Miranda Hester

Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

Previous research has shown that births that are preterm and postterm are linked to adverse neuropsychiatric outcomes. Whether variation in gestational age for deliveries at term also has a linked with neurodevelopment has remained less well studied. A 

The investigators ran a population-based cohort study that included pregnant women who were living in Rotterdam, the Netherlands. The expectant mothers had an expected delivery date between April 2002 and January 2006. Investigators looked at the singleton children who were delivered to those women. The gestational age at birth ranged from 26.3 to 43.3 weeks. The gestational age at birth was calculated using either ultrasonographic assessment of crown-rump length (<12 weeks 5 days) or biparietal diameter (≥12 weeks 5 days) at dedicated research centers. The children then had structural neuroimaging at age 10 years. The women and their children were part of the Generation R Study, which was a longitudinal, population-based prospective birth cohort from early pregnancy onward.

There were a total of 3079 children included in the study. When they were evaluated at 10 years of age, the researchers found that gestational age at birth was linearly linked with global and regional brain volumes. They also found that longer gestational duration was linked with larger brain volumes, with every additional week of gestational duration corresponding to an additional 4.5 cm3/wk (95% CI, 2.7-6.3 cm3/wk) larger total brain volume. This link continued when the researchers limited the sample to just children born at term, gestational age at birth of 37-42 weeks, (4.8 cm3/wk; 95% CI, 1.8-7.7 cm3/wk). There was no indication of nonlinear links between gestation age and brain morphometry observed.

The investigators concluded that duration of gestation had a linear link with brain morphometry in childhood, even in the window of term delivery. They believe that their findings should be of importance, especially because of the continuing high number of elective cesarean deliveries.

1. El Marroun H, Zou R, Leeuwenburg M, et al. Association of gestational age at birth with brain morphometry. 

. September 21, 2020. Epub ahead of print. doi:10.1001/jamapediatrics.2020.2991

Articles

Previous research has shown adverse neuropsychiatric outcomes among infants who are born preterm and postterm. An investigation examines the outcomes of children born at term.

At term delivery’s impact on neuropsychiatric outcomes

Childhood is filled with many things, including spending time with family, going to school, and forming the foundation for adult life. Unfortunately for some children, there can also be marginalization from peers. Little research has been done on how this peer rejection impacts long-term health outcomes. A 

 looks at the impact of peer status on circulatory outcomes in adulthood.

The researchers included participants who were born in 1953 and who also resided in the greater metropolitan area of Stockholm, Sweden in 1963. The study was based on the Stockholm Birth Cohort Multigenerational Study. Cohort members had their peer status assessed sociometrically at age 13 years. Inpatient care registers with information about circulatory diseases was linked to the survey material.

Investigators found that being marginalized by peers at age 13 years was linked with a significantly higher risk of circulatory disease in adulthood among both females (hazard ratio [HR] 1.33; 95% CI 1.04 to 1.70) and males (HR 1.34; 95% CI 1.09 to 1.64). Additionally, the researchers found a graded relationship between circulatory disease and peer status in the female participants (p=0.023). The same was not found with the male participants because only the lowest social status position was linked to a significantly increased risk of circulatory disease. The links between peer status and circulatory disease was significant, even after adjusting for other conditions.

The study had a number of strengths, including the use of longitudinal data that was linked to register data. There was also a high level of participation, which helped reduced biases that were linked to attrition or non-response. The homogenous nature of the study’s cohort also allowed certain influences, such as immigration, could be ruled out by the researchers. Limitations included very little information about the health and health-related behaviors in childhood. The timing of the presentation of health problems was also unable to identify.

The investigators concluded that circulatory disease in adulthood could potentially be traced to being marginalized by peers in childhood. Peer status in late childhood, which is when the child starts the process of social integration that will form the basis of adolescence and adulthood, can be a long-term stressor that could contribute to circulatory disease in a number of ways.

1. Miething A, Almquist Y. Childhood peer status and circulatory disease in adulthood: a prospective cohort study in Stockholm, Sweden. 

. September 15, 2020. Epub ahead of print. doi:10.1136/bmjopen-2019-036095

Many things in childhood can have a lifelong impact. A new study sheds light on how peer marginalization can impact cardiovascular outcomes in adulthood.

Social marginalization in childhood can impact circulatory health in adulthood

Congenital cytomegalovirus is a common source of birth defects. Microcephaly has been a birth defect that received a lot of media attention in 2016 because of the Zika virus epidemic. A new 

 looks at how many cases of microcephaly occur as a result of congenital microcephaly and how that number of cases could be more than were found to be linked to the 2016 Zika epidemic.

Investigators ran a population-based cohort study that included pregnant women and their offspring who had been identified in 2 insurance claims databases in the United States: IBM Researcher MarketScan, which included data for employer-sponsored private health insurance, and Medicaid Analytic eXtract. Every pregnancy that ended with a live delivery to a woman with full health birth was included.

There were a total of 2,338,580 pregnancies included in the cohort. Among these pregnancies, there were 336 infants who had a congenital cytomegalovirus diagnosis. The prevalence of microcephaly among infants with a congenital cytomegalovirus diagnosis was 655 per 10,000 live birth and it was 2.8 per 10,000 among newborns without a congenital cytomegalovirus diagnosis (prevalence ratio [PR], 232; 95% CI, 154-350). Following restricting to cytomegalovirus-test newborns, 572 individuals, to correct for preferential testing, the PR was 15 (95% CI, 5.2-41). This PR is biased if other congenital cytomegalovirus-related outcomes trigger testing as congenital cytomegalovirus prevalence in tested infants would overestimate it in the source population. This meant that the researchers compared the prevalence of congenital cytomegalovirus in overall infants with microcephaly to an external unbiased sample of US infants who were screened at birth to get an estimated PR of 7.4 (95% CI, 4.8-11.5) to serve as a conservative lower bound.

The researchers concluded that a congenital cytomegalovirus infection increases the prevalence of microcephaly at delivery by at least 7-fold. The researchers believe that preventing cytomegalovirus in pregnancy could be a substantial way to shrink the number of newborns who are born with microcephaly as well as other outcomes linked to congenital cytomegalovirus, such as hearing loss, in the United States.

1. Messinger C, Lipsitch M, Bateman B, et al. Association between congenital cytomegalovirus and the prevalence at birth of microcephaly in the United States. 

r. September 14, 2020. Epub ahead of print. doi:10.1001/jamapediatrics.2020.3009

The 2016 Zika epidemic made microcephaly a common term, but a new investigation indicates that congenital cytomegalovirus, which is much less studied, could be an even bigger cause of the birth defect.

Is congenital cytomegalovirus a leading cause of microcephaly?

Routine immunization has been a topic of much discussion over at least the past decade. Many of those vaccinations still occur in enough high enough numbers to do good. However, the human papillomavirus (HPV) vaccine has fought an uphill battle to be accepted in the United States. Other countries are well on their way to meeting their HPV vaccination goals, but the United States has frequently lagged behind. A 

 looks at whether the country will meet the Healthy People 2020 goal of 80% vaccine coverage.

Investigators used the MarketScan health care database to find participants. The children included in the study were followed from when they reached their 9th birthday until they received the HPV vaccination, were disenrolled from insurance, or had reached their 17th birthday, whichever came first.

The investigators included 7,837,480 children who represented a total of 19.8 million person-years. They found that proportion of girls and boys aged 15 years who had been administered at least 1 dose of the HPV vaccination increased from 38% and 5% in 2011 to 57% to 51% in 2017. Similarly, the proportion of 15-year-old girls and boys who had been given 2 doses of the HPV vaccine increased from 30% and 2% in 2011 to 46% and 39% in 2017. The investigators also found variation in vaccination according to geography. In 2017, the 2-dose HPV vaccine coverage ranged from 80% in the District of Columbia among girls to 15% in Mississippi among boys. The geographic range has a positive correlation with legislation for HPV vaccine education as well as pediatrician availability.

The investigators concluded that the current HPV coverage in children who are commercially insured was behind the set target of 80% total coverage. There were also frustrating disparities across states. A number of interventions have been tried to increase the vaccination’s coverage, but this investigation indicates that the most likely path to better coverage includes education legislation as well as better access to care.

1. Chen S, Huybrechts K, Bateman B, Hernández-Díaz S. Trends in human papillomavirus vaccination in commercially insured children in the United States. 

. September 14, 2020. Epub ahead of print. doi:10.1542/peds.2019-3557


Human papillomavirus (HPV) vaccination coverage has lagged in the United States. A report looks at whether the coverage will meet the Healthy People 2020 goal.

Author | Miranda Hester

Articles

At term delivery’s impact on neuropsychiatric outcomes

Social marginalization in childhood can impact circulatory health in adulthood

Is congenital cytomegalovirus a leading cause of microcephaly?

Will HPV vaccination coverage hit the mark?