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Dhume SH, Balogun K, Sarkar A, Acosta S, Mount HTJ, Cahill LS, Sled JG, Serghides L. Perinatal exposure to atazanavir-based antiretroviral regimens in a mouse model leads to differential long-term motor and cognitive deficits dependent on the NRTI backbone. Front Mol Neurosci 2024; 17:1376681. [PMID: 38646101 PMCID: PMC11027900 DOI: 10.3389/fnmol.2024.1376681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
Background Combination antiretroviral therapy (ART) use in pregnancy has been pivotal in improving maternal health and reducing perinatal HIV transmission. However, children born HIV-exposed uninfected fall behind their unexposed peers in several areas including neurodevelopment. The contribution of in utero ART exposure to these deficits is not clear. Here we present our findings of neurocognitive outcomes in adult mice exposed in utero to ART. Methods Dams were treated with a combination of ritonavir-boosted atazanavir with either abacavir plus lamivudine (ABC/3TC + ATV/r) or tenofovir disoproxil fumarate plus emtricitabine (TDF/FTC + ATV/r), or water as a control, administered daily from day of plug detection to birth. Offspring underwent a battery of behavioral tests that investigated motor performance and cognition starting at 6-weeks of age and ending at 8 months. Changes in brain structure were assessed using magnetic resonance imaging and immunohistochemistry. Expression of genes involved in neural circuitry and synaptic transmission were assessed in the hippocampus, a region strongly associated with memory formation, using qPCR. Findings Pups exposed to TDF/FTC + ATV/r showed increased motor activity and exploratory drive, and deficits in hippocampal-dependent working memory and social interaction, while pups exposed to ABC/3TC + ATV/r showed increased grooming, and deficits in working memory and social interaction. Significant volumetric reductions in the brain were seen only in the ABC/3TC + ATV/r group and were associated with reduced neuronal counts in the hippocampus. Altered neurotransmitter receptor mRNA expression as well as changes in expression of the neurotrophic factor BDNF and its receptors were observed in both ART-exposed groups in a sex-dependent manner. Interpretation In our model, in utero ART exposure had long-term effects on brain development and cognitive and motor outcomes in adulthood. Our data show that neurological outcomes can be influenced by the type of nucleoside reverse transcriptase inhibitor backbone of the regimen and not just the base drug, and display sex differences.
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Affiliation(s)
- Shreya H. Dhume
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Kayode Balogun
- Department of Pathology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, United States
| | - Ambalika Sarkar
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Sebastian Acosta
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Howard T. J. Mount
- Tanz Centre for Research in Neurodegenerative Diseases, Department of Psychiatry and Physiology, University of Toronto, Toronto, ON, Canada
| | - Lindsay S. Cahill
- Department of Chemistry, Memorial University of Newfoundland, St. John’s, NL, Canada
- Mouse Imaging Centre, Toronto Centre for Phenogenomics, Toronto, ON, Canada
| | - John G. Sled
- Mouse Imaging Centre, Toronto Centre for Phenogenomics, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Lena Serghides
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Women’s College Research Institute, Toronto, ON, Canada
- Department of Immunology, University of Toronto, Toronto, ON, Canada
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Rice M, Ozdemir S, Familiar-Lopez I, Arima EG, Awadu J, Ojuka JC, Boivin MJ. Attention Test Assessment from a Cluster Randomized Controlled Trial of Caregiver Training for Ugandan Preschool Children Living with Perinatal HIV. Dev Neuropsychol 2023; 48:361-372. [PMID: 37968963 DOI: 10.1080/87565641.2023.2280182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 11/01/2023] [Indexed: 11/17/2023]
Abstract
Fifty-six Ugandan mothers/caregivers received Mediational Intervention for Sensitizing Caregivers (MISC) biweekly for one year; 46 mothers received treatment-as-usual. Preschool PHIV child attention was measured by proportion of time viewing a 7-min animation (early childhood vigilance test or ECVT) at enrollment, 6 and 12 months. Analysis of covariance compared ECVT outcomes for the two intervention groups, controlling for baseline ECVT performance, age and weight-for-age z scores. Differences by trial arm were not significant at any of the three time points. MISC trial-arm children on combination ART during the study period displayed more stable ECVT scores across time points compared to controls.
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Affiliation(s)
- Micaela Rice
- College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Sevil Ozdemir
- College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | | | - Ethan Godwills Arima
- Child Development Center, Makerere University - Johns Hopkins University, Kampala, Uganda
| | - Jorem Awadu
- Department of Psychiatry, Michigan State University, East Lansing, Michigan, USA
| | | | - Michael J Boivin
- Department of Psychiatry, Michigan State University, East Lansing, Michigan, USA
- Department of Neurology & Ophthalmology, Michigan State University, East Lansing, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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Ruff A, Dlamini X, Nonyane BA, Simmons N, Kochelani D, Burtt F, Mlotshwa F, Gama N, Scheepers E, Schmitz K, Simelane L, Van Lith LM, Black MM. A trial of nurturing care among children who are HIV-exposed and uninfected in eSwatini. J Int AIDS Soc 2023; 26 Suppl 4:e26158. [PMID: 37909213 PMCID: PMC10618895 DOI: 10.1002/jia2.26158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/21/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Children who are HIV-exposed and uninfected (CHEU) are a growing population at potential risk of poor neurocognitive development. We tested a nurturing care intervention on children's neurocognitive development and maternal depressive symptoms (primary) with mediation through caregiving activities (secondary). METHODS This study was conducted among six intervention and nine comparison antenatal-care/prevention of vertical transmission (ANC/PVT) HIV clinics in eSwatini. We enrolled pregnant women and measured infant development at 9 and 18 months. mothers2mothers (m2m) designed and implemented the clinic-home-community-based intervention. We measured infants' neurodevelopment, maternal depressive symptoms and caregiving activities with the Mullen Scales of Early Learning (MSEL), Edinburgh Postnatal Depression Scale, HOME Inventory and Family Care Indicators. We fitted linear mixed effects regression models with clinic random effects to compare intervention versus comparison arms, and generalised structural equation models to evaluate mediation, adjusting for confounders. RESULTS Mother-infant pairs (n = 429) participated between January 2016 through May 2018. Socio-demographic characteristics were balanced between arms except for higher rates of peri-urban versus rural residence and single versus married mothers in the comparison group. The 18 month retention was 82% (180/220) intervention, 79% (166/209) comparison arm, with 25 infant deaths. Intervention MSEL scores were significantly, and modestly, higher in receptive language (55.7 [95% CI 54.6, 56.9] vs. 53.7 [95% CI 52.6, 54.8]), expressive language (42.5 [95% CI 41.6, 39.8] vs. 40.8 [95% CI 39.8, 41.7]) and composite MSEL (85.4 [95% CI 83.7, 84.5] vs. 82.7 [95% CI 81.0, 84.5]), with no difference in maternal depressive symptoms or in observations of mother-child interactions. Intervention book-sharing scores were higher (0.63 vs. 0.41) and mediated the effect on MSEL scores (indirect effect, p-values ≤ 0.024). The direct effects on visual reception and expressive language scores were significantly higher in the intervention compared to the comparison arm (coefficients 1.93 [95% CI 0.26, 3.60] and 1.66 [95% CI 0.51, 2.79, respectively]). CONCLUSIONS Nurturing care interventions can be integrated into ANC/PVT clinic-home-community programmes. The intervention, mediated through interactive caregiving activities, increased language development scores among CHEU. Partnering with a local team, m2m, to design and implement a culturally relevant intervention illustrates the ability to impact parent-child play and learning activities that are associated with children's neurodevelopment.
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Affiliation(s)
- Andrea Ruff
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Bareng As Nonyane
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nicole Simmons
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Duncan Kochelani
- Johns Hopkins Center for Communication Programs, Baltimore, Maryland, USA
| | | | - Fakazi Mlotshwa
- Johns Hopkins Center for Communication Programs, Baltimore, Maryland, USA
| | - Ncamsile Gama
- Johns Hopkins Center for Communication Programs, Baltimore, Maryland, USA
| | | | | | | | - Lynn M Van Lith
- Johns Hopkins Center for Communication Programs, Baltimore, Maryland, USA
| | - Maureen M Black
- University of Maryland School of Medicine, Baltimore, Maryland, USA
- RTI International, Research Triangle Park, North Carolina, USA
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Nove A, Bazirete O, Hughes K, Turkmani S, Callander E, Scarf V, Forrester M, Mandke S, Pairman S, Homer CS. Which low- and middle-income countries have midwife-led birthing centres and what are the main characteristics of these centres? A scoping review and scoping survey. Midwifery 2023; 123:103717. [PMID: 37182478 PMCID: PMC10281083 DOI: 10.1016/j.midw.2023.103717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/22/2023] [Accepted: 05/07/2023] [Indexed: 05/16/2023]
Abstract
Evidence about the safety and benefits of midwife-led care during childbirth has led to midwife-led settings being recommended for women with uncomplicated pregnancies. However, most of the research on this topic comes from high-income countries. Relatively little is known about the availability and characteristics of midwife-led birthing centres in low- and middle-income countries (LMICs). This study aimed to identify which LMICs have midwife-led birthing centres, and their main characteristics. The study was conducted in two parts: a scoping review of peer-reviewed and grey literature, and a scoping survey of professional midwives' associations and United Nations Population Fund country offices. We used nine academic databases and the Google search engine, to locate literature describing birthing centres in LMICs in which midwives or nurse-midwives were the lead care providers. The review included 101 items published between January 2012 and February 2022. The survey consisted of a structured online questionnaire, and responses were received from 77 of the world's 137 low- and middle-income countries. We found at least one piece of evidence indicating that midwife-led birthing centres existed in 57 low- and middle-income countries. The evidence was relatively strong for 24 of these countries, i.e. there was evidence from at least two of the three types of source (peer-reviewed literature, grey literature, and survey). Only 14 of them featured in the peer-reviewed literature. Low- and lower-middle-income countries were more likely than upper-middle-income countries to have midwife-led birthing centres. The most common type of midwife-led birthing centre was freestanding. Public-sector midwife-led birthing centres were more common in middle-income than in low-income countries. Some were staffed entirely by midwives and some by a multidisciplinary team. We identified challenges to the midwifery philosophy of care and to effective referral systems. The peer-reviewed literature does not provide a comprehensive picture of the locations and characteristics of midwife-led birthing centres in low- and middle-income countries. Many of our findings echo those from high-income countries, but some appear to be specific to some or all low- and middle-income countries. The study highlights knowledge gaps, including a lack of evidence about the impact and costs of midwife-led birthing centres in low- and middle-income countries.
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Affiliation(s)
| | - Oliva Bazirete
- Novametrics Ltd, Duffield, Derbyshire, UK; University of Rwanda School of Nursing and Midwifery, Kigali, Rwanda
| | | | - Sabera Turkmani
- Burnet Institute Global Women's and Newborn Health Group, Melbourne, Vic, Australia
| | - Emily Callander
- Monash University Health Systems Services & Policy Unit, Melbourne, Vic, Australia
| | - Vanessa Scarf
- University of Technology Sydney School of Nursing and Midwifery, Sydney, NSW, Australia
| | - Mandy Forrester
- International Confederation of Midwives, The Hague, The Netherlands
| | - Shree Mandke
- International Confederation of Midwives, The Hague, The Netherlands
| | - Sally Pairman
- International Confederation of Midwives, The Hague, The Netherlands
| | - Caroline Se Homer
- Burnet Institute Global Women's and Newborn Health Group, Melbourne, Vic, Australia; University of Technology Sydney School of Nursing and Midwifery, Sydney, NSW, Australia
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Abdoola S, Swanepoel DW, Graham MA, van der Linde J. Developmental characteristics of young children in a low-income South African community. J Child Health Care 2023:13674935231173023. [PMID: 37150599 DOI: 10.1177/13674935231173023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Adequate early childhood development is critical for later-life success. Developmental profiles of specific populations are required to support implementation of early intervention services. Three hundred fifty-three caregivers of children with mean age 17.9 months (SD = 10.5) were selected from a primary healthcare clinic. Overall positive identification of signs of a developmental delay, with the Bayley Scales of Infant and Toddler Development III, was 51.8% (n = 183). Logistic regression analysis determined the effect of age and gender on results. Prevalence of developmental delay increased with age from 33.1% for children under 12 months to 61.7% and 66.3% for children between 13-24 months and 25-36 months, respectively. Females were 1.82 times (95% CI [1.16, 2.85]) more likely to have had no signs of developmental delay; 2.30 times (95% CI [1.14, 4.65]) in motor and 2.06 times (95% CI [1.23, 3.45]) in adaptive behaviour domains. One-third of children presented with low levels of adaptive behaviour functioning. One hundred and one (28.6%) participants across age groups displayed superior social-emotional ability, possibly due to familial structures and relationships. One-third of children presented with poor adaptive behaviour function, attributed to cultural differences. This study contributes to information on developmental characteristics of children in South Africa.
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Affiliation(s)
- Shabnam Abdoola
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Marien Alet Graham
- Department of Science Mathematics and Technology Education, Faculty of Education, University of Pretoria, Pretoria, South Africa
| | - Jeannie van der Linde
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
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Eke AC, Mirochnick M, Lockman S. Antiretroviral Therapy and Adverse Pregnancy Outcomes in People Living with HIV. N Engl J Med 2023; 388:344-356. [PMID: 36720135 PMCID: PMC10400304 DOI: 10.1056/nejmra2212877] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Ahizechukwu C Eke
- From the Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, and the Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore (A.C.E.); the Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine (M.M.), the Division of Infectious Diseases, Brigham and Women's Hospital (S.L.), and the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health (S.L.) - all in Boston; and the Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana (S.L.)
| | - Mark Mirochnick
- From the Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, and the Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore (A.C.E.); the Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine (M.M.), the Division of Infectious Diseases, Brigham and Women's Hospital (S.L.), and the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health (S.L.) - all in Boston; and the Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana (S.L.)
| | - Shahin Lockman
- From the Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, and the Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore (A.C.E.); the Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine (M.M.), the Division of Infectious Diseases, Brigham and Women's Hospital (S.L.), and the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health (S.L.) - all in Boston; and the Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana (S.L.)
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Springer PE, Laughton B, Esterhuizen TM, Slogrove AL, Kruger M. The Molteno Adapted Scale: A child development screening tool for healthcare settings. AFRICAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2022. [DOI: 10.4102/ajopa.v4i0.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Wedderburn CJ, Weldon E, Bertran-Cobo C, Rehman AM, Stein DJ, Gibb DM, Yeung S, Prendergast AJ, Donald KA. Early neurodevelopment of HIV-exposed uninfected children in the era of antiretroviral therapy: a systematic review and meta-analysis. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:393-408. [PMID: 35483380 PMCID: PMC9090907 DOI: 10.1016/s2352-4642(22)00071-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND There are 15·4 million children who are HIV-exposed and uninfected worldwide. Early child development crucially influences later academic and socioeconomic factors. However, the neurodevelopmental outcomes of HIV-exposed uninfected (HEU) children in the era of maternal antiretroviral therapy (ART) remain unclear. We aimed to examine the effects of in-utero exposure to HIV and ART on child neurodevelopment. METHODS For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, Africa-Wide Information, PsycInfo, and Global Health databases from inception to May 27, 2020, for studies from the past two decades reporting neurodevelopment of HEU children aged 0-5 years compared with HIV-unexposed (HU) children (aim 1), and effects of different maternal ART regimens on neurodevelopment of HEU children (aim 2). We did narrative syntheses for both aims, and a random-effects meta-analysis of high-quality studies comparing HEU children and HU children, to obtain weighted pooled estimates of effect sizes. This study was registered with PROSPERO, CRD42018075910. FINDINGS We screened 35 527 records and included 45 articles from 31 studies. Overall, 12 (57%) of 21 studies comparing HEU children and HU children found worse neurodevelopment in HEU children in at least one domain. Study design and methodological quality were variable, with heterogeneity across populations. Meta-analysis included eight high-quality studies comparing 1856 HEU children with 3067 HU children at ages 12-24 months; among HEU children with available data, 1709 (99%) of 1732 were exposed to ART. HEU children had poorer expressive language (effect size -0·17 [95% CI -0·27 to -0·07], p=0·0013) and gross motor function (-0·13 [-0·20 to -0·07], p<0·0001) than HU children, but similar cognitive development (-0·06 [-0·19 to 0·06], p=0·34), receptive language development (-0·10 [-0·23 to 0·03], p=0·14), and fine motor skills (-0·05 [-0·15 to 0·06], p=0·36). Results suggested little or no evidence of an effect of specific maternal ART regimens on neurodevelopment; study heterogeneity prevented meta-analysis. INTERPRETATION HEU children are at risk of subtle impairments in expressive language and gross motor development by age 2 years. We found no consistent effect of maternal ART regimens analysed, although evidence was scarce. We highlight the need for large high-quality longitudinal studies to assess the neurodevelopmental trajectories of HEU children and to investigate underlying mechanisms to inform intervention strategies. FUNDING Wellcome Trust and Medical Research Council.
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Affiliation(s)
- Catherine J Wedderburn
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; The Neuroscience Institute, University of Cape Town, Cape Town, South Africa; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; MRC Clinical Trials Unit, University College London, London, UK.
| | - Ella Weldon
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Cesc Bertran-Cobo
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Andrea M Rehman
- MRC International Statistics & Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Dan J Stein
- The Neuroscience Institute, University of Cape Town, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; MRC Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Diana M Gibb
- MRC Clinical Trials Unit, University College London, London, UK
| | - Shunmay Yeung
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew J Prendergast
- Blizard Institute, Queen Mary University of London, London, UK; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Kirsten A Donald
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; The Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Shuffrey LC, Firestein MR, Kyle MH, Fields A, Alcántara C, Amso D, Austin J, Bain JM, Barbosa J, Bence M, Bianco C, Fernández CR, Goldman S, Gyamfi-Bannerman C, Hott V, Hu Y, Hussain M, Factor-Litvak P, Lucchini M, Mandel A, Marsh R, McBrian D, Mourad M, Muhle R, Noble KG, Penn AA, Rodriguez C, Sania A, Silver WG, O’Reilly KC, Stockwell M, Tottenham N, Welch MG, Zork N, Fifer WP, Monk C, Dumitriu D. Association of Birth During the COVID-19 Pandemic With Neurodevelopmental Status at 6 Months in Infants With and Without In Utero Exposure to Maternal SARS-CoV-2 Infection. JAMA Pediatr 2022; 176:e215563. [PMID: 34982107 PMCID: PMC8728661 DOI: 10.1001/jamapediatrics.2021.5563] [Citation(s) in RCA: 109] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Associations between in utero exposure to maternal SARS-CoV-2 infection and neurodevelopment are speculated, but currently unknown. OBJECTIVE To examine the associations between maternal SARS-CoV-2 infection during pregnancy, being born during the COVID-19 pandemic regardless of maternal SARS-CoV-2 status, and neurodevelopment at age 6 months. DESIGN, SETTING, AND PARTICIPANTS A cohort of infants exposed to maternal SARS-CoV-2 infection during pregnancy and unexposed controls was enrolled in the COVID-19 Mother Baby Outcomes Initiative at Columbia University Irving Medical Center in New York City. All women who delivered at Columbia University Irving Medical Center with a SARS-CoV-2 infection during pregnancy were approached. Women with unexposed infants were approached based on similar gestational age at birth, date of birth, sex, and mode of delivery. Neurodevelopment was assessed using the Ages & Stages Questionnaire, 3rd Edition (ASQ-3) at age 6 months. A historical cohort of infants born before the pandemic who had completed the 6-month ASQ-3 were included in secondary analyses. EXPOSURES Maternal SARS-CoV-2 infection during pregnancy and birth during the COVID-19 pandemic. MAIN OUTCOMES AND MEASURES Outcomes were scores on the 5 ASQ-3 subdomains, with the hypothesis that maternal SARS-CoV-2 infection during pregnancy would be associated with decrements in social and motor development at age 6 months. RESULTS Of 1706 women approached, 596 enrolled; 385 women were invited to a 6-month assessment, of whom 272 (70.6%) completed the ASQ-3. Data were available for 255 infants enrolled in the COVID-19 Mother Baby Outcomes Initiative (114 in utero exposed, 141 unexposed to SARS-CoV-2; median maternal age at delivery, 32.0 [IQR, 19.0-45.0] years). Data were also available from a historical cohort of 62 infants born before the pandemic. In utero exposure to maternal SARS-CoV-2 infection was not associated with significant differences on any ASQ-3 subdomain, regardless of infection timing or severity. However, compared with the historical cohort, infants born during the pandemic had significantly lower scores on gross motor (mean difference, -5.63; 95% CI, -8.75 to -2.51; F1,267 = 12.63; P<.005), fine motor (mean difference, -6.61; 95% CI, -10.00 to -3.21; F1,267 = 14.71; P < .005), and personal-social (mean difference, -3.71; 95% CI, -6.61 to -0.82; F1,267 = 6.37; P<.05) subdomains in fully adjusted models. CONCLUSIONS AND RELEVANCE In this study, birth during the pandemic, but not in utero exposure to maternal SARS-CoV-2 infection, was associated with differences in neurodevelopment at age 6 months. These early findings support the need for long-term monitoring of children born during the COVID-19 pandemic.
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Affiliation(s)
- Lauren C. Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Morgan R. Firestein
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Margaret H. Kyle
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Andrea Fields
- Department of Psychology, Columbia University, New York, New York
| | | | - Dima Amso
- Department of Psychology, Columbia University, New York, New York
| | - Judy Austin
- Heilbrunn Department of Population and Family Health, Columbia University Irving Medical Center, New York, New York
| | - Jennifer M. Bain
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, New York
| | - Jennifer Barbosa
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Mary Bence
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Catherine Bianco
- Department of Psychology, Columbia University, New York, New York
| | - Cristina R. Fernández
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Sylvie Goldman
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, New York
| | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla
| | - Violet Hott
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Yunzhe Hu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Maha Hussain
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Arthur Mandel
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, New York
| | - Rachel Marsh
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Danielle McBrian
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, New York
| | - Mirella Mourad
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center New York, New York
| | - Rebecca Muhle
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Kimberly G. Noble
- Department of Neuroscience and Education, Teachers College, Columbia University, New York, New York
| | - Anna A. Penn
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | | | - Ayesha Sania
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Wendy G. Silver
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, New York
| | - Kally C. O’Reilly
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York,New York State Psychiatric Institute, New York
| | - Melissa Stockwell
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Nim Tottenham
- Department of Psychology, Columbia University, New York, New York
| | - Martha G. Welch
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York,Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Noelia Zork
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center New York, New York
| | - William P. Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York,Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Catherine Monk
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York,Department of Obstetrics and Gynecology, Columbia University Irving Medical Center New York, New York
| | - Dani Dumitriu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York,Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
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10
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Toledo G, Côté HCF, Adler C, Thorne C, Goetghebuer T. Neurological development of children who are HIV-exposed and uninfected. Dev Med Child Neurol 2021; 63:1161-1170. [PMID: 33987826 DOI: 10.1111/dmcn.14921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 12/20/2022]
Abstract
Widespread use of antiretroviral drugs for pregnant/breastfeeding females with human immunodeficiency virus (HIV) has led to declining vertical transmission. Despite being HIV-uninfected, the increasing number of children who are HIV-exposed and uninfected (CHEU) often present with developmental alterations. We review seminal and recent evidence on the neurological development of CHEU and associations with early life HIV/antiretroviral exposure. Our conceptual model highlights the numerous exposures and universal risk factors for CHEU developmental disorders. Early studies suggest a significant association between HIV exposure and neurological abnormalities, varying according to the burden of HIV-specific exposures and other risk factors. More recent observations from the modern era are inconsistent, although some studies suggest specific antiretrovirals may adversely affect neurological development of CHEU. As the CHEU population continues to grow, alongside simultaneous increases in types and combinations of antiretrovirals used in pregnancy, long-term monitoring of CHEU is necessary for understanding the effects of HIV/antiretroviral exposure on CHEU developmental outcomes. What this paper adds Evidence on the neurological development of children who are human immunodeficiency virus (HIV)-exposed and uninfected (CHEU) is synthesized. Comparisons are made to children who are HIV-unexposed, across treatment eras and settings, and by antiretroviral drug regimens and drug classes. CHEU exposures are complex and include HIV-specific and universal risk factors which may affect development during the early years of life.
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Affiliation(s)
- Gabriela Toledo
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Hélène C F Côté
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada
| | - Catherine Adler
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Claire Thorne
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Tessa Goetghebuer
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
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11
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Garrison A, Boivin M, Khoshnood B, Courtin D, Alao J, Mireku M, Ibikounle M, Massougbodji A, Cot M, Bodeau-Livinec F. Soil-transmitted helminth infection in pregnancy and long-term child neurocognitive and behavioral development: A prospective mother-child cohort in Benin. PLoS Negl Trop Dis 2021; 15:e0009260. [PMID: 33739991 PMCID: PMC7978343 DOI: 10.1371/journal.pntd.0009260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 02/21/2021] [Indexed: 12/14/2022] Open
Abstract
Background An estimated 30% of women in Sub-Saharan Africa suffer from soil-transmitted helminth infection during pregnancy (SHIP), which has been shown to increase risk of pre-term birth, low birth weight, and maternal anemia. A previous study in Benin found that SHIP was associated with impaired cognitive and gross motor development scores in 635 one-year-old children. The objective of the present study was to follow children prospectively to investigate whether the association between SHIP and child neurocognitive and behavioral development persisted at age six. Principal findings Our prospective child cohort included 487 live-born singletons of pregnant women enrolled in the Malaria in Pregnancy Preventive Alternative Drugs clinical trial in Allada, Benin. SHIP was assessed at three antenatal visits (ANVs) through collection and testing of stool samples. Neurocognitive and behavioral development was assessed in six-year-old children by trained investigators using the Kaufman Assessment Battery for Children 2nd edition and the parent-reported Strengths and Difficulties Questionnaire (SDQ). Multiple linear regression models generated coefficients and 95% confidence intervals and potential mediating factors were tested. Prevalence of SHIP was 13% at the 1st ANV, 9% at the 2nd ANV, and 1% at delivery. SHIP was not associated with low neurocognitive scores in children at six years. Higher SDQ internalizing scores, indicating increased emotional impairments in children, were associated with helminth infection at the 2nd ANV/delivery 1.07 (95% CI 0.15, 2.00) and at least once during pregnancy 0.79 (95% CI 0.12, 1.46) in adjusted models. Mediation analysis did not reveal significant indirect effects of several mediators on this association. Conclusions Our study shows that while SHIP is not associated with impaired long-term neurocognitive development, infections may have significant negative impacts on emotional development in six-year-old children. SHIP remains a critical public health issue, and adequate prevention and treatment protocols should be enforced in low- and middle-income countries. Soil-transmitted helminth infections impact 1.5 billion individuals, primarily in low- and middle- income countries, each year and contribute to malnutrition, anemia, and impaired neurocognitive development in children. However, these infections in pregnancy and their impact on offspring have been less studied. One previous study found associations between soil-transmitted helminth infection during pregnancy and impaired cognitive functioning in offspring one year after birth. The current study aimed to follow these children prospectively until six years in order to confirm whether these associations persisted or not. Infections during pregnancy were no longer associated with cognitive or motor functioning in children; however, infections were associated with impaired behavioral development. Animal-based models have hypothesized maternal inflammation and poor birth outcomes to be the mechanisms behind this relationship; however, our findings did not support these mechanisms. This is one of very few prospective cohort studies in Sub-Saharan Africa to investigate these associations, and more research is needed to corroborate results. Limitations include limited power and the possibility that results are due to chance from multiple statistical tests. Adequate and accessible prevention and treatment efforts in pregnancy and childhood should be provided to populations in low- and middle- income countries at high risk of infection.
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Affiliation(s)
- Amanda Garrison
- Département Méthodes Quantitatives en Santé Publique (METIS), Ecole des Hautes Etudes en Santé Publique, Rennes, France
- Université de Paris, Center of Research in Epidemiology and Statistics/CRESS, INSERM, INRA, Paris, France
- Sorbonne Universités, Université de Paris, Paris, France
- * E-mail:
| | - Michael Boivin
- Departments of Psychiatry and Neurology/Ophthalmology, Michigan State University, East Lansing, Michigan, United States of America
| | - Babak Khoshnood
- Département Méthodes Quantitatives en Santé Publique (METIS), Ecole des Hautes Etudes en Santé Publique, Rennes, France
| | | | - Jules Alao
- Service de Pédiatrie, CHU de la Mère et de l’Enfant-Lagune de Cotonou, Cotonou, Benin
| | - Michael Mireku
- School of Psychology, University of Lincoln, Lincoln, England
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, England
| | - Moudachirou Ibikounle
- Centre de Recherche pour la lutte contre les Maladies Infectieuses Tropicales, Université d’Abomey-Calavi, Cotonou, Benin
| | | | - Michel Cot
- Université de Paris, MERIT, IRD, Paris, France
| | - Florence Bodeau-Livinec
- Département Méthodes Quantitatives en Santé Publique (METIS), Ecole des Hautes Etudes en Santé Publique, Rennes, France
- Université de Paris, Center of Research in Epidemiology and Statistics/CRESS, INSERM, INRA, Paris, France
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12
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White M, Connor KL. In Utero HIV Exposure and the Early Nutritional Environment Influence Infant Neurodevelopment: Findings from an Evidenced Review and Meta-Analysis. Nutrients 2020; 12:nu12113375. [PMID: 33147767 PMCID: PMC7692402 DOI: 10.3390/nu12113375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 12/17/2022] Open
Abstract
The developing brain is especially vulnerable to infection and suboptimal nutrition during the pre- and early postnatal periods. Exposure to maternal human immunodeficiency virus (HIV) infection and antiretroviral therapies (ART) in utero and during breastfeeding can adversely influence infant (neuro) developmental trajectories. How early life nutrition may be optimised to improve neurodevelopmental outcomes for infants who are HIV-exposed has not been well characterised. We conducted an up-to-date evidence review and meta-analysis on the influence of HIV exposure in utero and during breastfeeding, and early life nutrition, on infant neurodevelopmental outcomes before age three. We report that exposure to maternal HIV infection may adversely influence expressive language development, in particular, and these effects may be detectable within the first three years of life. Further, while male infants may be especially vulnerable to HIV exposure, few studies overall reported sex-comparisons, and whether there are sex-dependent effects of HIV exposure on neurodevelopment remains a critical knowledge gap to fill. Lastly, early life nutrition interventions, including daily maternal multivitamin supplementation during the perinatal period, may improve neurodevelopmental outcomes for infants who are HIV-exposed. Our findings suggest that the early nutritional environment may be leveraged to improve early neurodevelopmental trajectories in infants who have been exposed to HIV in utero. A clear understanding of how this environment should be optimised is key for developing targeted nutrition interventions during critical developmental periods in order to mitigate adverse outcomes later in life and should be a priority of future research.
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13
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Gruver RS, Mall S, Kvalsvig JD, Knox JR, Mellins CA, Desmond C, Kauchali S, Arpadi SM, Taylor M, Davidson LL. Cognitive and Language Development at Age 4-6 Years in Children HIV-Exposed But Uninfected Compared to Those HIV-Unexposed and to Children Living With HIV. New Dir Child Adolesc Dev 2020; 2020:39-54. [PMID: 32618410 DOI: 10.1002/cad.20351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Perinatal HIV infection is associated with delayed neurocognitive development, but less is known about children perinatally HIV-exposed but uninfected (CHEU). We compared cognitive and language outcomes in 4-6-year old CHEU versus children HIV-unexposed and uninfected (CHUU) and children living with HIV (CLHIV). We enrolled 1,581 children (77% of the child population) in five communities in KwaZulu-Natal, South Africa. Children completed: Grover-Counter Scale of cognitive development, sub-scales of the Kaufman Assessment Battery for Children, Reynell Developmental Language Scales. HIV status of children and primary caregivers was determined by repeated rapid tests or report of prior testing. We conducted a cross-sectional multivariable linear regression on 922 dyads with complete data (257 CHEU, 627 CHUU, 38 CLHIV). On all outcome measures, CHEU and CHUU groups had comparable scores; CLHIV scored significantly lower. Emerging global progress toward the elimination of vertical HIV transmission may not only reduce mortality, but also positively impact child development.
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Affiliation(s)
- Rachel S Gruver
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Sumaya Mall
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jane D Kvalsvig
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Justin R Knox
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Chris Desmond
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Shuaib Kauchali
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Stephen M Arpadi
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.,Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Myra Taylor
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Leslie L Davidson
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.,Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, NY, USA
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14
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Davis AG, Nightingale S, Springer PE, Solomons R, Arenivas A, Wilkinson RJ, Anderson ST, Chow FC. Neurocognitive and functional impairment in adult and paediatric tuberculous meningitis. Wellcome Open Res 2019; 4:178. [PMID: 31984243 PMCID: PMC6971841 DOI: 10.12688/wellcomeopenres.15516.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2019] [Indexed: 12/20/2022] Open
Abstract
In those who survive tuberculous meningitis (TBM), the long-term outcome is uncertain; individuals may suffer neurocognitive, functional and psychiatric impairment, which may significantly affect their ability to lead their lives as they did prior to their diagnosis of TBM. In children who survive, severe illness has occurred at a crucial timepoint in their development, which can lead to behavioural and cognitive delay. The extent and nature of this impairment is poorly understood, particularly in adults. This is in part due to a lack of observational studies in this area but also inconsistent inclusion of outcome measures which can quantify these deficits in clinical studies. This leads to a paucity of appropriate rehabilitative therapies available for these individuals and their caregivers, as well as burden at a socioeconomic level. In this review, we discuss what is known about neurocognitive impairment in TBM, draw on lessons learnt from other neurological infections and discuss currently available and emerging tools to evaluate function and cognition and their value in TBM. We make recommendations on which measures should be used at what timepoints to assess for impairment, with a view to optimising and standardising assessment of neurocognitive and functional impairment in TBM research.
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Affiliation(s)
- Angharad G Davis
- University College London, Gower Street, London, WC1E 6BT, UK.,Francis Crick Institute, Midland Road, London, NW1 1AT, UK.,Institute of Infectious Diseases and Molecular Medicine. Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - Sam Nightingale
- HIV Mental Health Research Unit, University of Cape Town,, Observatory, 7925, South Africa
| | - Priscilla E Springer
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Regan Solomons
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ana Arenivas
- The Institute for Rehabilitation and Research Memorial Hermann, Department of Rehabilitation Psychology and Neuropsychology,, Houston, Texas, USA.,Baylor College of Medicine, Department of Physical Medicine and Rehabilitation, Houston, Texas, USA
| | - Robert J Wilkinson
- Francis Crick Institute, Midland Road, London, NW1 1AT, UK.,Department of Infectious Diseases, Imperial College London, London, W2 1PG, UK.,Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Diseases and Molecular Medicine at Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - Suzanne T Anderson
- MRC Clinical Trials Unit at UCL, University College London, London, WC1E 6BT, UK.,Evelina Community, Guys and St Thomas' NHS Trust, 5 Dugard Way, London, SE11 4TH, UK
| | - Felicia C Chow
- Weill Institute of Neurosciences, Department of Neurology and Division of Infectious Diseases, University of California, San Francisco, California, USA
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