Mode of delivery and mortality among neonates with gastroschisis: A population-based cohort in Texas.

BACKGROUND: Mode of delivery is hypothesised to influence clinical outcomes among neonates with gastroschisis. Results from previous studies of neonatal mortality have been mixed; however, most studies have been small, clinical cohorts and have not adjusted for potential confounders. OBJECTIVES: To evaluate whether caesarean delivery is associated with mortality among neonates with gastroschisis. METHODS: We studied liveborn, nonsyndromic neonates with gastroschisis delivered during 1999-2014 using data from the Texas Birth Defect Registry. Using multivariable Cox proportional hazards regression, we separately assessed the relationship between caesarean and death during two different time periods, prior to 29 days (<29 days) and prior to 365 days (<365 days) after delivery, adjusting for potential confounders. We also updated a recent meta-analysis on this relationship, combining our estimates with those from the literature. RESULTS: Among 2925 neonates with gastroschisis, 63% were delivered by caesarean. No associations were observed between caesarean delivery and death <29 days (adjusted hazard ratio [aHR] 1.00, 95% confidence interval [CI] 0.63, 1.61) or <365 days after delivery (aHR 0.99, 95% CI 0.70, 1.41). The results were similar among those with additional malformations and among those without additional malformations. When we combined our estimate with prior estimates from the literature, results were similar (combined risk ratio [RR] 1.00, 95% CI 0.84, 1.19). CONCLUSIONS: Although caesarean rates among neonates with gastroschisis were high, our results suggest that mode of delivery is not associated with mortality among these individuals. However, data on morbidity outcomes (eg intestinal damage, infection) were not available in this study.

Estimated Maternal Pesticide Exposure from Drinking Water and Heart Defects in Offspring.

Our objective was to examine the relationship between estimated maternal exposure to pesticides in public drinking water and the risk of congenital heart defects (CHD). We used mixed-effects logistic regression to analyze data from 18,291 nonsyndromic cases with heart defects from the Texas Birth Defects Registry and 4414 randomly-selected controls delivered in Texas from 1999 through 2005. Water district-level pesticide exposure was estimated by linking each maternal residential address to the corresponding public water supply district's measured atrazine levels. We repeated analyses among independent subjects from the National Birth Defects Prevention Study (NBDPS) (1620 nonsyndromic cases with heart defects and 1335 controls delivered from 1999 through 2005). No positive associations were observed between high versus low atrazine level and eight CHD subtypes or all included heart defects combined. These findings should be interpreted with caution, in light of potential misclassification and relatively large proportions of subjects with missing atrazine data. Thus, more consistent and complete monitoring and reporting of drinking water contaminants will aid in better understanding the relationships between pesticide water contaminants and birth defects.

Maternal Hypertension During Pregnancy and the Risk of Congenital Heart Defects in Offspring: A Systematic Review and Meta-analysis.

Maternal hypertension is common during pregnancy, and multiple studies have reported on an association between maternal hypertension and congenital heart defects (CHDs) in offspring; however, there is variability in the quality of these studies. A systematic review and meta-analysis was conducted on the associations between untreated and treated maternal hypertension and the risk of CHDs, evaluating CHDs overall as well as specific CHD subtypes. A systematic search of peer-reviewed articles published before August 2013 identified 16 studies evaluating the associations between untreated and treated maternal hypertension and CHDs. Summary relative risk (RR) estimates were calculated using fixed-effects models and random-effects models. Significant associations were observed between maternal hypertension and overall CHDs, for both treated [RR 2.0; 95 % confidence interval (CI) 1.5, 2.7] and untreated (RR 1.4; 95 % CI 1.2, 1.7) hypertension, as well as for overall hypertension regardless of treatment status (RR 1.8; 95 % CI 1.5, 2.2). The magnitude of effect was similar for the majority of CHD subtypes evaluated. The effects were also similar among women with hypertension who used one of multiple specific hypertension medications. There was no evidence of publication bias, and our results were robust to several factors considered in sensitivity analyses (e.g., source of exposure data, adjustment for potential confounders, and study design). Maternal hypertension was associated with CHDs. By understanding the specific mechanisms involved, appropriate strategies may be developed to reduce this risk, in order to prevent CHDs.

Epidemiologic features of male genital malformations and subtypes in Texas.

Although distinct categories of male genital malformations share some common risk factors, few studies have systematically compared epidemiologic features across phenotypes. We evaluated the relationship between several maternal and infant characteristics and five categories of male genital malformations: second- or third-degree hypospadias, hypospadias (regardless of degree), small penis, cryptorchidism, and any male genital malformation. Data for 16,813 cases with isolated male genital malformations and 1,945,841 male live births delivered from 1999 to 2008 were obtained from the Texas Birth Defects Registry. For each phenotype category, 13 maternal and infant variables were assessed, and adjusted prevalence ratios were estimated based on the same multivariable Poisson regression model. A significant negative association was observed between previous live births versus no previous live births and four phenotypes (e.g., adjusted prevalence ratio [aPR] for any male genital malformation: 0.78, 95% confidence interval [CI]: 0.75-0.81). The prevalence of 4 of the phenotypes was significantly higher among multiple versus singleton pregnancies (e.g., aPR for any male genital malformation: 1.35, 95% CI: 1.25-1.47). We also observed significant associations between multiple phenotypes and residential region at delivery, delivery year, month of conception, and maternal age, race/ethnicity, education, and birthplace, including significant associations for trends (maternal age, maternal education, and birth year modeled ordinally). Our results allow for comparison of characteristics across phenotypes and suggest that there may be some common risk factors for multiple male genital malformations (e.g., characteristics related to maternal estrogen levels), while other risk factors may be unique to specific defects.

Evaluating the effects of maternal exposure to benzene, toluene, ethyl benzene, and xylene on oral clefts among offspring in Texas: 1999-2008.

BACKGROUND: There is evidence from previous studies that maternal occupational exposure to hazardous air pollutants (HAPs) is positively associated with oral clefts; however, studies evaluating the association between residential exposure to these toxicants and oral clefts are lacking. Therefore, our goal was to conduct a case-control study examining the association between estimated maternal residential exposure to benzene, toluene, ethyl benzene, and xylene (BTEX) and the risk of oral clefts among offspring. METHODS: Data on 6045 nonsyndromic isolated oral cleft cases (3915 cleft lip with or without cleft palate [CL ± P] and 2130 nonsyndromic isolated cleft palate [CP] cases) delivered between 1999 and 2008 were obtained from the Texas Birth Defects Registry. The control group was a sample of unaffected live births, frequency matched to cases on year of birth. Census tract-level estimates of annual average exposures were obtained from the U.S. Environmental Protection Agency 2005 Hazardous Air Pollutant Exposure Model (HAPEM5) for each pollutant and assigned to each subject based on maternal residence during pregnancy. Logistic regression was used to assess the relationship between estimated maternal exposure to each pollutant (BTEX) separately and the risk of oral clefts in offspring. RESULTS: High estimated maternal exposure to benzene was not associated with oral clefts, compared with low estimated exposure (CL ± P adjusted OR = 0.95; 95% CI = 0.81 - 1.12; CP adjusted OR = 0.85; 95% CI = 0.67 - 1.09). Similar results were seen for the other pollutants. CONCLUSION: In our study, there was no evidence that maternal exposure to environmental levels of BTEX was associated with oral clefts.

Performance and energy economics of mesophilic and thermophilic digestion in anaerobic hybrid reactor treating coal wastewater.

Two anaerobic hybrid AHRs (AHR), mesophilic (35 °C) and thermophilic (55 °C) were operated with coal wastewater at different hydraulic retention times (HRT) ranging from 3-0.5 to 3.12-0.6d with organic loading rates (OLR) of 1.12-6.72 g L(-1) d(-1). Synthetic coal wastewater with an average chemical oxygen demand (COD) of 2240 mg L(-1) and phenolics concentration of 752 mg L(-1) was used as substrate. At each HRT, the thermophilic AHR gave a better performance, measured in terms of phenolics/COD removal and gas production. The specific methane yield was also higher for thermophilic AHR at each HRT compared to mesophilic one. The volatile fatty acid concentration in the effluent increased with the lowering of HRT. The Stover-Kincannon model was applicable at both temperatures and showed higher substrate utilization in thermophilic AHR. Energy economic study of the AHRs revealed that 11,938 MJ d(-1) more energy can be generated using thermophilic AHR than mesophilic.

Performance of anaerobic hybrid reactors for the treatment of complex phenolic wastewaters with biogas recirculation.

This study investigates the application of a novel anaerobic hybrid reactor (AHR) configuration, incorporating support media for biomass immobilisation and biogas recirculation for improved mixing towards the anaerobic treatment of complex phenolic wastewater. Synthetic coal wastewater with an average phenolics and COD concentration of 752 and 2240 mg L(-1) was used as substrate. Biogas recirculation was employed at four different rates of 11.25, 16.87, 25.30 and 37.95 L d(-1) for 100 days. Phenolics and COD removal improved with increase in biogas recirculation. After 120 days of continuous operation, the results revealed that a high amount (14.0 g VSS) of biomass was able to attach itself to the support medium. The investigated AHR configuration achieved phenolics and COD removal efficiencies of 95% and 92% respectively at a hydraulic retention time (HRT) of 0.33 d. The corresponding average methane production obtained in this study was 0.02 mol methane g(-1) COD.

Comparative performance of UASB and anaerobic hybrid reactors for the treatment of complex phenolic wastewater.

The performance of an upflow anaerobic sludge blanket (UASB) reactor and an anaerobic hybrid reactor (AHR) was investigated for the treatment of simulated coal wastewater containing toxic phenolics at different hydraulic retention times (0.75-0.33d). Fast start-up and granulation of biomass could be achieved in an AHR (45d) than UASB (58d) reactor. Reduction of HRT from 1.5 to 0.33d resulted in a decline in phenolics removal efficiency from 99% to 77% in AHR and 95% to 68% in UASB reactor respectively. AHR could withstand 2.5 times the selected phenolics loading compared to UASB reactor that could not withstand even 1.2 times the selected phenolics loading. Residence time distribution (RTD) study revealed a plug flow regime in the AHR and completely mixed regime in UASB reactor respectively. Energy economics of the reactors revealed that 12,159MJd(-1) more energy can be generated using AHR than UASB reactor.

Effect of hydraulic retention time on the biodegradation of complex phenolic mixture from simulated coal wastewater in hybrid UASB reactors.

This study describes the feasibility of anaerobic treatment of complex phenolics mixture from a simulated synthetic coal wastewater using four identical 13.5L (effective volume) bench scale hybrid up-flow anaerobic sludge blanket (HUASB) (combining UASB+anaerobic filter) reactors at four different hydraulic retention times (HRT) under mesophilic (27+/-5 degrees C) conditions. Synthetic coal wastewater with an average chemical oxygen demand (COD) of 2240 mg/L and phenolics concentration of 752 mg/L was used as substrate. The phenolics contained phenol (490 mg/L); m-, o-, p-cresols (123.0, 58.6, 42 mg/L); 2,4-, 2,5-, 3,4- and 3,5-dimethyl phenols (6.3, 6.3, 4.4 and 21.3 mg/L) as major phenolic compounds. The study demonstrated that at optimum HRT, 24h, and phenolic loading rate of 0.75 g COD/(m(3)-d), the phenolics and COD removal efficiency of the reactors were 96% and 86%, respectively. Bio-kinetic models were applied to data obtained from experimental studies in hybrid UASB reactor. Grau second-order multi-component substrate removal model was best fitted to the hybrid UASB reactor. The second-order substrate removal rate constant (k(2(s))) was found as 1.72 h(-1) for the hybrid reactor treating complex phenolic mixture. Morphological examination of the sludge revealed rod-type Methanothrix-like, cells to be dominant on the surface.

Effect of effluent recycling and shock loading on the biodegradation of complex phenolic mixture in hybrid UASB reactors.

This study describes the feasibility of anaerobic treatment of synthetic coal wastewater using four identical 13.5L (effective volume) bench scale hybrid up flow anaerobic sludge blanket (HUASB) reactors (R1, R2, R3 and R4) under mesophilic (27+/-5 degrees C) conditions. Synthetic coal wastewater with an average chemical oxygen demand (COD) of 2240 mg/L and phenolics concentration of 752 mg/L was used as substrate. Effluent recirculation was employed at four different effluent to feed recirculation ratios (R/F) of 0.5, 1.0, 1.5 and 2.0 for 100 days to study the effect of recirculation on the performance of the reactors. Phenolics and COD removal was found to improve with increase in effluent recirculation. An effluent to feed recycle ratio of 1.0 resulted in maximum removal of phenolics and COD. Phenolics and COD removal improved from 88% and 92% to 95% each, respectively. The concentration of volatile fatty acids in the effluent was lower than the influent when effluent to feed recirculation was employed. Effect of shock loading on the reactors revealed that phenolics shock load up to 2.5 times increase in the normal input phenolics concentration in the form of continuous shock load for 4days did not affect the reactors performance irreversibly.