Are there differences in birth weight according to sex and associations with maternal exposure to air pollutants? A cohort study

Sex differences in delivery and neonatal characteristics of new-borns from the "MAMI-MED" cohort

Introduction

Exploring modifiable and non-modifiable determinants-like sex of new-borns, maternal characteristics, and lifestyle-of maternal and child health is a priority in Public Health. Understanding these sex-based differences is essential for tailored care and informed public health policies.

Methods

The present study aimed to delineate sex disparities in delivery and neonatal characteristics within the "MAMI MED" cohort, an ongoing prospective study involving mother-child pairs from Catania, Italy. The analysis included 1,090 mother-child pairs.

Results

The comparison of birth weight and birth length distribution showed some differences between sexes, confirmed by higher birth weight (β = 0.121; 95% CI = 0.071-0.172) and greater birth length (β = 0.659; 95% CI = 0.360-0.958) in males compared to females. However, the comparison of small and adequate for gestational age (SGA vs. AGA) revealed that the likelihood of being SGA was higher in males than in females (OR = 1.592; 95% CI = 1.005-2.563).

Discussion

Thus, the focus should be on improving the assessment of gender-based differences in diagnostic criteria and incorporating gender-specific aspects into existing preventive guidelines to deeply understand the effect of gender disparities and risk factors on maternal-child health.

Ambient air pollution and low birth weight in Brazil: A nationwide study of more than 10 million births between 2001 and 2018

Low birth weight (LBW) is a global health concern. While it is commonly associated with maternal health and behavior, exposure to ambient air pollution, can also play a role in contributing to LBW. In Brazil, where diverse environmental conditions and regional disparities exist, assessing the impact of ambient air pollution on LBW becomes particularly pertinent. To our knowledge, there is a gap in the existing literature, as no previous study has specifically investigated the relationship between ambient air pollution and LBW nationwide in Brazil. This study aims to fill this gap by examining the association between ambient air pollution and LBW in each trimester of pregnancy across the Brazilian states. In this work, birth data from January 1, 2001, to December 31, 2018 has been used. We utilized logistic regression models to estimate the odds ratio (OR) for low birth weight (LBW) associated with ambient air pollution (PM2.5, NO2, and O3) during each trimester of pregnancy (1st to 3rd trimester) across all 27 Brazilian states in our nationwide case-control study. We adjusted our model for several variables, including ambient temperature, relative humidity, and socioeconomic status (SES) variables at the individual level. We also conducted effect modification analyses by infant sex, mother's age, and the number of prenatal visits. Our study comprises over 10,213,144 birth records nationwide. Of these, 479,204 (4.92%) infants were included as cases of LBW. Our results indicate positive associations between PM2.5 and LBW, mainly in the Southern region. For example, in the state of Santa Catarina (South region), ORs were 1.003 (95% CI: 1.002, 1.004), 1.003 (95% CI: 1.002, 1.004), and 1.005 (95% CI: 1.003, 1.007) for the 1st, 2nd, and 3rd trimesters of exposure, respectively. NO2 had a robust association with LBW in the Northern and Northeastern states, including the state of Amapá (North region, where the Amazon Forest is located) with ORs of 1.377 (95% CI: 1.010, 1.878), 1.390 (95% CI: 1.020, 1.894), and 1.747 (95% CI: 1.297, 2.352) for the 1st, 2nd, and 3rd trimesters of exposure, respectively. Similarly, O3 had a robust association in the North and Midwest states, as observed in the state of Amapá with ORs of 1.033 (95% CI: 1.012, 1.054), and 1.033 (95% CI: 1.013, 1.053) for the 2nd, and 3rd trimesters, respectively. In the stratified analysis, boys were more vulnerable than girls, and the lower number of prenatal visits was associated with higher OR. Our findings are essential to the development of guidelines to prevent maternal exposure and protection of newborns in Brazil. This study provides valuable insights for region-specific strategies to improve maternal and neonatal health.

Late diagnosis of autism spectrum disorder-Journey, parents' concerns, and sex influences

Despite increasing awareness for diagnosing autism spectrum disorder (ASD) and initiating treatments early in life, many children and adolescents continue to be diagnosed at a relatively older age. Focusing on children who first received an ASD diagnosis at age six or older, this study aimed to describe the symptoms that parents reported when ASD was diagnosed, follow the patients' clinical trajectory prior to receiving the diagnosis, and describe differences in symptoms and prior diagnoses between males and females cases. We included 258 children (205 males and 53 females) who were first diagnosed with autism at age 6-18 in 2017-2018. We retrieved demographic information, neurologic and developmental symptoms, diagnoses, and medications dispensing history from the children's electronic medical charts. The data indicated that prior diagnoses of language delays and attention deficit hyperactivity disorder were common among children with a late ASD diagnosis. Two thirds of the children were prescribed one or more medications to treat psychosocial and behavioral conditions before receiving a late ASD diagnosis. Difficulties in social relationships with peers were the leading reported symptoms by parents at the time of ASD diagnosis. Across these different domains, some differences were found between males and females, including a somewhat higher cognitive level in males, who were also more likely to present aggressive behavior.

Fetal glycated albumin levels in offspring of obese women

OBJECTIVE

To determine the association between maternal obesity and fetal glycated albumin (GA) levels among pregnant women.

METHODS

A comparative, cross-sectional study of 59 consenting, normoglycemic, pregnant women, who met the criteria for maternal obesity, attending the antenatal clinic of the University College Hospital, Nigeria, from June 2019 to December 2019. They were recruited at 36 weeks of gestation, followed up until delivery, and compared with 58 nonobese, normoglycemic pregnant controls. At delivery, blood samples were taken from the mothers and from the umbilical cords of their newborns for serum GA assay. Maternal and newborn variables were recorded, and comparisons were made using χ² tests, independent t tests, odds ratios, analysis of variance, and Pearson correlates. Statistical significance was set at P < 0.05.

RESULTS

The odds of elevated newborn GA were 3.21 times higher in obese women compared with nonobese women (P = 0.005) and 5-min APGAR scores were higher in the newborns of nonobese women (P = 0.039). There was a significant correlation between maternal and neonatal GA for all participants (r = 0.346, P = 0.000).

CONCLUSION

These findings suggest that maternal obesity is associated with elevated fetal GA and low APGAR scores at 5 min in normoglycemic women.

Impact of children born with low birth weight on stunting and wasting in Sindh province of Pakistan: a propensity score matching approach

Low Birth Weight (LBW) is considered as a major public health issue and leading cause of neonatal death. Almost one in four newborns are reported as underweight in Pakistan. Children born with low birth weight are highly vulnerable to develop diseases and death and/or remain undernourished (i.e., stunted and wasted). This study determines the LBW newborns are more prone to develop stunting and wasting in province of Sindh, Pakistan. Moreover, regression-based estimation of the impact of LBW on the child health outcomes of under five years of age, may be prone to selection bias because of the nature of non-experimental data set, thus, propensity score matching methods are used in this study. Data for this study was used from Multiple Indicators Cluster Survey (MICS-2014). MICS is a two-stage, stratified cluster sampling household level data covering urban and rural areas and consists of 19,500 households from five administrative divisions and 28 districts of Sindh province of Pakistan. The total sample size of children less than five years of age after cleaning the data are 7781, of which 2095 are LBW having birth weight categorized as "smaller than average and very small" and 5686 are normal birth weight (NBW) having birth weight very large, larger than average, and average. This study employed propensity score matching (PSM) regression methods to understand whether the children born as low birth weight are more prone to stunting and wasting and/or both. In province of Sindh, moderate wasting children under five years were 21%, severe wasting 6% and both wasting and stunting 10%. The propensity score results are shown significant in all groups. Specifically, all four types of PSM methods confirm a significant difference in the potential outcome variables-meaning that a child born with LBW has a significant adverse effect on the potential child health outcome variables (stunting, wasting and both). Thus, the propensity score matching findings confirm a significant and adverse effect of LBW on potential health outcomes of under five children. Similarly, low birth weight children are significantly more likely to be moderately wasted (OR = 1.5, CI = 1.3-1.6) and severely wasted (OR = 1.6, CI = 1.3-2.0) and both (stunted and wasted, OR = 2.0, CI = 1.7-2.3) as compared to children with normal birth weight. Male children, if born with low birth weight, are significantly more likely to be moderately wasted (OR = 1.3, CI = 1.1-1.5) and both (wasted and stunted, OR = 1.3, CI = 1.1-1.5) than girls. This large data analysis finding proved that the LBW newborns are on higher risk to develop wasting and stunting in Pakistan.

Exposure to ambient particulate matter and biomass burning during pregnancy: associations with birth weight in Thailand

BACKGROUND

There is a growing evidence that exposure to ambient particulate air pollution during pregnancy is associated with adverse birth outcomes, including reduced birth weight (BW). The objective of this study was to quantify associations between BW and exposure to particulate matter (PM) and biomass burning during pregnancy in Thailand.

METHODS

We collected hourly ambient air pollutant data from ground-based monitors (PM with diameter of <10 µm [PM₁₀], Ozone [O₃], and nitrogen dioxide [NO₂]), biomass burning from satellite remote sensing data, and individual birth weight data during 2015-2018. We performed a semi-ecological analysis to evaluate the association between mean trimester exposure to air pollutants and biomass burning with BW and low-birth weight (LBW) (<2500 g), adjusting for gestation age, sex, previous pregnancies, mother's age, heat index, season, year, gaseous pollutant concentrations, and province. We examined potential effect modification of PM₁₀ and biomass burning exposures by sex.

RESULTS

There were 83,931 eligible births with a mean pregnancy PM₁₀ exposure of 39.7 µg/m³ (standard deviation [SD] = 7.7). The entire pregnancy exposure was associated with reduced BW both for PM₁₀ (-6.81 g per 10 µg/m³ increase in PM₁₀ [95% CI = -12.52 to -1.10]) and biomass burning (-6.34 g per 1 SD increase in fires/km² [95% CI = -11.35 to -1.34]) only after adjustment for NO₂. In contrast with these findings, a reduced odds ratio (OR) of LBW was associated with PM₁₀ exposure only in trimesters one and two, with no relationship across the entire pregnancy period. Associations with biomass burning were limited to increased ORs of LBW with exposure in trimester three, but only for male births.

CONCLUSION

Based on our results, we encourage further investigation of air pollution, biomass burning and BW in Thailand and other low-income and middle-income countries.

The factors affecting the physical development of neonates in pregnant women with or without gestational diabetes mellitus

OBJECTIVES

To explore the factors affecting neonatal physical development in pregnant women with or without gestational diabetes mellitus (GDM).

METHODS

The subjects were selected from the pregnant woman giving birth in 2nd Affiliated Hospital of Zhengzhou University, from November 2015 to May 2016. The age, occupation, education level, gestational age, body weight before pregnancy, body weight at delivery, body height, delivery pattern, GDM status of pregnant women and neonatal gender, birth weight (BW), chest circumference (CC), head circumference (HC) and birth length (BL) were collected through medical records and questionnaires. The clinical data were retrospectively analyzed and studied.

RESULTS

The significant differences were found between women with GDM and without GDM in following neonatal variables (P<0.05): BW, CC, and HC. GDM status increased the incidence of macrosomia (OR = 2.241, 95% CI: 1.406-3.573), large CC (OR = 2.470, 95% CI: 1.687-3.6153). Gestational weight gain (GWG) above IOM guideline was risk factor for macrosomia (OR = 1.763, 95% CI:1.098-2.833), large HC (OR = 1,584, 95% CI: 1.093-2.296) and large CC (OR = 1.707, 95% CI:1.163-2.506). Underweight was risk factor for short BL (OR = 2.543, 95% CI:1.161-5.571) and small CC (OR = 1.901, 95% CI:1.064-3.394). Female neonate was prone to appear short BL(OR = 2.831, 95% CI: 1.478-5.422) and small HC (OR = 2.750, 95% CI: 1.413-5.350), and not likely to macrosomia (OR = 0.538, 95% CI: 0.343-0.843), longer BL (OR = 0.584, 95% CI: 0.401-0.850), large HC (OR = 0.501, 95% CI: 0.352-0.713), and (OR = 0.640, 95% CI: 0.446-0.917). For women with GDM, gestational age was an risk factor of neonatal BW (low BW: OR = 0.207, 95% CI: 0.085-0.503; macrosomia: OR = 1.637, 95% CI: 1.177-2.276), BL (short BL: OR = 0.376, 95% CI: 0.241-0.585; long BL: OR = 1.422, 95% CI: 1.054-1.919), HC (small HC: OR = 0.343, 95% CI: 0.202-0.583; large HC: OR = 1.399, 95% CI: 1.063-1.842) and CC (small CC: OR = 0.524, 95% CI: 0.374-0.733; large CC: OR = 1.485, 95% CI: 1.138-1.936).

CONCLUSIONS

In our study, gestational age, GDM status, neonatal gender, GWG and pre-pregnancy body mass index (BMI) are associated the abnormal physical development of neonates. In women with GDM, gestational age was correlate with neonatal abnormal physical developments.

Association between antenatal maternal anxiety and fetal middle cerebral artery Doppler depends on fetal gender

Objective: Several studies have demonstrated that antenatal maternal anxiety (AMA) during pregnancy is associated with an increased risk of abnormal fetal Doppler parameters and adverse perinatal outcomes. Despite these studies, the evidence of the association between them remains inconclusive due in part to the methodological limitations of existing studies. Hence, in the present study, we established strict criteria and excluded patients who may have moderate or confounding variables to investigate the relationship between AMA and fetal Doppler findings and adverse perinatal outcomes.Methods: This was a cross-sectional study of 160 healthy nulliparous pregnant women (gestational age 31-33 weeks) with uncomplicated obstetric histories, who underwent Doppler flow studies on uterine, umbilical and fetal middle cerebral artery (MCA). Maternal anxiety was measured by STAI-State and STAI-Trait inventory.Results: Statistical analyses revealed that STAI-Trait anxiety was associated with lower MCA pulsatility index at 31-33 weeks gestational age and lower birth weight for the female fetus. There were no significant differences in the birth weight of boys of mothers with high anxiety and without high anxiety.Conclusions: The adaptation of the fetus to this hostile environment as AMA differs by gender. Adaptation for the female fetus means the "brain sparing effect" and reduced birth weight. The findings emphasize the potential importance of maternal psychological wellbeing during pregnancy for fetal development.

Maternal exposure to benzene and toluene and preterm birth. A longitudinal study

BACKGROUND

Exposure to air pollutants has several effects on human health, including during pregnancy.

OBJECTIVE

To identify whether exposure to benzene and toluene among pregnant women contributes to preterm delivery.

DESIGN AND SETTING

Longitudinal study using data on newborns from mothers living in São José dos Campos (SP) in 2016, who had been exposed to benzene and toluene.

METHODS

A logistic regression model with three hierarchical levels was constructed using maternal variables relating to newborns, and using benzene and toluene concentrations in quartiles. Occurrences of cesarean births, twins or malformations were excluded. Maternal exposure windows of 5, 10, 15, 30, 60 and 90 days prior to delivery were considered.

RESULTS

Out of the 9,562 live births, 3,671 newborns were included and 343 newborns were born at less than 37 weeks of gestation (9.3%). The average birth weight was 3,167.2 g. Exposure to benzene and toluene was significantly associated (P = 0.04) with preterm delivery in the five-day window. There was no association in any of the other exposure windows.

CONCLUSIONS

It was possible to identify that maternal exposure to benzene and toluene has an acute effect on preterm delivery.

Interactive effects of changing stratospheric ozone and climate on tropospheric composition and air quality, and the consequences for human and ecosystem health

The composition of the air we breathe is determined by emissions, weather, and photochemical transformations induced by solar UV radiation. Photochemical reactions of many emitted chemical compounds can generate important (secondary) pollutants including ground-level ozone (O₃) and some particulate matter, known to be detrimental to human health and ecosystems. Poor air quality is the major environmental cause of premature deaths globally, and even a small decrease in air quality can translate into a large increase in the number of deaths. In many regions of the globe, changes in emissions of pollutants have caused significant changes in air quality. Short-term variability in the weather as well as long-term climatic trends can affect ground-level pollution through several mechanisms. These include large-scale changes in the transport of O₃ from the stratosphere to the troposphere, winds, clouds, and patterns of precipitation. Long-term trends in UV radiation, particularly related to the depletion and recovery of stratospheric ozone, are also expected to result in changes in air quality as well as the self-cleaning capacity of the global atmosphere. The increased use of substitutes for ozone-depleting substances, in response to the Montreal Protocol, does not currently pose a significant risk to the environment. This includes both the direct emissions of substitutes during use and their atmospheric degradation products (e.g. trifluoroacetic acid, TFA).