Prenatal Exposure to Ambient Pesticides and Adverse Birth Outcomes in Agricultural Regions of California

Findings from studies of prenatal exposure to pesticides and adverse birth outcomes have been equivocal so far. We examined prenatal exposure to agricultural pesticides in relation to preterm birth and term low birthweight, respectively, in children born between 1998 and 2010, randomly selected from California birth records. We estimated residential exposure to agriculturally applied pesticides within 2 km of residential addresses at birth by pregnancy trimester for 17 individual pesticides and three chemical classes (organophosphates, pyrethroids, and carbamates). Among maternal addresses located within 2 km of any agricultural pesticide application, we identified 24,693 preterm and 220,297 term births, and 4412 term low birthweight and 194,732 term normal birthweight infants. First or second trimester exposure to individual pesticides (e.g., glyphosates, paraquat, imidacloprid) or exposure to 2 or more pesticides in the three chemical classes were associated with a small increase (3–7%) in risk for preterm birth; associations were stronger for female offspring. We did not find associations between term low birthweight and exposure to pesticides other than myclobutanil (OR: 1.11; 95% CI: 1.04–1.20) and possibly the pyrethroids class. Our improved exposure assessment revealed that first and second trimester exposure to pesticides is associated with preterm delivery but is rarely linked with term low birthweight.

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Influence of Prenatal Exposure to Mercury, Perceived Stress, and Depression on Birth Outcomes in Suriname: Results from the MeKiTamara Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17124444 ◽

2020 ◽

Vol 17 (12) ◽

pp. 4444

Author(s):

Anisma R. Gokoel ◽

Wilco C. W. R. Zijlmans ◽

Hannah H. Covert ◽

Firoz Abdoel Wahid ◽

Arti Shankar ◽

...

Keyword(s):

Preterm Birth ◽

Birth Outcomes ◽

Prenatal Exposure ◽

Perceived Stress ◽

Apgar Score ◽

Low Birthweight ◽

Depression Scale ◽

Study Cohort ◽

Adverse Birth Outcomes ◽

Probable Depression

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.

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Interventions to improve birth outcomes of pregnant women living in low- and middle-income countries: a systematic review and network meta-analysis

Gates Open Research ◽

10.12688/gatesopenres.13081.2 ◽

2020 ◽

Vol 3 ◽

pp. 1657

Author(s):

Jay J. H. Park ◽

Ofir Harari ◽

Ellie Siden ◽

Michael Zoratti ◽

Louis Dron ◽

...

Keyword(s):

Clinical Trials ◽

Preterm Birth ◽

Pregnant Women ◽

Birth Outcomes ◽

Low Birthweight ◽

Meta Analysis ◽

Standard Of Care ◽

Adverse Birth Outcomes ◽

Middle Income ◽

Middle Income Countries

Background: Improving the health of pregnant women is important to prevent adverse birth outcomes, such as preterm birth and low birthweight. We evaluated the comparative effectiveness of interventions under the domains of micronutrient, balanced energy protein, deworming, maternal education, and water sanitation and hygiene (WASH) for their effects on these adverse birth outcomes. Methods: For this network meta-analysis, we searched for randomized clinical trials (RCTs) of interventions provided to pregnant women in low- and middle-income countries (LMICs). We searched for reports published until September 17, 2019 and hand-searched bibliographies of existing reviews. We extracted data from eligible studies for study characteristics, interventions, participants’ characteristics at baseline, and birth outcomes. We compared effects on preterm birth (<37 gestational week), low birthweight (LBW; <2500 g), and birthweight (continuous) using studies conducted in LMICs. Results: Our network meta-analyses were based on 101 RCTs (132 papers) pertaining to 206,531 participants. Several micronutrients and balanced energy food supplement interventions demonstrated effectiveness over standard-of-care. For instance, versus standard-of-care, micronutrient supplements for pregnant women, such as iron and calcium, decreased risks of preterm birth (iron: RR=0.70, 95% credible interval [Crl] 0.47, 1.01; calcium: RR=0.76, 95%Crl 0.56, 0.99). Daily intake of 1500kcal of local food decreased the risks of preterm birth (RR=0.36, 95%Crl 0.16, 0.77) and LBW (RR=0.17, 95%Crl 0.09, 0.29), respectively when compared to standard-of-care. Educational and deworming interventions did not show improvements in birth outcomes, and no WASH intervention trials reported on these adverse birth outcomes. Conclusion: We found several pregnancy interventions that improve birth outcomes. However, most clinical trials have only evaluated interventions under a single domain (e.g. micronutrients) even though the causes of adverse birth outcomes are multi-faceted. There is a need to combine interventions that of different domains as packages and test for their effectiveness. Registration: PROSPERO CRD42018110446; registered on 17 October 2018.

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1096. Effect of Diarrheal Illness During Pregnancy on Adverse Birth Outcomes in Nepal

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.931 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S328-S329

Author(s):

Kira Newman ◽

Katie Gustafson ◽

Janet Englund ◽

Joanne Katz ◽

Amalia Magaret ◽

...

Keyword(s):

Preterm Birth ◽

Medical Care ◽

Pregnant Women ◽

Birth Outcomes ◽

Low Birthweight ◽

Published Data ◽

Adverse Birth Outcomes ◽

South Asian Population ◽

Adjusted Risk ◽

Diarrheal Illness

Abstract Background Adverse birth outcomes, including low birthweight (LBW), small-for-gestational-age (SGA) and preterm birth, contribute to 60–80% of infant mortality worldwide. Little published data exist on the association between diarrhea during pregnancy and adverse birth outcomes. We sought to identify whether diarrhea during pregnancy was associated with adverse birth outcomes. Methods We used data from a community-based, prospective randomized trial of maternal influenza immunization of pregnant women and their infants conducted in rural Nepal from 2011 to 2014. Illness episodes were defined as at least three watery bowel movements per day for one or more days with 7 diarrhea-free days between episodes. Diarrheal illnesses were identified through longitudinal household-based weekly symptom surveillance. The c2 test, two-sample t-test, and log-binomial regression were performed to evaluate baseline characteristics and the association between diarrhea during pregnancy and adverse birth outcomes. Results Of 3,682 women in the study, 527 (14.3%) experienced one or more episodes of diarrhea during pregnancy. Diarrhea incidence was not seasonal. Women with diarrhea had a median of one episode of diarrhea (interquartile range (IQR) 1–2 episodes) and two cumulative days of diarrhea (IQR 1–3 days). Of women with diarrhea, 16.1% (85) sought medical care. Mean maternal age, parity, biomass cook stove use, home latrine, water source, caste, and smoking did not differ in pregnant women with and without diarrhea. In crude and adjusted analyses, women with diarrhea during pregnancy were significantly more likely to have SGA infants (42.6% vs. 36.8%; adjusted risk ratio=1.20, 95% CI 1.06–1.36, P = 0.005). LBW and preterm birth incidence did not significantly differ between women with diarrhea during pregnancy and those without. There was no significant association between seeking medical care for diarrhea and birth outcomes. Conclusion Diarrheal illness during pregnancy was associated with a significantly higher risk of SGA infants in this rural South Asian population. Interventions to reduce the burden of diarrheal illness during pregnancy may have an impact on SGA births in resource-limited settings. Disclosures All authors: No reported disclosures.

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Adverse birth outcomes and associated factors among mothers who delivered in Bale zone hospitals, Oromia Region, Southeast Ethiopia

Journal of International Medical Research ◽

10.1177/03000605211013209 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110132

Author(s):

Sisay Degno ◽

Bikila Lencha ◽

Ramato Aman ◽

Daniel Atlaw ◽

Ashenafi Mekonnen ◽

...

Keyword(s):

Preterm Birth ◽

Antenatal Care ◽

Birth Outcomes ◽

Associated Factors ◽

Low Birthweight ◽

Multiple Pregnancy ◽

Bivariate Analysis ◽

Adverse Birth Outcomes ◽

Southeast Ethiopia ◽

Bale Zone

Objective Adverse birth outcomes, which include stillbirth, preterm birth, low birthweight, congenital abnormalities, and stillbirth, are the leading cause of neonatal and infant mortality worldwide. We assessed adverse birth outcomes and associated factors among mothers who gave birth in Bale zone hospitals, Oromia, Southeast Ethiopia. Methods We used systematic random sampling in this cross-sectional study. We identified factors associated with adverse birth outcomes using bivariate analysis and multivariable logistic regression analysis. Results The proportion of adverse birth outcomes among participants was 21%. Of 576 births, 70 (12.2%) were low birthweight, 49 (8.5%) were preterm birth, 45 (7.8%) were stillbirth, and 18 (3.1%) infants had congenital anomalies. Inadequate antenatal care (adjusted odds ratio [AOR] = 6.58, 95% confidence interval [CI] 3.25–13.32), multiple pregnancy (AOR = 4.74, 95% CI 1.55–14.45), premature rupture of membranes in the current pregnancy (AOR = 2.31, 95% CI 1.26–4.21), hemoglobin level < 11 g/dL (AOR = 3.22, 95% CI 1.85–5.58), and mid-upper arm circumference less than 23 cm (AOR = 5.93, 95% CI 3.49–10.08) were all significantly associated with adverse birth outcomes. Conclusions Approximately one in five study participants had adverse birth outcomes. Increasing antenatal care uptake, ferrous supplementation during pregnancy, and improving the quality of maternal health services are recommended.

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Effect of Diarrheal Illness During Pregnancy on Adverse Birth Outcomes in Nepal

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz011 ◽

2019 ◽

Vol 6 (2) ◽

Author(s):

Kira L Newman ◽

Kathryn Gustafson ◽

Janet A Englund ◽

Amalia Magaret ◽

Subarna Khatry ◽

...

Keyword(s):

Preterm Birth ◽

Birth Outcomes ◽

Low Birthweight ◽

Asian Population ◽

Published Data ◽

Adverse Birth Outcomes ◽

South Asian Population ◽

Adjusted Risk ◽

Diarrheal Illness ◽

Bowel Movements

Abstract Background Adverse birth outcomes, including low birthweight, small for gestational age (SGA), and preterm birth, contribute to 60%–80% of infant mortality worldwide. Little published data exist on the association between diarrhea during pregnancy and adverse birth outcomes. Methods Data were used from 2 community-based, prospective randomized trials of maternal influenza immunization during pregnancy conducted in rural Nepal from 2011 to 2014. Diarrheal illnesses were identified through longitudinal household-based weekly symptom surveillance. Diarrhea episodes were defined as at least 3 watery bowel movements per day for 1 or more days with 7 diarrhea-free days between episodes. The Poisson and log-binomial regression were performed to evaluate baseline characteristics and association between diarrhea during pregnancy and adverse birth outcomes. Results A total of 527 of 3693 women in the study (14.3%) experienced diarrhea during pregnancy. Women with diarrhea had a median of 1 episode of diarrhea (interquartile range [IQR], 1–2 episodes) and 2 cumulative days of diarrhea (IQR, 1–3 days). Of women with diarrhea, 85 (16.1%) sought medical care. In crude and adjusted analyses, women with diarrhea during pregnancy were more likely to have SGA infants (42.6% vs 36.8%; adjusted risk ratio = 1.20; 95% confidence interval, 1.06–1.36; P = .005). Birthweight and preterm birth incidence did not substantially differ between women with diarrhea during pregnancy and those without. Conclusions Diarrheal illness during pregnancy was associated with a higher risk of SGA infants in this rural South Asian population. Interventions to reduce the burden of diarrheal illness during pregnancy may have an impact on SGA births in resource-limited settings.

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Exploring airshed and watershed exposure pathways as mediators of the association between proximity to surface mining and adverse birth outcomes in Central Appalachia

10.21203/rs.3.rs-948330/v1 ◽

2021 ◽

Author(s):

Corrine Warren Ruktanonchai ◽

Molly Xi McKnight ◽

Lauren Grace Buttling ◽

Korine N Kolivras ◽

Leigh-Anne Krometis ◽

...

Keyword(s):

Preterm Birth ◽

Birth Outcomes ◽

Low Birthweight ◽

Surface Mining ◽

Active Surface ◽

Adverse Birth Outcomes ◽

Mining Activities ◽

Potential Exposure ◽

Exposure Pathways ◽

Central Appalachia

Abstract Background Previous work has determined an association between proximity to active surface mining in coal producing counties within Central Appalachia and an increased risk of preterm birth (PTB) and low birthweight (LBW); however, the relative importance of specific exposure pathways explaining this association remains poorly understood. Multiple potential exposure pathways to surface mining activities exist during gestation, including inhalation of particulate matter (airshed exposure), or via exposure to impacted surface waters (watershed exposure). Here, we perform a mediation analysis to explore these pathways and the odds of adverse birth outcomes. Methods We obtained birth records acquired through health departments in WV, KY, VA and TN between 1990 and 2015. Surface mine extents for each year were identified through remotely sensed Landsat imagery. Corresponding airsheds were estimated using the HYSPLIT4 atmospheric trajectory model, while watersheds were assigned using United States Geological Survey’s Watershed Boundary Dataset boundaries. We performed logistic regression to determine associations between exposure and the odds of preterm birth, low birthweight, and term low birthweight, and iteratively included within our models: a) the percent of active surface mining landcover within a 5 km buffer of maternal residence; b) the cumulative potential exposure to air pollutants via the airshed experienced at the maternal residence, and; c) the percent of land experiencing surface mining within the watershed of residency. Results Our baseline models found that active surface mining was associated with an increased odds of PTB (1.09, 1.05 – 1.13) and LBW (1.06, 1.02 – 1.11), while controlling for significant predictors. When mediators were added to the base model, the association between active mining and birth outcomes was reduced (PTB: 1.04, 0.99 – 1.09; LBW 1.04, 0.99 – 1.10), while the odds of PTB and LBW increased with airshed exposure (PTB: 1.14, 1.11 – 1.18; LBW: 1.06, 1.03 – 1.10). Conclusions Results were consistent with a hypothesis of mediation via airshed, but suggested mediation via watershed was less likely. These results suggest that air pollution resulting from surface mining activities may be the primary exposure pathway explaining the association between maternal residence proximity to active surface mining and PTB and LBW.

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Interventions to improve birth outcomes of pregnant women living in low- and middle-income countries: a systematic review and network meta-analysis

Gates Open Research ◽

10.12688/gatesopenres.13081.1 ◽

2019 ◽

Vol 3 ◽

pp. 1657 ◽

Cited By ~ 2

Author(s):

Jay J. H. Park ◽

Ofir Harari ◽

Ellie Siden ◽

Michael Zoratti ◽

Louis Dron ◽

...

Keyword(s):

Clinical Trials ◽

Preterm Birth ◽

Pregnant Women ◽

Birth Outcomes ◽

Low Birthweight ◽

Meta Analysis ◽

Standard Of Care ◽

Adverse Birth Outcomes ◽

Middle Income ◽

Middle Income Countries

Background: Improving the health of pregnant women is important to prevent adverse birth outcomes, such as preterm birth and low birthweight. We evaluated the comparative effectiveness of interventions under the domains of micronutrient, balanced energy protein, deworming, maternal education, and water sanitation and hygiene (WASH) for their effects on these adverse birth outcomes. Methods: For this network meta-analysis, we searched for randomized clinical trials (RCTs) of interventions provided to pregnant women in low- and middle-income countries (LMICs). We searched for reports published until September 17, 2019 and hand-searched bibliographies of existing reviews. We extracted data from eligible studies for study characteristics, interventions, participants’ characteristics at baseline, and birth outcomes. We compared effects on preterm birth (<37 gestational week), low birthweight (LBW; <2500 g), and birthweight (continuous) using studies conducted in LMICs. Results: Our network meta-analyses were based on 101 RCTs (132 papers) pertaining to 206,531 participants. Several micronutrients and balanced energy food supplement interventions demonstrated effectiveness over standard-of-care. For instance, versus standard-of-care, micronutrient supplements for pregnant women, such as iron and calcium, decreased risks of preterm birth (iron: RR=0.70, 95% credible interval [Crl] 0.47, 1.01; calcium: RR=0.76, 95%Crl 0.56, 0.99). Daily intake of 1500kcal of local food decreased the risks of preterm birth (RR=0.36, 95%Crl 0.16, 0.77) and LBW (RR=0.17, 95%Crl 0.09, 0.29), respectively when compared to standard-of-care. Educational and deworming interventions did not show improvements in birth outcomes, and no WASH intervention trials reported on these adverse birth outcomes. Conclusion: We found several pregnancy interventions that improve birth outcomes. However, most clinical trials have only evaluated interventions under a single domain (e.g. micronutrients) even though the causes of adverse birth outcomes are multi-faceted. There is a need to combine interventions that of different domains as packages and test for their effectiveness. Registration: PROSPERO CRD42018110446; registered on 17 October 2018.

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Mass incarceration and public health: the association between black jail incarceration and adverse birth outcomes among black women in Louisiana

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2690-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Lauren Dyer ◽

Rachel Hardeman ◽

Dovile Vilda ◽

Katherine Theall ◽

Maeve Wallace

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Black Women ◽

Low Birth Weight ◽

Racial Disparities ◽

Population Health ◽

Birth Outcomes ◽

Mass Incarceration ◽

Interquartile Range ◽

Adverse Birth Outcomes

Abstract Background A growing body of evidence is beginning to highlight how mass incarceration shapes inequalities in population health. Non-Hispanic blacks are disproportionately affected by incarceration and criminal law enforcement, an enduring legacy of a racially-biased criminal justice system with broad health implications for black families and communities. Louisiana has consistently maintained one of the highest rates of black incarceration in the nation. Concurrently, large racial disparities in population health persist. Methods We conducted a cross-sectional analysis of all births among non-Hispanic black women in Louisiana in 2014 to identify associations between parish-level (county equivalent) prevalence of jail incarceration within the black population and adverse birth outcomes (N = 23,954). We fit a log-Poisson model with generalized estimating equations to approximate the relative risk of preterm birth and low birth weight associated with an interquartile range increase in incarceration, controlling for confounders. In sensitivity analyses, we additionally adjusted for the parish-level index crime prevalence and analyzed regression models wherein white incarceration was used to predict the risk of adverse birth outcomes in order to quantify the degree to which mass incarceration may harm health above and beyond living in a high crime area. Results There was a significant 3% higher risk of preterm birth among black women associated with an interquartile range increase in the parish-level incarceration prevalence of black individuals, independent of other factors. Adjusting for the prevalence of index crimes did not substantively change the results of the models. Conclusion Due to the positive significant associations between the prevalence of black individuals incarcerated in Louisiana jails and estimated risk of preterm birth, mass incarceration may be an underlying cause of the persistent inequities in reproductive health outcomes experienced by black women in Louisiana. Not only are there economic and social impacts stemming from mass incarceration, but there may also be implications for population health and health inequities, including the persistence of racial disparities in preterm birth and low birth weight.

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Risk of pre-term births and major birth defects resulting from paternal intake of COVID-19 medications prior to conception

BMC Research Notes ◽

10.1186/s13104-020-05358-x ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

Silvia Rizzi ◽

Maarten J. Wensink ◽

Rune Lindahl-Jacobsen ◽

Lu Tian ◽

Ying Lu ◽

...

Keyword(s):

Cohort Study ◽

Birth Outcomes ◽

Birth Defects ◽

Sperm Quality ◽

The Other ◽

Reproductive Age ◽

Adverse Birth Outcomes ◽

Term Birth ◽

Large Numbers ◽

Term Births

Abstract Objective With the ongoing COVID-19 pandemic, large numbers of people will receive one of the several medications proposed to treat COVID-19, including patients of reproductive age. Given that some medications have shown adverse effects on sperm quality, there might be a transgenerational concern. We aim at examining the association between drugs proposed to treat COVID-19 when taken by the father around conception and any pre-term birth or major birth defects in offspring in a nation-wide cohort study using Danish registry data. Offspring whose father filled at least one prescription of the following medications in the 3 months preceding conception were considered exposed: chloroquine, hydroxychloroquine, losartan, azithromycin, naproxen, dexamethasone and prednisone. Results For azithromycin and naproxen, large numbers of offspring were exposed (> 1800 offspring), and we found no association with adverse birth outcomes. For chloroquine, losartan and dexamethasone, exposure was intermediate (~ 900 offspring), and there was no statistically significant association with birth defects. For hydroxychloroquine and prednisone, exposure was limited (< 300 offspring). Our evidence suggests that azithromycin and naproxen are safe with respect to pre-term birth and birth defects. For the other drugs investigated larger exposures are needed for conclusive statements.

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