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Prenatal alcohol exposure (PAE) can negatively affect brain development thereby increasing the risk of cognitive deficits, behavioral challenges, and mental health problems. Brain iron is important for a number of physiological processes for healthy brain development. Animal studies show that PAE reduced brain iron; however, this has not been investigated in human children with PAE.We studied 20 children and adolescents with PAE and 44 unexposed children and adolescents aged 7.5 to 15 years. All children underwent quantitative susceptibility mapping and T1-weighted magnetic resonance imaging scans. Susceptibility and volume measurements of the caudate, putamen, pallidum, thalamus, amygdala, hippocampus, and nucleus accumbens were extracted using FreeSurfer. ANCOVAs were used to compare volume and susceptibility between groups for each region of interest, controlling for age and gender. For structures where susceptibility differed by group, we also tested for an association between intelligence quotient (IQ) and susceptibility.There were no significant group differences in susceptibility after multiple comparison correction, though the PAE group had higher susceptibility in the thalamus compared to unexposed participants before correction (p = 0.032, q = 0.230). There was no association between IQ and thalamus susceptibility. The PAE group had significantly lower volume in the bilateral caudate, bilateral pallidum, and left putamen.These findings suggest susceptibility may be altered in children and adolescents with PAE, though more research is needed. Volume reductions are consistent with previous literature and likely underlie cognitive and behavioral deficits associated with PAE.

ImportanceOutcomes among patients with pregnancy-associated cancers (diagnosed during pregnancy or 1-year postpartum) other than breast cancer have received relatively little research attention. High-quality data from additional cancer sites are needed to inform the care of this unique group of patients.ObjectiveTo assess mortality and survival in premenopausal women with pregnancy-associated cancers, with a particular focus on cancers other than those of the breast.Design, Setting, and ParticipantsThis population-based retrospective cohort study included premenopausal women (aged 18-50 years) living in 3 Canadian provinces (Alberta, British Columbia, and Ontario) diagnosed with cancer between January 1, 2003, and December 31, 2016, with follow-up until December 31, 2017, or date of death. Data analysis occurred in 2021 and 2022.ExposuresParticipants were categorized as being diagnosed with cancer during pregnancy (from conception to delivery), during the postpartum period (up to 1 year after delivery), or during a time that was remote from pregnancy.Main Outcomes and MeasuresOutcomes were overall survival at 1 and 5 years and time from diagnosis to death due to any cause. Cox proportional hazard models were used to estimate mortality adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs), adjusting for age at cancer diagnosis, cancer stage, cancer site, and days from diagnosis to first treatment. Meta-analysis was used to pool results across all 3 provinces.ResultsDuring the study period there were 1014, 3074, and 20 219 participants diagnosed with cancer during pregnancy, postpartum, and periods remote from pregnancy, respectively. One-year survival was similar across the 3 groups, but 5-year survival was lower among those diagnosed with cancer during pregnancy or postpartum. Overall, there was a greater risk of death due to pregnancy-associated cancer among those diagnosed during pregnancy (aHR, 1.79; 95% CI, 1.51-2.13) and postpartum (aHR, 1.49; 95% CI, 1.33-1.67); however, these results varied across cancer sites. Increased hazard of mortality was observed for breast (aHR, 2.01; 95% CI, 1.58-2.56), ovarian (aHR, 2.60; 95% CI, 1.12-6.03), and stomach (aHR, 10.37; 95% CI, 3.56-30.24) cancers diagnosed during pregnancy, and brain (aHR, 2.75; 95% CI, 1.28-5.90), breast (aHR, 1.61; 95% CI, 1.32-1.95), and melanoma (aHR, 1.84; 95% CI, 1.02-3.30) cancers diagnosed postpartum.Conclusions and RelevanceThis population-based cohort study found that pregnancy-associated cancers had increased overall 5-year mortality, though not all cancer sites presented the same risk.

Social interactions like group inclusion, receiving praise, or treating others kindly can be motivating and enjoyable. Social reward sensitivity, including motivation and enjoyment, varies between individuals. In early childhood, this variation may relate to differences in social experience and development. Social reward questionnaires have been developed to measure individual differences in social enjoyment for adolescents and adults, but no early childhood measure currently exists. Here, we describe the development and validation of the parent/caregiver report Social Reward Questionnaire-Early Childhood (SRQ-EC) for children aged 3-7 years. The SRQ-EC was developed to quantify both wanting (motivation) and liking (enjoyment) of social rewards, which were considered in separate factor models. For wanting and liking models, exploratory (N = 126) and confirmatory (N = 344) factor analyses identified that three subscales best represented early childhood social reward sensitivity, which were: Sociability (large groups), Admiration (praise and positive attention), and Prosocial Interactions and Compliance (kindness and rule following). SRQ-EC subscales were internally consistent (ω = 0.76-0.91, α = 0.75-0.88, mean interitem correlations = 0.38-0.60) with high test-retest reliability over 2-weeks (r = 0.66-0.85, all p < .001). Subscales differentially associated with other social behavior and personality measures, suggesting construct validity. SRQ-EC subscale scores further showed differential and significant associations with autistic-like traits in nonautistic children. These results suggest that SRQ-EC subscale scores are reliable for assessing social reward sensitivity during early childhood, which could offer key developmental insight regarding interindividual variation in early social behavior.

Background: Antenatal depression (AD) is the most common complication of pregnancy in developed countries and increases risk of preterm birth (PTB). Many pregnant individuals with AD do not obtain treatment due in part to risks associated with antidepressant medications, the expense and wait times for psychological services, and perceived stigma. Accessible and timely treatment of antenatal depression is crucial to minimize foetal impacts and associated long-term child health outcomes. Previous studies show that behavioural activation and peer-support are promising avenues of treatment for perinatal depression. Additionally, remote and paraprofessional counselling interventions show promise as more accessible, sustainable, and cost-effective treatment avenues than traditional psychological services. The primary aim of this trial is to test the effectiveness of a remote, behavioural activation and peer support intervention, administered by trained peer para-professionals, for increasing gestational age at delivery among those with antenatal depression. The secondary aims are to evaluate the effectiveness for treating AD prior to delivery, with persistence into the postpartum; improving anxiety symptoms; and improving parenting self-efficacy compared to controls. Methods: A two-arm, single-blinded, parallel groups randomized controlled trial (RCT) with repeated measures will be conducted. Participants scoring >10 on the Edinburgh Postnatal Depression Scale will be recruited from the larger P3 cohort and invited to enroll. Assessments will be conducted prior to 27 weeks’ gestation at trial intake (T1), post-intervention, prior to delivery (T2), 5-6 months postpartum (T3), and 11-12 months postpartum (T4) and will include self-report questionnaires and linked medical records. Discussion: Our remote, peer paraprofessional-delivered behavioural activation plus peer support intervention has the potential to successfully reduce symptoms of AD, which may in turn decrease the risk of PTB and subsequent health impacts. The current trial builds on previous findings and uses a patient-oriented approach to address priorities for patient care and to provide a cost-effective, accessible, and evidence-based treatment to pregnant individuals with AD. Trial registration: ISRCTN51098220

BackgroundThe epidemiology of prenatal cannabis use in Canada following legalization remains unknown despite increasing evidence for associated health risks. Our study aimed to identify current risk factors for, and patterns of, prenatal cannabis use and second-hand cannabis exposure in Alberta.MethodsWe conducted a secondary analysis of prospective data from a 2019 study in Calgary AB, of 153 pregnant (ResultsOdds of prenatal cannabis use were significantly higher among those who did not own their home (Odds Ratio (OR) 3.1; 95% CI:1.6-9.6), smoked tobacco prenatally (OR 3.3,95% CI:1.2-9.3) and used illicit substances in the past (OR 3.2; 95% CI:1.7-9.9), and lower for those consuming alcohol prenatally (OR 0.3, 0.12-0.89). Among the 90 (58%) participants who used cannabis prenatally, the majority used for medicinal reasons (96%), at least daily (67%), by smoking (88%), in all trimesters of pregnancy (66%). Although reported dose-per-use was commonly low, cumulative doses over pregnancy were high.InterpretationOur study finds marked differences in prenatal cannabis use risk factors, and patterns of more frequent use sustained throughout pregnancy with perceived medicinal indications than pre-legalization studies. Prenatal care providers should include cannabis explicitly in medication counselling. Further prospective studies are needed as the impacts of prenatal cannabis on maternal and infant health in Canada may currently be underestimated.

Children and adolescents with cerebral palsy (CP) are at heightened risk for mental health problems. Physical activity is an effective strategy to promote quality of life (QoL) and reduce mental health symptoms along with evidence-based therapies. This study described existing literature examining the mental health outcomes (e.g., QoL, well-being, anxiety, and depression) of physical activity interventions in children and adolescents with CP to help inform the implementation of physical activity interventions for this population.Ascoping review framework was used to map the existing quantitative literature.The search returned 243 articles; after titles, abstracts, and full manuscripts were reviewed, 21 articles were included. The association between physical activity and QoL was examined in most studies (n = 17) with mixed findings. Eight studies documented at least one significant positive association between physical activity and QoL, and four found that physical activity interventions were highly enjoyable. Only one study assessed anxiety and/or depression following a PA intervention.Physical activity may benefit aspects of QoL and mental health symptoms; however, this was not a consistent finding in the existing literature. Along with other therapies, physical activity interventions may be valuable in improving QoL, and in turn, the mental health symptoms of children with CP.

We assessed different aspects of tactile perception in young children (3–6 years) with autism. Autistic and neurotypical children completed vibrotactile tasks assessing reaction time, amplitude discrimination (sequential and simultaneous) and temporal discrimination (temporal order judgment and duration discrimination). Autistic children had elevated and more variable reaction times, suggesting slower perceptual-motor processing speed and/or greater distractibility. Children with autism also showed higher amplitude discrimination and temporal order judgement thresholds compared to neurotypical children. Tactile perceptual metrics did not associate with social or tactile sensitivities measured by parent-reports. Altered tactile behavioral responses appear in early childhood, can be quantified but appear dissociated from sensitivity. This implies these measures are complementary, but not necessarily related, phenomena of atypical tactile perception in autism.

Several theories have been proposed to explain the presentation of intense interests in autism, including theories based on altered executive functioning, imbalanced reward sensitivity, and mitigating anxiety. These theories have yet to be examined in early childhood, yet knowledge of how intense interests emerge could provide insight into how best to manage intensity and support the many benefits of personal interests. Parents of 33 autistic and 42 non-autistic comparison children aged 3–6 years completed questionnaires to assess attention shifting and inhibitory control, responsiveness to rewards, and anxiety symptoms. Each behavior domain was examined for associations with parent-reported interest intensity. In autistic and comparison children, attention shifting was associated with interest intensity, where children with more difficulties showed more intense interests. In autistic children only, inhibitory control of attention also associated with interest intensity, where children with greater difficulties showed more intense interests. Reward and anxiety symptoms did not associate with interest intensity in either group, or across the sample. These findings suggest that, in early childhood, the presentation of intense interests is related to executive functioning regardless of diagnostic group. Helping children develop executive functioning skills may therefore be useful to assist with managing interest intensity in early childhood. Lay abstract Personal interests in autism are a source of joy, pride, and assist with the formation of social relationships. However, highly intense engagement can also interfere with other activities including activities of daily living. Theories have suggested that intense interests relate to executive functioning, reward sensitivity, and anxiety symptoms; but none of these theories have been tested in early childhood. Understanding which behavioral traits relate to intense interests in early childhood could help understand how intense interests may emerge, while also providing clues for how to manage interest intensity and best promote the many benefits of personal interests. We recruited families with autistic and non-autistic children aged 3–6 years. Parents completed questionnaires to assess children’s interest diversity and intensity, executive functioning, reward sensitivity, and anxiety symptoms. We found that for autistic and non-autistic children, greater difficulty shifting attention between activities related to more intense interests. In autistic children only, difficulty with inhibitory control of attention also related to more intense interests. However, reward sensitivity and anxiety symptoms did not relate to interest intensity. Based on these observations, assisting young children with developing executive functioning skills could help with mediating the interference of interests in daily life to ultimately promote the many benefits of personal interests.

Background. Many autistic students have a variety of strengths and the desire to succeed in postsecondary education. Nonetheless, most autistic students report not receiving adequate support in postsecondary education to ensure their success. Students also report difficulty in navigating complex institutional systems. We conducted an environmental scan of autism-specific supports (e.g., website information, transition programs, peer mentoring) available to autistic students within Canada’s publicly-funded postsecondary institutions. We also examined distribution of autism-specific supports across institutional type (i.e., university, junior college, technical/vocational) and geographic region.Method. A Boolean search strategy was used to collect data from institutional websites.Results. Of the 258 publicly-funded postsecondary institutions in Canada, only 15 institutions (6%) had at least one support. Of the 15 institutions identified, the most common autism-specific support included information on the institution’s website (67%), followed by transition to university support (47%), social group(s) (33%), peer mentoring (27%), specialist tutoring and support with daily living (20%), transition to employment support (13%), and student-led societies and autistic student advocate (7%). In general, universities and institutions in Central Canada (i.e., Ontario) had a higher number of provisions than expected.Conclusions. There are promising advances with respect to autism-specific supports in post-secondary institutions across Canada. We recommend further research to better understand how students access these supports and more comprehensive evaluations of such supports, specifically informed by collaborations with autistic students.

IMPORTANCE: The association between hydraulic fracturing and human development is not well understood. Several studies have identified significant associations between unconventional natural gas development and adverse birth outcomes; however, geology and legislation vary between regions. OBJECTIVE: To examine the overall association between residential proximity to hydraulic fracturing sites and adverse birth outcomes, and investigate whether well density influenced this association. DESIGN, SETTING, AND PARTICIPANTS: This population-based retrospective cohort study of pregnant individuals in rural Alberta, Canada, took place from 2013 to 2018. Participants included reproductive-aged individuals (18-50 years) who had a pregnancy from January 1, 2013, to December 31, 2018, and lived in rural areas. Individuals were excluded if they lived in an urban setting, were outside of the age range, or were missing data on infant sex, postal code, or area-level socioeconomic status. EXPOSURES: Oil and gas wells that underwent hydraulic fracturing between 2013 to 2018 were identified through the Alberta Energy Regulator (n = 4871). Individuals were considered exposed if their postal delivery point was located within 10 km of 1 or more wells that was hydraulically fractured during 1 year preconception or during pregnancy. MAIN OUTCOMES AND MEASURES: Outcomes investigated were spontaneous and indicated preterm birth, small for gestational age, major congenital anomalies, and severe neonatal morbidity or mortality. RESULTS: After exclusions, the sample included 26 193 individuals with 34 873 unique pregnancies, and a mean (SD) parental age of 28.2 (5.2) years. Small for gestational age and major congenital anomalies were significantly higher for individuals who lived within 10 km of at least 1 hydraulically fractured well after adjusting for parental age at delivery, multiple births, fetal sex, obstetric comorbidities, and area-level socioeconomic status. Risk of spontaneous preterm birth and small for gestational age were significantly increased in those with 100 or more wells within 10 km. CONCLUSIONS AND RELEVANCE: Results suggest that individuals who were exposed to hydraulic fracturing within pregnancy may be at higher risk of several adverse birth outcomes. These results may be relevant to health policy regarding legislation of unconventional oil and gas development in Canada and internationally.

Background: Unusual responses to sensory stimuli are frequently reported in individuals on the autism spectrum (AS). Despite the early emergence of sensory features (Methods: Here, we used electroencephalography (EEG) to investigate tactile cortical processing in young children aged 3-6 years with autism and in neurotypical (NT) children. Scalp EEG was recorded from 33 children with autism, including those with low cognitive and/or verbal abilities, and 45 age- and sex-matched NT children during passive tactile fingertip stimulation. We compared properties of early and later somatosensory-evoked potentials (SEPs) and their adaptation with repetitive stimulation between autistic and NT children and assessed whether these neural measures are linked to “real-world” parent-reported behavioral tactile sensitivity.Results: As expected, we found elevated behavioral tactile sensitivity in children on the autism spectrum. Our findings indicated no differences in amplitude or latency of early and mid-latency somatosensory-evoked potentials (P50, N80, P100), nor adaptation between autistic and NT children. However, latency of later processing of tactile information (N140) differed between young children with and without autism, suggesting faster processing speed in young autistic children. Further, correlational analyses and exploratory analyses using tactile phenotype as a grouping variable found that enhanced early neural responses were associated with greater behavioral tactile sensitivity in autism. Limitations: The relatively small sample size and the inclusion of a broad range of autistic children (e.g., with low cognitive and/or verbal abilities) may have limited our power to detect subtle group differences and associations. Hence, replications are needed to verify these results.Conclusions: Our findings suggest that electrophysiological somatosensory cortex processing measures may be indices of “real-world” tactile sensitivity in early childhood autism. Together, these findings advance our understanding of the neurophysiological mechanisms underlying tactile sensitivity in early childhood autism and, in the clinical context, may have therapeutic implications.

Objectives: Our aim is to understand the effect of the COVID-19 pandemic on families who have been followed longitudinally in two cohorts studied in Alberta, Canada. We will examine household infections during the COVID-19 pandemic, financial impact, domestic violence, substance use, child school and daily life and relationships in the home. We will identify risk and protective factors for maternal mental health outcomes using longitudinal data that can inform policy and government resource allocation in future disasters.Methods: Mothers who are currently participating in two longitudinal studies, Alberta Pregnancy Outcomes and Nutrition (APrON; N = 1,800) and All Our Families (AOF: N = 2,534) were eligible to participate. Mothers were invited to complete the baseline COVID-19 Impact Survey (20–30 min) within 4 months of March 15, 2020, which was when the province of Alberta, Canada, implemented school closures and physical-distancing measures to prevent the spread of COVID-19. Mothers were asked to report on their own, their child's and their family's functioning. Mothers were re-surveyed at 6 months after completion of the initial COVID-19 Impact Survey, and will be re-surveyed again at 12 months.Results: Responses from participants in both cohorts will be examined in harmonized analyses as well as separately. Descriptive, multivariable analysis will be undertaken to examine risk and resiliency over time and factors that predict mental health and well-being.Conclusions: This study will provide timely information on the impact of COVID-19 for Albertan families. It will identify risk and protective factors for mental health and well-being among contemporary urban families supported by a publicly funded health care system to inform allocation of resources to support those most vulnerable during a global pandemic.