The associations of neighborhood level socioeconomic deprivation and low birth weight were investigated among 1,030,443 singleton live births in the State of Florida between the years 1992 and 1997. Census data for per capita income, unemployment, percent of individuals living below the poverty line, vehicle ownership and educational attainment were used as neighborhood level indicators of socioeconomic status. Additionally, these variables were combined into a deprivation index to measure relative deprivation of neighborhoods across Florida. Birth data were linked to census block groups and tracts, which were used as proxies for low birth weight. Multilevel models were used to model the relationship between the deprivation index and each of the indicators and low birth weight, while adjusting for individual level risk factors. After adjusting for individual level factors no consistent relationship between neighborhood socioeconomic measures and low birth weight could be established. The relationship between neighborhood socioeconomic factors and low birth weight varied across ethnic categories. Among White Non-Hispanics and Hispanics measures of socioeconomic deprivation had a small association with low birth weight. However, for Black Non-Hispanics neighborhood measures had little consistency in predicting the occurrence of low birth weight

Intrauterine Growth Restriction (IUGR) is evident in infants born with a reduced weight or length, and/or increased thinness for gestational age. IUGR is associated with altered postnatal growth and regulation, due to unknown mechanisms. Much clinical IUGR results from the reduced delivery of essential substrates (oxygen and nutrients) to the fetus, due to either maternal or placental limitations. Catch-up growth (accelerated rate of growth in absolute or fractional terms) occurs in the majority of IUGR infants, and returns an infant to their predetermined growth curve. IUGR is associated with increased risks of morbidity and mortality in the perinatal period, and with a reduced final adult stature and increased risk of adult onset diseases, particularly diabetes and cardiovascular disease. Catch-up growth after IUGR predicts improved health in terms of reduced hospital visits in infants and children, and an increased final adult stature but also predicts an increased risk of developing obesity, as well as diabetes and cardiovascular disease. The underlying mechanisms for catch-up growth may contribute to this range of outcomes in later life, but are poorly understood. Studies in IUGR infants have demonstrated increased absolute and/or fractional growth rates following birth, termed catch-up growth, in the presence of reduced or normal plasma concentrations of the thyroid hormones and major anabolic hormones (insulin and/or IGF-I). This suggests that increased sensitivity to, rather than increased production of insulin, IGF-I and thyroid hormone, causes catch-up growth following IUGR. We therefore hypothesised that placental restriction of fetal growth would reduce size at birth and increase postnatal growth and adiposity in association with increased metabolic sensitivity to insulin, IGFs and thyroid hormones. This study has shown that the placentally restricted (PR) lamb has a reduced size at birth in terms of soft and skeletal tissues, has increased rates of growth postnatally, and has increased adiposity by six weeks of age. We have also shown that PR of fetal growth in the sheep did not alter gestational age at delivery, but reduced survival rate. PR lambs demonstrated catch-up growth in most parameters by 30 days of age and increased adiposity at six weeks of age compared to the control lambs. Placental restriction increased insulin and IGF sensitivity of circulating free fatty acids, which in turn, predicts increased adiposity. Neonatal catch-up growth after fetal growth restriction was substantially predicted by both abundance of, and metabolic sensitivity to insulin, suggesting increased insulin action as an underlying cause. Catch-up growth occurs in the neonate despite reduced concentrations of fasting plasma IGFs, along with increased IGF sensitivity of free fatty acid metabolism and adiposity. Plasma TH concentrations predicted growth of soft and skeletal tissue in lambs during early postnatal life, particularly in those undergoing catch-up growth following PR. Therefore neonatal catch-up growth after IUGR is associated with increased sensitivity to both insulin and IGFs, particularly of circulating free fatty acids, and appears to occur to the extent allowed by the prevailing abundance of these hormones and of thyroid hormones. If this altered endocrine state persists, increased adiposity and its subsequent amplification may contribute to the development of obesity, and related adverse metabolic and cardiovascular outcomes in adult life. / Thesis (Ph.D.)--School of Molecular and Biomedical Science, 2004.

<p><b>VLBW adolescents</b></p><p>We found that the VLBW adolescents had specific emotional and cognitive traits. Some of them fit with psychiatric concepts and others do not. They had an increased risk of developing psychiatric symptoms and disorders compared with controls, especially attention deficit, anxiety and relational problems affecting their social skills and overall functioning. Academic achievement was reduced. The attention problems were widespread, but only a minority fulfilled the diagnostic criteria of Attentiondeficit/ hyperactivity disorder. Increased prevalence of anxiety symptoms and disorders may be due to a number of factors, comprising both biological/neuroendocrine and psychosocial mechanisms. The peer problems and deficits in social skills may indicate specific difficulties in relating and adjusting to others, with deficits in comprehending the subtle cues of social relations. The implication of thought problems reported by teachers is unclear. Adolescents with birth weight ≤ 1000 g showed a tendency towards more psychiatric disorders than those with birth weight between 1000 and 1500 g. The lack of gender differences demonstrates that prematurity exceeds the usual effect of gender regarding vulnerability for developing psychiatric symptoms.</p><p>We found that the VLBW adolescents perceived self-esteem and quality of life as others did at the age of 14. However, parents reported functional disadvantages and reduced quality of life measures for their adolescents. The parents worried more for their children’s functioning and well-being, especially if the child had a psychiatric disorder or cerebral palsy. Still, being born VLBW did not influence the warmth in the parent-child relationship, nor did the parents have more mental health problems.</p><p>As the association between VLBW and psychiatric problems could not be explained by SES or the parents’ mental health, a biological cause-effect relationship seems plausible. The frequency of cerebral MRI abnormalities was higher in the VLBW group than in the control group. Furthermore, ADHD symptoms were associated with white matter reduction and thinning of the corpus callosum, while other psychiatric symptoms were not associated with MRI abnormalities. These results support the hypothesis of a specific (“pure”) type of ADHD with a dominant neurological aetiology, while interacting psychosocial experiences play a minor part. Our study indicates that being born VLBW involves a biological vulnerability with increased risk of psychiatric symptoms.</p><p><b>SGA adolescents</b></p><p>Although every fifth SGA adolescent had psychiatric symptoms, assessed by interview, the prevalence of symptoms and disorders did not differ significantly from controls. Yet, screening questionnaires displayed more behavioural problems, lowered social competence and a tendency towards attention deficit/hyperactivity. Teachers reported withdrawal and thought problems, while academic performance did not differ from controls. Boys had more attention and externalizing problems than girls.</p><p>Generally, on psychiatric measures, the term SGA group seemed to fall inbetween the VLBW and the control group, resembling the control group more than the VLBW group.</p><p>The SGA adolescents and their parents reported self-esteem and quality of life as in the control group. Being born SGA at term did not influence the warmth in the parent-child relationship, and the parents did not have more mental health problems than others. The frequency of cerebral MRI abnormalities in the SGA group did not differ from the control group, and no associations were found between psychiatric symptoms and MRI abnormalities.</p> / Paper V reprinted with kind permission of Elsevier, sciencedirect.com

<b>VLBW adolescents</b> We found that the VLBW adolescents had specific emotional and cognitive traits. Some of them fit with psychiatric concepts and others do not. They had an increased risk of developing psychiatric symptoms and disorders compared with controls, especially attention deficit, anxiety and relational problems affecting their social skills and overall functioning. Academic achievement was reduced. The attention problems were widespread, but only a minority fulfilled the diagnostic criteria of Attentiondeficit/ hyperactivity disorder. Increased prevalence of anxiety symptoms and disorders may be due to a number of factors, comprising both biological/neuroendocrine and psychosocial mechanisms. The peer problems and deficits in social skills may indicate specific difficulties in relating and adjusting to others, with deficits in comprehending the subtle cues of social relations. The implication of thought problems reported by teachers is unclear. Adolescents with birth weight ≤ 1000 g showed a tendency towards more psychiatric disorders than those with birth weight between 1000 and 1500 g. The lack of gender differences demonstrates that prematurity exceeds the usual effect of gender regarding vulnerability for developing psychiatric symptoms. We found that the VLBW adolescents perceived self-esteem and quality of life as others did at the age of 14. However, parents reported functional disadvantages and reduced quality of life measures for their adolescents. The parents worried more for their children’s functioning and well-being, especially if the child had a psychiatric disorder or cerebral palsy. Still, being born VLBW did not influence the warmth in the parent-child relationship, nor did the parents have more mental health problems. As the association between VLBW and psychiatric problems could not be explained by SES or the parents’ mental health, a biological cause-effect relationship seems plausible. The frequency of cerebral MRI abnormalities was higher in the VLBW group than in the control group. Furthermore, ADHD symptoms were associated with white matter reduction and thinning of the corpus callosum, while other psychiatric symptoms were not associated with MRI abnormalities. These results support the hypothesis of a specific (“pure”) type of ADHD with a dominant neurological aetiology, while interacting psychosocial experiences play a minor part. Our study indicates that being born VLBW involves a biological vulnerability with increased risk of psychiatric symptoms. <b>SGA adolescents</b> Although every fifth SGA adolescent had psychiatric symptoms, assessed by interview, the prevalence of symptoms and disorders did not differ significantly from controls. Yet, screening questionnaires displayed more behavioural problems, lowered social competence and a tendency towards attention deficit/hyperactivity. Teachers reported withdrawal and thought problems, while academic performance did not differ from controls. Boys had more attention and externalizing problems than girls. Generally, on psychiatric measures, the term SGA group seemed to fall inbetween the VLBW and the control group, resembling the control group more than the VLBW group. The SGA adolescents and their parents reported self-esteem and quality of life as in the control group. Being born SGA at term did not influence the warmth in the parent-child relationship, and the parents did not have more mental health problems than others. The frequency of cerebral MRI abnormalities in the SGA group did not differ from the control group, and no associations were found between psychiatric symptoms and MRI abnormalities. / Paper V reprinted with kind permission of Elsevier, sciencedirect.com

No description available.

Background: A multitude of studies suggest an association between periodontal disease and adverse birth outcomes. Although the evidence is controversial, it is biologically plausible, and the key link maybe inflammation. Purpose: To correlate levels of periodontal disease as measured by conventional methods with PMN counts from an oral rinse in pregnant women. Methods: Sixty-three pregnant women were recruited. Periodontal examinations were carried out. Fifteen-second saline rinses were collected. ABTS, a colour changing redox agent was added to each rinse. The intensity of the colour reaction was measured by absorbance to count the oral PMNs. Results: A statistically significant difference in oral PMN counts was observed between those with periodontal disease and the healthy patients (P < .05). The sensitivity and specificity using the bleeding index was 0.94 and 0.76 respectively. Conclusions: The rinse assay can be used as a screening tool for periodontal disease and oral inflammation in pregnant women.

Background: A multitude of studies suggest an association between periodontal disease and adverse birth outcomes. Although the evidence is controversial, it is biologically plausible, and the key link maybe inflammation. Purpose: To correlate levels of periodontal disease as measured by conventional methods with PMN counts from an oral rinse in pregnant women. Methods: Sixty-three pregnant women were recruited. Periodontal examinations were carried out. Fifteen-second saline rinses were collected. ABTS, a colour changing redox agent was added to each rinse. The intensity of the colour reaction was measured by absorbance to count the oral PMNs. Results: A statistically significant difference in oral PMN counts was observed between those with periodontal disease and the healthy patients (P < .05). The sensitivity and specificity using the bleeding index was 0.94 and 0.76 respectively. Conclusions: The rinse assay can be used as a screening tool for periodontal disease and oral inflammation in pregnant women.

SAIDA SHARAPOVA The role of stress in racial disparities of preterm and low birth weight births in Georgia (Under the direction of Richard Rothenberg, MD, MPH) Preterm birth (PTB) and low birth weight (LBW) are the leading causes of infant deaths in Georgia. Georgia PRAMS data (2004-2008) were analyzed for non-Hispanic White and non-Hispanic Black women with singleton births, using SAS 9.2 survey procedures. Thirteen stressful life events experienced in a year before delivery, socio-demographic, medical and behavioral risks were used as predictors of PTB and LBW. Significant racial disparity in birth outcomes and risks was found. In Whites stressful events were associated with adverse birth outcomes in bivariate logistic regression, but weakened when controlling for other factors (income, education, maternal age, maternal health, alcohol and tobacco use, infant’s gender and birth defects). In Blacks, association between stressful events and adverse birth outcomes adjusted for other risks was stronger. Socio-economic factors and mother’s health status were more significant in predicting birth outcome. Women’s health and SES improvement might increase favorable pregnancy outcomes and reduce racial disparities.

Although very low birth weight preterm (VLBW) infants with grade 3,4 retinopathy of prematurity (ROP) are at high risk for unfavorable visual outcomes, the middle school vision motor integration (VMI) skills and cognitive outcome scores of these children remain largely unknown. Data for 323 very VLBW survivors of the Multicenter Randomized Indomethacin IVH Prevention Trial (BW 600 1250 g) were analyzed to test the hypothesis that grades 3, 4 ROP would be an important predictor of cognitive and VMI skills. 3 subgroups were evaluated: ROP negative (N = 163), ROP grades 1,2 (N = 137) and ROP grades 3,4 (N = 23) were evaluated prospectively at 12 years of age with a neurocognitive battery. High-resolution volumetric MRI scans were quantified for 40 of the study subjects, and occipital brain volumes were correlated with Beery VMI scores. Children with ROP 3-4 had [arrow up - increased] vision impairment and lower test scores. Whole brain volumes were significantly less for children with any grade of ROP (p = 0.02), occipital white matter volumes tended to be less for the same study subjects (p = 0.08) and both total occipital brain volumes and occipital white matter volumes were significantly correlated with Beery VMI scores (r=0.610, p = 0.009 and r = 0.652, p =0.005, respectively). Prematurely-born children with a history of grade 3-4 ROP continue to have [arrow up - increased] vision impairment, special needs and lower performance on cognitive, language and visual motor integration scores at age 12 years. Both whole occipital brain volumes and occipital white matter volumes were predictive of VMI scores for children with ROP. (supp by NS 27116)

The purpose of this study was to determine the effect of posttraumatic stress disorder (PTSD), diagnosed prospectively during pregnancy, on the occurrence of low birthweight (<2500 grams) and preterm delivery (<37 weeks gestational age). A cohort of 1362 women was recruited from prenatal care visits and screened for depression, panic disorder, posttraumatic stress disorder, and substance use. Current episodes of PTSD were assessed using the MINI International Neuropsychiatric Interview. Pregnancy outcomes were abstracted from hospital records after delivery, and the data were analyzed using logistic regression. Two hundred sixty two women (33%) were lost to follow-up due to unavailable medical records, leaving 1100 women in the final analyses. Among these 1100 women, 31 (3%) were found to have PTSD during pregnancy. Substance use in pregnancy, panic disorder, major and minor depressive disorders, and prior preterm delivery were significantly associated with PTSD in the sample, while age, language spoken, and race were not. Low birthweight (LBW) was present in 6.5% of sampled women and was not significantly associated with a diagnosis of PTSD in pregnancy when adjusting for potential confounders. However, LBW was significantly associated with minor depressive disorder OR= 1.82 (CI=1.01, 3.29). Preterm delivery occurred in 7.0% of those without and 16.1% of those with PTSD (p=0.055). Because prior preterm delivery data were not available for 33% of women with PTSD, this variable was included only in secondary analyses. However, the association between PTSD and preterm delivery depended on this variable, with OR= 2.82 (0.95, 8.38) before controlling for prior preterm delivery and OR=3.35 (1.04, 10.85) after controlling for prior preterm delivery. These data suggest that a possible association of PTSD and preterm delivery was limited by the low rates of PTSD in this cohort and the inability to control for all confounders. Taken together, these findings provide limited support for the hypothesized association between PTSD and preterm delivery and no support for an association of PTSD with LBW.