Background: Opioid maintenance therapy has been advocated by American College of Obstetrics and Gynecology (ACOG) along with American Society of Addiction Medicine (ASAM) for opioid use disorder in pregnancy. Marijuana use has been increasing with legalization of marijuana in many states along with reported benefit of antiemetic effect in pregnancy. Both have been independently implicated in adverse neonatal outcome but they haven't been studied for concurrent use in pregnancy. Objective: Objective of the study was to look in to the use of opioid and marijuana in pregnancy related with neonatal outcomes; birth weight, Apgar scores,low birth weight, preterm birth along with social determinant of opioid and marijuana use in pregnancy. Design/Methods: A retrospective chart review from July 2011 to June 2016 of all births from 6 delivery hospitals in South-Central Appalachia was conducted to determine pregnancy and neonatal outcomes of pregnancies exposed to any form of opioid and positive urine drug screen (UDS) for marijuana(THC) at the time of delivery. Inclusion criteria were UDS positive for THC at delivery and exposure to opioid during pregnancy.18730 births were identified during the study period, 2638 pregnancy were opioid exposed, and 2375 pregnancies met the inclusion criteria were included for analysis with 108 pregnancies positive for THC in UDS at the time of delivery. Maternal characteristics, delivery and perinatal outcome were studied. Student t-test and Chi-Square test were used for group comparison for presence and absence of marijuana. Logistic regression was done for significant confounding variables like parity, maternal status, tobacco, and benzodiazepine to find aOR for marijuana exposure for NAS diagnosis, premature birth, and low birth weight (LBW). Results: Among opioid using women, marijuana positive women were more likely to be unmarried, nulliparous, and use tobacco and benzodiazepines. Infants born to the marijuana users were likely to be of earlier gestational age (3 days), lower birth weight, and preterm; with preterm birth and low birth weight (mean difference = 265 gms) increased two fold even after controlling for parity, marital status, tobacco and benzodiazepine use with aOR of 2.35 (1.30-4.23) and 2.02 (1.18-3.47) respectively. Conclusion(s): In view of ACOG and ASAM guidelines for continuing opioid for opioid use disorder during pregnancy, finding of increased prematurity along with LBW carries significance of advocating counseling against use of marijuana in pregnancy exposed to opioids.

Introduction Although studies have examined the association between childhood asthma and parental smoking and secondhand smoke, little research has explored the moderating role of birth weight and prematurity (BWP) status on this association. We examined the association between secondhand smoke exposure, asthma, and asthma severity in children aged six to 17 as well as the modifying effect of BWP on parental smoking and asthma. Methods We used data from 36,954 children from the National Survey of Children's Health 2017-2018. In addition to univariate analysis, adjusted and unadjusted logistic regression models were used to estimate the effect of secondhand smoke on asthma. The interaction term between parental smoking and BWP was tested. Multinomial regression was used to evaluate the association between secondhand smoke on asthma severity. Results About 15.1 % of children had asthma and 15.4% of parents reported smoking. Odds of asthma were higher in children living with an outdoor (AOR, 1.27; 95% CI, 1.06-1.52) and indoor (AOR, 1.46; 95% CI, 1.01-2.11) smoker in the adjusted model. The association of parental smoking with asthma differed by birth weight and premature status. Normal weight children who are premature had the highest odds ratio (AOR, 2.15; 95% CI, 1.2-3.86). In the multinomial model, low birth weight and premature children had higher odds of mild (AOR, 1.90; 95% CI, 1.40-2.56) and moderate/severe (AOR, 1.81; 95% CI, 1.16-2.84) asthma compared to the no asthma group. Conclusion The Association of parental smoking on asthma was modified by BWP. Focused asthma interventions in children should inquire about BWP status as well as parental smoking and household smoke exposure to reduce asthma morbidity and mortality.

Introduction: Fetal weight estimations are essential to identify and treat high-risk pregnancies. According to the Swedish association for obstetricians and gynecologists, the mean deviation of estimated weight from birth weight should be 0%, and the standard deviation 8%. Aim: To evaluate fetal weight estimations, by comparing the deviation from expected weight at the examination to at birth. Methods: Eight examiners were included from the Department of Obstetrics and Gynecology at Västerås Central Hospital. All singleton pregnancies with live births examined by these examiners from week 36+0, from January 1st to February 10th, 2022, were included, with a few exceptions. The deviations mentioned above were compared using a paired T-test. Mean and standard deviations were calculated for individual examiners. Midwives and doctors were compared using an independent T-test. Results: 86 examinations were included. There was a tendency to overestimate birth weight deviation by 1.0%, with a standard deviation of 7.8%. The differences between the deviation at the weight estimation and at birth, and between the professions, were not statistically significant. Both mean and standard deviation varied between individual examiners. Conclusions: The precision found in this study fell within what is considered acceptable according to the SFOG, and the mean did not differ statistically significantly from the recommended. Differences in fetal growth rate between examination and birth may have induced an error in the results, but the magnitude of that error cannot be determined. The study indicates differences between examiners, but a larger study is needed to draw any definite conclusions.

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Background: Folate and vitamin B12 have interdependent metabolic functions that are essential for neonate growth outcomes (i.e. birth weight) based on studies from India. The objective of this research was to evaluate the association of maternal folate and vitamin B12 concentrations with neonate birth weight in South Asian (SA) and white European (WE) populations. Methods: In this cross-sectional analysis of prospective cohort studies, maternal and neonatal data were collected during the second trimester from 3758 mother-child dyads living in Canada. Maternal diet and supplement use were assessed using a validated food frequency questionnaire. Biochemical indicators were analyzed in a subset of SA mothers. Birth weight was measured within 72 hours of delivery. All regression analyses were performed unadjusted and with adjustment for identified covariates. Results: Maternal folate and vitamin B12 (dietary, supplemental and total) were not associated with neonate birth weight in SA and WE pregnant women. Higher consumption of milk products by SA women was associated with higher birth weight (β=0.06; p=0.01), whereas higher consumption of egg by WE women was associated with lower birth weight (β=-0.19; p<0.01). Folate and vitamin B12 deficiency in the SA subgroup was 13.7% and 17.8%, respectively. Maternal serum vitamin B12 status was inversely associated with birth weight (β=-0.16; p=0.03). Conclusions: Folate and vitamin B12 may be proxies for poor nutritional status. Therefore, folate and vitamin B12 may have an association with neonate birth weight in a less developed area (i.e. India) rather than in a highly developed area (i.e. Canada). Highly developed countries have an adequate intake of folate and vitamin B12 and thus a higher nutritional baseline status. These findings complement current research on folate and vitamin B12 concentrations with birth weight in well-nourished populations. / Thesis / Master of Science (MSc) / Infant birth weight is an indicator of health and disease risk in adult life. The mother’s vitamin intake can influence the weight of the infant. This research aimed to study whether the mother’s folate and vitamin B12 status is related to infant birth weight. Dietary and supplemental data along with blood samples from South Asian and white European pregnant women living in Canada were collected during the second trimester. The mother’s dietary, supplemental and total folate and vitamin B12 intakes were not related to infant birth weight. In South Asian mothers, higher milk intake was related to higher birth weight and in white Europeans, higher egg intake was related to lower infant birth weight. Higher vitamin B12 in the blood was related to lower infant birth weight in South Asians. More research is needed to determine the relationship between folate and vitamin B12 with infant birth weight.