Effects of maternal gestational diabetes and adiposity on neonatal adiposity and blood pressure.

OBJECTIVE: To determine the effects of maternal factors, including prepregnancy maternal adiposity, weight gain during pregnancy, degree of abnormality of the glucose tolerance test, glycemia during pregnancy, and treatment with insulin versus diet therapy, on neonatal body weight, adiposity, and blood pressure in infants of mothers with gestational diabetes (IGDM) and control patients. RESEARCH DESIGN AND METHODS: A total of 119 term IGDM, including 57 large-for-gestational-age (LGA) and 62 appropriate-for-gestational-age (AGA) infants, and 143 term control infants, including 74 LGA and 69 AGA infants, were prospectively enrolled. Maternal measurements of prepregnancy weight, height, and weight gain were abstracted from medical records. A diagnosis of gestational diabetes was made on the basis of an initial 1-h 50-g glucose screen value > or = 130 mg/dl followed by two abnormal values in a 100-g oral glucose tolerance test. Infant anthropometric measurements were obtained, and blood pressure was measured on day 2 of life. Correlation analyses and multiple regression analyses were performed to assess the relationships among maternal factors and neonatal adiposity and blood pressure. RESULTS: Multiple regression analyses to determine the effects of significant maternal factors on infant body mass index (BMI) revealed that prepregnancy weight and weight gain were significant predictors for both IGDM and control infants. An increased glucose screen predicted BMI for control subjects, whereas the mean 2nd and 3rd trimester glucose values were the significant predictors for IGDM. Also, increased newborn triceps skinfold thickness measurements correlated with increased systolic blood pressure for IGDM (r = 0.29, P < 0.03). CONCLUSIONS: Increased maternal prepregnancy weight, weight gain in pregnancy, and glycemia in pregnancy all place IGDM at increased risk of macrosomia and adiposity. Increased adiposity in the IGDM appears to be related to increased infant blood pressure. Longitudinal evaluation is needed to determine whether neonatal adiposity in IGDM is predictive of increased adiposity and blood pressure during childhood.

Predicting maltreatment of children of teenage mothers.

OBJECTIVE: To determine the degree to which knowing certain characteristics about young high-risk families can help distinguish those families most likely to maltreat their children from those families at lower risk of maltreating their children. DESIGN: Observational cohort from which the following predictor variables were gathered when infants were 2 months old: maternal age, depressive symptoms, childrearing attitudes, social support, and living situation (with or apart from related adults). Families were followed up for 24 months to identify the occurrence of maltreatment. SETTING: An urban, socioeconomically disadvantaged cohort of teenage mothers and their infants attending a hospital-based special primary care clinic for teen mothers and their infants. PARTICIPANTS: All full-term infants and mothers enrolled into the clinic in 1990 participated in the study. This included 47 mother-infant pairs enrolled when infants were 2 months of age. Forty-five of these pairs were available for follow-up when infants were 24 months of age. MAIN OUTCOME MEASURES: Maltreatment defined as any incident that prompted investigation by the state child protective agency and was found to be a substantiated case of maltreatment by that agency. RESULTS: Maltreatment occurred in 15 of 45 families before the child's second birthday. Discriminate function analysis produced a model that correctly classified 13 of 15 maltreating mothers and misclassified one of 30 non-maltreating mothers. Stepwise analysis revealed that living situation was by far the strongest predictive variable (R2 = 7). CONCLUSION: Maltreatment was a predictable outcome within this extremely high-risk cohort. Living apart from related adults was the strongest risk factor associated with maltreatment. This easily obtainable piece of information may be an important risk marker for practitioners, social service personnel, and others working with this very-high-risk population. It may allow early supportive interventions that might prevent maltreatment.

Behavioral responsivity in preterm infants.

Both prematurity and the type and degree of perinatal complications affect behavioral responsivity. Decreased sociability and decreased soothability shown by preterm infants can be considered to be attributable to some stress on the central nervous system. Because marked individual differences are observed within preterm groups, stimulation should be geared to the individual's level of responsivity.

Cultural and biomedical correlates of neonatal behavior.

The Brazelton Neonatal Behavioral Assessment Scale was administered to 24 each Puerto Rican, Black, and Caucasian, 2-day-old, full-term healthy neonates. Comparisons on 8 Brazelton scale summary scores showed that Puerto Rican infants scored lower on habituation, higher on orientation, and higher on maintaining their organization with increasing stimulation than Black and Caucasian infants. Multiple regression analysis showed that the combination of biomedical variables was significantly correlated with 6 of the Brazelton scale summary scores for the Puerto Rican infants, 1 summary score for the Caucasian infants, and none for the Black infants; it revealed population differences with respect to the synergistic effects of biomedical variables on neonatal behavior.

Cultural influences on developmental processes and outcomes: implications for the study of development and psychopathology.

The purpose of this paper is to trace the role of culture as an explanatory construct in developmental processes and outcomes, and its implications in the understanding of developmental psychopathology. Literature reviews were conducted by historical period: 1930-1939, 1960-1969, and 1990-1999. The percentage of the total articles and chapters pertaining to cultural issues increased as a function of time. Both conceptual and methodological continuities and discontinuities were observed among the three periods. The preponderance of comparative studies using deficit models still remains, but more enlightened alternative conceptual models, within culture studies, and measures of cultural processes, are emerging. In contrast, although contextual influences are considered important in developmental psychopathology, the field lags in its empirical consideration of cultural influences. The need to seriously address these issues will increase as globalization and rapid cultural change become even more the norm than the exception.

Children and poverty: issues in contemporary research.

The state-of-the-art research in this volume is based on complex, multidimensional conceptions of poverty. Current research goes beyond description to emphasize analysis of processes by which effects occur and variations in effects associated with race, gender, and ethnicity. Child care, school, neighborhood, and community are studied as well as family contexts. The child outcomes investigated include both intellectual development and socioemotional functioning. It is multidisciplinary, using a broad range of analytic frameworks and research methods from economics, sociology, health, psychology, and other disciplines. In this introduction, the overall research trends are described, and new questions for future research are identified.

Mother-infant feeding interaction in full-term small-for-gestational-age infants.

Maternal and infant behavior during feeding was assessed in 30 mother-infant dyads: 15 small-for-gestational-age (SGA) infants (birth weights below the 10th percentile) and 15 appropriate-for-gestational-age (AGA) infants (birth weights between the 25th and 90th percentiles). The groups were balanced for gestational age, sex, neonatal risk factors, and maternal age, parity, socioeconomic status, and race. Behaviors indicative of infant feeding difficulties were coded for mother and infant. The SGA mothers had higher frequencies of these behaviors than did their AGA counterparts. Qualitative ratings of interactive behavior were recorded for mother and infant: SGA infants had ratings indicative of less optimal interactions than those of the AGA group. Infant caloric intake (calories per kilogram per feeding) was calculated by first dividing the change in infant weight in grams before feeding and immediately after feeding by the infant's weight before feeding and then converting it to calories. Although no difference in caloric intake was observed between the two groups, infant behaviors and ratings were associated with caloric intake. These data suggest the importance of including neonatal behavior during feeding in the risk assessment of potential growth failure in SGA infants.

The home environments of children in the United States part I: variations by age, ethnicity, and poverty status.

Although measures of the home environment have gained wide acceptance in the child development literature, what constitutes the "average" or 'typical" home environment in the United States, and how this differs across ethnic groups and poverty status is not known. Item-level data from the National Longitudinal Survey of Youth on four age-related versions of the Home Observation for Measurement of the Environment-Short Form (HOME-SF) from five biennial assessments (1986-1994) were analyzed for the total sample and for four major ethnic groups: European Americans, Asian Americans, African Americans, and Hispanic Americans. The percentages of homes receiving credit on each item of all four versions of the HOME-SF are described. For the majority of items at all four age levels differences between poor and nonpoor families were noted. Differences were also obtained among African American, European American, and Hispanic American families, but the magnitude of the effect for poverty status was greater than for ethnicity, and usually absorbed most of the ethnic group effects on HOME-SF items. For every item at every age, the effects of poverty were proportional across European American, African American, and Hispanic American groups.

The home environments of children in the United States part II: relations with behavioral development through age thirteen.

This study examined the frequency with which children were exposed to various parental actions, materials, events, and conditions as part of their home environments, and how those exposures related to their well-being. Part 1 focused on variations by age, ethnicity, and poverty status. In Part 2 of the study, relations between major aspects of the home environment (including maternal responsiveness, learning stimulation, and spanking) and developmental outcomes for children from birth through age 13 were investigated. The outcomes examined were early motor and social development, vocabulary development, achievement, and behavior problems. These relations were examined in both poor and nonpoor European American, African American, and Hispanic American families using hierarchical linear modeling. The most consistent relations found were those between learning stimulation and children's developmental status, with relations for parental responsiveness and spanking varying as a function of outcome, age, ethnicity, and poverty status. The evidence indicated slightly stronger relations for younger as compared with older children.

Neurodevelopmental and medical status of low-birthweight survivors of bronchopulmonary dysplasia at 10 to 12 years of age.

Thirty low-birthweight (less than 1500g) infants (15 with bronchopulmonary dysplasia (BPD), and 15 controls less than or equal to 5 days O2) and 15 fullterm controls were evaluated at 10 to 12 years of age. BPD children weighted less than fullterm children and had smaller head circumferences than either preterm or fullterm controls. They also had significantly more neurological abnormality than both control groups. BPD children and preterm controls had lower WISC-R arithmetic scores and lower Beery VMI scores, as well as greater need of resources and special education compared with fullterm controls. BPD survivors at 10 to 12 years of age continue to manifest sequelae related to their early pulmonary disease.

Behavioral changes correlated with brain-stem auditory evoked responses in term infants with moderate hyperbilirubinemia.

The purpose of this study was to test the hypotheses that newborn infants with moderate serum bilirubin concentrations have depressed Brazelton scores and increased brain-stem conduction time and that serum bilirubin levels correlate with Brazelton behavior scores and brain-stem auditory evoked response changes. Fifty term infants who were enrolled into either a low serum bilirubin group (less than 8 mg/dl) or a moderate serum bilirubin group (10 to 20 mg/dl) were tested with the Brazelton Neonatal Behavioral Assessment Scale and a brain-stem auditory evoked response test. Partial correlation analysis controlling for phototherapy revealed that increased bilirubin concentration correlated negatively with the Brazelton orientation and with state range clusters and individual Brazelton test items that involve auditory processing. Increased bilirubin concentration correlated with an increased latency of brain-stem auditory evoked response wave 4, 5. An increased interpeak 1-5 (brain-stem conduction time) correlated with the decreased animate visual and auditory item. We conclude that moderate hyperbilirubinemia in term infants affects both infant behavior, as measured by specific components of the Brazelton test, and brain-stem conduction time, as measured by the brain-stem auditory evoked response test.