Possible Risk Factors and Their Potential Associations with Combined Heavy Metal Exposures in Pregnant Women in the Republic of Suriname.

Background: The exposure of pregnant women to multiple environmental pollutants may be more disadvantageous to birth outcomes when compared to single-compound contaminations. Objective: This study investigated the mixed exposures to mercury, manganese, or lead in 380 pregnant Surinamese women. The factors that might be associated with the heavy metal exposures and the relative risk of the potential factors to cause the mixed exposures were explored. The influencing factors of exposures to mixed contaminants assessed were living in Suriname's rural regions, several parts of which are contaminated with heavy metals emitted from artisanal and small-scale gold mining and agricultural activities; the consumption of potentially contaminated foods; advanced maternal age; as well as a relatively low formal educational level and monthly household income. Methods: Descriptive statistics were used to calculate frequency distributions and χ2-contingency analyses to calculate associations and relative risks (RR) with 95% confidence intervals (CI). Findings: Blood levels of two or three of the heavy metals above public health limits were observed in 36% of the women. These women were more often residing in the rural regions, primarily consumed potentially contaminated food items, were 35 years or older, were lower educated, and more often had a lower household income. However, only living in the rural regions (RR = 1.48; 95% CI 1.23-1.77) and a low household income (RR = 1.38; 95% CI 1.15-1.66) significantly increased the risk of exposure exceeding levels of concern to two or three of the heavy metals (by 48% and 38%, respectively). Conclusion: More comprehensive pharmacological, ecological, and epidemiological studies about exposures to mixed heavy metal contaminations in pregnant women are warranted.

Development of a Pilot Literacy Scale to Assess Knowledge, Attitudes, and Behaviors towards Climate Change and Infectious Disease Dynamics in Suriname.

Prior research has shown that climate literacy is sparse among low- and middle-income countries. Additionally, no standardized questionnaire exists for researchers to measure climate literacy among general populations, particularly with regards to climate change effects on vector-borne diseases (VBDs). We developed a comprehensive literacy scale to assess current knowledge, attitudes, and behaviors towards climate change and VBD dynamics among women enrolled in the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH) cohort in Suriname. Items were generated by our research team and reviewed by a group of six external climate and health experts. After the expert review, a total of 31 climate change and 21 infectious disease items were retained. We estimated our sample size at a 10:1 ratio of participants to items for each scale. In total, 301 women were surveyed. We validated our scales through exploratory (n = 180) and confirmatory factor analyses (n = 121). An exploratory factor analysis for our general Climate Change Scale provided a four-construct solution of 11 items. Our chi-squared value (X2 = 74.32; p = 0.136) indicated that four factors were sufficient. A confirmatory factor analysis reinforced our findings, providing a good model fit (X2 = 39.03; p = 0.23; RMSEA = 0.015). Our Infectious Disease Scale gave a four-construct solution of nine items (X2 = 153.86; p = 0.094). A confirmatory factor analysis confirmed these results, with a chi-squared value of 19.16 (p = 0.575) and an RMSEA of 0.00. This research is vitally important for furthering climate and health education, especially with increases in VBDs spread by Aedes mosquitoes in the Caribbean, South America, and parts of the southern United States.

Association between fluoride exposure in drinking water and cognitive deficits in children: A pilot study.

Fluoride (F) exposure in drinking water may lead to reduced cognitive function among children; however, findings largely remain inconclusive. In this pilot study, we examined associations between a range of chronic F exposures (low to high: 0.4 to 15.5 mg/L) in drinking water and cognition in school-aged children (5-14 years, n = 74) in rural Ethiopia. Fluoride exposure was determined from samples of community-based drinking water wells and urine. Cognitive performance was measured using: 1) assessments of ability to draw familiar objects (donkey, house, and person), and 2) a validated Cambridge Neuropsychological Test Automated Battery's (CANTAB) Paired Associate Learning (PAL), which examines memory and new learning and is closely associated with hippocampus function of the brain. Associations between F and cognitive outcomes were evaluated using regression analysis, adjusting for demographic, health status, and other covariates. The median (range) of water and urine F levels was 7.6 (0.4-15.5 mg/L) and 6.3 (0.5-15.7 mg/L), respectively; these measures were strongly correlated (r = 0.74), indicating that water is the primary source of F exposure. Fluoride in drinking water was negatively associated with cognitive function, measured by both drawing and CANTAB test performance. Inverse relationships were also found between F and drawing objects task scores, after adjusting for covariates (p < 0.05). Further analysis using CANTAB PAL tasks in the children confirmed that F level in drinking water was positively associated with the number of errors made by children (p < 0.01), also after adjusting for covariates (p < 0.05). This association between water F and total errors made became markedly stronger as PAL task difficulty increased. Fluoride exposure was also inversely associated with other PAL tasksthe number of patterns reached, first attempt memory score and mean errors to success. These findings provide supportive evidence that high F exposures may be associated with cognitive deficits in children. Additional well-designed studies are critically needed to establish the neurotoxicity of F in children and adults exposed to both low levels known to protect dental caries, as well as excess F levels in drinking water.

Contrasting mercury contamination scenarios and site susceptibilities confound fish mercury burdens in Suriname, South America.

In Suriname, mercury (Hg) use has recently increased because of gold mining, which has put fish-reliant communities (e.g., Indigenous and Tribal) at risk of enhanced Hg exposure through the riverine fish these communities consume. To quantify how the magnitude of these risks change according to location and time, we measured total mercury (HgT) in fish at sites downstream and upstream of an artisanal and small-scale gold mining (ASGM) operation in 2004-2005 and in 2017-2018. We tested whether fish HgT burdens over dynamic ranges were increased. Surprisingly, our findings did not support broadly increased fish Hg burden over time or that proximity to ASGM was diagnostic to fish HgT-burden. Subsequently, we elected to test the HgT stable isotope ratios on a set of freshly collected 2020 fish to determine whether differences in Hg source and delivery pathways might cofound results. We found that remote unmined sites were more susceptible to gaseous elemental Hg deposition pathways, leading to enhanced risk of contamination, whereas ASGM proximate sites were not. These results highlight that elemental mercury releases from ASGM practices may have significant impact on fish-reliant communities that are far removed from ASGM point source contamination.

Fatal drug use in the COVID-19 pandemic response: Changing trends in drug-involved deaths before and after stay-at-home orders in Louisiana.

The effect of disaster events on increasing drug-involved deaths has been clearly shown in previous literature. As the COVID-19 pandemic led to stay-at-home orders throughout the United States, there was a simultaneous spike in drug-involved deaths around the country. The landscape of a preexisting epidemic of drug-involved deaths in the United States is one which is not geographically homogenous. Given this unequal distribution of mortality, state-specific analysis of changing trends in drug use and drug-involved deaths is vital to inform both care for people who use drugs and local policy. An analysis of public health surveillance data from the state of Louisiana, both before and after the initial stay-at-home order of the COVID-19 pandemic, was used to determine the effect the pandemic may have had on the drug-involved deaths within this state. Using the linear regression analysis of total drug-involved deaths, as well as drug-specific subgroups, trends were measured based on quarterly (Qly) deaths. With the initial stay-at-home order as the change point, trends measured through quarter 1 (Q1) of 2020 were compared to trends measured from quarter 2 (Q2) of 2020 through quarter 3 (Q3) of 2021. The significantly increased rate of change in Qly drug-involved deaths, synthetic opioid-involved deaths, stimulant-involved deaths, and psychostimulant-involved deaths indicates a long-term change following the initial response to the COVID-19 pandemic. Changes in the delivery of mental health services, harm reduction services, medication for opioid use disorder (MOUD), treatment services, withdrawal management services, addiction counseling, shelters, housing, and food supplies further limited drug-involved prevention support, all of which were exacerbated by the new stress of living in a pandemic and economic uncertainty.

The Single and Combined Effects of Prenatal Nonchemical Stressors and Lead Exposure on Neurodevelopmental Outcomes in Toddlers: Results from the CCREOH Environmental Epidemiologic Study in Suriname.

The primary aim of this prospective study was to examine the single and combined effect of prenatal exposure to perceived stress, probable depression, and lead on toddlers' neurodevelopment using the Bayley Scales of Infant and Toddler Development, third edition. Data from 363 mother-toddler pairs enrolled in the Caribbean Consortium for Research in Environmental and Occupational Health prospective cohort study were analyzed. A prenatal lead exposure of ≥3.5 µg/dL was associated with significantly lower receptive (p = 0.008) and expressive (p = 0.006) communication scaled scores. Moderate and severe maternal prenatal probable depression scores were associated with significantly lower fine (p = 0.009) and gross (p = 0.009) motor scaled scores. However, a maternal report of prenatal stress was not associated with neurodevelopmental outcomes. After adjusting for maternal demographics, prenatal stress and lead exposure, prenatal probable depression remained predictive of the toddlers' gross motor scaled scores (ß -0.13, 95% CI [-0.24--0.02]). Similarly, when adjusting for demographics, prenatal stress and probable depression, prenatal lead exposure remained a significant predictor of their receptive communication scaled scores (ß -0.26, 95% CI [-0.49--0.02]). An analysis testing combined exposure to perceived stress, probable depression, and lead exposure, measured using a cumulative risk index, significantly predicted the child fine motor scaled scores after adjusting for other covariates (ß -0.74, 95% CI: [-1.41--0.01]).

Geographic differences in exposures to metals and essential elements in pregnant women living in Suriname.

BACKGROUND: In Suriname, 20% of pregnancies end in adverse birth outcomes. While prenatal exposure to metals may lead to adverse health outcomes, exposure assessments in Suriname are scant. Environmental contamination from mercury (Hg) used in artisanal goldmining in the Amazonian Interior, and the uncontrolled use of pesticides in suburban regions are of particular concern. OBJECTIVE: This study assessed geographic differences in exposures to metals and essential elements in pregnant Surinamese women. METHODS: This study is a subset (n = 400) of the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH) cohort study. Sector-field inductively-coupled plasma mass spectrometry was used to determine concentrations of lead (Pb), Hg, selenium (Se), cadmium (Cd), manganese (Mn) and tin (Sn) in whole blood of the pregnant women. High vs. low exposures to Pb and Hg were determined and were based respectively on CDC (3.5 ug/dL) and USEPA (3.5 ug/L) action levels. Differences in geographic exposures were tested with the Mann-Whitney U-test, and differences between blood elemental concentrations and action levels for Pb and Hg with the Wilcoxon signed rank test. The association between demographics and high exposures of Pb and Hg was examined with multivariate logistic regression models. RESULTS: The median concentrations of Pb, Hg and Se (5.08 µg/dL, 7.87 µg/L, and 228.26 µg/L respectively) in Interior women, were higher than the Urban and Suburban regions (p < 0.001), and higher than internationally accepted action levels (p < 0.001). The median concentrations of Mn and Sn found in Suburban women (17.55 and 0.97 ug/L respectively) were higher than Urban and Interior regions (p < 0.02). SIGNIFICANCE: Pregnant women living in Suriname's Amazonian Interior are exposed to Hg and Pb at levels of public health concern. Urgently needed is a comprehensive source characterization assessment and the development, implementation and monitoring of environmental health policies, specifically addressing the chemicals of concern. IMPACT: In a subset of participants enrolled in the CCREOH environmental epidemiology cohort study elevated levels of Hg and Pb were identified. This is the first comprehensive exposure assessment in the Surinamese population. Health concerns include adverse birth- and neurodevelopmental outcomes. Geographic differences require a tailored approach to health intervention and comprehensive source characterization. Future research should ascertain the role of Se as a potential protective factor. Environmental policy development, implementation and monitoring is pivotal to mitigate exposures to these neurotoxicants.

Characterization of Urinary Pesticide Metabolite Concentrations of Pregnant Women in Suriname.

Prenatal exposure to pesticides and the association with adverse health outcomes have been examined in several studies. However, the characterization of pesticide exposure among Surinamese women during pregnancy has not been assessed. As part of the Caribbean Consortium of Research in Environmental and Occupational Health research program, 214 urine samples were collected from pregnant women living in three regions in Suriname with different agricultural practices: capital Paramaribo, the rice producing district Nickerie, and the tropical rainforest, the Interior. We used isotope dilution tandem mass spectrometry to quantify urinary concentrations of biomarkers of three pesticide classes, including phenoxy acid herbicides and organophosphate and pyrethroid insecticides, all of which are commonly used in agricultural and residential settings in Suriname. We observed that participants residing in Nickerie had the highest urinary metabolite concentrations of 2,4-dichlorophenoxyacetic acid and pyrethroids compared to those from Paramaribo or the Interior. Paramaribo had the highest concentrations of organophosphate metabolites, specifically dialkyl phosphate metabolites. Para-nitrophenol was detected in samples from Paramaribo and the Interior. Samples from Nickerie had higher median urinary pesticide concentrations of 2,4-dichlorophenoxyacetic acid (1.06 µg/L), and the following metabolites, 3,5,6-trichloro-2-pyridinol (1.26 µg/L), 2-isopropyl-4-methyl-6-hydroxypyrimidine (0.60 µg/L), and 3-phenoxybenzoic acid (1.34 µg/L), possibly due to residential use and heavy rice production.

The Association between Mercury and Lead Exposure and Liver and Kidney Function in Pregnant Surinamese Women Enrolled in the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH) Environmental Epidemiologic Cohort Study.

Exposure to mercury (Hg) and lead (Pb) may have an effect on pregnant women. We assessed the effect of exposure to mercury and lead on liver and kidney functions in a subcohort of pregnant women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH)­Meki Tamara, study. From 400 women aged 16−46 living in rural, urban, and interior regions of Suriname, we measured blood mercury and blood lead levels. Creatinine, urea, and cystatin C were measured to assess kidney function, and aspartate amino transferase (AST), alanine amino transferase (ALT), and gamma-glutamyl transferase (GGT) were measured to assess liver function. Education, region, and ethnicity showed significant differences for both blood mercury and lead levels, which all had p-values < 0.001. Creatinine and urea were elevated with higher mercury blood levels. Our findings also suggest a relationship between high mercury blood levels and potential harmful effects on liver and kidney function.

Sociodemographic Influences on Perceived Stress during Pregnancy: Results from the CCREOH Environmental Epidemiologic Study, Suriname.

Screening for prenatal stress is not routine in Suriname, despite its significant impact on maternal and newborn health. This study assessed the prevalence of high perceived prenatal stress and its sociodemographic predictors in three geographic areas in Suriname. In this cross-sectional study, data from 1190 participants of the Caribbean Consortium for Research in Environmental and Occupational Health cohort study were analyzed. Cohen's Perceived Stress Scale was completed during pregnancy to ascertain high perceived stress (cut-off score 20). The association between maternal sociodemographic factors and high perceived stress was examined using the chi-square test and logistic regression models; 27.5% of all participants had high perceived stress with statistically significant lower rates in Nickerie (18.8%) compared with Paramaribo (29.8%; p = 0.001) and the Interior (28.6%; p = 0.019). Maternal sociodemographic factors moderated the difference between the Interior and Nickerie. Participants from Paramaribo had statistically significant higher odds of high perceived stress compared to those from Nickerie, independent of their age and educational level (adjusted OR = 1.94; 95% confidence interval 1.32-2.86). Perceived stress during pregnancy is predicted by sociodemographic factors. These findings identified target groups for interventions in Suriname. Policy makers should consider integrating perceived stress assessment as a routine part of prenatal care.

Prenatal Exposure to Mercury, Manganese, and Lead and Adverse Birth Outcomes in Suriname: A Population-Based Birth Cohort Study.

Globally, adverse birth outcomes are increasingly linked to prenatal exposure to environmental contaminants, such as mercury, manganese, and lead. This study aims to assess an association between prenatal exposure to mercury, manganese, and lead and the occurrence of adverse birth outcomes in 380 pregnant women in Suriname. The numbers of stillbirths, preterm births, low birth weights, and low Apgar scores were determined, as well as blood levels of mercury, manganese, lead, and relevant covariates. Descriptive statistics were calculated using frequency distributions. The associations between mercury, manganese, and lead blood levels, on the one hand, and adverse birth outcomes, on the other hand, were explored using contingency tables, tested with the χ2-test (Fisher's exact test), and expressed with a p value. Multivariate logistic regression models were computed to explore independent associations and expressed as (adjusted) odds ratios (aOR) with 95% confidence intervals (CI). The findings of this study indicate no statistically significant relationship between blood mercury, manganese, or lead levels and stillbirth, preterm birth, low birth weight, and low Apgar score. However, the covariate diabetes mellitus (aOR 5.58, 95% CI (1.38-22.53)) was independently associated with preterm birth and the covariate hypertension (aOR 2.72, 95% CI (1.081-6.86)) with low birth weight. Nevertheless, the observed high proportions of pregnant women with blood levels of mercury, manganese, and lead above the reference levels values of public health concern warrants environmental health research on risk factors for adverse birth outcomes to develop public health policy interventions to protect pregnant Surinamese women and their newborns from potential long-term effects.

The distribution of disease in the Republic of Suriname - A pharmacoepidemiological analysis using the claims database of the State Health Foundation of the year 2017.

The patterns of prescription drug use in Suriname in the year 2017 have been determined with the purpose of obtaining indications about the distribution of disease in the country. The claims database of the State Health Foundation (Staatsziekenfonds, SZF) of Suriname was used for calculations of prescription rates of the fifty most prescribed drugs overall and after stratification according to gender, age, and residence of the insured persons. Information in the database had been de-identified, and the prescribed medicines had been coded according to the Anatomic Therapeutic Chemical Classification System. Statistically significant differences among the prescription rates were assessed with the two samples test of proportions using normal theory method and χ2 Goodness of Fit tests (p < 0.05). Additionally, the Bonferroni adjustment was used to adjust for type 1 error inflation resulting from multiple comparisons. Overall, drugs for the cardiovascular, respiratory, and musculo-skeletal systems had the highest prescription rates (p < 0.001). Furthermore, rates were generally higher in females than in males, in the older age groups than in younger individuals, and in the coastal regions compared to the country's interior (p < 0.001). These findings are largely in line with data found in the literature and support the use of this pharmacoepidemiological approach to assess the distribution of disease in Suriname.

Prevalence and safety of prescription medicine use during pregnancy in the Republic of Suriname in the year 2017: a pharmacoepidemiological analysis.

BACKGROUND: Using the claims database of the State Health Foundation from 2017, the prevalence and safety of prescription medicines given to pregnant women in Suriname (South America) have been determined. METHODS: Prescription rates and proportions of the total number of prescriptions were calculated, overall and stratified for subgroups of age, region of residence, major Anatomical Therapeutic Chemical - and safety classification (Australian categorization system). Data were compared with the Σ2-test and the two samples test of proportions using normal theory method; p-values <0.01 were considered statistically significant differences. RESULTS: Average prescription rates (number of prescriptions by number of patients) were 24.0, 29.7, and 32.5 in age groups 15-29, 30-44, and 45+ years, respectively (p<0.001), and 26.4, 23.0, and 14.0 in the urban-coastal, rural-coastal, and rural-interior region, respectively (p<0.001). CONCLUSIONS: The use of prescription medicines was common (rates up to 40.4), ranged from antibiotics to vitamins, and most were safe. However, 3.2% (some antibiotics and antiepileptics) belonged to safety category D, carrying a definite human fetal risk. However, the potential benefits of these drugs warranted their use in pregnant women. These findings are largely in line with literature data, although future studies must verify their generalizability to the total Surinamese population.

Poor Adherence to the WHO Guidelines on Feeding Practices Increases the Risk for Respiratory Infections in Surinamese Preschool Children.

Poor feeding practices in infants and young children may lead to malnutrition, which, in turn, is associated with an increased risk of infectious diseases, such as respiratory tract infections (RTIs), a leading cause of under-five mortality. We explored the association between RTIs and the WHO infant and young child feeding (IYCF) indicators: minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD), among infants and preschool children in Suriname. A validated pediatric food frequency questionnaire was used and data on RTIs, defined as clinical care for fever with respiratory symptoms, bronchitis, or pneumonia were obtained. Associations between feeding indicators and RTIs were explored using hierarchical logistic regression. Of 763 children aged 10-33 months, 51.7% achieved the MDD, 88.5% the MMF, and 46.5% the MAD. Furthermore, 73% of all children experienced at least one upper and/or lower RTI. Children meeting the MDD and MAD had significantly lower odds on RTIs (OR 0.53; 95%CI: 0.37-0.74, p < 0.001; OR 0.55; 95%CI: 0.39-0.78, p < 0.001, respectively). The covariates parity and household income were independently associated with RTIs. In conclusion, MDD and MAD were associated with (upper) RTIs. Whether these indicators can be used as predictors for increased risk for RTIs should be assessed in future prospective studies.

Self-reported oil spill exposure and birth outcomes among southern Louisiana women at the time of the Gulf oil spill: The GROWH study.

BACKGROUND: The chemical, physical, economic, and social effects of a major oil spill might adversely affect pregnancy health. OBJECTIVES: To examine the relationship between oil spill exposure and birth outcomes in a cohort of women living near the Gulf of Mexico at the time of the 2010 oil spill. METHODS: Between 2012 and 2016, 1375 women reported their exposure to the oil spill, and at least one livebirth. Five hundred and three had births both before and after the oil spill. Indicators of oil spill exposure included self-reported financial consequences, direct contact with oil, traumatic experiences, loss of use of the coast, and involvement in litigation. Birth outcomes were low birthweight (LBW; birthweight <2500 g) and preterm birth (PTB; >3 weeks early). Women who were not pregnant at the time of the interview (n = 1001) self-reported outcomes, while women who were pregnant (n = 374) primarily had them abstracted from medical records (n = 374). All pregnancies prior to the oil spill were considered unexposed; those after the oil spill were considered exposed or unexposed depending on interview responses. Generalized estimating equations were used to control for clustering within women, with control for confounders. RESULTS: The most common type of exposure was economic (49%), but 302 women (22.0%) reported some degree of direct contact with the oil. Associations between most indicators of oil spill exposure and pregnancy outcomes were null, although when all pregnancies were examined, associations were seen with high levels of contact with oil for LBW (adjusted Odds Ratio [aOR] 2.19, 95% CI, 1.29-3.71) and PTB (aOR 2.27, 1.34-3.87). DISCUSSION: In this community-based cohort, we did not find associations between report of exposure to the oil spill, with the possible exception of high oil contact in some analyses, and birth outcomes. Research incorporating specific biomarkers of oil spill exposure and stress biomarkers would be valuable, to allow for assessing both perceived and actual exposure, especially when direct toxicant exposure is minimal.

The Cumulative Risk of Prenatal Exposures to Chemical and Non-Chemical Stressors on Birth Outcomes in Suriname.

The cumulative exposure to chemical and non-chemical stressors may have an impact on birth outcomes. The aim of this study is to examine the cumulative exposure of a mixture of chemicals (mercury, lead, selenium and tin) and non-chemical stressors (social support, perceived stress, probable depression and BMI) on birth outcomes (birthweight, gestational age at birth, and Apgar score at 5 min). The study population is a subset (n = 384) of the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara prospective cohort study. Associations between the latent chemical construct, non-chemical stressors and birth outcomes were assessed using path models. The results showed a significant direct relationship between perceived stress and birthweight (ß = -0.17), however even though the relationship between perceived stress and depression was significant in all three path models (ß = 0.61), the association between depression and birth outcomes was not significant. Perceived stress was significantly associated with community engagement (ß = -0.12) and individual resilience (ß = -0.12). BMI (ß = 0.12) was also significantly directly associated with birthweight. The latent chemical construct did not show an association with the birth outcomes. Our data indicate the need for the development of a support system for pregnant women by involving them in prenatal care programs to reduce maternal stress, which may also influence depression and (in)directly improve the birth outcomes. Interventions regarding weight management for women of childbearing age are necessary to halt obesity and its negative effects on birth outcomes.

Association of Mercury Exposure and Maternal Sociodemographics on Birth Outcomes of Indigenous and Tribal Women in Suriname.

Information regarding adverse birth outcomes (ABO) of Indigenous and Tribal women living in the remote tropical rainforest of Suriname, where mercury (Hg) use is abundant in artisanal gold mining, is not available. In the context of a health system analysis, we examined the association between Hg exposure, maternal sociodemographics on the ABO of Indigenous and Tribal women living in Suriname's interior and its capital, Paramaribo. ABO were determined in pregnant women enrolled from December 2016 to July 2019 in the Caribbean Consortium for Environmental and Occupational Health prospective environmental epidemiologic cohort study. Associations were explored using Pearson's χ2-test and the Mann-Whitney U-test. Among 351 singleton participants, 32% were Indigenous, residing mainly in the interior (86.8%), and 23.1% had ABO. Indigenous participants had higher rates of ABO (29.8% vs. 19.8%) and preterm birth (PTB) (21.2% vs. 12.4%), higher Hg levels, delivered at a younger age, were less educated, and had lower household income compared to Tribal participants. Multivariate logistic regression models revealed that Indigenous participants had higher odds of ABO (OR = 3.60; 95% CI 1.70-7.63) and PTB (OR = 3.43; 95% CI 1.48-7.96) compared with Tribal participants, independent of Hg exposure and age at delivery. These results highlight the importance of effective risk reduction measures in support of Indigenous mothers, families, and communities.

Influence of perceived stress on prenatal depression in Surinamese women enrolled in the CCREOH study.

BACKGROUND: Prenatal depression may have adverse health effects on mothers and their offspring. Perceived stress is an important risk factor for depression during pregnancy. Studies have shown that both perceived stress and depression may negatively influence birth outcomes. While 20% of pregnancies in Suriname, a middle-income Caribbean country located in northern South America, results in adverse birth outcomes, data on prenatal depression and its risk factors are lacking. This study aimed to assess the influence of perceived stress on depression during pregnancy in Surinamese women. METHODS: Survey data were used from 1143 pregnant women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara prospective cohort study that addresses the impact of chemical and non-chemical environmental exposures in mother/child dyads in Suriname. The Edinburgh Depression Scale and Cohen Perceived Stress Scale were used to screen for probable depression (cut-off ≥ 12) and high stress (cut-off ≥ 20), respectively. The association between perceived stress and depression was examined using bivariate and multiple logistic regression analyses, adjusted for social support (including resilience) and maternal demographics. RESULTS: The prevalence of high perceived stress during the first two trimesters and the third trimester were 27.2% and 24.7% respectively. 22.4% of the participants had probable depression during first or second trimester and 17.6% during the third trimester. Women experiencing high stress levels during the first two trimesters had 1.92 increased odds (95% CI 1.18-3.11, p = 0.008) of having probable depression during the third trimester of pregnancy than those with low stress levels. Pregnant women with low individual resilience during early pregnancy (52.1%) had 1.65 (95% CI 1.03-2.63, p = 0.038) increased odds of having probable depression during later stages of pregnancy compared to those with high individual resilience. Low educational level (p = 0.004) and age of the mother (20-34 years) (p = 0.023) were significantly associated with probable depression during the third trimester. CONCLUSIONS: Early detection and management of stress and depression during pregnancy are important. Health education programs, targeting the reduction of stress during pregnancy, may help to reduce depression and its potential adverse health effects on the mother and child.

Depression during pregnancy may lead to adverse health effects in mothers and children. While one in five pregnancies resulted in an adverse birth outcome in Suriname, and perceived stress and depression are important risk factors for birth outcomes, data on depression and its risk factors are lacking. This study aimed to determine the association between perceived stress and prenatal depression in Surinamese pregnant women participating in the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara study.A total of 1143 pregnant women were included in the study. Using questionnaires, data was collected on demographic factors, perceived stress, social support (including resilience), and probable depression.Perceived stress was somewhat higher during the first two trimesters (27.2%), than the third trimester (24.7%). This was also the case for probable depression; higher during the first two trimesters (22.4%) than during the third trimester (17.6%). The study found a statistically significant association of high perceived stress, low perceived individual resilience, lower education and older maternal age with probable depression during pregnancy.Early detection and effective management of perceived stress and depression during pregnancy are very important. There is a need for prenatal clinics in Suriname to routinely screen for symptoms of perceived stress and depression to minimize the potential impact on mother and child. Health education programs, targeting the reduction of stress during pregnancy, may help to reduce depression and its potential adverse health effects on the mother and child.

Adverse Childhood Experiences are Associated with Miscarriage in Adulthood: The GROWH Study.

OBJECTIVES: To investigate whether adverse childhood experiences are associated with miscarriage. METHODS: The Gulf Resilience on Women's Health Consortium recruited from clinics and community organizations in Southern Louisiana, 2011-2016. Data from 1511 reproductive-aged women with at least one pregnancy were analyzed. Adverse childhood experiences including abuse, neglect, and family dysfunction, as a child (< age 12), and as an adolescent (12-17), were assessed. Outcome measures were self-reported miscarriage at first pregnancy and at any pregnancy, analyzed with logistic regression with adjustment for maternal age at pregnancy, race, BMI, education, marital and smoking status. RESULTS: Women reporting four or more adversities as a child and as a teen had higher odds of experiencing miscarriage at first pregnancy (AORchild 1.71, 95% CI 1.00-2.90; AORteen 1.73, 95% CI 1.05-2.87) and miscarriage at any pregnancy (AORchild 1.74, 95% CI 1.16-2.62; ORteen 1.65, 95% CI 1.10-2.45) compared to those with no adverse childhood experiences. Similar patterns of association were seen for other ACE sub-categories. CONCLUSIONS: Childhood adversities were associated with miscarriage. Further research is needed on the pathways which created this association, including psychological, behavioral, and physiological mechanisms and factors which can mitigate the effects of these outcomes.

Heart Failure Hospitalizations and Risk Factors among the Multi-Ethnic Population from a Middle Income Country: The Suriname Heart Failure Studies.

INTRODUCTION: Heart failure (HF) is an emerging epidemic with poor disease outcomes and differences in its prevalence, etiology and management between and within world regions. Hypertension (HT) and ischemic heart disease (IHD) are the leading causes of HF. In Suriname, South-America, data on HF burden are lacking. The aim of this Suriname Heart Failure I (SUHF-I) study, is to assess baseline characteristics of HF admitted patients in order to set up the prospective interventional SUHF-II study to longitudinally determine the effectiveness of a comprehensive HF management program in HF patients. METHODS: A cross-sectional analysis was conducted of Thorax Center Paramaribo (TCP) discharge data from January 2013-December 2015. The analysis included all admissions with primary or secondary discharge of HF ICD-10 codes I50-I50.9 and I11.0 and the following variables: patient demographics (age, sex, and ethnicity), # of readmissions, risk factors (RF) for HF: HT, diabetes mellitus (DM), smoking, and left ventricle (LV) function. T-tests were used to analyze continuous variables and Chi-square test for categorical variables. Differences were considered statistically significant when a p-value <0.05 is obtained. RESULTS: 895 patients (1:1 sex ratio) with either a primary (80%) or secondary HF diagnosis were admitted. Female patients were significantly older (66.2 ± 14.8 years, p < 0.01) at first admission compared to male patients (63.5 ± 13.7 years) and the majority of admissions were of Hindustani and Creole descent. HT, DM and smoking were highly prevalent respectively 62.6%, 38.9 and 17.3%. There were 379 readmissions (29.1%) and 7% of all admissions were readmissions within 30 days and 16% were readmissions for 31-365 day. IHD is more prevalent in patients from Asian descendant (52.2%) compared to African descendant (11.7%). Whereas, HT (39.3%) is more prevalent in African descendants compared to Asian descendants (12.7%). There were no statistically significant differences in age, sex, ethnicity, LV function and RFs between single admitted and readmitted patients. CONCLUSION: RF prevalence, ethnic differences and readmission rates in Surinamese HF patients are in line with reports from other Caribbean and Latin American countries. These results are the basis for the SUHF-II study which will aid in identifying the country specific and clinical factors for the successful development of a multidisciplinary HF management program.