Outcomes up to age 36 months after congenital Zika virus infection-U.S. states.

BACKGROUND: To characterize neurodevelopmental abnormalities in children up to 36 months of age with congenital Zika virus exposure. METHODS: From the U.S. Zika Pregnancy and Infant Registry, a national surveillance system to monitor pregnancies with laboratory evidence of Zika virus infection, pregnancy outcomes and presence of Zika associated birth defects (ZBD) were reported among infants with available information. Neurologic sequelae and developmental delay were reported among children with ≥1 follow-up exam after 14 days of age or with ≥1 visit with development reported, respectively. RESULTS: Among 2248 infants, 10.1% were born preterm, and 10.5% were small-for-gestational age. Overall, 122 (5.4%) had any ZBD; 91.8% of infants had brain abnormalities or microcephaly, 23.0% had eye abnormalities, and 14.8% had both. Of 1881 children ≥1 follow-up exam reported, neurologic sequelae were more common among children with ZBD (44.6%) vs. without ZBD (1.5%). Of children with ≥1 visit with development reported, 46.8% (51/109) of children with ZBD and 7.4% (129/1739) of children without ZBD had confirmed or possible developmental delay. CONCLUSION: Understanding the prevalence of developmental delays and healthcare needs of children with congenital Zika virus exposure can inform health systems and planning to ensure services are available for affected families. IMPACT: We characterize pregnancy and infant outcomes and describe neurodevelopmental abnormalities up to 36 months of age by presence of Zika associated birth defects (ZBD). Neurologic sequelae and developmental delays were common among children with ZBD. Children with ZBD had increased frequency of neurologic sequelae and developmental delay compared to children without ZBD. Longitudinal follow-up of infants with Zika virus exposure in utero is important to characterize neurodevelopmental delay not apparent in early infancy, but logistically challenging in surveillance models.

Associations Between Adverse Childhood Experiences and Stressful Life Events and Health Outcomes in Pregnant and Breastfeeding Women from Diverse Racial and Ethnic Groups.

Background: This study sought to understand the characteristics of racially/ethnically diverse pregnant and breastfeeding women who have experienced adverse childhood experiences (ACEs) and stressful life events (SLEs) and the relationship among ACEs, SLEs, and health outcomes in this population. Materials and Methods: This was a secondary analysis of cross-sectional data from the Family Matters study. The participants in this study were families with children ages 5-9 (N = 1,307) recruited from Minneapolis-St. Paul primary care clinics representing six racial/ethnic backgrounds (White, Black, Native American, Hmong, Somali, Latino). Primary caregivers completed surveys about personal health, parenting styles, resilience, ACEs, and SLEs. Linear and logistic regression models were used to examine the associations between ACEs and SLEs with health outcomes of pregnant and breastfeeding women at the individual level. Results: A total of 123 racially/ethnically diverse women in this study reported being pregnant or currently breastfeeding. Eighty-eight (72%) reported a history of ACEs or SLEs. Those with both ACEs/SLEs reported more depression, economic strain, and a shorter duration of living in the United States. An increase in one reported ACE or SLE was positively associated with self-reported stress, number of reported medical conditions, substance use, self-efficacy, and permissive parenting (all ß coefficients p < 0.05). SLEs independently demonstrated increased predictive probability of severe mental health distress (6.7 percentage points, confidence interval [95% CI: 0.02-0.11; p < 0.01]) and moderate or severe anxiety (7.5 percentage points [95% CI: 0.04-0.11; p < 0.001]). Conclusion: Exposure to ACEs and SLEs appear to have significant impacts on physical health, mental health, and substance use in pregnant racially/ethnically diverse women.

The protective role of parental vigilance in the link between risky childhood environments and health.

Growing up in a risky environment is associated with poor lifespan physical and mental health. However, promotive factors that have protective or compensatory effects (i.e., buffer against negative outcomes or promote positive ones in the context of risk) allow individuals to remain healthy despite adverse upbringings. Parental vigilance, including parents' efforts to set boundaries and limitations and/or monitor and have knowledge of children's daily lives, has been shown to buffer and protect against negative health outcomes among individuals who grow up in risky environments. Conversely, some aspects of parental vigilance have been shown to be maladaptive for, or unrelated to, health among individuals who are raised in low-risk environments. The current study leveraged longitudinal data from the National Longitudinal Survey of Youth 97 (NLSY97; https://www.nlsinfo.org/content/cohorts/nlsy97) to explore the link between environmental risk in adolescence and indices of physical and mental health in young adulthood, and whether parental vigilance (limit-setting and knowledge) buffered these associations (n = 4829). Results indicated that childhood environmental risk predicted a greater likelihood of experiencing physical health limitations at age 29 but was not significantly associated with mental health symptoms at approximately age 34. Further, there was evidence that parental limit-setting (but not knowledge) buffered the relation between childhood risk and physical health limitations, such that the association between risk and physical limitations became slightly less pronounced at greater levels of parental limit-setting. Additionally, maternal knowledge was associated with fewer mental health symptoms in young adulthood among all participants. Results highlight the importance of parental limit-setting in reducing physical health consequences associated with childhood risk and suggest that there may be long-term mental health benefits of maternal knowledge of adolescents, regardless of childhood risk exposure.