Associations between the social environment and early childhood developmental outcomes of Puerto Rican children with prenatal Zika virus exposure: a cross-sectional study.

BACKGROUND: Prenatal exposure to the Zika virus can lead to microcephaly and adverse developmental outcomes, even in children without evident birth defects. The social environment plays a crucial role in infant health and developmental trajectories, especially during periods of heightened brain plasticity. The study aimed to assess socioenvironmental factors as predictors of developmental outcomes of 36-month-old children exposed to Zika virus prenatally. STUDY DESIGN: This cross-sectional study included 53 mothers and 55 children enrolled in the Pediatric Outcomes of Prenatal Zika Exposure cohort study in Puerto Rico. The study performs follow-up developmental assessments of children born to mothers with confirmed and probable Zika virus infection during pregnancy. Mothers completed socioenvironmental questionnaires (e.g., Perceived Neighborhood Scale and US Household Food Insecurity Survey). Children's developmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development: Third Edition, the Ages and Stages Questionnaires: Third Edition, the Ages and Stages Questionnaire-Socioemotional: Second Edition, and the Child Adjustment and Parent Efficacy Scale. RESULTS: Linear regression models, adjusting for a child's sex and age and maternal education, revealed that early life exposure to food insecurity and maternal pregnancy stressors were significantly associated with poorer developmental outcomes in Zika virus-exposed children at 36 months of age. Maternal resilience representation of adaptive ability was associated with the preservation of adequate developmental outcomes in children. CONCLUSIONS: Pregnancy and early childhood are critical life periods for ensuring optimal brain development in children. While the mechanisms in the interaction of children with their environment are complex, the risk and protective factors identified in the study are modifiable through public policy and preventive initiatives. Implementation of comprehensive strategies that improve access to social support programs, educational and nutritional interventions, and mental health services during pregnancy and early childhood can enhance the developmental potential of vulnerable children.

Stressors and Impact of the COVID-19 Pandemic on Vulnerable Hispanic Caregivers and Children.

Psychological sequelae are important elements of the burden of disease among caregivers. Recognition of the impact of adversity and stress biomarkers is important to prevent mental health problems that affect rearing practices and child well-being. This cross-sectional study explored social determinants of health (SDoH)-mediated stressors during COVID-19 and risks for mental health problems among caregivers of children with prenatal Zika virus exposure. Twenty-five Hispanic caregivers completed surveys assessing SDoH vulnerabilities, COVID-exposures and impact, post-traumatic stress disorder (PTSD) symptomatology, and provided a hair sample for cortisol concentration (HCC). Most caregivers had low education, household income < $15,000/year, and were unemployed. Stressors included disrupted child education and specialized services, and food insecurity. While most reported PTSD symptomatology, multivariate linear regression models adjusted for the caregiver's age, education, and the child's sex, revealed that caregivers with high symptomatology had significantly lower HCC than those with low symptomatology and those with food insecurity had significantly higher HCC than participants without food insecurity. The impact of COVID-19 on daily life was characterized on average between worse and better, suggesting variability in susceptibility and coping mechanisms, with the most resilient identifying community support and spirituality resources. SDoH-mediators provide opportunities to prevent adverse mental health outcomes for caregivers and their children.

Early Childhood Neurodevelopmental Outcomes in Children with Prenatal Zika Virus Exposure: A Cohort Study in Puerto Rico.

OBJECTIVE: To describe anthropometric, sensory, and neurodevelopmental outcomes of children who were Zika virus-exposed from birth to 36 months. STUDY DESIGN: The study cohort included 114 children born to mothers with confirmed and probable Zika virus pregnancy infection in 2016-2017. Children attending study visits from May 2017 through February 2020 underwent physical/neurologic, sensory examinations, and neurodevelopmental assessments with the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) and Ages and Stages Questionnaires, Third Edition (ASQ-3). RESULTS: Three of the 114 children (2.6%) had microcephaly (z-score for head circumference ≤-2) at birth, 19 of 35 (54.3%) had posterior eye abnormalities in retinal images, and 11 of 109 (10.1%) had nonspecific findings on brain ultrasound. Three of 107 children (2.8%) failed hearing screening at birth. Of those children with follow-up data, 17 of 97 (17.5%) failed age-appropriate vision screening. The BSID-III identified developmental delay in at least 1 domain in at least one-third of children, with higher prevalence in the language domain. ASQ-3 screen positive delay peaked at around 24 or 36 months, with some domains showing a decrease at older ages. Correlations among BSID-III and ASQ-3 scores were observed, representing professional and parental perspectives at 24 and 36 months (r = 0.32-0.78; P < .05). CONCLUSIONS: The presence of neurodevelopmental sequelae in early childhood suggests that identification of long-term impairment remains critical to attaining optimal child development. Long-term follow-up highlights vulnerability in the language domain, which likely could be influenced by early intervention, promoting cognitive development and school readiness in exposed children.