Nelson Pace

Background: Adverse birth outcomes are important public health measures and account for a substantial public health burden. There is considerable diversity of these health endpoints, as well as in the many factors suspected or recognized to increase their risk. This diversity renders it challenging to synthesize the totality of the evidence by carrying out a systematic review. Methods: We undertook an expert elicitation to characterize the state of the literature on this topic, the interconnections amongst risk factors, and identify those that are a priority for future research. A panel of 30 scientists and physicians with expertise in birth outcome epidemiology were solicited to identify a series of health outcomes, and associated risk factors. Results: This resulted in a listing of 15 birth outcomes, and 247 possible risk factors in total, with varying numbers of risk factors for each health outcome. Each panel member was asked to score the weight of evidence (WOE) of each risk factor and birth outcome combination ( n = 1127) on a scale of 1 (no evidence) to 5 (strong evidence) for which the expert had a working knowledge of the literature. Not all experts scored each/every outcome/risk factor combination, reflecting the different types of expertise on the panel. The compilation of these WOE scores was used to create a publicly available database for birth outcomes risk factors ( https://scipinion‐rfbo.onrender.com ) that is intended to be updated over time so as to serve as an up to date resource for the research and medical community. Conclusions: This expert approach serves as a unique and valuable approach to data reduction that can help to inform research priorities, while providing an open access resource to identify risk factors that may act as confounders and/or modifiers in future epidemiology studies and clinical trials.

Objective: To assess differences in internalized stigma of mental illness based on demographic characteristics and mental healthcare utilization among college students. Participants: Students with self-reported mental illness (n = 128) were recruited via random sampling. Methods: Participants completed an online survey, including questions related to demographic characteristics and mental healthcare utilization. The survey also included the Internalized Stigma of Mental Illness (ISMI) scale. Data were analyzed using descriptive and inferential statistics. Results: Students accessing mental healthcare (pharmacological and/or psychotherapeutic) reported higher ISMI scores than students who did not access services during past year. Students with sexual minority statuses also reported higher ISMI scores than their heterosexual counterparts. Conclusions: Results highlight differences in internalized stigma based on demographics characteristics and mental healthcare utilization among college students. More research is needed to better understand intersectional stigma. Further, universities need tailored and specific interventions to address internalized stigma among students with diverse backgrounds and needs.

Background: While there is evidence that parental exposure to medical radiation is associated with increased risk of sporadic bilateral retinoblastoma in offspring, this association has not been confirmed. Additionally, the relationship between paternal and maternal exposures and sporadic unilateral retinoblastoma has not been fully investigated.Procedure: Data were obtained from two large multicenter case‐control studies of retinoblastoma. For the paternal analyses, 268 bilateral cases, 155 unilateral cases, and 358 controls were included. For the maternal analyses, 298 bilateral cases, 184 unilateral cases, and 404 controls were included. Logistical regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) to evaluate the associations between parental exposures to medical radiation and sporadic retinoblastoma, while adjusting for potential confounders.Results: Paternal exposure to medical radiation was not significantly associated with sporadic bilateral retinoblastoma in offspring. However, increasing paternal exposure to gonadal radiation was associated with increased risk of unilateral retinoblastoma (P‐trend = .03). Maternal history of upper and lower gastrointestinal (GI) series was associated with bilateral retinoblastoma (OR = 1.9, 95% CI: 1.1‐3.2 and OR = 6.9, 95% CI: 2.9‐16.4, respectively). However, there was no association between maternal exposure to medical radiation and unilateral retinoblastoma in offspring.Conclusion: Our investigation adds to the evidence that medical radiation exposure in fathers as well as mothers prior to pregnancy may increase the risk of germline alterations leading to the development of retinoblastoma in their offspring. However, our findings could point to a more complex etiological framework for this important pediatric malignancy.

Objective: To investigate first‐year survival of infants born with spina bifida, and examine the association of maternal prepregnancy body mass index (BMI) with infant mortality.Methods: This is a retrospective cohort study of 1,533 liveborn infants with nonsyndromic spina bifida with estimated dates of delivery from 1998 to 2011 whose mothers were eligible for the National Birth Defects Prevention Study (NBDPS). NBDPS data were linked to death records to conduct survival analyses. Kaplan–Meier survival functions estimated mortality risk over the first year of life. Cox proportional hazards models estimated hazard ratios (HRs) for maternal prepregnancy BMI categorized as underweight (<18.5), normal (18.5–24.9), overweight (25–29.9), and obese (≥30).Results: Infant mortality risk among infants with spina bifida was (4.4% [3.52, 5.60%]). Infants with multiple co‐occurring defects, very preterm delivery, multiple gestation, high‐level spina bifida lesions, or non‐Hispanic Black mothers had an elevated risk of infant mortality. Maternal prepregnancy underweight and obesity were associated with higher infant mortality (15.7% [7.20, 32.30%] and 5.82% [3.60, 9.35%], respectively). Adjusted HR estimates showed underweight and obese mothers had greater hazard of infant mortality compared to normal weight mothers (HR: 4.5 [1.08, 16.72] and 2.6 [1.36, 8.02], respectively).Conclusion: The overall risk of infant mortality for infants born with spina bifida was lower than most previously reported estimates. Infants born with spina bifida to mothers who were underweight or obese prepregnancy were at higher risk of infant mortality. This study provides additional evidence of the importance of healthy maternal weight prior to pregnancy.

Maternal mental health during pregnancy and postpartum is especially critical, as the health of both mother and child are dynamically interconnected. Stigma can hinder mental health service utilization. Perinatal Mood and Anxiety Disorders (PMAD) refers to mental illness that occurs during pregnancy or postpartum. This acronym’s pronunciation, “P-MAD,” reinforces societal stigma. As pregnant and postpartum women may avoid revealing mental illness to appease cultural expectations, stigmatizing terms may exacerbate this issue. We, therefore, discourage the use of the term, “P-MAD.”

Background: Approximately 1 in 2000 infants is born with a limb deficiency in the US. Research has shown that women's periconceptional diet and use of vitamin supplements can affect risk of birth defects. We investigated whether maternal consumption of nutritional antioxidants was associated with occurrence of transverse limb deficiency (TLD) and longitudinal limb deficiencies (LLD).Methods: We analysed case–control data from mothers and their singleton infants with TLD (n = 566), LLD (n = 339), or no malformation (controls; n = 9384) in the National Birth Defects Prevention Study (1997–2009). Using a modified food frequency, we estimated usual pre‐pregnancy antioxidant consumption by total fruit and vegetable consumption (in grams) grouped into tertiles, and cumulative antioxidant score (ranging from 1 to 10) based on consumption of three antioxidants: beta‐carotene, lycopene, and lutein. We estimated odds ratios (OR) adjusted for maternal age, race/ethnicity, education, smoking, alcohol use, body mass index, and total energy.Results: Compared to women in the lowest tertile of fruit and vegetable consumption, women in the highest tertile were less likely to have infants with TLD (OR 0.74, 95% CI 0.57, 0.96) or LLD (OR 0.82, 95% CI 0.59, 1.13). Compared to the lowest antioxidant consumption score of 1, those with the highest score of 10 had ORs of 0.68 (95% CI 0.48, 0.95) for TLD and 0.77 (95% CI 0.50, 1.17) for LLD.Conclusions: Dietary intake of antioxidants was associated with reduced odds of limb deficiencies. These findings add further evidence for women's periconceptional diet reducing occurrence of some birth defects.