Prenatal Acetaminophen, Adverse Birth Outcomes, and ADHD: Mediation Analysis in a Prospective Cohort

Background Although we previously reported an association of prenatal acetaminophen exposure with more than two-fold increased odds of child ADHD, it is unknown whether prenatal acetaminophen is associated with adverse birth outcomes, and if birth outcomes may mediate the association of prenatal acetaminophen with ADHD. Methods This birth cohort from Sherbrooke, Quebec, Canada, included 773 live births. Mothers with no thyroid disease enrolled at their first prenatal care visit or delivery. Acetaminophen was measured in meconium for 393 children at delivery. Physician diagnosis of ADHD was determined when children were 6-7 years old. We first tested associations of prenatal acetaminophen with birthweight, preterm birth, gestational age, and small and large for gestational age. Then we assessed whether these birth outcomes mediate the association of prenatal acetaminophen with ADHD. We imputed missing data via multiple imputation and used inverse probability weighting to account for confounding and selection bias. Results Acetaminophen was detected in 222 meconium samples (56.5%). Prenatal acetaminophen exposure was associated with decreased birthweight by 136 grams (beta = -136; 95%CI [-229, -43]), 20% increased weekly hazard of delivery (hazard ratio = 1.20; 95%CI [1.00, 1.43]), and over 60% decreased odds of being born large for gestational age (odds ratio = 0.38; 95%CI [0.20, 0.75]). There was no evidence for adverse birth outcomes mediating the association of prenatal acetaminophen with child ADHD. Conclusions Although unobserved confounding and confounding by indication are possible, these results warrant further investigation into adverse perinatal effects of prenatal acetaminophen exposure.

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Adverse Birth Outcomes Associated with Types of Eating Disorders: A Review

Canadian Journal of Dietetic Practice and Research ◽

10.3148/cjdpr-2018-044 ◽

2019 ◽

Vol 80 (3) ◽

pp. 131-136 ◽

Cited By ~ 4

Author(s):

Kimberly D. Charbonneau ◽

Jamie A. Seabrook

Keyword(s):

Eating Disorder ◽

Birth Outcomes ◽

Gestational Age ◽

Large For Gestational Age ◽

Adverse Birth Outcomes ◽

Birth Complications ◽

Adverse Neonatal Outcomes ◽

Low Bmi ◽

Weight Gain During Pregnancy ◽

A Current

At least 5% of women have an eating disorder (ED) during pregnancy. These EDs affect prepregnancy body mass index (BMI) and weight gain during pregnancy, factors associated with birth complications and adverse neonatal outcomes. This review contributes to the literature by examining several adverse birth outcomes associated with EDs and differentiates between past and present EDs. Of the 18 articles reviewed, EDs were associated with preterm birth in 5/14 (36%) and small-for-gestational-age in 5/8 (63%) studies. Anorexia Nervosa increases the odds of a low birth weight baby, particularly when women enter pregnancy with a low BMI. Binge Eating Disorder is positively associated with having a large-for-gestational-age infant, and Bulimia Nervosa is associated with miscarriage when symptomatic during pregnancy. Having a current ED increases the risk for adverse birth outcomes more than a past ED. Since the aetiology of adverse birth outcomes is multi-factorial, drawing conclusions about causal relationships between EDs and birth outcomes is problematic given the small number of studies reporting these outcomes. Resources should target preconception interventions that put EDs into remission and help women achieve a healthier BMI prior to pregnancy, as these have been consistently shown to improve birth outcomes.

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Fetal Sex-Dependent Associations Between Gestational Hormone Concentrations and Adverse Birth Outcomes

10.21203/rs.3.rs-151002/v1 ◽

2021 ◽

Author(s):

Amber L. Cathey ◽

Deborah J. Watkins ◽

Zaira Y. Rosario ◽

Carmen M. Vélez Vega ◽

Bhramar Mukherjee ◽

...

Keyword(s):

Birth Outcomes ◽

Gestational Age ◽

A Priori ◽

Endocrine Function ◽

Sensitivity Analyses ◽

Large For Gestational Age ◽

Adverse Birth Outcomes ◽

Spontaneous Preterm Birth ◽

Fetal Sex ◽

Mother And Child

Abstract Adverse birth outcomes remain significant public health problems that can have long-lasting impacts on mother and child. Understanding biological mechanisms underlying these outcomes, including altered endocrine function, can inform prevention efforts. The aim of this study was to evaluate associations between hormones at two times points during mid-gestation and adverse birth outcomes, and to assess effect modification by fetal sex. Repeated gestational hormone measurements (at 18 and 26 weeks) and birth outcomes were assessed among 976 women in PROTECT, a longitudinal prospective birth cohort in northern Puerto Rico, from 2011 to 2018. Birth outcomes assessed included preterm and spontaneous preterm birth (PTB), preeclampsia, gestational diabetes mellitus (GDM), small/large for gestational age (SGA, LGA), birthweight z-score, and gestational age at birth. Multivariate logistic and linear regressions were fit using visit-specific concentrations of hormones. We also conducted sensitivity analyses assessing impacts of fetal sex on observed associations. All models were adjusted for maternal age and education, and other confounders were assessed separately between birth outcomes based on a priori knowledge and observed associations with exposure and outcome measures. We observed increased odds of spontaneous PTB with IQR increases in progesterone (OR: 2.12, 95% CI: 1.29, 3.47), fT4 (OR: 1.73, 95% CI: 1.04, 2.86), and the ratio of progesterone to estriol (OR: 1.63, 95% CI: 1.05, 2.54) at 26 weeks. Elevated estriol was protective against preeclampsia at 26 weeks (OR: 0.42, 95% CI: 0.17, 0.99). Increases in TSH and T3 conferred greater risk of GDM at 18 weeks. Many associations were modified by fetal sex, with hormone alterations during male pregnancies conferring greater risk of PTB, spontaneous PTB, and GDM. In conclusion, associations between hormones and birth outcomes vary based on timing of hormone measurement and fetal sex. Future studies are needed to understand mechanisms involved in adverse birth outcomes and fetal sex differences.

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Fetal Sex-Dependent Associations Between Gestational Hormone Concentrations and Adverse Birth Outcomes: A Cohort Study

10.21203/rs.3.rs-60256/v1 ◽

2020 ◽

Author(s):

Amber L Cathey ◽

Deborah J Watkins ◽

Zaira Y Rosario ◽

Carmen M Vélez Vega ◽

Bhramar Mukherjee ◽

...

Keyword(s):

Birth Weight ◽

Birth Outcomes ◽

Gestational Age ◽

Endocrine Function ◽

Sensitivity Analyses ◽

Large For Gestational Age ◽

Adverse Birth Outcomes ◽

Z Score ◽

Spontaneous Preterm Birth ◽

Fetal Sex

Abstract Background: Adverse birth outcomes remain significant public health problems that can have long-lasting impacts on mother and child. Understanding biological mechanisms underlying these outcomes, including altered endocrine function, can inform prevention efforts. Thus, we aimed to explore associations between repeated gestational hormone measurements and birth outcomes. Secondarily, we assessed impacts of fetal sex and timing of hormone measurement on these associations. Methods: We explored associations between repeated gestational hormone measurements and birth outcomes among 976 women in PROTECT, a longitudinal prospective birth cohort in northern Puerto Rico. Birth outcomes assessed included preterm and spontaneous preterm birth (PTB), preeclampsia, gestational diabetes mellitus (GDM), small/large for gestational age (SGA, LGA), birth weight z-score, and gestational age at birth. Multivariate logistic and linear regressions were fit using pregnancy average concentrations of hormones. We also conducted sensitivity analyses assessing impacts of fetal sex and timing of hormone measurement on observed associations. Results: Among male fetuses, spontaneous PTB was associated with increased average corticotropin releasing hormone (CRH) (OR: 2.50, 95% CI: 1.19, 5.24), increased total triiodothyronine (T3) (OR: 1.80, 95% CI: 1.02, 3.16) and decreased testosterone (OR: 0.34, 95% CI: 0.15, 0.74). Odds of GDM increased with average free thyroxine (fT4) (OR: 2.80, 95% CI: 1.06, 7.41), and decreased with average testosterone (OR: 0.23, 95% CI: 0.06, 0.86). Progesterone/estriol ratio was inversely associated with birth weight z-score (b: -0.14, 95% CI: -0.27, -0.01) and gestational age (b: -0.39 weeks, 95% CI: -0.66 , -0.12), and positively associated with odds of SGA (OR: 2.08, 95% CI: 1.36, 3.19). Among females, birth weight z-score was inversely associated with progesterone (b: -0.17, 95% CI: -0.31, -0.02) and total thyroxine (T4) (b: -0.16, 95% CI: -0.30, -0.02), and GDM was inversely associated with progesterone/estriol (OR: 0.34, 95% CI: 0.12, 0.99). Conclusions: Associations between hormones and birth outcomes vary based on timing of hormone measurement and fetal sex. Future studies are needed to understand mechanisms involved in adverse birth outcomes and fetal sex differences.

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Maternal exposure to airborne polychlorinated biphenyls (PCBs) and risk of adverse birth outcomes

European Journal of Epidemiology ◽

10.1007/s10654-021-00793-x ◽

2021 ◽

Author(s):

Ane Bungum Kofoed ◽

Laura Deen ◽

Karin Sørig Hougaard ◽

Kajsa Ugelvig Petersen ◽

Harald William Meyer ◽

...

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Sex Ratio ◽

Polychlorinated Biphenyls ◽

Birth Outcomes ◽

Gestational Age ◽

Small For Gestational Age ◽

Maternal Exposure ◽

Adverse Birth Outcomes ◽

Secondary Sex Ratio

AbstractHuman health effects of airborne lower-chlorinated polychlorinated biphenyls (LC-PCBs) are largely unexplored. Since PCBs may cross the placenta, maternal exposure could potentially have negative consequences for fetal development. We aimed to determine if exposure to airborne PCB during pregnancy was associated with adverse birth outcomes. In this cohort study, exposed women had lived in PCB contaminated apartments at least one year during the 3.6 years before conception or the entire first trimester of pregnancy. The women and their children were followed for birth outcomes in Danish health registers. Logistic regression was performed to estimate odds ratios (OR) for changes in secondary sex ratio, preterm birth, major congenital malformations, cryptorchidism, and being born small for gestational age. We performed linear regression to estimate difference in birth weight among children of exposed and unexposed mothers. All models were adjusted for maternal age, educational level, ethnicity, and calendar time. We identified 885 exposed pregnancies and 3327 unexposed pregnancies. Relative to unexposed women, exposed women had OR 0.97 (95% CI 0.82, 1.15) for secondary sex ratio, OR 1.13 (95% CI 0.76, 1.67) for preterm birth, OR 1.28 (95% CI 0.81, 2.01) for having a child with major malformations, OR 1.73 (95% CI 1.01, 2.95) for cryptorchidism and OR 1.23 (95% CI 0.88, 1.72) for giving birth to a child born small for gestational age. The difference in birth weight for children of exposed compared to unexposed women was − 32 g (95% CI—79, 14). We observed an increased risk of cryptorchidism among boys after maternal airborne LC-PCB exposure, but due to the proxy measure of exposure, inability to perform dose–response analyses, and the lack of comparable literature, larger cohort studies with direct measures of exposure are needed to investigate the safety of airborne LC-PCB exposure during pregnancy

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Effects of maternal exposure to acute stress on birth outcomes: a quasi-experiment study

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174421000611 ◽

2021 ◽

pp. 1-12

Author(s):

Asma Ahmed ◽

Suzanne King ◽

Guillaume Elgbeili ◽

David P. Laplante ◽

Seungmi Yang

Keyword(s):

Birth Outcomes ◽

Gestational Age ◽

Acute Stress ◽

Maternal Stress ◽

Population Based ◽

Substantial Effect ◽

Maternal Exposure ◽

Large For Gestational Age ◽

Ice Storm ◽

Quasi Experimental

Abstract Numerous studies have shown associations between maternal stress and poor birth outcomes, but evidence is unclear for causal inference. Natural disasters provide an opportunity to study effects of quasi-randomized hardship with an accurate measure of onset and duration. In a population-based quasi-experimental study, we examined the effect of maternal exposure to the January 1998 Québec ice storm on birth outcomes by comparing pregnant mothers who lived in an area hard hit by the ice storm with those in two unaffected regions. In a total of 147,349 singleton births between 1995 and 2001, we used a difference-in-differences method to estimate the effects of the ice storm on gestational age at delivery (GA), preterm birth (PTB), weight-for-gestational-age z-scores (BWZ), large for gestational age (LGA), and small for gestational age (SGA). After adjusting for maternal and sociodemographic characteristics, there were no differences between the exposed and the unexposed mothers for birth outcomes. The estimated differences (exposed vs. unexposed) were 0.01 SDs (95% CI: −0.02, 0.05) for BWZ; 0.10% point (95% CI: −0.95%, 1.16%) for SGA; 0.25% point (95% CI: −0.78%, 1.28%) for LGA; −0.01 week (95% CI: −0.07, 0.05) for GA; and 0.16% point (95% CI: −0.66%, 0.97%) for PTB. Neither trimester-specific nor dose–response associations were observed. Overall, exposure to the 1998 Québec ice storm as a proxy for acute maternal stress in pregnancy was not associated with poor birth outcomes. Our results suggest that acute maternal hardship may not have a substantial effect on adverse birth outcomes.

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Geospatial analysis of exposure to violent crime during pregnancy and adverse birth outcomes: Evidence from São Paulo’s Western Region Birth Cohort

10.21203/rs.3.rs-33991/v1 ◽

2020 ◽

Author(s):

Angelica Carreira dos Santos ◽

Alexandra Brentani ◽

Günther Fink

Keyword(s):

Socioeconomic Status ◽

Birth Weight ◽

Low Birth Weight ◽

Violent Crime ◽

Birth Outcomes ◽

Gestational Age ◽

Violence Exposure ◽

Western Region ◽

Adverse Birth Outcomes ◽

Violent Crimes

Abstract Background Low birth weight and prematurity remain leading causes of infant mortality and morbidity globally. Although an extensive literature has highlighted the importance of socioenvironmental characteristics for birth outcomes, the role of indirect violence on health remains fairly understudied. Methods Using geocoded birth records from the ongoing Western Region Birth Cohort ( Região Oeste Coorte – ROC-Cohort) of infants born between 2012-2014 and geocoded crime reports, we assessed the associations between exposure to violent crimes during pregnancy within a 1-km radius of mother’s residence and low birth weight, preterm delivery, and being born small-for-gestational-age. Violent crime exposure was categorized into quintiles. Multivariate logistic regressions were used to examine the associations between violence exposure and birth outcomes. Models were adjusted for sex, maternal age and education, socioeconomic status, and risk factors such as hypertension, diabetes, smoking, and drinking during pregnancy. ResultsAmong the 5,268 infants included, the average crime exposure during the first two trimesters of pregnancy ranged from 0.44 violent crimes in the least exposed quintile to 12.74 crimes in the most exposed. Compared to children with the lowest violence exposure, children in the highest exposure quintile were at higher odds of being born small-for-gestational-age (1.41[1.06-1.89]), preterm (1.35[1.01-1.80]), and low birth weight (1.42[1.03-1.98]). While socioeconomic status and maternal education were positively associated with lower violence exposure, no associations were found between these characteristics and the birth outcomes. Conclusions Higher exposure to external violent crimes in the close vicinity are associated with substantial increases in the odds of adverse birth outcomes. Policies to improve neighborhood safety can contribute not only to the short-term well-being of populations but may also have large social, economic, and health benefits in the long run.

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The Zambian Preterm Birth Prevention Study (ZAPPS): Cohort characteristics at enrollment

Gates Open Research ◽

10.12688/gatesopenres.12820.1 ◽

2018 ◽

Vol 2 ◽

pp. 25 ◽

Cited By ~ 3

Author(s):

Marcela C. Castillo ◽

Nurain M. Fuseini ◽

Katelyn Rittenhouse ◽

Joan T. Price ◽

Bethany L. Freeman ◽

...

Keyword(s):

Preterm Birth ◽

Birth Outcomes ◽

Gestational Age ◽

Clinical Care ◽

Adverse Outcomes ◽

Sub Saharan Africa ◽

Growth Monitoring ◽

Adverse Birth Outcomes ◽

Prevention Study ◽

Background Rate

Background: Sub-Saharan Africa bears a disproportionate burden of preterm birth and other adverse outcomes. Not only is the background rate of preterm birth higher than in North America and Europe, but many facilities lack essential equipment and personnel resources to care for preterm neonates. A better understanding of the demographic, clinical, and biologic underpinnings of preterm birth is urgently needed to plan interventions and inform new discovery. Methods: The Zambian Preterm Birth Prevention Study (ZAPPS) is a prospective antenatal cohort established at the Women and Newborn Hospital of the University Teaching Hospital (UTH) in Lusaka, Zambia. We recruit pregnant women from the antenatal clinics of district health centers and the UTH for study participation. Women undergo ultrasound examination to determine eligibility by gestational age criteria. Enrolled participants receive routine antenatal and postnatal care, lab testing, midtrimester cervical length measurement, serial fetal growth monitoring and careful assessment of birth outcomes. Results: Between August 2015 and September 2017, we screened 1784 women, of whom 1450 (81.2%) met inclusion criteria and were enrolled. The median age at enrollment of study participants is 27 years (IQR 23–32). Participants are enrolled at a median gestational age of 16 weeks (IQR 13–18). Among all parous participants (N=866; 64%), 21% (N=182) reported a prior miscarriage, 49% (N=424) reported a prior preterm birth, and 13% (N=116) reported a prior stillbirth. The HIV seroprevalence in our cohort is 24%. Discussion: We have established a large antenatal cohort to characterize the epidemiological and biological determinants of adverse birth outcomes in Lusaka, Zambia. Findings from this cohort will help guide future studies, clinical care, and policy in the prevention and treatment of adverse birth outcomes.

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No Strings Attached: The Impact of an Unconditional Prenatal Income Supplement on First Nations Birth and Early Childhood Outcomes

International Journal for Population Data Science ◽

10.23889/ijpds.v3i4.635 ◽

2018 ◽

Vol 3 (4) ◽

Author(s):

Marni Brownell ◽

Mariette Chartier ◽

Nathan Nickel ◽

Rhonda Campbell ◽

Jennifer Enns ◽

...

Keyword(s):

Early Childhood ◽

Birth Weight ◽

Low Birth Weight ◽

First Nations ◽

Birth Outcomes ◽

Gestational Age ◽

Low Income ◽

Large For Gestational Age ◽

Breastfeeding Initiation ◽

Early Childhood Outcomes

IntroductionIn Manitoba, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit (HBPB), an unconditional income supplement provided during the second and third trimester of pregnancy. HBPB is associated with improved birth outcomes for Manitoba women; its association with birth outcomes for First Nations (Indigenous) women is unknown. Objectives and ApproachTo determine the association between HBPB and First Nations’ (FN) newborn and early childhood outcomes, we linked whole-population data from health, public health, family services and education. We included only FN women receiving income assistance during pregnancy (n=7074) to develop comparable treatment (received HBPB; n=5283) and comparison (no HBPB; n=1791) groups. Propensity score weighting adjusted for differences in maternal characteristics between groups. Multi-variable regressions compared groups on breastfeeding initiation, low birth weight, preterm birth, small- and large-for-gestational age, Apgar scores, complete immunizations at 1 and 2 years, and developmental vulnerability in kindergarten measured with the Early Development Instrument (EDI). ResultsReceipt of the HBPB was associated with reductions in low birth weight births (adjusted Relative Risk (aRR): 0.77; 95% CI: 0.63, 0.93) and preterm births (aRR: 0.78 (0.68, 0.90)), and increases in breastfeeding initiation (aRR: 1.05 (1.00, 1.09)) and large-for-gestational age births (aRR: 1.11 (1.01, 1.23)). HBPB receipt during pregnancy was also associated with increases in 1- and 2-year immunizations for FN children (aRR: 1.14 (1.09, 1.19), and aRR: 1.28 (1.19, 1.36), respectively). Reductions in the risk of being developmentally vulnerable in the language and cognitive domain of the EDI were also found for FN children whose mothers had received the HBPB during pregnancy (aRR: 0.85 (0.74, 0.97). Conclusion/ImplicationsA modest unconditional income supplement during pregnancy was associated with improved birth outcomes, increased immunization rates, and improved language and cognitive development at kindergarten for children born to low-income First Nations women. Long-term strategies to address structural inequities and the ongoing effects of colonization are also needed.

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Pregnancy-associated cancers and birth outcomes in children: a Danish and Swedish population-based register study

BMJ Open ◽

10.1136/bmjopen-2018-022946 ◽

2018 ◽

Vol 8 (12) ◽

pp. e022946 ◽

Cited By ~ 2

Author(s):

Natalie C Momen ◽

Linn Håkonsen Arendt ◽

Andreas Ernst ◽

Jørn Olsen ◽

Jiong Li ◽

...

Keyword(s):

Logistic Regression ◽

Birth Weight ◽

Caesarean Section ◽

Low Birth Weight ◽

Birth Outcomes ◽

Gestational Age ◽

Apgar Score ◽

Population Based ◽

Adverse Birth Outcomes

ObjectivesThis study aims to estimate the association between pregnancy-associated maternal cancers, diagnosed both prenatally and postnatally, and birth outcomes.DesignPopulation-based register study.SettingNational registers of Denmark and Sweden.ParticipantsA total of 5 523 365 children born in Denmark (1977–2008) and Sweden (1973–2006).Primary and secondary outcome measures: gestational age, birth weight, size for gestational age, Apgar score, caesarean section and sex were the outcomes of interest. ORs and relative risk ratios (RRR) with 95% CIs were estimated using logistic regression and multinomial logistic regression, respectively.ResultsIn this study, 2% of children were born to mothers with a diagnosis of cancer. Children whose mothers received a prenatal cancer diagnosis had higher risk of being born preterm (RRR: 1.77, 95% CI 1.64 to 1.90); low birth weight (RRR 1.84, 95% CI 1.69 to 2.01); low Apgar score (OR 1.36, 95% CI 1.20 to 1.56); and by caesarean section (OR: 1.69, 95% CI 1.59 to 1.80). Associations moved towards the null for analyses using postnatal diagnoses, but preterm birth (RRR: 1.13, 95% CI 1.09 to 1.17) and low birth weight (RRR: 1.14, 95% CI 1.09 to 1.18) remained statistically significant, while risk of caesarean section became so (OR: 0.95, 95% CI 0.91 to 0.98). Additionally, statistical significance was reached for large for gestational age (RRR: 1.06, 95% CI 1.01 to 1.11), high birth weight (RRR: 1.04, 95% CI 1.01 to 1.06) and caesarean section (OR: 0.95, 95% CI 0.91 to 0.98).ConclusionsResults suggest an association between pregnancy-associated cancers and adverse birth outcomes in the offspring. While this is strongest for prenatally diagnosed cancers, some smaller associations exist for postnatally diagnosed cancers, indicating that cancer itself could affect fetal development, or that cancer and adverse birth outcomes share risk factors. Future studies on maternal cancer during pregnancy should consider including some postnatal years in their exposure window.

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Examining the association between maternal atopy and birth outcomes using a retrospective cohort in the southeastern region of the USA

BMJ Open ◽

10.1136/bmjopen-2017-017161 ◽

2017 ◽

Vol 7 (11) ◽

pp. e017161

Author(s):

Ayesha Johnson ◽

Thomas Mason ◽

Russell S Kirby ◽

Dennis Ledford ◽

Hamisu M Salihu

Keyword(s):

Birth Weight ◽

Birth Outcomes ◽

Gestational Age ◽

Retrospective Cohort ◽

Adverse Birth Outcomes ◽

The Usa ◽

Gestational Age At Birth ◽

Primiparous Women ◽

Southeastern Region ◽

Age At Birth

ObjectiveTo assess birth outcomes in primiparous women with diagnosis of non-asthmatic atopy (NAA). Researchers hypothesised that women with NAA would have reduced the risk of adverse birth outcomes compared with women without NAA. NAA is defined as having allergic rhinitis and/or atopic dermatitis.SettingWomen were mostly treated in primary care settings in South Carolina, USA.ParticipantsThis is a retrospective cohort study in which participants were identified using a Medicaid database. Participants were primiparous women aged 19 to 25. Births occurring between 2004 and 2014 were identified using the South Carolina’s Vital Statistics (VS) records of live births. Incomplete records (ie, information on plural birth, gestational age at birth or birth weight missing), plural births or infants born before completing 24 weeks of gestation were excluded. This provided 65 650 complete maternal–infant dyads, representing 97.6% of the maternal records and 96.9% of the VS records. Women previously diagnosed with NAA were frequency matched 1:4 to non–atopic controls for a total of 9965 maternal–infant dyads used in the statistical analysis.Primary outcome measuresLow birth weight, small for gestational age and preterm birth.ResultsLinear tests for trend were statistically significant (p<0.001), indicating that NAA was associated with improved birth weight and gestational age at birth. After controlling for potential confounders, mothers with NAA had equal risk for each outcome when compared with mothers with no diagnosis of NAA.ConclusionA diagnosis of NAA among women living in the southeastern region of the USA does not reduce the risk of adverse birth outcomes nor does it elevate the risk of same. Additional studies with more rigorous designs are warranted to confirm the findings in this study.

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