Search

Sleep disorders often co-occur with autism spectrum disorder. They further exacerbate autism spectrum disorder symptoms and interfere with children's and parental quality of life. This study examines whether gastrointestinal dysfunctions increase the odds of having sleep disorders in 610 children with idiopathic autism spectrum disorder, aged 2-18 years, from the Autism Genetic Resource Exchange research program. The adjusted odds ratio for sleep disorder among those with gastrointestinal dysfunctions compared to those without was 1.74 (95% confidence interval: 1.22-2.48). In addition, the odds of having multiple sleep disorder symptoms among children with gastrointestinal dysfunctions, adjusted for age, gender, behavioral problems, bed wetting, current and past supplements, and current and past medications for autism spectrum disorder symptoms were 1.75 (95% confidence interval: 1.10-2.79) compared to children without gastrointestinal dysfunctions. Early detection and treatment of gastrointestinal dysfunctions in autism spectrum disorder may be means to reduce prevalence and severity of sleep problems and improve quality of life and developmental outcomes in this population.

Background Women who smoke cigarettes while pregnant are at elevated risk of having low birth weight infants (LBW, < 2500 g) which increases risks of infant mortality and morbidity, including chronic conditions later in life. Objective Smoking cessation during pregnancy can reduce the risk of poor birth outcomes. However, the effect that timing of smoking cessation has on the reduction of poor birth outcomes in term pregnancies is unknown. Study Design This retrospective cohort study used birth certificate data from Missouri singleton, full-term, live births from 2010 to 2012 (N = 179,653) to examine the rates and timing of smoking cessation during pregnancy on birthweight. Smoking exposure was categorized as non-smoker, preconception cessation, first trimester cessation, second trimester cessation, and smoker. The outcome was low birth weight (LBW). Covariates included maternal race/ethnicity, age, education level, type of payment for the delivery, marital status, paternal acknowledgement, prenatal sexually transmitted infection (STI), comorbidities, and body mass index. Bivariate and multivariable analyses were used to assess relationships between smoking and LBW status. Results Preconception cessation did not have a statistically higher risk for LBW than mothers who never smoked (aOR 1.12; 95% CI 0.98, 1.28). First trimester cessation (aOR 1.26; 95% CI 1.05, 1.52), second trimester cessation (aOR 2.00; 95% CI 1.60, 2.67), and smoker (aOR 2.46; 95% CI 2.28, 2.67) had increasing odds for LBW relative to mothers who did not smoke. All covariates had significant relationships with the smoking exposure. Conclusion Preconception cessation yielded LBW rates comparable to non-smokers. The risk for LBW increased as smoking continued throughout pregnancy among full term births, an important new finding in contrast with other studies., Author(s): Pamela K. Xaverius [sup.1] , Zach O'Reilly [sup.2] , April Li [sup.1] , Louise H. Flick [sup.1] , Lauren D. Arnold [sup.1] Author Affiliations: (Aff1) 0000 0004 1936 9342, [...]

Objectives Children born large for gestational age (LGA) are at risk of numerous adverse outcomes. While the racial/ethnic disparity in LGA risk has been studied among women with Gestational Diabetes Mellitus (GDM), the independent effect of race on LGA risk by maternal prepregnancy BMI is still unclear among women without GDM. Therefore, the objective of this study was to assess the association between maternal race/ethnicity and LGA among women without GDM. Methods This was a population-based cohort study of 2,842,278 singleton births using 2012 U.S. Natality data. We conducted bivariate and multivariate logistic regression analyses to assess the association between race and LGA. Due to effect modification by maternal prepregnancy BMI, we stratified our analysis by four BMI subgroups. Results The prevalence of LGA was similar across the different racial/ethnic groups at about 9%, but non-Hispanic Asian Americans had slightly higher prevalence of 11%. After controlling for potential confounders, minority women had higher odds of birthing LGA babies compared to non-Hispanic white women. Non-Hispanic Asian Americans had the highest odds of LGA babies across all BMI categories: underweight (aOR = 2.67; 95% CI: 2.24, 3.05); normal weight (aOR = 2.53; 2.43, 2.62); overweight (aOR = 2.45; 2.32, 2.60) and obese (aOR = 2.05; 1.91, 2.20). Conclusions for practice Racial/ethnic disparities exist in LGA odds, particularly among women with underweight or normal prepregnancy BMI. Most minorities had higher LGA odds than non-Hispanic white women regardless of prepregnancy BMI category. These racial/ethnic disparities should inform public health policies and interventions to address this problem., Author(s): Nhial T. Tutlam [sup.1] [sup.2] , Yun Liu [sup.1] , Erik J. Nelson [sup.1] , Louise H. Flick [sup.1] , Jen Jen Chang [sup.1] Author Affiliations: (1) Department of [...]

Studies examining the relationship between young maternal age and maternal outcomes are often cross-sectional or short term. We review birth cohort studies that investigate life course outcomes of teen mothers past age 25. Strengths of birth cohort studies include a focus on a complete cohort, rather than a sample, and prospective data collection beginning before or at birth. Limitations are high cost, attrition and unmeasured background factors. Some 20 studies from six countries met study criteria. This narrative review describes how teenage mothers fare as adults, identifies factors that modify outcomes and examines whether outcomes reflect specific time periods or cohorts. Childhood disadvantage was a greater marker of teen mothering in more recent cohorts, even in countries with strong social welfare programmes. The effects of young maternal age on all outcomes diminished when strong controls adjusted for selectivity into teen mothering. [ABSTRACT FROM AUTHOR]

Objectives Few studies focus on the symptoms of common mental disorders during pregnancy (CMDP) and risk of preterm birth subtypes (PTB). The purpose of this study was to estimate the association between CMDP and PTB, and to examine whether or not the association between CMDP and PTB varies with the subtype of PTB in Chinese. Methods This population-based case control study, conducted in Wuhan, China, defined cases as every pregnant woman who had a PTB among all births in Wuhan, from June 10, 2011, to June 9, 2013. The same number of pregnant women who had term births was randomly selected as controls. The Electronic Perinatal Health Care Information System, a questionnaire designed for the study, provided data about the participants. Logistic regression analyses were used to model associations betweenCMDP and PTB, and to test associations between CMDP and two subtypes of PTB. Results The study recruited 8616 cases and an equal number of controls. We successfully collected maternal information on 6656 cases and controls for a response rate of 77.3 %. The incidence of PTB in Wuhan was 4.5 %. Spontaneous preterm births (SPTB) accounted for 60.1 %, and medically induced preterm births (IPTB) accounted for 39.9 % of preterm births. The prevalence rate of CMDP was 15.8 %. CMDP was slightly associated with PTB (crude OR 1.16, 95 % CI 1.01-1.32; adjusted OR 1.15, 95 % CI 1.00-1.32), further analyses showed CMDP was associated with IPTB (aOR 1.25, 95 % CI 1.04-1.50), but not with SPTB. Conclusion Our data suggest that CMDP is related to an increased risk of PTB, and that this association is primarily due to IPTB rather than SPTB., Author(s): Rong Yang[sup.1] , Shengwen Liang[sup.2] , Louise H. Flick[sup.3] , Shaoping Yang[sup.1] , Ke Hu[sup.2] , Jing Wang[sup.3] , Ronghua Hu[sup.1] , Zhen Huang[sup.2] , Guanghui Dong[sup.4] , Yiming [...]

Objectives To examine correlates of lifetime mental health services (MHS) use among pregnant women reporting prenatal depressive symptoms by race/ethnicity. Methods This cross-sectional population-based study included 81,910 pregnant women with prenatal depressive symptoms using data from the Florida Healthy Start prenatal screening program (2008-2012). Multivariable logistic regression was conducted to ascertain adjusted odds ratios and corresponding 95 % confidence intervals for racial/ethnic differences in the correlates of lifetime MHS use. Results Findings of this study revealed racial/ethnic differences in MHS use among women with prenatal depressive symptoms, the highest rates being among non-Hispanic Whites and the lowest rates among Mexicans and other Hispanics. Most need for care factors, including illness, tobacco use, and physical or emotional abuse, consistently predicted MHS use across racial/ethnic groups after adjusting for covariates. Adjusted associations between predisposing and enabling/restricting factors and MHS use were different for different racial/ethnic groups. Conclusions Racial/ethnic differences in MHS use were found, with pregnant Hispanic women reporting prenatal depressive symptoms being the least likely to use MHS. Our study findings have significant public health implications for targeted intervention for pregnant women with prenatal depressive symptoms., Author(s): Jen Jen Chang[sup.1] , Maya Tabet[sup.1] , Keith Elder[sup.2] , Deborah W. Kiel[sup.3] , Louise H. Flick[sup.1] Author Affiliations: (1) Department of Epidemiology, Saint Louis University College for Public [...]

Women living in poverty are at increased risk for depression, especially during their childbearing years. Whereas poverty has known adverse effects on children's cognitive, social, and communication development, maternal depression may place these children at additional risk of developmental delays. The maternal sensitivity of mothers with and without depression and its relationship to maternal-child communicative patterns was investigated. We analyzed cross-sectional data on a sample of 23 African American and Caucasian mother-child dyads (13 with and 10 without depression) living in poverty, drawn from a prospective cohort study. Maternal depression was identified using the Diagnostic Interview Schedule-IV based on diagnostic criteria from the "Diagnostic and Statistical Manual of Mental Disorders" (4th ed.). Language samples of maternal-child interaction were analyzed using measures of maternal sensitivity, speech acts, and mother-child interchanges. Significant differences in maternal sensitivity, as well as different patterns of relationships between sensitive and communicative behaviors, were found between the groups. Early childhood professionals need to be aware of the effects maternal depression has on communicative interactions and children's development. (Contains 6 tables.)

Objectives. We examined the association between psychiatric disorders and tobacco use during pregnancy. Methods. Data were derived from a population-based cohort of 744 pregnant African American and White low-income women living in urban and rural areas. The Diagnostic Interview Schedule was used to assess women for 20 different psychiatric disorders. Results. In comparison with nonusers, persistent tobacco users (women who had used tobacco after confirmation of their pregnancy) and nonpersistent users (women who had used tobacco but not after pregnancy confirmation) were 2.5 and 2 times as likely to have a psychiatric disorder. Twenty-five percent of persistent users had at least 1 of the following diagnoses: generalized anxiety disorder, bipolar I disorder, oppositional disorder, drug abuse or dependence, and attention deficit-hyperactivity disorder. Conclusions. In this cohort study, 5 diagnoses were more prevalent among persistent tobacco users than among nonusers, suggesting that several psychiatric disorders contribute to difficulty discontinuing tobacco use during pregnancy. Smoking cessation efforts focusing on pregnant women may need to address co-occurring psychiatric disorders if they are to be successful.

Objective  The similarity in size among siblings has implications for neonatal death, but research in this area is lacking in the United States. We examined the association between small-for-gestational age (SGA), defined as a birthweight <10th percentile for gestational age, and neonatal death, defined as death within the first 28 days of life, among second births who had an elder sibling with SGA ("repeaters") versus those whose elder sibling did not have SGA ("nonrepeaters"). Study Design  We conducted a population-based retrospective cohort study including 179,436 women who had their first two nonanomalous singleton live births in Missouri (1989–2005). Logistic regression was used to evaluate the association between SGA and neonatal death among second births, stratified by whether the elder sibling was SGA. Results  Out of 179,436 second births, 297 died in the neonatal period. There was a significant interaction between birthweight-for-gestational age of first and second births in relation to neonatal death (p  = 0.001). Second births with SGA had increased odds of neonatal death by 2.15-fold if they were "repeaters," and 4.44-fold if they were "nonrepeaters," as compared with non-SGA second births. Conclusion  Our findings suggest that referencing sibling birthweight may be warranted when evaluating infant size in relation to neonatal death. [ABSTRACT FROM AUTHOR]

Abstract Background Young maternal age has long been associated with higher infant mortality rates, but the role of socioeconomic factors in this association has been controversial. We sought to investigate the relationships between infant mortality (distinguishing neonatal from post-neonatal deaths), socioeconomic status and maternal age in a large, retrospective cohort study. Methods We conducted a population-based cohort study using linked birth-death certificate data for Missouri residents during 1997–1999. Infant mortality rates for all singleton births to adolescent women (12–17 years, n = 10,131; 18–19 years, n = 18,954) were compared to those for older women (20–35 years, n = 28,899). Logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for all potential associations. Results The risk of infant (OR 1.95, CI 1.54–2.48), neonatal (1.69, 1.24–2.31) and post-neonatal mortality (2.47, 1.70–3.59) were significantly higher for younger adolescent (12–17 years) than older (20–34 years) mothers. After adjusting for race, marital status, age-appropriate education level, parity, smoking status, prenatal care utilization, and poverty status (indicated by participation in WIC, food stamps or Medicaid), the risk of post-neonatal mortality (1.73, 1.14–2.64) but not neonatal mortality (1.43, 0.98–2.08) remained significant for younger adolescent mothers. There were no differences in neonatal or post-neonatal mortality risks for older adolescent (18–19 years) mothers. Conclusion Socioeconomic factors may largely explain the increased neonatal mortality risk among younger adolescent mothers but not the increase in post-neonatal mortality risk.

OBJECTIVE: To estimate the prevalence of posttraumatic stress disorder and its treatment in economically disadvantaged pregnant women. METHODS: The sample included 744 pregnant Medicaid-eligible women from Women, Infants and Children Supplemental Nutrition Program sites in 5 counties in rural Missouri and the city of St. Louis. Race (black and white) was proportional to clients seen at each site. Women were assessed by using standardized measures of posttraumatic stress disorder, 18 other psychiatric disorders, environmental stressors, and pregnancy characteristics. Logistic regression identified risk factors associated with posttraumatic stress disorder. RESULTS: Posttraumatic stress disorder prevalence was 7.7% (n = 57⁄744). Comorbid disorders were common. Women with posttraumatic stress disorder were 5 times more likely to have a major depressive episode (odds ratio 5.17; 95% confidence interval 2.01, 10.20) and more than 3 times as likely to have generalized anxiety disorder (odds ratio 3.25; 95% confidence interval 1.22, 8.62). Besides these comorbid disorders, risk factors for posttraumatic stress disorder included a history of maternal separation for 6 months and multiple traumatic events. Although most women with posttraumatic stress disorder reported moderate impairment in their daily lives, only 7 of the 57 women with this disorder reported speaking with any health professional about it in the last 12 months. CONCLUSIONS: The prevalence of posttraumatic stress disorder in pregnancy and low treatment rates suggest that screening for this disorder should be considered in clinical practice. [ABSTRACT FROM AUTHOR]