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Birth weight for gestational age (BW/GA) has been associated with a risk of adverse health outcomes. Biological indices of pregnancy complications, maternal mid-pregnancy serum biomarkers and placental pathology may shed light on these associations, but at present, they are most often examined as single entities and offer little insight about overlap. In addition, these indices are typically assessed in relation to the extremes of the BW/GA distribution, leaving open the question of how they relate to the entire BW/GA distribution. Addressing issues such as these may help elucidate why postnatal health outcomes vary across the BW/GA continuum. In this study, we focused on a subset of women who participated in the Pregnancy Outcomes and Community Health Study (n = 1371). We examined BW/GA (i.e. gestational age and sex-referenced z-scores) in relation to obstetric complications, second trimester maternal serum screening results and histologic evidence of placental pathology along with maternal demographics, anthropometrics and substance use. In adjusted models, mean reductions in BW/GA z-scores were associated with preeclampsia (β = −0.70, 95% CI −1.04, −0.36), high maternal serum alpha fetoprotein (β = −0.28, 95% CI −0.43, −0.13), unconjugated estriol (β = −0.31/0.5 multiples of the median decrease, 95% CI −0.41, −0.21) and high levels of maternal obstructive vascular pathology in the placenta (β = −0.46, 95% CI −0.67, −0.25). The findings were similar when preterm infants, small-for-gestational age or large-for-gestational age infants were excluded. More research is needed to examine how the factors studied here might directly mediate or mark risk when evaluating the associations between BW/GA and postnatal health outcomes. [ABSTRACT FROM PUBLISHER]

Disparities in preterm birth by race and ethnic group have been demonstrated in the United States. Recent research has focused on the impact of neighborhood context on racial disparities in pregnancy outcomes. The authors utilized vital-record birth certificate data and US Census data from eight geographic areas in four states (Maryland, Michigan, North Carolina, and Pennsylvania) to examine the relation between neighborhood deprivation and preterm birth among non-Hispanic White and Black women. The years covered by the data varied by site and ranged from 1995 to 2001. Results were adjusted for maternal age and education, and specific attention was paid to racial and geographic differences in the relation between neighborhood deprivation and preterm birth. Preterm birth rates were higher for non-Hispanic Blacks (10.42-15.97%) than for non-Hispanic Whites (5.77-9.13%), and neighborhood deprivation index values varied substantially across the eight areas. A significant association was found between neighborhood deprivation and risk of preterm birth; for the first quintile of the deprivation index versus the fifth, the adjusted summary odds ratio was 1.57 (95% confidence interval: 1.41, 1.74) for non-Hispanic Whites and 1.15 (95% confidence interval: 1.08, 1.23) for non-Hispanic Blacks. In this study, deprivation at the neighborhood level was significantly associated with increased risk of preterm birth among both non-Hispanic White women and non-Hispanic Black women. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The purposes of this study were to test the hypothesis that vaginal douching is linked to bacterial vaginosis in both symptomatic and asymptomatic women and to identify other demographic, reproductive, and lifestyle factors associated with bacterial vaginosis. METHODS: In this cross-sectional study involving 3 clinic sites, 496 nonpregnant women completed a self-administered questionnaire. Their vaginal smears were assessed and cross-validated for bacterial vaginosis. RESULTS: The prevalence of bacterial vaginosis across clinics ranged from 15% to 30%. In analyses restricted to site 1, adjusted odds ratios (ORs) for bacterial vaginosis remained significant for African American women with 13 or fewer years of education (OR = 5.5, 95% confidence interval [CI] = 2.1, 14.5), hormone use within the past 6 months (OR = 0.5, 95% CI = 0.2, 0.8), and vaginal douching within the past 2 months (OR = 2.9, 95% CI = 1.5, 5.6). CONCLUSIONS: Two lifestyle factors emerge as strongly associated with bacterial vaginosis: systemic contraceptives appear protective, whereas douching is linked to an increase in prevalence. The temporal relationship between douching and bacterial vaginosis needs further clarification. [ABSTRACT FROM AUTHOR]

OBJECTIVE. Alcohol has been shown to have teratogenic effects on the fetal central nervous system. However, little research has been done to assess the impact of prenatal alcohol exposure on premature infants, a group particularly vulnerable to perinatal brain injury. METHODS. We examined the relation between maternal alcohol use and the most common forms of brain injury in premature infants--germinal matrix/intraventricular hemorrhage (GM/IVH) and white-matter damage--in a large population-based cohort of infants weighing 2000 g or less. The analyses included 349 infants younger than 31 weeks' gestation who received at least one cranial ultrasound scan and whose mothers were queried about prenatal alcohol use in a postpartum interview. RESULTS. Infants of mothers who reported 'moderate' alcohol use (fewer than seven drinks per week and fewer than three drinks per occasion) to 'high' use (seven or more drinks per week and/or three or more drinks per occasion) before recognized pregnancy, and moderate alcohol use during pregnancy, were not at increased risk for brain injury. However, after controlling for potentially confounding factors, infants of women reporting high alcohol use during pregnancy were at increased risk of developing isolated brain hemorrhage (odds ratio [OR] = 5.5, 95% confidence interval [CI] = 1.2, 24.7), any brain hemorrhage (OR = 6.7, 95% CI = 1.8, 26.4), and white-matter damage (OR = 9.5, 95% CI = 1.9, 46.4). CONCLUSION. Premature infants of women who report consuming seven or more drinks per week and/or three or more drinks per occasion during pregnancy have substantially elevated risks of both of the most common forms of brain injury in premature infants. [ABSTRACT FROM AUTHOR]

Neighborhood socioeconomic effects on health have been estimated using multiple variables and indices. This inconsistent estimation approach makes comparison across geographic areas challenging. In this paper, we developed indices representing specific socioeconomic domains that can be reproduced in other areas to estimate elements of the neighborhood socioeconomic environment on health outcomes, specifically preterm birth. Using year 2000 U.S. census data and principal components analysis, socioeconomic indices were developed representing a priori -- defined domains of education, employment, housing, occupation, poverty and residential stability. These socioeconomic indices were subsequently used in race-stratified multilevel logistic regression models of preterm birth in eight socioeconomically distinct study areas in the U.S. Maternal residence was obtained from birth records and was geocoded to census tracts. In maternal age and education adjusted models, living in tracts with high unemployment, low education, poor housing, low proportion of managerial or professional occupation and high poverty was associated with increased odds of preterm birth for non-Hispanic white women at most sites. Among non-Hispanic black women, similar associations were noted for tract-level low education, high unemployment, low occupation, and high poverty, but the effect estimates were generally smaller than those seen for white women. Increasing amounts of residential stability were not associated with preterm birth in these analyses. We combined the domain estimates across the eight study sites to produce pooled effect estimates for the socioeconomic domains on preterm birth. The research reported here suggests that specific neighborhood-level socioeconomic features may be especially influential to health outcomes. These socioeconomic domains represent potential targets for intervention or policy efforts designed to improve maternal and child health and reduce health disparities. [ABSTRACT FROM AUTHOR]

Objective: Maternal lipid levels increase in normal pregnancies. Here, we examine whether pregnancies with the highest total cholesterol, low-density lipoprotein (LDL) or triglyceride levels or the lowest high-density lipoprotein (HDL) levels predict future dyslipidemia post-pregnancy., Design: Longitudinal cohort study., Setting: Five communities in Michigan, USA., Sample: Pregnant women (n = 649) with blood lipid levels measured at mid-pregnancy in the Pregnancy Outcomes and Community Health (POUCH) Study and at the POUCHmoms Study follow-up, 7-15 years later., Methods: Maternal mid-pregnancy lipid levels were defined as 'high' (upper quartile of triglycerides ≥ 216 mg/dL, LDL ≥ 145 mg/dL and total cholesterol ≥ 256 mg/dL) or 'low' (lower quartile, HDL < 58 mg/dL) using whole sample lipid distributions. At follow-up, dyslipidemia was classified by the clinical cutoffs of triglycerides and total cholesterol ≥ 200 mg/dL, LDL ≥ 130 mg/dL and HDL < 50 mg/dL. Weighted regression models estimated the risk of dyslipidemia at follow-up in relation to pregnancy lipid levels, adjusted for baseline confounders., Main Outcome Measure: Dyslipidemia later in life., Results: Mid-pregnancy triglycerides, LDL, and total cholesterol levels at the upper quartile were associated with at least threefold increase in the risk of abnormal triglycerides, LDL and total cholesterol levels later in life. Women with low mid-pregnancy HDL levels had just over a twofold increased risk of abnormally low HDL levels at follow-up. These associations persisted following adjustment for covariates, i.e. demographics, lifestyle, and years of follow-up., Conclusions: Higher mid-pregnancy LDL, total cholesterol and triglycerides and lower levels of HDL may signal future dyslipidemia risk and the need for closer lipid monitoring to ensure timely interventions that can attenuate cardiovascular disease risk., (© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Background: Nearly half of all pregnancies in the United States are considered unintended (mistimed or unwanted), and this rate is even higher among younger and lower income women. The Affordable Care Act (ACA) dependent coverage provision may have influenced the frequency of unintended pregnancies by increasing accessibility to and affordability of family planning services among young adults. Furthermore, the impact of this provision may differ by young adult income level as those with lower income are less likely to be insured and thus more likely to benefit from this provision. Our objective was to estimate the association between the ACA dependent coverage provision and unintended pregnancy, overall, and by young adult income level. Methods: We applied a difference-in-differences approach to data from multiple cycles of the National Survey of Family Growth ( n = 10,104) and compared trends in unintended pregnancy between those who were eligible to benefit (ages 18-25 years) and those who were ineligible to benefit (ages 26-33 years) from the provision, overall, and among income subgroups. Results: We found evidence that the dependent coverage provision was associated with a -7.4 percentage point reduction (95% CI: -13.5, -1.3) in the prevalence of unintended pregnancy among young adults with lower income (<100% of the federal poverty level). There was limited evidence, however, that the provision was associated with unintended pregnancy among young adults with higher income levels. Conclusions: These findings suggest the ACA dependent coverage provision may have reduced unintended pregnancy among a particularly high-risk group (i.e., young adults with lower income).

Objective: To predict birth weight at various potential gestational ages of delivery based on data routinely available at the first antenatal visit., Design: Individual participant data meta-analysis., Data Sources: Individual participant data of four cohorts (237 228 pregnancies) from the International Prediction of Pregnancy Complications (IPPIC) network dataset., Eligibility Criteria for Selecting Studies: Studies in the IPPIC network were identified by searching major databases for studies reporting risk factors for adverse pregnancy outcomes, such as pre-eclampsia, fetal growth restriction, and stillbirth, from database inception to August 2019. Data of four IPPIC cohorts (237 228 pregnancies) from the US (National Institute of Child Health and Human Development, 2018; 233 483 pregnancies), UK (Allen et al, 2017; 1045 pregnancies), Norway (STORK Groruddalen research programme, 2010; 823 pregnancies), and Australia (Rumbold et al, 2006; 1877 pregnancies) were included in the development of the model., Results: The IPPIC birth weight model was developed with random intercept regression models with backward elimination for variable selection. Internal-external cross validation was performed to assess the study specific and pooled performance of the model, reported as calibration slope, calibration-in-the-large, and observed versus expected average birth weight ratio. Meta-analysis showed that the apparent performance of the model had good calibration (calibration slope 0.99, 95% confidence interval (CI) 0.88 to 1.10; calibration-in-the-large 44.5 g, -18.4 to 107.3) with an observed versus expected average birth weight ratio of 1.02 (95% CI 0.97 to 1.07). The proportion of variation in birth weight explained by the model (R 2 ) was 46.9% (range 32.7-56.1% in each cohort). On internal-external cross validation, the model showed good calibration and predictive performance when validated in three cohorts with a calibration slope of 0.90 (Allen cohort), 1.04 (STORK Groruddalen cohort), and 1.07 (Rumbold cohort), calibration-in-the-large of -22.3 g (Allen cohort), -33.42 (Rumbold cohort), and 86.4 g (STORK Groruddalen cohort), and observed versus expected ratio of 0.99 (Rumbold cohort), 1.00 (Allen cohort), and 1.03 (STORK Groruddalen cohort); respective pooled estimates were 1.00 (95% CI 0.78 to 1.23; calibration slope), 9.7 g (-154.3 to 173.8; calibration-in-the-large), and 1.00 (0.94 to 1.07; observed v expected ratio). The model predictions were more accurate (smaller mean square error) in the lower end of predicted birth weight, which is important in informing clinical decision making., Conclusions: The IPPIC birth weight model allowed birth weight predictions for a range of possible gestational ages. The model explained about 50% of individual variation in birth weights, was well calibrated (especially in babies at high risk of fetal growth restriction and its complications), and showed promising performance in four different populations included in the individual participant data meta-analysis. Further research to examine the generalisability of performance in other countries, settings, and subgroups is required., Trial Registration: PROSPERO CRD42019135045., Competing Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from the National Institute for Health and Care Research Health Technology Assessment UK programme for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work., (Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Survival is possible for children perinatally exposed to or infected by HIV in the post-combined antiretroviral therapy era and identifying factors affecting children's ability to thrive has public health significance. Caregiver mental health is one such factor to consider given its impact on child development, but previous work has not included a full complement of HIV exposure/infection groups within HIV-endemic settings. We compared depressive symptoms among caregivers of 3 groups of 6-10-year-olds in Uganda: children with perinatally acquired HIV infection (CPHIV, n  = 102), children with perinatal HIV exposure, but no infection (CPHEU, n  = 101), and children without perinatal HIV exposure or infection (CHUU, n  = 103). The Hopkins Symptom Checklist was used to assess caregiver depressive symptoms. Generalized linear models were used to estimate group mean differences. Adjusted models included caregiver demographics, social support, and lifetime trauma. Depression symptoms were higher among CPHEU compared to CPHIV caregivers (model coefficient [B]  = -3.5, 95%CI -5.3, -1.8). This finding was minimally attenuated following adjustment for covariates ( B  = -2.2, 95%CI -4.1, -0.4) and among biological mothers. At lower levels of social support and wealth, CPHEU caregivers reported higher levels of depression symptoms than CPHIV caregivers. Our findings point to unmet mental health needs among CPHEU caregivers.