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

Miranda Hester

Research continues to find more data that show the negative health outcomes that are associated with poverty and facing difficult life events, such as eviction from home. The financial fallout of the pandemic has increased the number of people at risk for such an incident. An

examined whether a mother’s eviction during pregnancy was linked to adverse birth outcomes, which can be a determinant of a person’s lifetime health.

The investigators looked at births in Georgia. The state was selected because of its large and diverse population, longitudinally linked birth records, and mostly complete eviction data. Additionally, the 2016 rate of eviction, 4.71 for every 100 renter homes, was more than double the national average. The data on all births from January 2000 to December 2016 were from the state’s Department of Health. Eviction data came from LexisNexis Risk Solutions. In Georgia, evictions can happen because of rental/lease agreement violations and late payment or nonpayment for any duration of time.

During the study period, there were 88,862 births to 45,122 mothers and 99,517 births in total. There were 10,135 births to mothers who had an eviction action occur during pregnancy and 78,727 births to mothers who had eviction action that occurred outside of her pregnancy. When compared to mothers who had eviction actions at other times, evictions during pregnancy were linked to lower infant birth weight (difference, −26.88 [95% CI, −39.53 to 14.24] g), lower gestational age (difference, −0.09 [95% CI, −0.16 to −0.03] weeks), increased rates of low birth weight (0.88 [95% CI, 0.23-1.54] percentage points), and increase rates of prematurity (1.14 [95% CI, 0.21-2.06] percentage points). A nonsignificant increase in mortality (1.85 [95% CI, −0.19 to 3.89] per 1000 births) was also noted. The investigators also found that the link between eviction and birth weight was strongest in the second and third trimesters, with birth weight reductions of 34.74 (95% CI, −57.51 to −11.97) and 35.80 (95% CI, −52.91 to −18.69) g, respectively.

The investigators’ findings appear to indicate that eviction occurring during pregnancy was linked to adverse outcomes, which can have long-ranging consequences. Advocating for housing assistance for pregnant women could be an important way to improve infants’ health.

1. Himmelstein G, Desmond M. Association of eviction with adverse birth outcomes among women in Georgia, 2000 to 2016. 

. March 1, 2021. Epub ahead of print. doi:10.1001/jamapediatrics.2020.6550

Articles

Poverty is connected to a number of negative health outcomes. An investigation examines whether receiving a home eviction during pregnancy is linked to adverse birth outcomes, a determinant of a child’s lifelong health.

Are house evictions in pregnancy linked to adverse birth outcomes?

As the United States approaches the 1-year anniversary of the start of shut downs related to the coronavirus 2019 (COVID-19) disease in the United States, there’s a sense of both hope, due to the recent authorization of 3 vaccines, and fatigue because many people feel worn out from dealing with business, educational and recreational closings and limitations. 

Accelerated vaccination efforts, rumored easing of 

recommendations among those who have been fully vaccinated, and the complete lifting of masking restrictions in certain states like Texas, could all lead to even those people who have been most vigilantly staying at home during this pandemic, tempted to relax their protocols.  However, officials with Infectious Diseases Society of America hosted a briefing that serves as a reminder that infection prevention measures that have existed from the beginning, testing and wearing masks, will be just as important to ending the pandemic as the vaccines.

In her opening remakes in the briefing, Romney M. Humphries, PhD, D(ABMM), M(ASCP), professor of pathology, microbiology and immunology at Vanderbilt University Medical Center in Nashville, Tennessee, stated that although vaccination may be seen as a priority to many, robust testing for COVID-19 remains essential to infection control. It’s an important tool in not only finding cases, but helping with enrollment for therapeutic clinical trials, determining a community’s quarantine requirements, tracking spikes in cases, and monitoring for variants and further evolution in the virus. Then Mary K. Hayden, MD, FIDSA, professor of internal medicine and pathology at Rush Medical College in Chicago, Illinois, spoke about how one of the difficulties of testing is the vast number of scenarios. She stressed that testing was important not only because of public health implications, but it can also help prevent spread in the home due to family members taking measures, such as wearing masks and having the COVID-19 positive person be physically separated from others.

Humphries discussed whether COVID-19 testing in schools could be a helpful way to control the spread of the disease as well as an avenue for keeping schools open. Testing for COVID-19 in schools would likely follow the patterns of many other things in schools: wealthy districts would have the needed resources and poorer districts might not. She also noted that a lack of infrastructure made it unlikely that schools would be a major area of testing.

She said that other measures, such as having children with symptoms remain at home and monitoring their disease course would be just as helpful in controlling the spread.

The authorization of at-home testing for COVID-19 has made the idea of more robust testing a possibility, but at a literal and figurative price. The $25 or more price point of the tests likely prices it out of the range for some of the most vulnerable population. Additionally, Humphries noted that the test needs to be performed as accurately as possible to get credible results and user error could create problems. Also, home testing may prevent an accurate look at epidemiological data if the results of home tests aren’t provided to health care providers or local public health departments.

Hayden remarked that both testing and the vaccine are just 2 elements of ending the pandemic and that a successful response would include:

, President Joseph Biden stated that as a result of new pharmaceutical collaborations on vaccine production, and new deals struck with currently regulated vaccine developers including Janssen, the US is on pace to provide a vaccine for every adult by the end of May.

As of March 2, the US has reported 3 straight days of fewer than 60,000 new COVID-19 cases. In that same time period, the country surpassed 50 million total administered COVID-19 vaccines—and 25 million persons fully vaccinated with either the two-dose mRNA products from Pfizer or Moderna, or the single-shot adenovirus vaccine from Janssen.

In a briefing this morning, the Infectious Diseases Society of America (IDSA) stressed the continued importance of coronavirus 2019 disease (COVID-19) control measures that have been there from the start.

IDSA: Testing, masking still key to COVID-19 infection control

Type 1 diabetes has an impact on a number of health outcomes in children including an impact on the brain and cognitive ability when compared to those who do not have the autoimmune condition. An 

 looks into whether these continue, worsen, or improve as a child enters puberty as well as whether the differences were linked to hyperglycemia.

The investigators looked at 2 cohorts of children, those with type 1 diabetes and age-matched control subjects who did not have diabetes. Each child had unsedated magnetic resonance imaging and cognitive testing up to 4 times over 6.4 ± 0.4 (range 5.3–7.8) years. Continuous glucose monitoring and HbA1c monitoring happened on a quarterly basis. FreeSurfer brain imaging software-derived brain volumes and cognitive metrics were examined longitudinally between both groups using mixed-effects models at 6, 8, 10, and 12 years.

A total of 216 children were included in the study, with 144 in the type 1 diabetes group and 72 in the age-matched control group. Overall, the total brain, gray, and white matter volumes as well as verbal and full-scale intelligence quotients (IQs) were lower in the diabetes group at 6, 8, 10, and 12 years. The estimated group differences in full-scale IQ were −4.15, −3.81, −3.46, −3.11, respectively (

 < 0.05), and the total brain volume differences were −15,410, −21,159, −25,548, −28,577 mm3 × 103 at 6, 8, 10, and 12 years, respectively (

 < 0.05). The investigators found that the differences noted at baseline either persisted or increased over time. Additionally, the brain volumes and cognitive scores have a negative correlation with a life-long HbA1c and higher sensor glucose in diabetes.

The investigators concluded that the detectable differences in both brain volumes and cognitive scores continue in children who have early-onset type 1 diabetes and these differences are linked to metrics of hyperglycemia. They urge further study to discover whether these outcomes could be altered by rigorous diabetes control.

1. Mauras N, Buckingham B, White N, et al. Impact of type 1 diabetes in the developing brain in children: a longitudinal study. 

Previous research has shown that type 1 diabetes can impact the brain. A study examines whether this impact can persist or even worsen.

Does type 1 diabetes impact on the brain persist into puberty?

The reasoning behind the widespread closure of schools was to slow or prevent the spread of coronavirus disease 2019 (COVID-19) during the pandemic. A number of reasons were given for why such closures were harmful, including lack of access to nutrition for children in need, the difficulties of effectively learning through Zoom classes, and the inability to access needed resources for children with disabilities. An 

 looks at whether other behavioral changes had a bigger impact on COVID-19 incidence and mortality than school closures.

Researchers performed a population-based, interrupted-time-series analysis that used publicly available observational data from March 8, 2020, to May 18, 2020. Behavior changes included consumption of restaurant meals, time at work, time in the home, and searching for hand sanitizer. Information about behavior was collected using either anonymized cell phone data or internet data for people living in the United States. The behaviors were compared to a baseline of January 3, 2020, to February 6, 2020.

In the study period, the rate of restaurant dining decreased from a year earlier by an average of 98.3%; time at work decreased by an average of 40.0%; and time at home increased by an average of 15.4%. In fully adjusted models, a 1-day delay in beginning mandatory school closure was linked to a 3.5% reduction in incidence of COVID-19, reduction (incidence rate ratio [IRR], 0.965; 95% CI, 0.946-0.984), whereas a day of delay in behavioral changes were linked to 9.3% reduction in incidence (IRR, 0.907; 95% CI, 0.890-0.925). Each day of delay for school closures was linked to a subsequent 3.8% reduction (IRR, 0.962; 95% CI, 0.926-0.998) and every day of behavioral change delay was tied to a 9.8% reduction (IRR, 0.902; 95% CI, 0.869-0.936). The researchers created simulations that showed that a 2-week delay in school closure would be linked to an additional 23,000 (95% CI, 2000-62,000) deaths and a 2-week delay in voluntary behavioral change with school closures remaining the same would be linked to an additional 140,000 (95% CI, 65,000-294,000) deaths.

The researchers concluded that leveraging voluntary behavioral change would have a greater effect on preventing COVID-19 spread than mandatory school closures. Given the harm that school closures can do, advocating voluntary behavioral changes, including fewer restaurant meals and less time at work, could be a better way to improve COVID-19 outcomes without harming children.

1.Zimmerman F, Anderson N. Association of the timing of school closings and behavioral changes with the evolution of the coronavirus disease 2019 pandemic in the US. 

. February 22, 2021. Epub ahead of print. doi:10.1001/jamapediatrics.2020.6371

School closures were seen as a key way to prevent the spread of coronavirus disease 2019 (COVID-19), but were there other methods that would have been more effective and less harmful?

Miranda Hester

Articles

Are house evictions in pregnancy linked to adverse birth outcomes?

IDSA: Testing, masking still key to COVID-19 infection control

Does type 1 diabetes impact on the brain persist into puberty?

Voluntary behavioral changes have bigger impact on COVID-19 outcomes than school closures