The tragedy of smoking, alcohol, and multiple substance use during pregnancy.

BACKGROUND: Antenatal substance use is a significant public health concern in South Africa (SA). Information on smoking, drinking and drug use during pregnancy was collected prospectively for the Safe Passage Study of the PASS (Prenatal Alcohol in Sudden infant death syndrome and Stillbirth) Network. OBJECTIVES: Data from 4 926 pregnant women in a community near Tygerberg Academic Hospital, Cape Town, were examined to determine whether associations between different substance use groups and postnatal infant outcomes at birth and 1 year were significant. METHODS: Gestational age (GA) was determined by earliest ultrasound. Maternal data were collected at enrolment or first antenatal visit. Substance use data were obtained at up to four occasions. Birthweight data were derived from medical records, and birthweight z-scores (BWZs) were specifically calculated using INTERGROWTH-21st study data. Statistical analyses were done with Statistica version 13.  Results. Women who used more substances enrolled later, were younger, and had smaller mid-upper arm circumferences (MUACs), less education and lower monthly income than women who used no substances (control group). Infants born to women who used more substances had lower GA at delivery, birthweight and BWZ than infants from the control group. At 1 year, infants born to women who used more substances had a lower weight, shorter length and smaller head circumference. Education was positively associated with all infant outcomes at birth and 1 year. MUAC was positively associated with infant BWZ, and weight and length at 1 year. Income was negatively associated with BWZ, but positively associated with all 1-year outcomes. CONCLUSION: Substance use during pregnancy affects infant outcomes at birth and 1 year of age. The addictive properties of substance use make cessation difficult, so prevention strategies should be implemented long before pregnancy. Higher maternal education, associated with better infant outcomes at birth and 1 year and acting as a countermeasure to substance use, is of paramount importance.

Neurodevelopmental and behavioural outcomes of HIV-exposed uninfected and HIV-unexposed children at 2-3 years of age in Cape Town, South Africa.

Successful vertical HIV transmission prevention programmes (VTP) have resulted in an expanding population of HIV-exposed uninfected (HEU) infants whose growth, health and neurodevelopmental outcomes could have consequences for future resource allocation. We compared neurodevelopmental and behavioural outcomes in a prospective cohort of 2-3 year old HEU and HIV-unexposed uninfected (HU) children.Women living with and without HIV and their infants were enrolled within three days of birth from a low-risk midwife obstetric unit in Cape Town, South Africa during 2012 and 2013, under WHO Option A VTP guidelines. HIV-uninfected children aged 30-42 months were assessed using the Bayley scales of Infant Development-Third edition (BSID) and Strengths and Difficulties questionnaire (SDQ).Thirty-two HEU and 27 HU children (mean birth weight 3048g vs 3096g) were assessed. HEU children performed as well as HU children on BSID cognitive, language and motor domains. Mean scores fell within the low average range. Mothers of HEU children reported fewer conduct problems but stunting was associated with increased total difficulties on the SDQ.HEU and HU children's performance on the BSID was similar. In this low-risk cohort, HIV exposure did not confer additional risk. Stunting was associated with increased behavioural problems irrespective of HIV exposure.

Comparison of the demographic and diagnostic profile of new patients attending a neurodevelopmental clinic in 2008/2009 and 2016

Background. Literature suggests an increasing prevalence of developmental disabilities, and specifically ofconditions such as autism and attention deficit/hyperactivity disorder. The resulting burden on paediatric neurodevelopmental services has not been described in the South African setting.Objective. To compare the demographic and diagnostic profile of new patients attending a neurodevelopmental service across two 12-month periods, after a change in referral pathway and the introduction of a secondary clinic.Methods. We conducted a retrospective, descriptive cross-sectional folder review of new patients seen in the neurodevelopmental service at Tygerberg Hospital in 2008/2009 and 2016.Results. The number of new patients increased from 84 in 2008/2009 to 240 in 2016. In both periods the majority of patients were male.The median (IQR) age decreased from 62 (31 - 92) months in 2008/2009 to 53 (37 - 67) months in 2016 (p=0.17). In 2008/2009 only one patient was from the Khayelitsha health subdistrict compared with 49 (20.4%) in 2016, following the subdistrict's addition to the hospital's drainage area in 2011. The number of patients referred by allied health professionals increased between the two periods (30.4% in 2016 v. 16.4% in 2008/2009). Cases of autism spectrum disorder (ASD) increased notably: from 10 (8.4%) in 2008/2009 to 84 (35%) in 2016.Conclusion. The notable increase in neurodevelopmental referrals over the past 8 years cannot be fully explained by a regional population increase or a change in referral pathway. The number of ASD cases has increased disproportionately, with important implications for health and educational service planning