Morphological and clinical findings in placentas and newborns with a history of tobacco, alcohol, and other substance abuse during pregnancy.

BACKGROUND: Exposure to toxins during pregnancy is the main modifiable behavior that affects the placenta and, consequently, the fetus. In particular, smoking is a recognized risk factor for negative outcomes. Our study pretended to examine gross and microscopic placental features in women who reported exposure to tobacco, alcohol, or other psychoactive substances. METHODS: In this observational case-control study, we collected 706 placentas to assess precise substance exposure histological-interaction features of in the placenta. We examined gross and microscopic placental features, and then recorded maternal and newborn clinical conditions. RESULTS: We found that 4.8% of mothers admitted to consumption of some type of (harmful) substance. The most common pre-existing maternal condition was obesity (20.3%); predominant complications included amniotic infection (32.3%), urinary tract infection (14.5%) and hypertensive disorders of pregnancy (14.5%). In newborns, we discovered positive associations as respiratory distress syndrome. Macroscopically, exposed mothers had heavier placentas, more true knots, and single umbilical artery; microscopically, they were more likely to exhibit fetal vascular malperfusion (FVM). CONCLUSIONS: Until our present study, no research linked umbilical cord defects to toxic substance exposure; our study results do confirm association with adverse outcomes in neonates and alterations in the neuro-cardio-placental circuit through FVM. IMPLICATIONS: The results are confirming the importance of this modifiable risk factor and how its presence may potentially affect the course of pregnancy, as well as the health of both mother and child.

Perinatal factors as risk factors of bipolar disorder onset in young adulthood: a 22-year birth cohort.

BACKGROUND: Bipolar disorder (BD) is a leading cause of disability-adjusted life years in young adults. Complications during prenatal periods have been associated with BD previously. The study aims to examine the association between perinatal factors and BD in order to prevent the risk of developing BD. METHODS: 3,794 subjects from the 1993 Pelotas population-based birth cohort study were included. We assessed 27 initial variables at birth and modelled BD onset at 18 and 22 years. We performed bivariate analysis, using binomial logistic regression models. The variables with p-value smaller than 0.05 were included into a multiple regression with confounding variables. RESULTS: Maternal smoking was associated with a 1.42-fold increased risk of BD at 18 or 22 years old (95% CI: 1.091-1.841), and maternal passive exposure to tobacco with a 1.43-fold increased risk (95% CI: 1.086-1.875). No association was found between other perinatal factors and BD after controlling for confounding factors. CONCLUSION: The results of this cohort corroborate with previous findings in the literature that already indicate the negative outcomes of maternal smoking during pregnancy. They may now be linked to other studies to target these factors for preventing the development of BD.

Perinatal risk factors for the onset of bipolar disorder in young adulthood: a 22-year birth cohort

Objective: Bipolar disorder (BD) is a major cause of disability-adjusted life years in young adults. Pregnancy complications have previously been associated with BD. The current study aimed to examine the association between perinatal factors and BD. Methods: We included 3,794 subjects from the 1993 Pelotas population-based birth cohort study. We assessed 27 variables at birth and modeled BD onset at 18 and 22 years. Bivariate analysis was performed by means of binomial logistic regression models. The variables with p-values less than 0.05 were included in a multiple regression with confounders. Results: Maternal smoking was associated with a 1.42-fold increased risk of BD at 18 or 22 years old (95%CI 1.091-1.841), and maternal passive exposure to tobacco with a 1.43-fold increased risk (95%CI 1.086-1.875). No association was found between other perinatal factors and BD after controlling for confounders. Conclusion: The results of the present cohort study corroborate previous reports in the literature indicating a negative effects of maternal smoking during pregnancy. These findings can be further tested and support the development of strategies to prevent the onset development of BD.

Maternal smoking during pregnancy and intelligence quotient of offspring aged 18 and 30 years: Evidence from two birth cohorts in southern Brazil.

Maternal smoking during pregnancy causes several harmful effects, including deficits in the intelligence quotient (IQ), a measure associated with academic achievements and higher socioeconomic position. We aimed to measure the association between maternal smoking during pregnancy and offspring's IQ in two birth cohorts from Pelotas, Brazil. Data from the 1982 and 1993 birth cohorts were analyzed. Smoking during pregnancy was ascertained at the perinatal follow-up, and IQ was measured at 30 years (1982) and 18 years (1993). Simple and multiple linear regressions were used for crude and adjusted analysis. Mediation analysis was performed using birth weight and breastfeeding as possible mediators. Data analysis was conducted in 2020. There were 3611 and 4050 participants from the 1982 and 1993 cohorts, respectively. After adjustment for potential confounders, the inverse association between smoking during pregnancy and children's IQ remained significant in both cohorts. Offspring of mothers who smoked during pregnancy had an average of 1.32 less IQ points (95%CI: -2.23, -0.242) in the 1982 cohort, and an average of 1.66 less IQ points (95%CI: -2.42, -0.90) in the 1993 cohort. Neither cohort showed association with paternal smoking (negative controls) after adjustment. Breastfeeding's mediated effects accounted for 26.2% and 23.9% of the association in the 1982 and 1993 cohorts, respectively, while birth weight's accounted for 6.8% and 30.1%, respectively; indirect effects were not significant. The inverse association between maternal smoking and IQ and the lack of association with paternal smoking reinforces our findings of a negative association between exposure and outcome.

Maternal smoking during pregnancy is risk factor for gallbladder disease in offspring during adulthood: a prospective study from UK Biobank.

INTRODUCTION AND OBJECTIVES: Gallbladder disease is a common disease with high prevalence. Majority of gallbladder disease is due to gallstone. Though genetics are believed to play a role in its pathogenesis, the contribution of environmental pressures in early life to the development of this disease in adulthood has not been ever investigated. This study aimed to clarify the risk of maternal smoking exposure in association with gallbladder disease in adulthood. The interaction of maternal smoking and own smoking during adulthood on this association was studied as well. PATIENTS AND METHODS: A total of 286,731 eligible participants from the UK Biobank population-based cohort were included. Multivariable Cox regression analysis were used to examine the HR and 95% CI with adjustment for covariates. RESULT: During a median of 8.8 years follow-up, 7110 incident cases of gallbladder disease including 6800 (95.6%) gallstone were identified. Maternal smoking was associated with increased risk of incident total gallbladder disease (HR = 1.13; 95%CI: 1.06 - 1.21; P = 0.0002) as well as gallstones (HR = 1.13; 95%CI: 1.06 -1.21; P = 0.0003) in adulthood. Compared with those who were neither exposed to maternal smoking nor own smoking, subjects adherence to no smoking during adulthood but having maternal smoking exposure still had increased risk of total gallbladder disease (HR = 1.21; 95%CI: 1.1-1.34, P=0.0001) and gallstones (HR = 1.21; 95%CI: 1.1-1.35, P=0.0001). CONCLUSION: The present study using large prospective cohort data from UK Biobank, for the first time, demonstrated maternal smoking exposure bringing elevated risk of incident total gallbladder disease/gallstone in adulthood.

Association between Neonatal Intensive Care Unit Admission and Supine Sleep Positioning, Breastfeeding, and Postnatal Smoking among Mothers of Late Preterm Infants.

OBJECTIVE: To evaluate the association between neonatal intensive care unit (NICU) admission and breastfeeding practices, infant supine sleep positioning, and postnatal smoking among mothers of late preterm infants. STUDY DESIGN: Data from 36 states using the 2000-2013 Pregnancy Risk Assessment Monitoring System were analyzed. χ2 tests and 95% CI assessed infant and maternal characteristics and recommended care practices for late preterm infants based on NICU admission after birth. Adjusted prevalence ratios (APR) for breastfeeding initiation and continuation at 10 weeks, supine sleep position, and postnatal smoking were estimated using multivariable logistic regression models, controlling for infant and maternal characteristics. Analyses were weighted and SEs accounted for the complex survey design. RESULTS: Our sample included 62 494 late preterm infants, representing a weighted population of 1 441 451 late preterm infants. In the adjusted analysis, mothers of late preterm infants admitted to a NICU were more likely to initiate breastfeeding (APR 1.07; 95% CI 1.05-1.09) and place their infants in supine sleep position (1.04; 95% CI 1.01-1.06) than mothers of late preterm infants not admitted to a NICU. There was no significant difference between groups for breastfeeding continuation or postnatal smoking. CONCLUSIONS: Mothers of late preterm infants admitted to a NICU were more likely to initiate breastfeeding and practice supine sleep position than mothers of late preterm infants not admitted to a NICU. Future work should seek to identify the drivers of these differences to develop effective strategies to engage mothers in these health promoting infant care practices.

Prenatal Exposure to Tobacco and Offspring Neurocognitive Development in the Healthy Start Study.

OBJECTIVE: To explore the associations between prenatal exposure to tobacco and neurocognitive development, in the absence of prematurity or low birth weight. STUDY DESIGN: We followed mother-child pairs within Healthy Start through 6 years of age. Children were born at ≥37 weeks of gestation with a birth weight of ≥2500 g. Parents completed the Third Edition Ages and Stages Questionnaire (n = 246) and children completed a subset of the National Institutes of Health Toolbox Cognition Battery (n = 200). The Ages and Stages Questionnaire domains were dichotomized as fail/monitor and pass. Maternal urinary cotinine was measured at approximately 27 weeks of gestation. Separate logistic regression models estimated associations between prenatal exposure to tobacco (cotinine below vs above the limit of detection) and the Ages and Stages Questionnaire domains. Separate linear regression models estimated associations between prenatal exposure to tobacco and fully corrected T-scores for inhibitory control, cognitive flexibility, and receptive language, as assessed by the National Institutes of Health Toolbox. A priori covariates included sex, maternal age, maternal education, daily caloric intake during pregnancy, race/ethnicity, household income, maternal psychiatric disorders, and, in secondary models, postnatal exposure to tobacco. RESULTS: Compared with unexposed offspring, exposed offspring were more likely to receive a fail/monitor score for fine motor skills (OR, 3.9; 95% CI, 1.5-10.3) and decreased inhibitory control (B: -3.0; 95% CI, -6.1 to -0.7). After adjusting for postnatal exposure, only the association with fine motor skills persisted. CONCLUSIONS: Prenatal and postnatal exposures to tobacco may influence neurocognitive development, in the absence of preterm delivery or low birth weight. Increased developmental screening may be warranted for exposed children.

Maternal smoking during pregnancy and offspring body composition in adulthood: Results from two birth cohort studies.

OBJECTIVE: To evaluate the association of maternal smoking during pregnancy with offspring body composition in adulthood and explore the causality of this association. DESIGN: Birth cohort. SETTING: Population-based study in Pelotas, Brazil. PARTICIPANTS: All newborn infants in the city's hospitals were enrolled in 1982 and 1993. At a mean age of 30.2 and 22.6 years, the 1982 and 1993 cohorts, respectively, followed the subjects and 7222 subjects were evaluated. PRIMARY OUTCOME MEASURES: Body mass index (BMI), fat mass index, android to gynoid fat ratio, waist circumference, waist to height ratio, lean mass index and height. RESULTS: Prevalence of maternal smoking during pregnancy was 35.1% and 32.6%, in 1982 and 1993 cohorts, respectively. Offspring of smoking mothers showed higher mean BMI (ß: 0.84; 95% CI: 0.55 to 1.12 kg/m2), fat mass index (ß: 0.44; 95% CI: 0.23 to 0.64 kg/m2), android to gynoid fat ratio (ß: 0.016; 95% CI: 0.010 to 0.023), waist circumference (ß: 1.74; 95% CI: 1.15 to 2.33 cm), waist to height ratio (ß: 0.013; 95% CI: 0.010 to 0.017) and lean mass index (ß: 0.33; 95% CI: 0.24 to 0.42 kg/m2), whereas height was lower (ß: -0.95; -1.26 to -0.65). Weight gain in the first 2 years captured most of the association of maternal smoking with BMI (96.2%), waist circumference (86.1%) and fat mass index (71.7%). CONCLUSIONS: Maternal smoking in pregnancy was associated with offspring body composition measures in adulthood.

Síndrome de muerte súbita del lactante / Sudden Infant Death Syndrome (SIDS)

Resumen El síndrome de muerte súbita del lactante es la principal causa de muerte infantil post neonatal en los países desarrollados. El mismo se caracteriza por una muerte repentina e inexplicable de un infante menor a un año. La compleja interacción de múltiples factores en su patogénesis se ilustra con la teoría del triple riesgo, la cual involucra un infante vulnerable en un periodo crítico de su desarrollo ante un factor de riesgo externo. Por medio de educación a los cuidadores y padres se ha documentado una disminución importante en su incidencia, aunque la misma continúa siendo muy alta.

Abstract Sudden infant death syndrome is the leading cause of post neonatal infant death in the developed countries. It is characterized for the sudden and unexplained death of an infant younger than one year old. The interaction of multiple factors in its pathogenesis is illustrated by the triple risk theory, which involves a vulnerable infant at a critical moment of its development facing an external risk factor. Through education to caregivers and parents a drop in incidence has been documented, although it is still very high.

Ventilatory Responses to Hypercarbia in Infants of Mothers Who Smoke and Misuse Substances.

The ventilatory response of infants of mothers who smoke and misuse substances and controls to carbon dioxide was assessed at 6-12 weeks and the perinatal period. Infants of mothers who smoke and misuse substances had a dampened response at the peak age of sudden infant death syndrome, greater than in the perinatal period.