HIV self-test kits may have the potential to increase testing rates around the globe, and thereby lead to reductions in HIV-related incidence and mortality. However, the effectiveness of these ...self-test kits and the issues surrounding self-testing have been greatly debated in recent years. We conducted a literature review on the acceptability, feasibility, and effectiveness of HIV self-testing (HST) around the world. Of the 28 articles abstracted, several themes of HST were explored, including behavioral risk compensation, presence of counseling, uses of HST, ability to perform the self-test, sensitivity and specificity, concordance with confirmatory testing, perceptions surrounding HST, instruction and supervision, and cost. Overall, this literature review found that this diverse group of participants generally performed HST correctly with a few exceptions, were accepting of the test if available at a relatively low cost, and preferred the oral-based HST over the blood-based test.
In Kenya, HIV testing during first antenatal care (ANC) visit is a standard practice for pregnant women. Despite a policy promoting male partner testing in ANC, few male partners accompany their ...partners for HIV testing. We evaluated the impact of using oral HIV self-testing on HIV couples testing among ANC clients in Kenya and their male partners.
In a 3-arm randomized control study in eastern and central Kenya, consenting women attending the first ANC visit were randomized to receive: (1) standard-of-care and a standard information card; (2) an improved card stating the importance of male HIV testing; and (3) 2 oral HIV self-test kits and HIV testing information. Women completed a baseline and endline questionnaire, and consenting male partners were surveyed 3 months after enrolling female ANC clients. The primary outcome was HIV couples testing as reported by the female partners.
We randomized 1410 women at their first ANC visit of which 1215 were successfully followed up. One thousand one hundred thirty-three male partners consented to the survey. In the self-testing study arm 3, 79.1% (334/422) of the women reported that their partner tested for HIV as part of a couple, compared with 27% (110/406) and 35.1% (136/387) in study arm 1 and study arm 2, respectively. More than 90% of male partners who used the oral HIV self-test kits reported that it was easy to take sample and read the test results.
The study demonstrates that the ANC platform offers a unique opportunity to increase HIV couples testing among men using self-testing through distribution by their female partners.
Poor asthma control is common during pregnancy and contributes to adverse pregnancy outcomes. Identification of risk factors for poor gestational asthma control is crucial.
Examine associations of ...body composition and gestational weight gain with asthma control in a prospective pregnancy cohort (n = 299).
Exposures included pre-pregnancy body mass index (BMI), first trimester skinfolds, and trimester-specific gestational weight gain. Outcomes included percent predicted forced expiratory volumes (FEV1, FEV6), forced vital capacity (FVC), peak expiratory flow (PEF), FEV1/FVC, symptoms (activity limitation, nighttime symptoms, inhaler use, and respiratory symptoms), and exacerbations (asthma attacks, medical encounters). Linear and Poisson models examined associations with lung function (β (95% confidence interval (CI)), asthma symptom burden (relative rate ratio (RR (95%CI)), and exacerbations (RR (95%CI)).
Women with a BMI ≥ 30 had lower percent predicted FVC across pregnancy (βThirdTrimester: -5.20 (-8.61, -1.78)) and more frequent night symptoms in the first trimester (RR: 1.66 (1.08, 2.56)). Higher first trimester skinfolds were associated with lower FEV1, FEV6, and FVC, and more frequent night symptoms and inhaler use across pregnancy. Excessive first trimester gestational weight gain was associated with more frequent activity limitation in the first trimester (RR: 3.36 (1.15, 9.80)) and inhaler use across pregnancy (RRThirdTrimester: 3.49 (1.21, 10.02)).
Higher adiposity and first trimester excessive gestational weight gain were associated with restrictive changes in lung function and symptomology during pregnancy.
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Prenatal phthalate exposure has been linked to reductions in fetal growth in animal and laboratory studies, but epidemiologic evidence is equivocal.
Examine the association between ...prenatal phthalate metabolite mixtures and fetal growth and evaluate whether that association is modified by fetal sex or omega-3 intake during pregnancy.
Analyses included 604 singleton pregnancies from TIDES, a prospective pregnancy cohort with spot urine samples and questionnaires collected in each trimester. Pregnancy-averaged phthalate exposure estimates were calculated as the geometric means of specific-gravity corrected phthalate metabolites. Fetal growth outcomes included birthweight and length, and ultrasound-derived size and velocity of estimated fetal weight, femur length, abdominal and head circumferences in the second and third trimesters. We used a novel application of quantile g-computation to estimate the joint association between pregnancy-averaged phthalate exposure and fetal growth, and to examine effect modification of that association by infant sex or omega-3 intake during pregnancy.
There were few statistically significant differences in birth size and fetal growth by exposure. A one-quartile increase in the phthalate mixture was modestly associated with reduced birthweight(β 95% confidence interval): −54.6 −128.9, 19.7 grams; p = 0.15) and length (−0.2 −0.6, 0.2 centimeters; p = 0.40). A one-quartile increase in the phthalate mixture was associated with reduced birth length in males (−0.5 −1.0, 0.0 centimeters) but not for females (0.1 −0.2, 0.3 centimeters); interaction p = 0.05. The phthalate metabolite mixture was inversely associated with ultrasound-derived fetal growth among those with adequate omega-3 intake. For example, a one-quartile increase in the phthalate mixture was associated with reduced abdominal circumference in the third trimesters in those with adequate omega-3 intake (−3.3 −6.8, 0.1 millimeters) but not those with inadequate omega-3 intake (1.8 −0.8, 4.5 millimeters); interaction p = 0.01.
Prenatal phthalate exposure was not significantly associated with fetal growth outcomes, with some exceptions for certain subgroups.
This study aimed to investigate asthma medication reduction in the periconceptional period as it relates to asthma status and adverse outcomes in pregnancy.
In a prospective cohort study, ...self-reported current and past asthma medications were collected and analyzes compared measures of asthma status in women who discontinued asthma medication in the 6 months prior to enrollment ("step-down") versus those who did not ("no change"). Evaluation of asthma was done at three study visits (one per trimester) and by daily diaries, including measures of lung function (percent predicted forced expiratory volume in 1 and 6 s %FEV1, %FEV6, peak expiratory flow %PEF, forced vital capacity %FVC, FEV1 to FVC ratio FEV1/FVC), lung inflammation (fractional exhaled nitric oxide FeNO, ppb), rate of asthma symptoms (activity limitation, night symptoms, rescue inhaler use, wheeze, shortness of breath, cough, chest tightness, chest pain), and rate of asthma exacerbations. Adverse pregnancy outcomes were also evaluated. Adjusted regression analyses examined whether adverse outcomes differed by periconceptional asthma medication changes.
Of 279 participants included in analyses, 135 (48.4%) did not change asthma medication in the periconceptional period, whereas 144 (51.6%) reported a step down in medication. Those in the step-down group were more likely to have milder disease (88 61.1% in the step-down vs. 74 54.8% in the no change group), exhibited less activity limitation (rate ratio RR: 0.68, 95% confidence interval CI: 0.47-0.98), and experienced fewer asthma attacks (RR: 0.53, 95% CI: 0.34-0.84) during pregnancy. The step-down group had a nonsignificant increase in overall odds of experiencing an adverse pregnancy outcome (odds ratio: 1.62, 95% CI: 0.97-2.72).
Over half of women with asthma reduce asthma medication in the periconceptional period. Although these women typically have milder disease, a step down in medication may be associated with an increased risk of adverse pregnancy outcomes.
· Many women reduce their asthma medication in pregnancy.. · Reduction is more common among those with mild disease.. · Medication reduction may lead to adverse pregnancy outcomes..
Air pollution is associated with mental health in the general population, but its influence on maternal mental health during pregnancy has not been assessed.
We evaluated the relationship between ...unspecified mental disorders complicating pregnancy and depression with average air pollution exposure during 3-months preconception, first trimester and whole pregnancy.
Ambient air pollution was derived from a modified Community Multiscale Air Quality model and mental health diagnoses were based on electronic intrapartum medical records. Logistic regression models assessed the odds of unspecified mental disorder complicating pregnancy (n = 11,577) and depression (n = 9793) associated with an interquartile range increase in particulate matter (PM) less than 2.5 μm (PM2.5), PM10, carbon monoxide (CO), nitrogen dioxide (NO2), nitrogen oxide (NOx), sulfur dioxide (SO2), and ozone (O3). Pregnancies without mental health disorders were the reference group (n = 211,645). Models were adjusted for maternal characteristics and study site; analyses were repeated using cases with no additional mental health co-morbidity.
Whole pregnancy exposure to PM10, PM2.5, NO2, and NOx was associated with a 29%–74% increased odds of unspecified mental disorders complicating pregnancy while CO was associated with 31% decreased odds. Results were similar for depression: whole pregnancy exposure to PM10, PM2.5, NO2, and NOx was associated with 11%–21% increased odds and CO and O3 were associated with 16%–20% decreased odds. SO2 results were inconsistent, with increased odds for unspecified mental disorders complicating pregnancy and decreased odds for depression. While most findings were similar or stronger among cases with no co-morbidity, PM2.5 and NOx were associated with reduced risk and SO2 with increased risk for depression only.
Whole pregnancy exposure to PM10, PM2.5, NO2, and NOx were associated with unspecified mental disorder complicating pregnancy and depression, but some results varied for depression only. These risks merit further investigation.
•Mental health disorders complicating pregnancy adversely affect pregnancy outcomes.•Air pollution crosses the blood-brain barrier, and may influence mental health disorders.•PM10, PM2.5, NO2, and NOx increased mental health disorders complicating pregnancy.•Some pollutants (e.g. CO) decreased mental disorders complicating pregnancy.•Additional research is needed to elucidate these novel findings.
Reductions in fetal growth are associated with adverse outcomes at birth and later in life. However, identifying fetuses with pathologically small growth remains challenging. Definitions of ...small-for-gestational age are often used as a proxy to identify those experiencing pathologic growth (ie, fetal growth restriction). However, this approach is subject to limitation as most newborns labeled small-for-gestational age are constitutionally, not pathologically, small. Incorporating repeated ultrasound measures to examine fetal growth trajectories may help distinguish pathologic deviations in growth from normal variability, beyond a simple definition of small-for-gestational age.
This study aimed to characterize phenotypes of growth using ultrasound trajectories of fetal growth among small-for-gestational-age births.
This study identified and described trajectories of fetal growth among small-for-gestational-age births (<10th percentile weight for gestational age; n=245) in the LIFECODES Fetal Growth Study using univariate and multivariate trajectory modeling approaches. Available ultrasound measures of fetal growth (estimated fetal weight, head circumference, abdominal circumference, and femur length) from health records were abstracted. First, univariate group-based trajectory modeling was used to define trajectories of estimated fetal weight z scores during gestation. Second, group-based multi-trajectory modeling was used to identify trajectories based on concurrent measures of head circumference, abdominal circumference, and femur length z scores. Last, how these trajectories were related to patient demographics, pregnancy characteristics, and birth outcomes compared with those observed among appropriate-for-gestational-age controls was described.
Of note, 3 univariate trajectories of estimated fetal weight and 4 multivariate trajectories of fetal growth among small-for-gestational-age births were identified. In our univariate approach, infants with the smallest estimated fetal weight trajectory throughout pregnancy had poorer outcomes, including the highest risk of neonatal intensive care unit admission. The remaining univariate trajectory groups did not have an elevated risk of adverse birth outcomes relative to appropriate-for-gestational-age controls. In our multivariate approach, 2 groups at increased or moderately increased risk of neonatal intensive care unit admission were identified, including infants that remained extremely small for all parameters throughout pregnancy and those who had disproportionately smaller femur length and abdominal circumference compared with head circumference. The remaining multivariate trajectory groups did not have an elevated risk of adverse birth outcome relative to appropriate-for-gestational-age controls.
Latent class group-based trajectory modeling applied to ultrasound measures of fetal growth may help distinguish pathologic vs constitutional growth profiles among newborns born small-for-gestational age. Although trajectories cannot be fully characterized until delivery, limiting the direct clinical application of these methods, they may still contribute to the development of approaches for separating growth restriction from constitutional smallness.
Organophosphate esters (OPEs), used ubiquitously as flame retardants and plasticizers in consumer products, are suspected of having developmental toxicity.BACKGROUNDOrganophosphate esters (OPEs), ...used ubiquitously as flame retardants and plasticizers in consumer products, are suspected of having developmental toxicity.Our study aimed to estimate associations between prenatal exposure to OPEs and fetal growth, including both ultrasound (head circumference, abdominal circumference, femur length, and estimated fetal weight) and delivery birth weight z-score, small-for-gestational age (SGA), and large-for-gestational age (LGA) measures of growth.OBJECTIVESOur study aimed to estimate associations between prenatal exposure to OPEs and fetal growth, including both ultrasound (head circumference, abdominal circumference, femur length, and estimated fetal weight) and delivery birth weight z-score, small-for-gestational age (SGA), and large-for-gestational age (LGA) measures of growth.In the LIFECODES Fetal Growth Study (2008-2018), an enriched case-cohort of 900 babies born at the small and large ends of the growth spectrum, we quantified OPE biomarkers in three urine samples per pregnant participant and abstracted ultrasound and delivery measures of fetal growth from medical records. We estimated associations between pregnancy-averaged log-transformed OPE biomarkers and repeated ultrasound measures of fetal growth using linear mixed-effects models, and delivery measures of fetal growth using linear (birth weight) and logistic (SGA and LGA) regression models.METHODSIn the LIFECODES Fetal Growth Study (2008-2018), an enriched case-cohort of 900 babies born at the small and large ends of the growth spectrum, we quantified OPE biomarkers in three urine samples per pregnant participant and abstracted ultrasound and delivery measures of fetal growth from medical records. We estimated associations between pregnancy-averaged log-transformed OPE biomarkers and repeated ultrasound measures of fetal growth using linear mixed-effects models, and delivery measures of fetal growth using linear (birth weight) and logistic (SGA and LGA) regression models.Most OPE biomarkers were positively associated with at least one ultrasound measure of fetal growth, but associations with delivery measures were largely null. For example, an interquartile range (IQR; 1.31 ng/mL) increase in bis(2-chloroethyl) phosphate concentration was associated with larger z-scores in head circumference mean difference (difference): 0.09; 95% confidence interval (CI): 0.01, 0.17, abdominal circumference (difference: 0.10; 95% CI: 0.02, 0.18), femur length (difference: 0.11; 95% CI: 0.03, 0.19), and estimated fetal weight (difference: 0.13; 95% CI: 0.04, 0.22) but not birth weight (difference: 0.04; 95% CI: -0.08, 0.17). At delivery, an IQR (1.00 ng/mL) increase in diphenyl phosphate (DPHP) concentration was associated with an SGA birth (odds ratio: 1.46; 95% CI: 1.10, 1.94).RESULTSMost OPE biomarkers were positively associated with at least one ultrasound measure of fetal growth, but associations with delivery measures were largely null. For example, an interquartile range (IQR; 1.31 ng/mL) increase in bis(2-chloroethyl) phosphate concentration was associated with larger z-scores in head circumference mean difference (difference): 0.09; 95% confidence interval (CI): 0.01, 0.17, abdominal circumference (difference: 0.10; 95% CI: 0.02, 0.18), femur length (difference: 0.11; 95% CI: 0.03, 0.19), and estimated fetal weight (difference: 0.13; 95% CI: 0.04, 0.22) but not birth weight (difference: 0.04; 95% CI: -0.08, 0.17). At delivery, an IQR (1.00 ng/mL) increase in diphenyl phosphate (DPHP) concentration was associated with an SGA birth (odds ratio: 1.46; 95% CI: 1.10, 1.94).In a large prospective cohort, gestational OPE exposures were associated with larger fetal size during pregnancy, but associations at delivery were null. DPHP concentrations were associated with heightened risk of an SGA birth. These findings suggest that OPE exposure may affect fetal development. https://doi.org/10.1289/EHP14647.CONCLUSIONSIn a large prospective cohort, gestational OPE exposures were associated with larger fetal size during pregnancy, but associations at delivery were null. DPHP concentrations were associated with heightened risk of an SGA birth. These findings suggest that OPE exposure may affect fetal development. https://doi.org/10.1289/EHP14647.
Physical activity (PA) prior to and during pregnancy may have intergenerational effects on offspring health through placental epigenetic modifications. We are unaware of epidemiologic studies on ...longitudinal PA and placental DNA methylation.
We evaluated the association between PA before and during pregnancy and placental DNA methylation.
Placental tissues were obtained at delivery and methylation was measured using HumanMethylation450 Beadchips for participants in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singletons among 298 participants. Using the Pregnancy Physical Activity Questionnaire, women recalled periconception PA (past 12 mo) at 8-13 wk of gestation and PA since last visit at 4 follow-up visits at 16-22, 24-29, 30-33, and 34-37 wk. We conducted linear regression for associations of PA at each visit with methylation controlling for false discovery rate (FDR). Top 100 CpGs were queried for enrichment of functional pathways using Ingenuity Pathway Analysis.
Periconception PA was significantly associated with 1 CpG site. PA since last visit for visits 1-4 was associated with 2, 2, 8, and 0 CpGs (log fold changes ranging from -0.0319 to 0.0080, after controlling for FDR). The largest change in methylation occurred at a site in TIMP2 , which is known to encode a protein critical for vasodilation, placentation, and uterine expansion during pregnancy (log fold change: -0.05; 95% CI: -0.06, -0.03 per metabolic equivalent of task-h/wk at 30-33 wk). Most significantly enriched pathways include cardiac hypertrophy signaling, B-cell receptor signaling, and netrin signaling. Significant CpGs and enriched pathways varied by visit.
Recreational PA in the year prior and during pregnancy was associated with placental DNA methylation. The associated CpG sites varied based on timing of PA. If replicated, the findings may inform the mechanisms underlying the impacts of PA on placenta health. This study was registered at clinicaltrials.gov as NCT00912132.
Abstract
STUDY QUESTION
Are children who were conceived with infertility treatment at an increased risk of developing asthma and atopic conditions?
SUMMARY ANSWER
Infertility treatment is associated ...with an elevated risk of asthma and atopic conditions in early and middle childhood, even after adjustment for parental asthma and atopy.
WHAT IS KNOWN ALREADY
Asthma and atopic conditions are prevalent in childhood. The development of these conditions may be linked to early life exposures, including the use of infertility treatments.
STUDY DESIGN, SIZE, DURATION
Upstate KIDS is a prospective cohort study of singletons and multiples born between 2008 and 2010. A total of 5034 mothers and 6171 children were enrolled and followed up until 2019, and 2056 children participated in the middle childhood follow-up.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Women reported the fertility agents used to become pregnant on a baseline questionnaire. Treatment was categorized as ART (∼22%) use, ovulation induction via oral/injectable medications with or without IUI (OI/IUI, ∼20%), or no treatment (∼58%). Outcomes were assessed by maternal report on questionnaires in early (up to age 3 years, prevalence 9–28%) and middle (7–9 years, prevalence 10–16%) childhood. Weighted Poisson regression models with robust standard errors were used to analyze the risk of atopic outcomes in relation to infertility treatment exposure.
MAIN RESULTS AND THE ROLE OF CHANCE
Compared to children conceived without treatment, children conceived with any infertility treatment were at an increased risk of persistent wheeze by age 3 years (relative risk (RR): 1.66; 95% CI: 1.17, 2.33) with adjustments for parental atopy among other risk factors. Around 7–9 years, children conceived with treatment were more likely to have current asthma (RR: 1.30; 95% CI: 0.98, 1.71), eczema (RR: 1.77; 95% CI: 1.25, 2.49) or be prescribed allergy-related medications (RR: 1.45; 95% CI: 1.06, 1.99). Similar effect sizes were found when examining associations by treatment type (i.e. ART versus OI/IUI).
LIMITATIONS, REASONS FOR CAUTION
Childhood outcomes were based on maternal report and are subject to potential misclassification. There was attrition in this study, which limits the precision of our measures of association.
WIDER IMPLICATIONS OF THE FINDINGS
Though future research is needed to clarify the mechanisms involved, our findings support that both ART and OI/IUI influences the development of asthma and atopic conditions in the offspring from an early age.
STUDY FUNDING/COMPETING INTEREST(S)
This work was supported by the National Institutes of Health’s Intramural Research Program at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; contracts #HHSN275201200005C, #HHSN267200700019C, #HHSN275201400013C, #HHSN275201300026I/27500004, #HHSN275201300023I/27500017). The authors have no relevant conflicts of interest to disclose.
TRIAL REGISTRATION NUMBER
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