy on the need for or duration of NAS treatment. The results were unchanged when evaluated for potential confounding variables. Conclusions Gestational age (pre-term, term or late term) at birth appears to be unrelated to the need for pharmacotherapy to treat neonatal abstinence syndrome (NAS) in late pre-term and term infants. If treatment is needed it may tend to be given for longer in term than pre-term or late term infants. [ABSTRACT FROM AUTHOR]

The article discusses a study which showed the link of antenatal opioid exposure to reduced birth head circumference in newborns as of January 2019. Topics covered include infants with neonatal abstinence syndrome (NAS), NAS prevention, and the long-term effects of fetal and neonatal opioid exposure on the developing child. Also noted are such questions as the possible mediation of fetal opioid exposure during a critical window, and the dose and duration of drugs to be used.

Previous studies have reported the harmful effects of exposure to phthalic acid (PA) on heart. No studies have reported the effects of prenatal PA exposure on the structure or function of heart. The current study aimed to investigate the effects of prenatal PA exposure on the markers of oxidative stress and cardiac structure in rats' offspring. Twenty-four pregnant rats were randomly categorized into three groups of control, exposed to 2.5 and 5 % PA. The morphometric properties of coronary arteries, markers of oxidative stress, and NOS activity were measured in offspring rats. By a dose-dependent manner, the body weight (BW), heart weight (HW), and HW/BW of the intervention groups were reduced and their heart rate and blood pressure were conversely increased compared to the control group. Also, the wall thickness, cross-sectional area of the aorta and septal branch of the descending left coronary artery were significantly increased in the intervention group. In addition, PA significantly increased the level of malondialdehyde and decreased the level of superoxide dismutase and glutathione peroxidase, compared to the control group. This study revealed that prenatal exposure of rats to PA causes vascular dysfunction, increasing oxidative stress, and reduction in cardiac nitric oxide synthetase activity among offspring rats. [ABSTRACT FROM AUTHOR]

Opioid addiction in pregnancy is a growing concern that has recently received a great deal of attention. When comparing recommended opioid agonist therapies, many currently published studies guiding practice may have been affected by unmeasured confounding by indication. Populations of women who receive methadone are generally different from those treated with buprenorphine. Women treated with methadone frequently have more severe and uncontrolled addiction than buprenorphine-treated patients; however, these factors are typically unmeasured or unavailable in large observational data sets. Consequently, findings of superior perinatal outcomes with buprenorphine may in truth be a result of an overall healthier profile of women taking this medication. In this issue of the Journal, Brogly et al. (Am J Epidemiol. 2018;187(6):1153-1161) describe an approach utilizing detailed data from an external cohort (n = 113) to account for confounding by indication in a larger Medicaid population (n = 1,020) in order to more accurately compare opioid agonist therapies in pregnancy. They found that the decreases in risk of preterm birth and length of infant hospitalization associated with buprenorphine as compared with methadone were attenuated after accounting for the additional confounding. Brogly et al. should be commended for providing a novel method with which to address this bias in future studies. [ABSTRACT FROM AUTHOR]

AIMS - The aim of this study was to investigate whether the mother's substance abuse, psychiatric problems and socio-economic situation are related to 1) disorders of psychological development, 2) behavioural and emotional disorders, and 3) mood disorders and neurotic, stress-related and somatoform disorders in children aged 0-12 years. DATA & METHODS - The research is based on data on all children born in Finland in 1997 who have not died before their first birthday (n=58 761). These children were followed until their 12th birthday. Information from national registers covering health and social care, education, relationship status, age and receipt of income support were analysed using cross-tabulation with χ2-tests and logistic regression analysis. RESULTS - Based on the register data of children, 1.4% (n = 798) had a mother with substance abuse problems only, 3.2% (n = 1854) had a mother with psychiatric disorders only, and 1.1% (n = 652) had a mother with both substance abuse and psychiatric disorders. Among children with mothers with substance abuse, psychiatric disorders or both, the risks of all categories of psychiatric diseases studied were significantly higher than in the comparison group. It was a bigger risk for the child to have a mother with both substance abuse and psychiatric disorders than either of these alone. CONCLUSION - The mother's substance abuse and her other psychiatric disorders are significant risk factors for her children's psychiatric development, even when the socio-economic factors are taken into account. Children of mothers with both substance abuse and psychiatric disorders are at a particularly high risk. [ABSTRACT FROM AUTHOR]