Socioeconomic inequities during COVID 19 pandemic increase preterm birth and low birth weight in the most underprivileged.

BACKGROUND: The mitigation measures implemented to face the healthcare emergency brought by COVID 19 pandemic generated an increase in socioeconomic inequities in the most underprivileged population which is also the most threatened in their human rights. In Uruguay, this population is assisted in the public health care system. To analyze how these measures impacted on these mothers and their neonates we selected outcomes that most contributed to neonatal mortality. OBJECTIVE: To analyze the incidence of Preterm Birth (PB), Intrauterine Growth Restriction (IUGR) and Low Birth Weight (LBW) in the public health care system in Uruguay, during the period of time in which the strictest measures were adopted to mitigate the COVID 19 pandemic in 2020 (para-pandemic period) compared to the same period in 2019 (pre-pandemic). METHODS: A retrospective, cross sectional, descriptive study was performed to compare PB, IUGR and LBW from 15 March to 30 September 2019 (before COVID 19 pandemic) to the same period of 2020 (when COVID 19 pandemic bloomed), in the public health care subsystem. The analysis was performed with data from the national perinatal database system (SIP). RESULTS: In 2020, a significative increase in PB, RR: 1.14 (CI 95%: 1.03-1.25), and in LBW, RR: 1.16 (CI 95% 1.02-1.33), was registered compared to 2019 (pre-pandemic period). IUGR also showed an increase, but without statistical significance (4.6% in 2019 vs 5.2% in 2020, RR 1.13 CI 95% 0.98-1.31). The compared groups showed no differences in the distribution of biological confounding variables that could explain the increase in incidence of the main outcomes. CONCLUSIONS: In the absence of other factors that could explain the results we consider that social crisis associated to the restrictive measures implemented in the country to dwindle the effect of the pandemic exacerbated the adverse conditions that affect the reproductive process for those underprivileged women assisted in the public sector, increasing PB and LBW. It is important to consider the future impact of these results on neonatal and infant mortality and to implement social measures to reduce the damage as soon as possible.

Industrial air pollution and low birth weight in New Mexico, USA.

In recent decades, the low birth weight (LBW) rate in New Mexico has consistently exceeded the Unites States average. Maternal exposure to air pollution during pregnancy may be a significant contributor to LBW in offspring. This study investigated the links between maternal residential exposure to air pollution from industrial sources and the risk of LBW in offspring. The analysis included 22,375 LBW cases and 233,340 controls. It focused on 14 common chemicals listed in the Toxic Release Inventory (TRI) and monitoring datasets, which have abundant monitoring samples. The Emission Weighted Proximity Model (EWPM) was used to calculate maternal air pollution exposure intensity. Adjusted odds ratios (adjORs) were calculated using binary logistic regressions to examine the association between maternal residential air pollution exposure and LBW, while controlling for potential confounders, such as the maternal age, race/ethnicity, gestational age, prenatal care, education level, consumption of alcohol during pregnancy, public health regions, child's sex, and the year of birth. Multiple comparison correction was applied using the False Discovery Rate approach. The results showed that maternal residential exposure to 1,2,4-trimethylbenzene, benzene, chlorine, ethylbenzene, and styrene had significant positive associations with LBW in offspring, with adjusted odds ratios ranging from 1.10 to 1.13. These five chemicals remained as significant risk factors after dividing the estimated exposure intensities into four categories. In addition, significant linear trends were found between LBW and maternal exposure to each of the five identified chemicals. Furthermore, 1,2,4-trimethylbenzene was identified as a risk factor to LBW for the first time. The findings of this study should be confirmed through additional epidemiological, biological, and toxicological studies.

Maternal exposure to metal components of PM2.5 and low birth weight in New Mexico, USA.

Infants with low birth weight (LBW) are more likely to have health problems than normal weight infants. In studies examining the associations between particulate matter (PM) exposures and LBW, there is a tendency to focus on PM2.5 as a whole. However, insufficient information is available regarding the effects of different components of PM2.5 on birth weight. This study identified the associations between maternal exposure to 10 metal components of PM2.5 and LBW in offspring based on small area (divided by population size) level data in New Mexico, USA, from 2012 to 2016. This study used a pruned feed-forward neural network (pruned-FNN) approach to estimate the annual average exposure index to each metal component in each small area. The linear regression model was employed to examine the association between maternal PM2.5 metal exposures and LBW rate in small areas, adjusting for the female percentage and race/ethnicity compositions, marriage status, and educational level in the population. An interquartile range increase in maternal exposure to mercury and chromium of PM2.5 increased LBW rate by 0.43% (95% confidence interval (CI): 0.18-0.68%) and 0.63% (95% CI: 0.15-1.12%), respectively. These findings suggest that maternal exposure to metal components of air pollutants may increase the risk of LBW in offspring. With no similar studies in New Mexico, this study also posed great importance because of a higher LBW rate in New Mexico than the national average. These findings provide critical information to inform further epidemiological, biological, and toxicological studies.

Ethnicity and Low Birth Weight: Inequalities Between Ethnic Minorities and the Predominant Mestizo Population, Colombia, 2008-2014.

Low birth weight (LBW) is a global problem that annually affects nearly 20 million children, 96% of these in developing countries. According to the WHO, the poorest and the ethnic minorities are the groups most affected by this indicator. A cross-sectional study of the database of all newborns officially registered in Colombia in 2008-2014 was done. While dichotomizing the mestizo population and ethnic minorities (Afro-descendants, indigenous, ROM), normal and low birth weight was used as the dependent variable and ethnicity as the explanatory variable. Other variables of the parents and the newborns were used as covariates. To assess associations, bivariate and multivariate logistic regression analyses were performed. The incidence of LBW among newborns registered in Colombia fluctuated at around 9%. Among the ethnic minorities, the probability of LBW, adjusted for other variables, was significantly higher (OR 1.07, 95% CI 1.05-1.08) than among mestizos. A significantly higher risk of LBW to newborns in the ethnic minorities' group, and those with unfavorable socioeconomic conditions, was found.

RESUMEN: El bajo peso al nacer (BPN) es un problema global que afecta anualmente a casi 20 millones de niños, el 96% de estos en países en desarrollo. Según la OMS, las más pobres y las minorías étnicas son los grupos más afectados por este indicador. Se realizó un estudio transversal de la base de datos de todos los recién nacidos registrados oficialmente en Colombia en 2008-2014. La población fue dicotomizaba en mestiza y minorías étnicas (afrodescendientes, indígenas, ROM). Se utilizó Bajo Peso al Nacer (BPN) como variable dependiente y el origen étnico como variable explicativa. Otras variables de los padres y los recién nacidos se utilizaron como covariables. Para evaluar las asociaciones, se realizaron análisis de regresión logística bivariada y multivariada. La incidencia de BPN entre los recién nacidos registrados en Colombia fluctuó alrededor del 9%. Entre las minorías étnicas, la probabilidad de LBW, ajustada por otras variables, fue significativamente mayor (OR = 1.07, 95% _CI: 1.05-1.08) que entre los mestizos. Se encontró un riesgo significativamente más alto de BPN para los recién nacidos en el grupo de minorías étnicas y aquellos con condiciones socioeconómicas desfavorables.

Low Birthweight as a Risk Factor for Non-communicable Diseases in Adults.

According to studies undertaken over the past 40 years, low birthweight (LBW) is not only a significant predictor of perinatal death and morbidity, but also increases the risk of chronic non-communicable diseases (NCDs) in adulthood. The purpose of this paper is to summarize the research on LBW as a risk factor for NCDs in adults. The Barker hypothesis was based on the finding that adults with an LBW or an unhealthy intrauterine environment, as well as a rapid catch-up, die due to NCDs. Over the last few decades, terminology such as thrifty genes, fetal programming, developmental origins of health and disease (DOHaD), and epigenetic factors have been coined. The most common NCDs include cardiovascular disease, diabetes mellitus type 2 (DMT2), hypertension (HT), dyslipidemia, proteinuria, and chronic kidney disease (CKD). Studies in mothers who experienced famine and those that solely reported birth weight as a risk factor for mortality support the concept. Although the etiology of NCD is unknown, Barry Brenner explained the notion of a low glomerular number (nGlom) in LBW children, followed by the progression to hyperfiltration as the physiopathologic etiology of HT and CKD in adults based on Guyton's renal physiology work. Autopsies of several ethnic groups have revealed anatomopathologic evidence in fetuses and adult kidneys. Because of the renal reserve, demonstrating renal function in proportion to renal volume in vivo is more difficult in adults. The greatest impact of these theories can be seen in pediatrics and obstetrics practice.

Breastfeeding Trends Among Very Low Birth Weight, Low Birth Weight, and Normal Birth Weight Infants.

OBJECTIVE: To examine the change in breastfeeding behaviors over time, among low birth weight (LBW), very low birth weight (VLBW), and normal birth weight (NBW) infants using nationally representative US data. STUDY DESIGN: Univariate statistics and bivariate logistic models were examined using the Early Child Longitudinal Study-Birth Cohort (2001) and National Study of Children's Health (2007 and 2011/2012). RESULTS: Breastfeeding behaviors improved for infants of all birth weights from 2007 to 2011/2012. In 2011/2012, a higher percentage of VLBW infants were ever breastfed compared with LBW and NBW infants. In 2011/2012, LBW infants had a 28% lower odds (95% CI, 0.57-0.92) of ever breastfeeding and a 52% lower odds (95% CI, 0.38-0.61) of breastfeeding for ≥6 months compared with NBW infants. Among black infants, a larger percentage of VLBW infants were breastfed for ≥6 months (26.2%) compared with LBW infants (14.9%). CONCLUSIONS: Breastfeeding rates for VLBW and NBW infants have improved over time. Both VLBW and NBW infants are close to meeting the Healthy People 2020 ever breastfeeding goal of 81.9%. LBW infants are farther from this goal than VLBW infants. The results suggest a need for policies that encourage breastfeeding specifically among LBW infants.

Early treatment with metformin induces resistance against tumor growth in adult rats.

It is known that antidiabetic drug metformin, which is used worldwide, has anti-cancer effects and can be used to prevent cancer growth. We tested the hypothesis that tumor cell growth can be inhibited by early treatment with metformin. For this purpose, adult rats chronically treated with metformin in adolescence or in adulthood were inoculated with Walker 256 carcinoma cells. Adult rats that were treated with metformin during adolescence presented inhibition of tumor growth, and animals that were treated during adult life did not demonstrate any changes in tumor growth. Although we do not have data to disclose a molecular mechanism to the preventive metformin effect, we present, for the first time, results showing that cancer growth in adult life is dependent on early life intervention, thus supporting a new therapeutic prevention for cancer.

Intimate partner violence, substance use, and adverse neonatal outcomes among urban women.

OBJECTIVE: To assess the prevalence of intimate partner violence, substance use, and their co-occurrence during pregnancy and to examine their associations with adverse neonatal outcomes. STUDY DESIGN: Between February 2009-February 2010, pregnant women receiving obstetrical care at 3 urban clinics were screened for intimate partner violence and substance use between 24-28 weeks gestation. A chart review was conducted upon delivery to assess for adverse neonatal outcomes of low birth weight, preterm birth, and small for gestational age (SGA). RESULTS: Maternal and neonatal data were collected on 166 mothers and their neonates. Overall, 19% of the sample reported intimate partner violence during their pregnancies. Of the study's neonates, 41% had at least 1 adverse neonatal outcome. Nearly one-half of the mothers reported using at least 1 substance during pregnancy. Women experiencing intimate partner violence had a higher prevalence of marijuana use than their nonabused counterparts (P < .01). Experiencing intimate partner violence was associated with a 4-fold increase in having a SGA neonate (aOR = 4.00; 95% CI 1.58-9.97). Women who reported marijuana use had 5 times the odds of having a neonate classified as SGA (aOR = 5.16, 95% CI 2.24-11.89) or low birth weight (aOR 5.00; 95% CI 1.98-12.65). CONCLUSIONS: The prevalence of intimate partner violence during pregnancy and substance use is high in urban mothers, the risks of which extend to their neonates. Pediatric providers are urged to routinely screen for both issues and recognize the impact of co-occurrence of these risk factors on poor neonatal and childhood outcomes.