Background: Some studies have suggested that the risk of preeclampsia in HIV positive pregnant women has increased since the use of HAART became routine. There is also a concern that HIV positive women on HAART have a higher risk of adverse fetal outcomes compared to HIV negative women. Methods: In this matched retrospective cohort study, the risk of preeclampsia and adverse fetal outcomes was examined in 91 HIV positive pregnant women receiving HAART and 273 HIV negative pregnant women. Multivariate logistic regression models were used to adjust for confounding factors. Results: The risk of preeclampsia and preterm birth did not differ significantly between HIV positive and HIV negative women. HIV treated with HAART was an independent predictor for giving birth to a low birthweight baby. Conclusions: HIV positive women on HAART do not have a higher risk of preeclampsia. They do however have a higher risk for lower birthweight infants.

The Atlanta Beltline is an urban redevelopment project that was designed to increase access to trails, parks, and greenspace in Atlanta, Georgia. Thirty-three miles of new trail will be developed, providing a place for the community to engage in purposeful physical activity and active transport around the city of Atlanta. Because physical activity is associated with improvements in birth outcomes and under the assumption that close proximity to the Atlanta Beltline encourages physical activity, I hypothesize that women residing within 0.5 mile of the Atlanta Beltline will show improvements in birth outcomes, as compared to women residing 1-1.5 miles away from the Beltline. Birth outcomes were measured as rates for low birth weight, premature live birth, and fetal mortality rates. Census tract data for birth outcomes for the time period “pre-Beltline,” 2002 - 2007, and “post-Beltline,” 2008 - 2012, was obtained from Georgia Department of Public Health. 18 census tracks in three areas along the Beltline (Northside, Eastside, West End) were identified as exposed and 17 in the same areas were unexposed. We found the following mean rates (SDs) of the outcomes in the exposed census tracks during the pre-Beltline period: 119.22 (48.39) low birth weight, 154.94 (55.80) premature birth, and 16.17(15.81) fetal death, all per 1,000 live birth. During the post-Beltline period in the exposed area, these measurements were: 107.55 (39.66) low births weight, 131.06 (48.92) premature birth, and 12.28 (13.51) fetal death, all per 1000 live birth. In the unexposed census tracks during the pre-Beltline period, mean rates (SDs) of the outcomes were 110.82 (42.81) low births weight, 144.88 (46.49) premature birth, and 19.94 (35.45) fetal death, all per 1000 live birth. During the post-Beltline period, these measurements in the unexposed area were: 100.88 (40.76) low births, 134.17 (47.85) premature birth, and 8.06 (6.89) fetal death, all per 1000 live birth. Overall in both the exposed and unexposed areas, the time trends for the examined measurements of birth outcomes were towards improvement; however, only a decrease in premature live birth in the exposed area (p=0.2) and fetal mortality in the unexposed area (p=0.1) were of statistically marginal significance. We conclude that currently no significant improvements in birth outcomes, associated with close proximity to the Atlanta Beltline have been detected.

Birthweight is one of the most important health indicators for a newborn infant. Birthweight at either the lower or higher end is associated with adverse health outcomes in later life. In recent years, birthweight distribution in the United States has shifted to the lower end. This dissertation uses US vital statistics data from 1989 to 2007 to document recent birthweight trends in the US and examines the possible causes behind the trends. Results are reported for all births and by race/ethnicity/nativity. Descriptive analysis suggests that the lowering birthweight trend is the result of the rapid increase of lower-birthweight multiple births and decreasing birthweight among singleton births. The lowering birthweight is reflected in all birthweight measures. Low-birthweight rate is rising, mean birthweight is declining, and the proportion of macrosomic infants is decreasing. While this trend is most pronounced among US-born non-Hispanic whites and least among non-Hispanic blacks, it is prevalent among all race/ethnicity/nativity groups. Regression results suggest that much of the birthweight trend can be explained by shortened gestational age but common maternal socio-demographic, health and behavioral, and health care and medical intervention factors cannot fully explain the birthweight trend. Regression decomposition concludes that both the trends in maternal factors and the changes in the effects of these factors on birthweight contribute to the birthweight trend. Trend in gestational age is the biggest contributor, contributing more than 100% to the birthweight trend, while improvement in education, reduction of smoking during pregnancy and improvement in prenatal care have slowed down the birthweight decrease. Further research needs to be done to identify factors leading to the recent birthweight trend that are not available from the vital statistics. / text

Vitamin D status is assessed with circulating 25-hydroxyvitamin D [25(OH)D]. As some evidence suggests that low vitamin D status adversely affects neonatal health, this project aimed to determine the association between cord blood 25(OH)D levels and preterm birth (PTB; <37 weeks gestation), low birthweight (LBW; <2500 grams) and small for gestational age (SGA; <10th percentile) and to examine the relationship between maternal 25(OH)D levels during the first trimester of pregnancy and fetal 25(OH)D levels at birth in a Canadian population. This nested case-control study used serums, questionnaires and chart reviews collected in Quebec City. Compared to 25(OH)D concentrations ≥75 nmol/L, concentrations 37.5-<75, 50-<75, and <75 nmol/L were associated with lower odds of LBW, PTB and an adverse neonatal composite outcome, and PTB as well as LBW, respectively. Maternal and neonatal 25(OH)D were correlated (r=0.23, p<0.01; adjusted r=0.46, p<0.01). This study contributes to evidence for identifying further policy and research directions.

Introduction: The past decade has seen a significant shift in the demographics of childbearing in the United States. The average age of women at first birth has steadily increased over the last four decades, with the birth rate for women aged 40-44 more than doubling from 1990 to 2012. The aim of this study was to evaluate the risk of adverse pregnancy outcomes with increasing maternal age and paternal age using national health statistics data. Methods: The study population included 3 495 710 live births among women 15-54+ years of age from the 2012 Natality dataset. Outcomes were modeled for both maternal and paternal 5-year age groups using logistic regression analysis to calculate adjusted and unadjusted odds ratios (AORs, ORs) with 95% confidence intervals. Analysis was performed to examine the association between maternal and paternal age across seven different adverse outcomes, including low birthweight, low Apgar score, early term pregnancies, abnormal newborn conditions and presence of congenital anomalies. Results: The risks for most outcomes paralleled with advanced maternal age and paternal age. Logistic regression models demonstrated that maternal age groups 40-44, 45-49 and 50-54+ were at highest risk for an adverse pregnancy outcome compared to the 30-34 year old reference group. Abnormal newborn conditions including assisted ventilation, NICU admission and use of antibiotics were significant for all age groups 40 and older. Low Apgar score, low birthweight and early term pregnancies were significantly higher among mothers as well as fathers with advanced age. Conclusions: These findings suggest that advanced maternal age is a risk factor for a variety of adverse pregnancy outcomes. Women aged 35-39 have a similar risk of an adverse outcome as their younger counterparts. This suggests that perhaps we should begin assessing high-risk pregnancies as starting at an older age versus the de facto standard of 35.

Infant mortality (IM) rates in the United States remains high. The higher rates of IM among specific groups in the United States is believed to be fueled by the high rates of adverse birth outcomes including low birthweight (LBW) and preterm births (PTB) among these groups. Adverse birth outcomes have also been linked to the presence of hypertensive disorders during pregnancy. The purpose of this cross-sectional study was to explore the association between hypertensive disorders during pregnancy and adverse birth outcomes and the impact of the residential neighborhood of expectant mothers on this association. The life course health development theory guided the framework for this study. Study data were obtained from the 2010 New York City birth records and the 2010 US Census. Descriptive statistics and logistic regression analysis were used to address the 3 research hypotheses of the study. The study found that prepregnancy hypertension (HTN) (AOR: 2.84 & 3.25), gestational HTN (AOR: 2.28 & 3.33) and eclampsia (AOR: 4.41 & 6.70) were significantly associated with PTB and LBW respectively. Neighborhood segregation was not significant for PTB (AOR: 1.01) or LBW (AOR: 1.03). Neighborhood poverty was significant for PTB (AOR: 0.86) but not for LBW (AOR: 1.05). Neighborhood segregation and poverty had significant moderating effects on the prepregnancy HTN (p = 0.00), gestational HTN (p = 0.00), eclampsia (p = 0.00) and PTB and LBW association. Results from this study can help to address disparities in birth outcomes among women of differing races and ethnicities and thereby contribute to positive social change.

This three-essay dissertation examines racial disparities in infant health outcomes and exposure to air pollution in Texas. It also asks whether the EPA's Risk-Screening Environmental Indicators Geographic Microdata (RSEI-GM) might be used to assess the effects of little-studied toxic air pollutants on infant health outcomes. Chapter 1 contributes to the ``weathering'' literature, which has shown that disparities in infant health outcomes between non-Hispanic black and non-Hispanic white women tend to widen with age. In this study, we ask whether the same patterns are observed in Texas and among Hispanic women, since other studies have focused on black and white women from other regions. We find that black and Hispanic women in Texas do ``weather'' earlier than white mothers with respect to rates of low birthweight and preterm birth. This differential weathering appears to be mediated by racial disparities in the distribution and response to socioeconomic risk factors, though a large gap between black and white mothers across all ages remains unexplained. Chapter 2 extends the statistical environmental justice literature by examining the distribution of toxic air pollution across infants in Texas. We find that, within Texas cities, being black or Hispanic is a significant predictor of how much pollution one is exposed to at birth. We further find that, among mothers who move between births, white mothers tend to move to significantly cleaner areas than black or Hispanic mothers. In Chapter 3, we use geocoded birth records matched to square-kilometer pollution concentration estimates from the RSEI-GM to ask whether the pollution-outcome relationships that emerge through regression analysis are similar to the effects found in previous research. If so, the RSEI-GM might be used to study the health effects of nearly 600 chemicals tracked in that dataset. We conclude, based on instability of results across various specifications and lack of correspondence to previous results, that the merged birth record-RSEI data are not appropriate for statistical epidemiology research.

No description available.

Ambient air pollution has been associated with restricted fetal growth, which is linked with adverse respiratory health in childhood. We assessed the effect of maternal exposure to low concentrations of ambient air pollution on birthweight. We pooled data from 14 population-based mother-child cohort studies in 12 European countries. Overall, the study population included 74-178 women who had singleton deliveries between Feb 11, 1994, and June 2, 2011, and for whom information about infant birthweight, gestational age, and sex was available. The primary outcome of interest was low birthweight at term (weight <2500 g at birth after 37 weeks of gestation). Mean concentrations of particulate matter with an aerodynamic diameter of less than 2·5 μm (PM2·5), less than 10 μm (PM10), and between 2·5 μm and 10 μm during pregnancy were estimated at maternal home addresses with temporally adjusted land-use regression models, as was PM2·5 absorbance and concentrations of nitrogen dioxide (NO2) and nitrogen oxides. We also investigated traffic density on the nearest road and total traffic load. We calculated pooled effect estimates with random-effects models. A 5 μg/m3 increase in concentration of PM2·5 during pregnancy was associated with an increased risk of low birthweight at term (adjusted odds ratio [OR] 1·18, 95% CI 1·06-1·33). An increased risk was also recorded for pregnancy concentrations lower than the present European Union annual PM2·5 limit of 25 μg/m3 (OR for 5 μg/m3 increase in participants exposed to concentrations of less than 20 μg/m3 1·41, 95% CI 1·20-1·65). PM10 (OR for 10 μg/m3 increase 1·16, 95% CI 1·00-1·35), NO2 (OR for 10 μg/m3 increase 1·09, 1·00-1·19), and traffic density on nearest street (OR for increase of 5000 vehicles per day 1·06, 1·01-1·11) were also associated with increased risk of low birthweight at term. The population attributable risk estimated for a reduction in PM2·5 concentration to 10 μg/m3 during pregnancy corresponded to a decrease of 22% (95% CI 8-33%) in cases of low birthweight at term. Exposure to ambient air pollutants and traffic during pregnancy is associated with restricted fetal growth. A substantial proportion of cases of low birthweight at term could be prevented in Europe if urban air pollution was reduced. / The European Union

Orientadores: Jose Dirceu Ribeiro, Maria Aparecida Marques dos Santos Mezzacappa / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T08:58:42Z (GMT). No. of bitstreams: 1 Mendes_ThaisdeBarros_M.pdf: 697160 bytes, checksum: 683a02d47dfa9c24c4f1e7ea7b12f590 (MD5) Previous issue date: 2006 / Resumo: A doença pelo refluxo gastroesofágico (DRGE) é a enfermidade esofágica mais comum no período neonatal, e tem sido implicada como um fator contribuinte para as doenças respiratórias. Entretanto, muitos de seus aspectos são controversos e não são adequadamente conhecidos em recém-nascidos prematuros. A displasia broncopulmonar (DBP) é a doença pulmonar crônica mais freqüente em recém-nascidos de muito baixo peso (RNMBP). Em virtude da escassez de informações sobre o diagnóstico de DRGE em pacientes com DBP e dadas às conseqüências sobre a sua morbidade, pareceu-nos importante conhecer os fatores de risco para a associação, podendo colaborar com a melhora da qualidade da assistência prestada. Este estudo teve o objetivo de conhecer os fatores de risco para a DRGE em RNMBP com DBP, investigados por meio da monitorização prolongada do pH esofágico distal. Verificar se o corticóide pré-natal é fator de risco para a DRGE, bem como identificar os fatores de risco demográficos do RN, definir os fatores de risco referentes à evolução pós-natal do RN e determinar se alguns dos procedimentos e os medicamentos administrados ao RN são fatores de risco para a DRGE. Foi realizado um estudo observacional, retrospectivo, de caso-controle. O diagnóstico de DRGE foi estabelecido pelas manifestações clínicas e pelo índice de refluxo = 10%. Foram estudados todos os RN com DBP que receberam diagnóstico de DRGE por meio da monitorização do pH esofágico, em condições padronizadas, no período janeiro de 2001 a outubro de 2005, no Centro de Atenção Integral à Saúde da Mulher. O tamanho da amostra foi de 23 casos e igual número de controles, não emparelhados, que foram comparados quanto à idade gestacional, peso ao nascimento, gênero, uso de corticóide pré-natal, tempo de ventilação assistida, oxigenoterapia, tempo de uso de sonda gástrica, xantinas, idade pós-conceptual e peso à monitorização do pH esofágico. Para a análise estatística foram empregados, inicialmente, os testes de Qui-quadrado e o teste Exato de Fisher, para as variáveis categóricas e para as variáveis numéricas a comparação entre os grupos foi realizada pelo teste U de Mann-Whitney. Em seguida, para analisar a influência dos fatores de risco para a DRGE foi realizada análise por regressão logística univariada e múltipla para estabelecer o odds-ratio (OR) e o seu respectivo intervalo de confiança de 95% (IC). Foram considerados como significativos os valores de p< 0,05. Os dois grupos (com e sem DRGE) não apresentaram diferenças significativas em relação às variáveis demográficas, as de evolução pós-natal, ao uso de corticóide pré e pós-natal, bem como ao tempo de uso de cafeína, ventilação mecânica e oxigenoterapia. Entretanto, as variáveis: intolerância alimentar (OR 6,55; IC 1,05 - 40,8) e tempo de uso de sonda gástrica (OR 1,67; IC 1,11 - 2,51) associaram-se independentemente à DRGE. A maior idade pós-conceptual ao exame (OR 0,02; IC <0,001 - 0,38) foi identificada como fator protetor para a DRGE. O presente estudo permite inferir que o tempo prolongado de uso de sonda gástrica e a ocorrência de intolerância alimentar aumentam a probabilidade para a DRGE, em RNPT menores de 1500 gramas com DBP. Já a maior idade pós-conceptual ao exame diminui a chance para a DRGE. Estes achados merecem atenção e outros estudos, para maximizar a correlação dos fatores de risco para a DRGE em neonatos com DBP / Abstract: Gastroesophageal reflux disease (GERD) is the most common illness in neonatal period, and is considered an associated factor for respiratory diseases. However, several aspects of GERD are controversy and not appropriately known in premature. Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in very low birth weight (VLBW) infants. Due to shortage of information¿s about diagnosis of GERD in patients with BPD and considering the consequences about his morbidity, seems to us important to know the risk factors for the association, be able to collaborate with the improvement of quality of treatment. The objective of this study was to determine the risk factors for GERD in extremely low birth weight infants with BPD. A retrospective case-control study was realized, including 23 patients and 23 control subjects who were diagnosed by clinical manifestations and 24 hours esophageal pH monitoring presenting reflux index = 10%. All newborn with BPD were studied from January 2001 to October 2005 at the Center for Women¿s Integral Health Care. Cases and controls were compared for gestational age, birth weight, gender, antenatal steroid use, assisted ventilation time, oxygen therapy and time of feed tube use, xanthine, post conceptual age and weight on esophageal pH monitoring. For the statistic analysis were utilized, initially, the square¿ test and the Fisher¿s exact test for the numerical variables, and Mann-Whitney¿s test for category variables. Multiple logistic regression was made for to establish odds-ratio (OR) with confidence interval of 95% (CI). Were considered significant p< 0.05. Both groups (with and without GERD) didn¿t show significant differences on variables: demographics, postnatal evolution, prenatal and postnatal steroids use, caffeine utilization, mechanical ventilation and oxygen therapy. The variables feeding intolerance (OR 6.55; CI 1.05; 40.8) and time of gastric tube use (OR 1.67; CI 1.11; 2.51) showed be risk factors for GERD. The major post conceptual age on esophageal Ph monitoring (OR 0.02; CI <0.001; 0.38) showed be protector factor for GERD. The obtained data showed that a prolonged gastric tubes use and the feeding intolerance increase probability for GERD. While the major post conceptual age on esophageal pH monitoring decrease likelihood for GERD in premature neonates with BPD / Mestrado / Saude da Criança e do Adolescente / Mestre em Saude da Criança e do Adolescente