RESUMO
BACKGROUND: Studies examining the association between in utero Zika virus (ZIKV) exposure and child neurodevelopmental outcomes have produced varied results. METHODS: We aimed to assess neurodevelopmental outcomes among normocephalic children born from pregnant people enrolled in the Zika in Pregnancy in Honduras (ZIPH) cohort study, July-December 2016. Enrollment occurred during the first prenatal visit. Exposure was defined as prenatal ZIKV IgM and/or ZIKV RNA result at enrollment. Normocephalic children, >6 months old, were selected for longitudinal follow-up using the Bayley Scales of Infant and Toddler Development (BSID-III) and the Ages & Stages Questionnaires: Social-Emotional (ASQ:SE-2). RESULTS: One hundred fifty-two children were assessed; after exclusion, 60 were exposed and 72 were unexposed to ZIKV during pregnancy. Twenty children in the exposed group and 21 children in the unexposed group had a composite score <85 in any of the BSID-III domains. Although exposed children had lower cognitive and language scores, differences were not statistically significant. For ASQ:SE-2 assessment, there were not statistically significant differences between groups. CONCLUSIONS: This study found no statistically significant differences in the neurodevelopment of normocephalic children between in utero ZIKV exposed and unexposed. Nevertheless, long-term monitoring of children with in utero ZIKV exposure is warranted. IMPACT: This study found no statistically significant differences in the neurodevelopment in normocephalic children with in utero Zika virus exposure compared to unexposed children, although the exposed group showed lower cognitive and language scores that persisted after adjustment by maternal age and education and after excluding children born preterm and low birth weight from the analysis. Children with prenatal Zika virus exposure, including those normocephalic and have no evidence of abnormalities at birth, should be monitored for neurodevelopmental delays. Follow-up is important to be able to detect developmental abnormalities that might not be detected earlier in life.
Assuntos
Craniossinostoses , Complicações Infecciosas na Gravidez , Efeitos Tardios da Exposição Pré-Natal , Infecção por Zika virus , Zika virus , Gravidez , Lactente , Recém-Nascido , Feminino , Humanos , Estudos de Coortes , Infecção por Zika virus/diagnóstico , Desenvolvimento InfantilRESUMO
BACKGROUND: Prenatal depression may have adverse health effects on mothers and their offspring. Perceived stress is an important risk factor for depression during pregnancy. Studies have shown that both perceived stress and depression may negatively influence birth outcomes. While 20% of pregnancies in Suriname, a middle-income Caribbean country located in northern South America, results in adverse birth outcomes, data on prenatal depression and its risk factors are lacking. This study aimed to assess the influence of perceived stress on depression during pregnancy in Surinamese women. METHODS: Survey data were used from 1143 pregnant women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara prospective cohort study that addresses the impact of chemical and non-chemical environmental exposures in mother/child dyads in Suriname. The Edinburgh Depression Scale and Cohen Perceived Stress Scale were used to screen for probable depression (cut-off ≥ 12) and high stress (cut-off ≥ 20), respectively. The association between perceived stress and depression was examined using bivariate and multiple logistic regression analyses, adjusted for social support (including resilience) and maternal demographics. RESULTS: The prevalence of high perceived stress during the first two trimesters and the third trimester were 27.2% and 24.7% respectively. 22.4% of the participants had probable depression during first or second trimester and 17.6% during the third trimester. Women experiencing high stress levels during the first two trimesters had 1.92 increased odds (95% CI 1.18-3.11, p = 0.008) of having probable depression during the third trimester of pregnancy than those with low stress levels. Pregnant women with low individual resilience during early pregnancy (52.1%) had 1.65 (95% CI 1.03-2.63, p = 0.038) increased odds of having probable depression during later stages of pregnancy compared to those with high individual resilience. Low educational level (p = 0.004) and age of the mother (20-34 years) (p = 0.023) were significantly associated with probable depression during the third trimester. CONCLUSIONS: Early detection and management of stress and depression during pregnancy are important. Health education programs, targeting the reduction of stress during pregnancy, may help to reduce depression and its potential adverse health effects on the mother and child.
Depression during pregnancy may lead to adverse health effects in mothers and children. While one in five pregnancies resulted in an adverse birth outcome in Suriname, and perceived stress and depression are important risk factors for birth outcomes, data on depression and its risk factors are lacking. This study aimed to determine the association between perceived stress and prenatal depression in Surinamese pregnant women participating in the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara study.A total of 1143 pregnant women were included in the study. Using questionnaires, data was collected on demographic factors, perceived stress, social support (including resilience), and probable depression.Perceived stress was somewhat higher during the first two trimesters (27.2%), than the third trimester (24.7%). This was also the case for probable depression; higher during the first two trimesters (22.4%) than during the third trimester (17.6%). The study found a statistically significant association of high perceived stress, low perceived individual resilience, lower education and older maternal age with probable depression during pregnancy.Early detection and effective management of perceived stress and depression during pregnancy are very important. There is a need for prenatal clinics in Suriname to routinely screen for symptoms of perceived stress and depression to minimize the potential impact on mother and child. Health education programs, targeting the reduction of stress during pregnancy, may help to reduce depression and its potential adverse health effects on the mother and child.
Assuntos
Depressão/epidemiologia , Complicações na Gravidez/psicologia , Gestantes/psicologia , Estresse Psicológico/epidemiologia , Adulto , Região do Caribe , Feminino , Humanos , Gravidez , Complicações na Gravidez/epidemiologia , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Estresse Psicológico/complicações , Estresse Psicológico/psicologia , Suriname/epidemiologia , Adulto JovemRESUMO
The cumulative exposure to chemical and non-chemical stressors may have an impact on birth outcomes. The aim of this study is to examine the cumulative exposure of a mixture of chemicals (mercury, lead, selenium and tin) and non-chemical stressors (social support, perceived stress, probable depression and BMI) on birth outcomes (birthweight, gestational age at birth, and Apgar score at 5 min). The study population is a subset (n = 384) of the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara prospective cohort study. Associations between the latent chemical construct, non-chemical stressors and birth outcomes were assessed using path models. The results showed a significant direct relationship between perceived stress and birthweight (ß = -0.17), however even though the relationship between perceived stress and depression was significant in all three path models (ß = 0.61), the association between depression and birth outcomes was not significant. Perceived stress was significantly associated with community engagement (ß = -0.12) and individual resilience (ß = -0.12). BMI (ß = 0.12) was also significantly directly associated with birthweight. The latent chemical construct did not show an association with the birth outcomes. Our data indicate the need for the development of a support system for pregnant women by involving them in prenatal care programs to reduce maternal stress, which may also influence depression and (in)directly improve the birth outcomes. Interventions regarding weight management for women of childbearing age are necessary to halt obesity and its negative effects on birth outcomes.
Assuntos
Efeitos Tardios da Exposição Pré-Natal , Peso ao Nascer , Região do Caribe , Feminino , Humanos , Recém-Nascido , Gravidez , Gestantes , Estudos Prospectivos , SurinameRESUMO
The impact of Zika virus (ZIKV) infection on pregnancies shows regional variation emphasizing the importance of studies in different geographical areas. We conducted a prospective study in Tegucigalpa, Honduras, recruiting 668 pregnant women between July 20, 2016, and December 31, 2016. We performed Trioplex real-time reverse transcriptase-PCR (rRT-PCR) in 357 serum samples taken at the first prenatal visit. The presence of ZIKV was confirmed in seven pregnancies (7/357, 2.0%). Nine babies (1.6%) had microcephaly (head circumference more than two SDs below the mean), including two (0.3%) with severe microcephaly (head circumference [HC] more than three SDs below the mean). The mothers of both babies with severe microcephaly had evidence of ZIKV infection. A positive ZIKV Trioplex rRT-PCR was associated with a 33.3% (95% CI: 4.3-77.7%) risk of HC more than three SDs below the mean.
Assuntos
Microcefalia/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Infecção por Zika virus/diagnóstico , Zika virus/genética , Adolescente , Adulto , Feminino , Idade Gestacional , Honduras/epidemiologia , Humanos , Incidência , Microcefalia/complicações , Microcefalia/epidemiologia , Microcefalia/virologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Diagnóstico Pré-Natal/métodos , Estudos Prospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Infecção por Zika virus/complicações , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/virologiaRESUMO
Previous research has found that women and children living in rural, interior communities in Suriname have high concentrations of mercury in hair. Freshwater fish from these areas also have high concentrations of mercury. Artisanal and small-scale gold mining operations in parts of the country use elemental mercury to extract gold from soils and sediments. Total mercury and methylmercury concentrations have been determined in hair and blood from pregnant women across the country. Pregnant women from interior communities have significantly higher concentrations of both total and methylmercury in hair (median total mercury in hair 3.64 µg/g) compared with pregnant women from two urban coastal cities, Paramaribo (0.63 µg/g) and Nickerie (0.74 µg/g). Total and methylmercury concentrations in blood and hair are highly correlated (r = 0.986, r = 0.974) with methylmercury making up 86% of the total in blood and 97% of the total in hair. Most women in the interior regions rely heavily on local fish as part of their regular diet, and many live outsides of areas with active ASGM operations. This study demonstrates that diet and fish consumption largely govern mercury exposures in pregnant women in Suriname.
Assuntos
Mercúrio , Compostos de Metilmercúrio , Animais , Criança , Cidades , Exposição Ambiental/análise , Feminino , Peixes , Contaminação de Alimentos , Ouro , Humanos , Mercúrio/análise , Gravidez , Gestantes , Saúde Pública , SurinameRESUMO
Prenatal exposure to mercury, stress, and depression may have adverse effects on birth outcomes. Little is known on the influence of chemical and non-chemical stressors on birth outcomes in the country of Suriname. We assessed the influence of prenatal exposure to mercury, perceived stress, and depression on adverse birth outcomes in 1143 pregnant Surinamese women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara prospective cohort study. Associations between mercury (≥1.1 µg/g hair, USEPA action level/top versus bottom quartile), probable depression (Edinburgh Depression Scale ≥12), high perceived stress (Cohen's Perceived Stress Scale ≥20), and adverse birth outcomes (low birthweight (<2500 g), preterm birth (<37 completed weeks of gestation), and low Apgar score (<7 at 5 min)) were assessed using bivariate and multivariate logistic regressions. Prevalence of elevated mercury levels, high perceived stress, and probable depression were 37.5%, 27.2%, and 22.4%, respectively. Mercury exposure was significantly associated with preterm birth in the overall study cohort (OR 2.47; 95% CI 1.05-5.83) and perceived stress with a low Apgar score (OR 9.73; 95% CI 2.03-46.70). Depression was not associated with any birth outcomes. These findings can inform policy- and practice-oriented solutions to improve maternal and child health in Suriname.
Assuntos
Depressão , Mercúrio , Nascimento Prematuro , Efeitos Tardios da Exposição Pré-Natal , Estresse Psicológico , Adulto , Região do Caribe , Criança , Feminino , Humanos , Recém-Nascido , Mercúrio/toxicidade , Gravidez , Estudos Prospectivos , Suriname , Adulto JovemRESUMO
Prenatal mercury (Hg) exposure was determined in a sub-cohort of the Caribbean Consortium for Environmental and Occupational Health's environmental epidemiologic prospective cohort study of pregnant women living in Suriname's interior. The associations between Hg exposure, low birth weight (LBW, <2500 g) and preterm birth (PTB, <37 weeks) were explored. Correlation analysis, Fisher's exact test and logistic regression analyses were conducted to evaluate the associations between maternal hair Hg levels and birth weight, LBW and PTB, and between potential confounders, LBW and PTB, respectively. Among 204 singleton births were 198 live births, five stillbirths and one miscarriage. The mean participant age was 26 years; 15.7% of participants had PTBs and 8.1% delivered a child with a LBW. The median hair Hg level was 3.48 µg/g hair. Low hair Hg exposure, based on lowest tertile < 2.34 µg/g, was associated with LBW (OR = 7.2; 95% CI 1.5-35.6; p = 0.015); this association was independent of maternal age, ethnic background, household income and village location, and no correlation was found between hair Hg and PTB. Young maternal age was associated with PTB (RR = 5.09, 95% CI: 1.92-13.85; p = 0.0004) while maternal age was not associated with hair Hg or LBW. The impact of prenatal Hg exposure on pediatric neurodevelopment is currently being evaluated in the infant sub-cohort.
Assuntos
Exposição Materna/estatística & dados numéricos , Mercúrio , Resultado da Gravidez/epidemiologia , Nascimento Prematuro , Região do Caribe , Criança , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Estudos Prospectivos , Suriname/epidemiologiaRESUMO
BACKGROUND AND OBJECTIVE: The Zika virus outbreak has drawn attention to microcephaly, whose definition is based on head circumference measuring below a percentile or number of SDs below the mean. The objective of this analysis was to assess how differences in measurement precision might affect prevalence and trends of microcephaly. METHODS: Data from all births in Uruguay during 2010-2015 were obtained from the Perinatal Information System. The prevalence of births with microcephaly was calculated based on head circumference measurement at birth applying the INTERGROWTH-21st standards for sex and gestational age, and compared by method of ascertaining gestational age. RESULTS: Rounding and digit preference was observed: 74% of head circumference measurements were reported as a whole centimetre value. The prevalence of births varied substantially by the criterion used to define microcephaly (<3 SD, <2 SD, <3rd percentile for gestational age) and could be halved or doubled based on adding or subtracting a half-centimetre from all reported head circumference measurements. If 4 days were added to gestational age calculations, rather than using completed gestational weeks (without days) for gestational age reporting, the prevalence was 1.7-2 times higher. DISCUSSION: Rounding in measurement of head circumference and reporting preferences of gestational age may have contributed to a lower prevalence of microcephaly than expected in this population. Differences in head circumference measurement protocols and gestational age dating have the potential to affect the prevalence of babies reported with microcephaly, and this limitation should be acknowledged when interpreting head circumference data collected for surveillance.
Assuntos
Cefalometria , Precisão da Medição Dimensional , Microcefalia/diagnóstico , Microcefalia/epidemiologia , Humanos , Recém-Nascido , Microcefalia/virologia , Prevalência , Uruguai/epidemiologia , Infecção por Zika virus/complicaçõesRESUMO
OBJECTIVE: To examine the relationship between generation 1 (grandmaternal) cardiometabolic risk factors and generation 3 (grandchild's) birthweight and gestational age. STUDY DESIGN: Mother-daughter pairs in the Bogalusa Heart Study (1973-present) were linked to their children's birth certificates; women were also interviewed about their reproductive histories, creating a 3-generation linkage including 177 generation 1 (grandmothers), 210 generation 2 (mothers), and 424 generation 3 (children). Prepregnancy cardiometabolic risk factors (body mass index [BMI], lipids, glucose) or generation 1 (mean age 16.2 years) and 2 (mean age 11.1 years) were examined as predictors of generation 3 birthweight and gestational age using linear and logistic regression with adjustment for age, race, parity, and other confounders. RESULTS: Generation 2 higher BMI was associated with higher birthweight (28 g per 1 unit, 95% CI 12-44) and gestational age (0.08 weeks, 95% CI 0.02-0.14) in generation 3, and generation 1 higher BMI was associated with higher birthweight (52 g, 95% CI 34-70) in the generation 2. Generation 1's higher glucose levels were associated with higher birthweight in generation 3 (adjusted beta 111 g, 95% CI 33-189), and triglycerides (adjusted beta -21, 95% CI -43-0) and low-density lipoprotein (adjusted beta -24, 95% CI -48-0) were associated with lower birthweight. CONCLUSIONS: These results suggest the possibility of multigenerational developmental programming of birth outcomes, although mechanisms (whether biological or environmental) are undetermined.
Assuntos
Peso ao Nascer , Doenças Cardiovasculares/epidemiologia , Efeito de Coortes , Síndrome Metabólica/diagnóstico , Resultado da Gravidez , Adolescente , Adulto , Fatores Etários , Índice de Massa Corporal , Doenças Cardiovasculares/diagnóstico , Criança , Pré-Escolar , Feminino , Idade Gestacional , Avós , Inquéritos Epidemiológicos , Humanos , Incidência , Recém-Nascido , Síndrome Metabólica/epidemiologia , Mães , Núcleo Familiar , Valor Preditivo dos Testes , Gravidez , Medição de RiscoRESUMO
OBJECTIVE: We aimed to examine the relationship between exposure to the 2010 Haiti earthquake and pregnancy wantedness, interpregnancy interval, and birth weight. METHODS: From the nationally representative Haiti 2012 Demographic and Health Survey, information on "size of child at birth" (too small or not) was available for 7280 singleton births in the previous 5 years, whereas information on birth weight was available for 1607 births. Pregnancy wantedness, short (<1 year) interpregnancy interval, and maternal-reported birth weight were compared before and after the earthquake and by level of damage. Multiple logistic regression and linear regression analyses were conducted. RESULTS: Post-earthquake births were less likely to be wanted and more likely to be born after a short interpregnancy interval. Earthquake exposure was associated with increased likelihood of a child being born too small: timing of birth (after earthquake vs. before earthquake, adjusted odds ratio [aOR]: 1.27, 95% confidence interval [CI]: 1.12-1.45), region (hardest-hit vs. rest of country; aOR: 1.43, 95% CI: 1.14- 1.80), and house damage (aOR: 1.27 95% CI: 1.02-1.58). Mean birth weight was 150 to 300 g lower in those exposed to the earthquake. CONCLUSIONS: Experience with the earthquake was associated with worse reproductive and birth outcomes, which underscores the need to provide reproductive health services as part of relief efforts.