Prenatal and Perinatal Factors Associated with Pediatric Autism Spectrum Disorder in East China

Background Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by persistent challenges in social communication and interaction and restricted/repetitive patterns of behavior, interests or activities. An increasing number of studies have revealed that environmental exposure is a potential risk factor for ASD. The relationship between prenatal and perinatal risk factors and ASD has rarely been studied in large samples in China. Therefore, in this study, we compared children with ASD with typical developing (TD) children to assess the ASD-associated prenatal and perinatal risk factors and provide effective information for ASD prevention. Methods A case-control study of 709 children with autism spectrum disorder (ASD) and 709 gender-matched children with typical development was conducted to investigate the prenatal and perinatal risk factors of children with ASD compared with children with typical development ( TD). Through a self-developed general information questionnaire, the basic information (name, age, gender), prenatal factors (parents’ age at the child’s birth, parents’ education levels, use of assisted reproductive technology, history of miscarriage, gestational diabetes mellitus, gestational hypertension), and perinatal factors (delivery mode, full-term birth, parity, birth weight) of the children in the two groups were examined. Results The prenatal and perinatal factors of the groups were submitted to univariate analysis, the parent’s age at childbirth, education level, history of miscarriage, use of ART, pregnancy-induced hypertension, and GDM differed significantly between the two groups (P<0.05), and that among perinatal factors, infant parity and maturity also differed significantly between the two groups (P<0.05). These statistically significant factors were included in a binary logistic regression model. The results showed that the prenatal factors of young maternal age at the child’s birth (≤24 years vs 25-29 years, OR=2.408,95%CI:1.335~4.345), old paternal age at the childbirth(≥45years vs≤24years, OR=4.744, 95%CI:1.281~17.570 ), pregnancy induced hypertension (OR=6.178, 95%CI:2.311~16.517) and GDM(OR=0.220,95%CI:0.149~0.324), the perinatal factors of preterm birth(OR=4.434, 95%CI:2.872~6.846) and non-firstborn child(OR=1.387, 95%CI:1.029~1.869) are likely risk factors for ASD. Conclusion We show that some prenatal and perinatal factors are associated with a high prevalence of ASD in children.

Correlates of Insulin Selection as a First-Line Pharmacological Treatment for Gestational Diabetes

Objective The aim of this study was to investigate prenatal factors associated with insulin prescription as a first-line pharmacotherapy for gestational diabetes mellitus (GDM; compared with oral antidiabetic medication) after failed medical nutrition therapy. Methods This is a retrospective cohort study of 437 women with a singleton pregnancy and diagnosis of A2GDM (GDM requiring pharmacotherapy), delivering in a university hospital between 2015 and 2019. Maternal sociodemographic and clinical characteristics, as well as GDM-related factors, including provider type that manages GDM, were compared between women who received insulin versus oral antidiabetic medication (metformin or glyburide) as the first-line pharmacotherapy using univariable and multivariable analyses. Results In univariable analysis, maternal age, race and ethnicity, insurance, chronic hypertension, gestational age at GDM diagnosis, glucose level after 50-g glucose loading test, and provider type were associated with insulin prescription. In multivariable analysis, after adjusting for sociodemographic and clinical maternal factors, GDM characteristics and provider type, Hispanic ethnicity (0.26, 95% confidence interval [CI]: 0.09–0.73), and lack of insurance (0.34, 95% CI: 0.13–0.89) remained associated with lower odds of insulin prescription, whereas endocrinology management of GDM (compared with obstetrics and gynecology [OBGYN]) (8.07, 95% CI: 3.27–19.90) remained associated with higher odds of insulin prescription. Conclusion Women of Hispanic ethnicity and women with no insurance were less likely to receive insulin and more likely to receive oral antidiabetic medication for GDM pharmacotherapy, while management by endocrinology was associated with higher odds of insulin prescription.This finding deserves more investigation to understand if differences are due to patient choice or a health disparity in the choice of pharmacologic agent for A2GDM. Key Points

Analysis of Selected Risk Factors Depending on the Type of Cerebral Palsy

Background: Cerebral palsy (CP) is not a defined, separate disease classification, but a set of etiologically diverse symptoms that change with the child’s age. According to the up-to-date definition, CP is a group of permanent but not unchanging disorders of movement and/or posture and motor function, which are due to a nonprogressive interference, lesion, or abnormality of the developing/immature brain. CP is one of the most frequent causes of motor disability in children. The aim of the present study was to analyze whether selected risk factors may vary depending on particular types of CP. Methods: 181 children with CP (aged 4–17 years), hospitalized at the Department of Pediatrics and Developmental Age Neurology in Katowice in the years 2008–2016 were retrospectively analyzed in the present study. The assumed risk factors of CP were divided into two groups: 1—pre-conception and prenatal (mother’s age, family history of epilepsy, burdened obstetric history, mother’s systemic diseases, pregnancy order, multiple pregnancy, duration of pregnancy, bleedings from the genital tract during gestation, arterial hypertension during pregnancy, infections during pregnancy, preterm contractions, maintained pregnancy, premature rupture of membranes, abruptio placentae, and others), 2—perinatal and postnatal (mode of delivery, birth weight, Apgar score at the first and fifth minute, neonatal convulsions, respiratory failure, infections in neonatal and infant period, and intraventricular bleeding). The division into particular CP types was based on Ingram’s classification. Results: The following risk factors were the most frequent in the total group: respiratory failure, infections, intraventricular bleeding, and prematurity. Among the analyzed preconception and prenatal factors, the duration of pregnancy and preterm contractions during pregnancy significantly differentiated the subgroups of patients depending on the type of CP. The prevalence of almost all analyzed perinatal, neonatal, and infant-related risk factors (i.e., birth weight, Apgar score at the first and fifth minute, neonatal convulsions, respiratory failure, infections in neonatal and infant period, and intraventricular bleeding) significantly differed between CP types, apart from the mode of delivery. However, in multivariate regression, only intraventricular bleeding was an independent predictor for tetraplegic CP type when compared to joined extrapyramidal and ataxic types (OR = 2.801, p = 0.028). Conclusions: As CP is a syndrome of multifactorial etiology, the identification of CP risk factors entails the need for careful observation and comprehensive care of children in the risk group. The presence of certain risk factors may be a prognostic indicator for particular types of CP. The knowledge about the association between the risk factor(s) and the CP type could be a very useful tool for pediatricians looking after the child at risk of developmental disorders.

Pre-conception and prenatal factors influencing gestational weight gain: a prospective study in Tigray region, northern Ethiopia

Background In low-income countries, the high prevalence of pre-pregnancy undernutrition remains a challenge for the future health of women and their offspring. On top of good nutrition, adequate gestational weight gain has been recognized as an essential prerequisite for optimal maternal and child health outcomes. However, good-quality data on factors influencing gestational weight gain is lacking. Therefore, this study was aimed to prospectively identify pre-conception and prenatal factors influencing gestational weight gain in Ethiopia. Methods A population based prospective study was undertaken between February 2018 and January 2019 in the Tigray region, northern Ethiopia. Firstly, the weight of non-pregnant women of reproductive age living in the study area was measured between August and October 2017. Subsequently, eligible pregnant women identified during the study period were included consecutively and followed until birth. Data were collected through an interviewer-administered questionnaire and anthropometric measurements complemented with secondary data. Gestational weight gain, i.e., the difference between 32 to 36 weeks of gestation and pre-pregnancy weights, was classified as per the Institute of Medicine (IOM) guideline. Linear, spline, and logistic regression models were used to estimate the influence of pre-conception and prenatal factors on gestational weight gain. Results The mean gestational weight gain (standard deviation[SD]) was 10.6 (2.3) kg. Overall, 64.0% (95% CI 60.9, 67.1) of the women did not achieve adequate weight gain. Factors associated with higher gestational weight gain were higher women empowerment (B 0.60, 95% CI 0.06, 1.14), dietary diversity (B 0.39, 95% CI 0.03, 0.76), pre-pregnancy body mass index (B 0.13, 95% CI 0.05, 0.22), and haemoglobin (B 0.54, 95% CI 0.45, 0.64). Additionally, adequate prenatal care (B 0.58, 95% CI 0.28, 0.88) was associated with higher gestational weight gain. Conclusions Adequate gestational weight gain was not achieved by most women in the study area, primarily not by those who were underweight before pregnancy. Interventions that advance women’s empowerment, dietary quality, pre-pregnancy nutritional status, and prenatal care utilization may improve gestational weight gain and contribute to optimizing maternal and child health outcomes.

RETROSPECTIVE ANALYSIS OF PREDICTOR OF RECURRENT RESPIRATORY INFECTIONS IN PRESCHOOL CHILDREN

Among the current trends in the systemic prevention of recurrent respiratory infections in preschool children is the differentiated detection and clustering of the most significant ante- and prenatal factors associated with frequent acute respiratory infections. Thus, a comprehensive retrospective investigation of such factors in terms of their association with the integral indicators of acute respiratory infections recurrence in preschool children is exceptionally relevant. The study of particular manifestations of undifferentiated connective tissue dysplasia during recurrent respiratory infections is of great clinical and social relevance. This study research aims at determining the levels of inter-dependency between recurrence indicators of acute respiratory infections in preschool children and ante- and prenatal predictors analyzed retrospectively. Fifty-one children (24 boys and 27 girls) aged 1 to 6 years old, undergoing inpatient treatment for acute respiratory infection, were involved in the clinical study. Two markers of acute respiratory infection recurrence (infection index, resistance index) and dolichostenomelia integral indicator, which is used as the marker of external signs of connective tissue undifferentiated dysplasia, were calculated for each child. In addition, the retrospective analysis of 67 ante- and prenatal factors directly related to the children were examined. The statistical processing of the obtained digital material was performed by IBM SPSS Statistics 26 licensed software. Only non-parametric statistics methods were applied in the purpose. The first stage of investigating the inter-dependency between the acute respiratory infections frequency, the particular manifestations of undifferentiated connective tissue dysplasia, on the one hand, and the ante- and prenatal predictors, on the other hand, was carried out. The results obtained provided the grounds for the further research in the outlined direction involving the higher number of patients and using the more sensitive statistical methods. The higher infectious index values in the preschool children correlate with the following factors as lower initial overall age of their parents, smaller number of their mothers’ previous pregnancies, larger mothers’ body weight at the beginning of pregnancies, longer deliveries, lower Apgar scores in the newborns and no vaccination for tuberculosis. The resistance index values in the examined children increase with the simultaneous decreasing in the haemoglobin concentration in the mothers’ blood just before the deliveries and in cases of no vaccination in newborns for tuberculosis. The dolichostenomelia integral indicator in the patients aged from 1 to 6 years directly correlates with their age as well as with such retrospectively studied predictors as the newborns body mass index, the presence of foetoplacental insufficiency and the total number of complications caused by connective tissue dysplasia in their mothers during the pregnancies and deliveries.

Abstract P201: Early Life Exposure To Environmental Tobacco Smoke And Cardiometabolic Diseases In Middle Age: A 4-decade Follow-up Study Of The Collaborative Perinatal Project

Introduction: Environmental tobacco smoke (ETS) is a major source of indoor air pollution and has been associated with cardiovascular diseases (CVD) risks. There is little research on the associations of ETS exposure in early life with CVD risks in later life. Hypothesis: We hypothesized that ETS exposures in the uterus, childhood, and teenage increase midlife CVD risks. Methods: For 1,623 offspring born in 1959-1966 at two sites from the Collaborative Perinatal Project, we defined intrauterine ETS exposure in each trimester if the mother smoked (1-19 or ≥20 cigs/day). ETS exposure in each year from birth to 18 years was quantified by total daily-average hours of parents smoking weighted by daily packs from a questionnaire at the adult follow-up (mean age: 39 years). Ever diagnoses of diabetes (cumulative incidence: 3.0%), heart diseases (1.5%), hypertension (17.3%), and high cholesterol (25.3%) until adult follow-up were reported. Cardiometabolic diseases (CMD, cumulative incidence: 35.4%) were defined as any diagnosis. We estimated odds ratio (OR) for CMD by ETS exposures in each trimester adjusting for prenatal factors (maternal SES, pre-pregnancy BMI, parity, newborn sex); additionally adjusted for maternal smoking in pregnancy, birth weight, and gestational age for ETS exposure from birth to 18 years. We also stratified the analyses by adult smoking status. Results: Exposure to ≥20 cigs/day in the 1 st (OR: 1.52, 95% CI: 1.02-2.26) and 2 nd (OR: 1.50, 95% CI: 1.01-2.24) trimester was significantly associated with hypertension compared to none exposure, and the associations were stronger in adult offspring who were smokers. Among the 70% of participants who reported childhood ETS exposure, the average exposure was 8.5 smoker-hours/day and 10.5 smoker-hour*packs/day (HP/Day), with a declining trend from birth to 18 years. ETS exposure (per SD increment) in early life from birth to 18 years, separately or cumulatively (OR=1.24, 95% CI: 1.07-1.43), was associated with higher odds of adult hypertension. ETS exposure in teenage (11-18 years, OR=1.26, 95% CI: 1.05-1.50), but not in childhood (birth to 10 years, OR=1.18, 95% CI: 0.96-1.45), was associated with higher odds of a combination of adult heart disease and diabetes, which was more striking in adult non-smokers than smokers. Odds of adult CMD increased by 13% (95% CI: 1%-28%) for each SD (about 10 HP/Day) increment in ETS in the whole childhood and by 16% (95% CI: 3%-30%) in teenage. The results for smoker-hours/day were similar to those for smoker-hour*packs/day. Conclusions: Intrauterine exposure to maternal smoking and ETS exposures (time and total amount) from birth to 18 years increase the risk of adult hypertension. ETS exposure in early life may also increase the risk of adult cardiometabolic diseases. Teenage may be a sensitive window for elevated risk of adult heart diseases and diabetes associated with ETS exposure.

Does the prenatal factor or the postnatal factor contribute more to changes in the child sex ratio in India? An investigation in the context of fertility and mortality transition

There has been a drastic decline in the child sex ratio (number of females per 1000 males between ages 0 and 4) in India and many of its states. This study aimed to examine if prenatal factors, such as change in sex ratio at birth, or postnatal factors, such as change in relative mortality of females and males, contribute to this more by analysing the dynamics of the child sex ratio. Changes in the child sex ratio during 2001–2011 were decomposed into a ‘fertility’ component attributable to prenatal sex selection and a ‘mortality’ component attributable to sex differentials in postnatal survival at the country as well as the state level. Between the prenatal factor and the postnatal factor, the contribution of the latter to the declining child sex ratio has been greater than the former in India as a whole and in most of the states. By focusing on both prenatal and postnatal factors, the imbalance in the child sex ratio in the country can be reduced to a large extent.

Overweight in childhood and early adulthood is associated with parental Body Mass Index and perinatal risk factors

Background: To investigate the associations of pregnancy and pre-pregnancy parental characteristics on child’s weight and progression at the early adulthood. Material and Methods: Α random sample of 5,125 dyads children and their mothers was assessed. Mothers were asked to provide information contained in their medical booklets and pregnancy ultrasound records. With the use of a standardized questionnaire, telephone interviews were carried out for the collection of parental factors and offspring’s BMI. Results: Mother’s overweight (including obesity) before pregnancy was found to significantly increase the likelihoods of offspring’s overweight (including obesity) at the age of 8-9 years and 15-25 years (odds ratio (OR) 1.97; 95% confidence interval %CI: 1.65, 2.30 and OR 2.0; 95%CI: 1.67, 2.36, respectively). Paternal BMI (OR 1.41; 95% CI: 1.20–1.62), maternal smoking at pregnancy (OR 1.22; 95% CI: 1.14–1.30), gestational weight gain (OR 1.44; 95% CI 1.24–1.66), and gestational hypertension OR 1.30; 95% CI 1.14–1.49) were also found to significantly increase the odds of children’s obesity. Conclusion: Among prenatal factors considered, mother’s pre-pregnancy and father’s BMI, GWG, not breastfeeding, smoking in pregnancy and gestational hypertension increased the odds of offspring’s overweight/obesity in childhood and early adulthood, even after adjustment for several covariates.

Is Handedness at Five Associated with Prenatal Factors?

The goal of the study was to investigate some of the factors suspected to be related to children’s handedness: presentation during the last weeks of gestation and at birth (cephalic or breech), side of presentation (right or left), number of weeks of gestation, season of birth, parents’ handedness and sex. We analyzed the relationships between these factors and the child’s handedness at five years. Children (n = 1897) from the EDEN cohort participated in the study, among which 1129 were tested for handedness at five. The father’s handedness, but not the mother’s, was significantly related to the child’s hand preference. The percentage of left-handed children was significantly larger when the father was non-right-handed compared to right-handed, and tended to be larger among children in non-left-cephalic presentation compared to left-cephalic presentation. Girls, but not boys, were significantly less lateralized when they were born before 37 weeks of pregnancy than after. Finally, children born in winter or spring were slightly but significantly less lateralized than children born in summer or autumn. All six children who were not lateralized at 5 presented one or several of these factors. These results are discussed in light of the mixed model of handedness.