1
|
Tshiambara P, Hoffman M, Legodi H, Botha T, Mulol H, Pisa P, Feucht U. Comparison of Feeding Practices and Growth of Urbanized African Infants Aged 6-12 Months Old by Maternal HIV Status in Gauteng Province, South Africa. Nutrients 2023; 15:nu15061500. [PMID: 36986230 PMCID: PMC10053312 DOI: 10.3390/nu15061500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/15/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
Appropriate feeding practices are protective against malnutrition and poor growth. We compared feeding practices and growth in HIV-exposed-uninfected (HEU) and HIV-unexposed-uninfected (HUU) between 6-12 months of age in urbanized African infants in South Africa. A repeated cross-sectional analysis was used to determine differences in infant feeding practices and anthropometric measures by HIV exposure status at 6, 9, and 12 months in the Siyakhula study. The study included 181 infants (86 HEU; 95 HUU). Breastfeeding rates were lower in HEU vs. HUU infants at 9 (35.6% vs. 57.3%; p = 0.013) and 12 months (24.7% vs. 48.0%; p = 0.005). Introduction to early complementary foods was common (HEU = 16.2 ± 11.0 vs. HUU = 12.8 ± 9.3 weeks; p = 0.118). Lower weight-for-age Z-scores (WAZ) and head circumference-for-age Z-scores (HCZ) were found in HEU infants at birth. At 6 months, WAZ, length-for-age Z-scores (LAZ), HCZ, and mid-upper-arm circumference-for-age Z-scores (MUACAZ) were lower in HEU vs. HUU infants. At 9 months, lower WAZ, LAZ, and MUACAZ were found in HEU vs. HUU infants. At 12 months, lower WAZ, MUACAZ, and weight-for-length Z-scores (-0.2 ± 1.2 vs. 0.2 ± 1.2; p = 0.020) were observed. HEU infants had lower rates of breastfeeding and poorer growth compared to HUU infants. Maternal HIV exposure affects the feeding practices and growth of infants.
Collapse
Affiliation(s)
- Phumudzo Tshiambara
- Department of Human Nutrition, Faculty of Health Sciences, University of Pretoria, Prinshof Campus, Pretoria 0084, South Africa
- Department of Consumer and Food Sciences, Faculty of Natural and Agricultural Sciences, University of Pretoria, Hatfield Campus, Pretoria 0028, South Africa
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Kalafong Provincial Tertiary Hospital, Pretoria 0001, South Africa
- Research Unit for Maternal and Infant Health Care Strategies, South African Medical Research Council, Pretoria 0001, South Africa
| | - Marinel Hoffman
- Department of Consumer and Food Sciences, Faculty of Natural and Agricultural Sciences, University of Pretoria, Hatfield Campus, Pretoria 0028, South Africa
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Kalafong Provincial Tertiary Hospital, Pretoria 0001, South Africa
- Research Unit for Maternal and Infant Health Care Strategies, South African Medical Research Council, Pretoria 0001, South Africa
| | - Heather Legodi
- Department of Human Nutrition, Faculty of Health Sciences, University of Pretoria, Prinshof Campus, Pretoria 0084, South Africa
| | - Tanita Botha
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Hatfield Campus, Pretoria 0028, South Africa
| | - Helen Mulol
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Kalafong Provincial Tertiary Hospital, Pretoria 0001, South Africa
- Research Unit for Maternal and Infant Health Care Strategies, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Paediatrics, Faculty of Health Sciences, University of Pretoria, Prinshof Campus, Pretoria 0084, South Africa
| | - Pedro Pisa
- Department of Human Nutrition, Faculty of Health Sciences, University of Pretoria, Prinshof Campus, Pretoria 0084, South Africa
| | - Ute Feucht
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Kalafong Provincial Tertiary Hospital, Pretoria 0001, South Africa
- Research Unit for Maternal and Infant Health Care Strategies, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Paediatrics, Faculty of Health Sciences, University of Pretoria, Prinshof Campus, Pretoria 0084, South Africa
| |
Collapse
|
2
|
Chen S, Xiao X, Song X, Qi Z, Li Y. Prediction of cord blood leptin on infant's neurodevelopment: A birth cohort in rural Yunnan, China. Psychoneuroendocrinology 2023; 148:105955. [PMID: 36442291 DOI: 10.1016/j.psyneuen.2022.105955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/17/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Leptin, one of the peptide hormones secreted by adipocytes, plays a vital part in metabolism, but its role in early-life neurodevelopment remains poorly understood. METHODS We performed leptin analysis on 323 cord blood samples collected from a birth cohort in Yunnan rural area, China, and assessed infants' neurodevelopment at one year of age by the Bayley Scales of Infant and Toddler Development-Third Edition (BSID-III). Multiple linear regression and binary logistic regression models were used to explore the associations between cord blood leptin (CBL) concentrations and infants' neurodevelopment and the ability of CBL to predict the probabilities of infants' neurodevelopment delay. RESULTS Overall, 323 infants were included in this study. The median concentration of CBL was 4.7 ng/ml. The proportion of 1-year-old infants identified as being neurodevelopmental delayed was 34.5%, and delays in cognitive, language, and motor domains were 11.1%, 26.6%, and 13.9%, respectively. Multiple linear regression analyses manifested that the CBL concentration (log10-transformed) was positively correlated with the cognitive, language, and motor composite scores in infants, respectively (β = 7.76, 95%CI: 3.81-11.71; β = 6.73, 95%CI: 3.41-10.06; and β = 6.88, 95%CI: 3.48-10.29, respectively). Binary logistic regression analysis showed that compared with the higher, lower CBL (< 4.7 ng/ml) yielded a 1.41-fold increase in the risk of language development delay (OR = 2.41,95%CI: 1.42-4.09), a 1.49-fold higher risk of motor development delay (OR = 2.49, 95%CI: 1.25-4.96), and a 1.71-fold higher risk of neurodevelopment delay (OR = 2.71, 95%CI: 1.64-4.48) among infants. The prediction models showed that the probabilities of development delay in infants' language, motor, and neurodevelopment increased with the decline of CBL concentrations [rs = -0.63 (95% CI: -0.71, -0.56), rs = -0.46 (95% CI: -0.55, -0.38), rs = -0.55 (95% CI: -0.63, -0.46), respectively]. CONCLUSION The decline of CBL was associated with the decrease in infants' neurodevelopment scores at one year of age. CBL below 4.7 ng/ml may increase the risk of infants' neurodevelopment delay. The probabilities of infants' neurodevelopment delay increased with the decrease of CBL concentrations. CBL may be a predictor of the probability of children's neurodevelopment delay.
Collapse
Affiliation(s)
- Shuqi Chen
- School of Public Health, Kunming Medical University, Kunming, China; Ministry of Child Health, Longgang District Maternity & Child Healthcare Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Xia Xiao
- School of Public Health, Kunming Medical University, Kunming, China
| | - Xiaoxiao Song
- School of Public Health, Kunming Medical University, Kunming, China
| | - Zhiye Qi
- School of Public Health, Kunming Medical University, Kunming, China; Department of Pediatrics, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yan Li
- School of Public Health, Kunming Medical University, Kunming, China.
| |
Collapse
|
3
|
[Neuropsychological development of human immunodeficiency virus-exposed uninfected infants/young children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:967-972. [PMID: 36111712 PMCID: PMC9495237 DOI: 10.7499/j.issn.1008-8830.2203037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To investigate the level of neuropsychological development in human immunodeficiency virus (HIV)-exposed uninfected (HEU) infants/young children and the influence of maternal HIV infection on the neuropsychological development of HEU infants/young children. METHODS A total of 141 HEU infants/young children, aged 0-18 months and born to HIV-infected mothers, who were managed in four maternal and child health care hospitals in Yunnan Province of China from June 2019 to December 2020 and met the inclusion criteria were enrolled as the HEU group. A total of 141 HIV-unexposed uninfected (HUU) infants/young children who were born to healthy mothers and managed in the same hospitals, matched at a ratio of 1:1 based on sex, age, method of birth, birth weight, and gestational age, were enrolled as controls. Griffiths Development Scales-Chinese Edition was used to assess the development in the five domains of locomotion, personal-social, hearing and language, eye-hand co-ordination, and performance (visual perception and space integration ability). A questionnaire survey was performed to collect relevant information. The multivariate logistic regression analysis was used to assess the influence of maternal HIV infection on the neuropsychological development of HEU infants/young children. RESULTS Compared with the HUU group, the HEU group had significantly higher detection rates of retardation in the domains of hearing and language and performance (P<0.05). The multivariate logistic regression analysis showed that maternal HIV infection increased the risk of retardation in the domains of hearing and language (OR=2.661, 95%CI: 1.171-6.047, P<0.05) and performance (OR=2.321, 95%CI: 1.156-4.658, P<0.05). CONCLUSIONS Maternal HIV infection can negatively affect the development of hearing and language and performance in HEU infants/young children, and further studies are needed to clarify related mechanisms.
Collapse
|
4
|
Chen S, Xiao X, Qi Z, Chen L, Chen Y, Xu L, Zhang L, Song X, Li Y. Effects of prenatal and infant daily exposure to pyrethroid pesticides on the language development of 2-year-old toddlers: a prospective cohort study in rural Yunnan, China. Neurotoxicology 2022; 92:180-190. [DOI: 10.1016/j.neuro.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 10/15/2022]
|
5
|
Wedderburn CJ, Weldon E, Bertran-Cobo C, Rehman AM, Stein DJ, Gibb DM, Yeung S, Prendergast AJ, Donald KA. Early neurodevelopment of HIV-exposed uninfected children in the era of antiretroviral therapy: a systematic review and meta-analysis. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:393-408. [PMID: 35483380 PMCID: PMC9090907 DOI: 10.1016/s2352-4642(22)00071-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND There are 15·4 million children who are HIV-exposed and uninfected worldwide. Early child development crucially influences later academic and socioeconomic factors. However, the neurodevelopmental outcomes of HIV-exposed uninfected (HEU) children in the era of maternal antiretroviral therapy (ART) remain unclear. We aimed to examine the effects of in-utero exposure to HIV and ART on child neurodevelopment. METHODS For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, Africa-Wide Information, PsycInfo, and Global Health databases from inception to May 27, 2020, for studies from the past two decades reporting neurodevelopment of HEU children aged 0-5 years compared with HIV-unexposed (HU) children (aim 1), and effects of different maternal ART regimens on neurodevelopment of HEU children (aim 2). We did narrative syntheses for both aims, and a random-effects meta-analysis of high-quality studies comparing HEU children and HU children, to obtain weighted pooled estimates of effect sizes. This study was registered with PROSPERO, CRD42018075910. FINDINGS We screened 35 527 records and included 45 articles from 31 studies. Overall, 12 (57%) of 21 studies comparing HEU children and HU children found worse neurodevelopment in HEU children in at least one domain. Study design and methodological quality were variable, with heterogeneity across populations. Meta-analysis included eight high-quality studies comparing 1856 HEU children with 3067 HU children at ages 12-24 months; among HEU children with available data, 1709 (99%) of 1732 were exposed to ART. HEU children had poorer expressive language (effect size -0·17 [95% CI -0·27 to -0·07], p=0·0013) and gross motor function (-0·13 [-0·20 to -0·07], p<0·0001) than HU children, but similar cognitive development (-0·06 [-0·19 to 0·06], p=0·34), receptive language development (-0·10 [-0·23 to 0·03], p=0·14), and fine motor skills (-0·05 [-0·15 to 0·06], p=0·36). Results suggested little or no evidence of an effect of specific maternal ART regimens on neurodevelopment; study heterogeneity prevented meta-analysis. INTERPRETATION HEU children are at risk of subtle impairments in expressive language and gross motor development by age 2 years. We found no consistent effect of maternal ART regimens analysed, although evidence was scarce. We highlight the need for large high-quality longitudinal studies to assess the neurodevelopmental trajectories of HEU children and to investigate underlying mechanisms to inform intervention strategies. FUNDING Wellcome Trust and Medical Research Council.
Collapse
Affiliation(s)
- Catherine J Wedderburn
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; The Neuroscience Institute, University of Cape Town, Cape Town, South Africa; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; MRC Clinical Trials Unit, University College London, London, UK.
| | - Ella Weldon
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Cesc Bertran-Cobo
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Andrea M Rehman
- MRC International Statistics & Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Dan J Stein
- The Neuroscience Institute, University of Cape Town, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; MRC Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Diana M Gibb
- MRC Clinical Trials Unit, University College London, London, UK
| | - Shunmay Yeung
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew J Prendergast
- Blizard Institute, Queen Mary University of London, London, UK; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Kirsten A Donald
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; The Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
6
|
Qi Z, Song X, Xiao X, Loo KK, Wang MC, Xu Q, Wu J, Chen S, Chen Y, Xu L, Li Y. Effects of prenatal exposure to pyrethroid pesticides on neurodevelopment of 1-year- old children: A birth cohort study in China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 234:113384. [PMID: 35286956 DOI: 10.1016/j.ecoenv.2022.113384] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
Pregnant women have been ubiquitously exposed to pyrethroid pesticides. Previous studies, mainly based on third trimester measurements of maternal urinary pyrethroid metabolites, have reported inconsistent findings in the effects of prenatal pyrethroid exposure on children's neurodevelopmental outcomes. The purpose of this study was to clarify if pyrethroid exposure during the entire three trimesters of pregnancy may be associated with deleterious effects on infant neurodevelopmental status, particularly at a high dosage of exposure. We measured maternal urinary concentrations of pyrethroid metabolites in all trimesters of pregnancy and assessed children's neurodevelopment at one year of age using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). Multiple linear regression models were used to estimate the effects of metabolites (3-PBA, 4 F-3-PBA, cis-DBCA) in each trimester on BSID-III composite scores. Logistic regression analyses were applied to predict developmental delay vs non-delayed status (cut-off composite score of below 80 for developmental delay) based on the maternal levels of pyrethroid metabolites. In the first, second and third trimesters of pregnancy, the detection rates of pyrethroid metabolites were 94.7%, 90.7%, and 89.0%; the 50th percentiles of exposure level were 0.24 μg/g, 0.24 μg/g and 0.21 μg/g for 3-PBA, 0.14 μg/g, 0.17 μg/g and 0.15 μg/g for 4 F-3PBA, 0.21 μg/g, 0.25 μg/g and 0.19 μg/g for cis-DBCA respectively. In the second trimester, 3-PBA was inversely associated with Cognition and Language scores [β = -3.34 (95% CI = -6.11, -0.57) and β = -2.90 (95% CI = -5.20, -0.61), respectively], and significantly increased the risk of Cognition and Language developmental delay [OR= 1.64 (95% CI = 1.03, 2.62) and OR = 1.52 (95% CI = 1.06, 2.19), respectively]; cis-DBCA was inversely associated with Adaptive Behavior scores [β = -0.73 (95% CI = -1.27, -0.19)], and significantly increased the risk of Adaptive Behavior developmental delay [OR= 1.11 (95% CI = 1.02, 1.21)]. When the maternal levels of pyrethroid metabolites were stratified into the regression models according to the 90th percentile of exposure, in the first trimester, Cognition and Motor scores were inversely associated with higher cis-DBCA [β = -7.19 (95% CI = -12.97, -1.41) and β = -8.20 (95% CI = -13.35, -3.05), respectively], Language scores were inversely associated with higher 3-PBA [β = -6.01 (95% CI = -10.96, -1.06)]; in the second trimester, Cognition scores were inversely associated with higher cis-DBCA [β = -6.64 (95% CI = -12.51, -0.76)], Language scores were inversely associated with higher 3-PBA [β = -5.17 (95% CI = -10.07, -0.27)] and cis-DBCA [β = -5.40 (95% CI = -10.28, -0.52)]. We concluded that pyrethroid exposure in the first and second trimesters was associated with poorer infants neurodevelopmental outcomes at one year of age, and these effects were particularly pronounced at high levels of pyrethroid exposure.
Collapse
Affiliation(s)
- Zhiye Qi
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China; Department of Pediatrics, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xiaoxiao Song
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Xia Xiao
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Kek Khee Loo
- Developmental-Behavioral Pediatrics, Department of Pediatrics, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, United States
| | - May C Wang
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA, United States
| | - Qinghua Xu
- Yunnan Institute of Pediatric Research, Kunming Children's Hospital, The Affiliated Children's Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Jie Wu
- Department of Pediatrics, Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Shuqi Chen
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Ying Chen
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Lingling Xu
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Yan Li
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China.
| |
Collapse
|
7
|
Nöthling J, Laughton B, Seedat S. Maternal depression and infant social withdrawal as predictors of behaviour and development in vertically HIV-infected children at 3.5 years. Paediatr Int Child Health 2021; 41:268-277. [PMID: 35235497 DOI: 10.1080/20469047.2021.2023436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In low- and middle-income countries, there is a high prevalence of post-partum depression and it is often associated with HIV status. Maternal depression negatively affects mothering and can lead to social withdrawal in infants. Maternal depression and infant social withdrawal can have deleterious long-term effects on children's behaviour and neurodevelopmental trajectories. AIM To investigate whether maternal depression and infant social withdrawal at 10-12 months post-partum were significant predictors of child behaviour and development at 42 months. METHOD Seventy-four mother-infant dyads living with HIV were followed in a prospective, longitudinal design. Mothers were assessed for depression using the Center for Epidemiologic Studies Depression scale (CES-D). Infant social withdrawal was assessed by the modified Alarm Distress Baby Scale (m-ADBB), and development and behaviour were evaluated by the Griffiths Mental Development Scales (GMDS) and the Child Behavior Checklist (CBCL), respectively. RESULTS Maternal depression explained 4.8% of the variance in child behaviour (β = 0.98, t = 2.05, p < 0.05) and 10.3% of the variance in development (β = -0.30, t = -2.66, p < 0.05). Infant social withdrawal was not a significant predictor of behaviour (β = 3.27, t = 1.36, p = 0.18), but it did uniquely explain 7% of the variance in development (β = -1.32, t = -2.48, p < 0.05). CONCLUSION In the context of HIV, screening for maternal depression and the quality of mother-infant interactions are important (especially in the 1st year post-partum), given the significant long-term impact they have on behaviour and neurodevelopment. ABBREVIATIONS ANOVA: analysis of variance; ART: antiretroviral therapy; CBCL: Child Behavioral Checklist; CES-D: Center for Epidemiologic Studies Depression Scale; CHEI: children HIV-exposed and infected; CHER: Children with HIV Early Antiretroviral Treatment Trial; CHEU: children HIV-exposed and uninfected; CHUU: children HIV-unexposed and -uninfected; GMDS: Griffiths Mental Development Scales; HIV: human immunodeficiency virus; LMIC: low- and middle-income countries; m-ADBB: modified Alarm Distress Baby Scale; NRF: National Research Foundation; SAMRC: South African Medical Research Council; WHO: World Health Organization.
Collapse
Affiliation(s)
- Jani Nöthling
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Barbara Laughton
- Department of Paediatrics and Child Health, The Family Centre for Research with Ubuntu, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
8
|
Smith BL. Improving translational relevance: The need for combined exposure models for studying prenatal adversity. Brain Behav Immun Health 2021; 16:100294. [PMID: 34589787 PMCID: PMC8474200 DOI: 10.1016/j.bbih.2021.100294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/18/2022] Open
Abstract
Prenatal environmental adversity is a risk factor for neurodevelopmental disorders (NDDs), with the neuroimmune environment proposed to play a role in this risk. Adverse maternal exposures are associated with cognitive consequences in the offspring that are characteristics of NDDs and simultaneous neuroimmune changes that may underlie NDD risk. In both animal models and human studies the association between prenatal environmental exposure and NDD risk has been shown to be complex. Maternal overnutrition/obesity and opioid use are two different examples of complex exposure epidemics, each with their own unique comorbidities. This review will examine maternal obesity and maternal opioid use separately, illustrating the pervasive comorbidities with each exposure to argue a need for animal models of compound prenatal exposures. Many of these comorbidities can impact neuroimmune function, warranting systematic investigation of combined exposures to begin to understand this complexity. While traditional approaches in animal models have focused on modeling a single prenatal exposure or second exposure later in life, a translational approach would begin to incorporate the most prevalent co-occurring prenatal exposures. Long term follow-up in humans is extremely challenging, so animal models can provide timely insight into neurodevelopmental consequences of complex prenatal exposures. Animal models that represent this translational context of comorbid exposures behind maternal obesity or comorbid exposures behind maternal opioid use may reveal potential synergistic neuroimmune interactions that contribute to cognitive consequences and NDD risk. Finally, translational co-exposure models can identify concerning exposure combinations to guide treatment in complex cases, and identify high risk children starting in the prenatal period where early interventions improve prognosis.
Collapse
Affiliation(s)
- Brittany L. Smith
- Department of Pharmacology & Systems Physiology, University of Cincinnati, Cincinnati, OH, USA
| |
Collapse
|
9
|
Young JM, Bitnun A, Read SE, Smith ML. Early academic achievement of HIV-exposed uninfected children compared to HIV-unexposed uninfected children at 5 years of age. Child Neuropsychol 2021; 27:532-547. [PMID: 33461418 DOI: 10.1080/09297049.2021.1871891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
HIV-exposed uninfected (HEU) children may be at-risk for poorer academic achievement compared to HIV-unexposed uninfected (HUU) children due to in utero and perinatal exposure to HIV and/or anti-retroviral (ARV) medication. Understanding the risk factors for academic underachievement is important for implementing timely intervention and academic supports. HEU (N = 110, mean (SD) age 5.59 (0.22) years) and HUU (N = 43, mean (SD) age 5.73 (0.64) years) children completed assessments of general intelligence (WPPSI-III) and academic achievement (WRAT-4). Parent interviews and medical record reviews were used to obtain sociodemographic and maternal health data. HUU children scored significantly higher than HEU children on single word reading (p = 0.006), math calculation skills (p = 0.003), Verbal IQ, Performance IQ, Full Scale IQ, and Processing Speed (all WPPSI-III measures p < 0.001). Verbal IQ at 3-4 years predicted academic achievement at 5-6 years of age, yet sociodemographic and medical factors did not. These findings demonstrate that HEU children obtained significantly lower scores of intellectual, reading, and math abilities during early childhood. Addressing these early gaps before HEU children enter primary school will be critical for optimizing their learning and academic potential.
Collapse
Affiliation(s)
- Julia M Young
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Neurosciences and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ari Bitnun
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Stanley E Read
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Mary Lou Smith
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Neurosciences and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario, Canada
| |
Collapse
|
10
|
White M, Feucht UD, Duffley E, Molokoane F, Durandt C, Cassol E, Rossouw T, Connor KL. Does in utero HIV exposure and the early nutritional environment influence infant development and immune outcomes? Findings from a pilot study in Pretoria, South Africa. Pilot Feasibility Stud 2020; 6:192. [PMID: 33308322 PMCID: PMC7730756 DOI: 10.1186/s40814-020-00725-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 11/11/2020] [Indexed: 03/08/2023] Open
Abstract
Background As mother-to-child transmission of HIV decreases, and the population of infants who are born HIV-exposed, but uninfected (HEU) continues to rise, there is a growing need to understand the development and health outcomes of infants who are HEU to ensure that they have the healthiest start to life. Methods In a prospective cohort pilot study at Kalafong Hospital, Pretoria, South Africa, we aimed to determine if we could recruit new mothers living with HIV on antiretrovirals (ART; n = 20) and not on ART (n = 20) and new mothers without HIV (n = 20) through our clinics to study the effects of HEU on growth and immune- and neurodevelopment in infants in early life, and test the hypothesis that infants who were HEU would have poorer health outcomes compared to infants who were HIV-unexposed, uninfected (HUU). We also undertook exploratory analyses to investigate relationships between the early nutritional environment, food insecurity and infant development. Infant growth, neurodevelopment (Guide for Monitoring Child Development [GMCD]) and levels of monocyte subsets (CD14, CD16 and CCR2 expression [flow cytometry]) were measured in infants at birth and 12 weeks (range 8–16 weeks). Results We recruited 33 women living with HIV on ART and 22 women living without HIV within 4 days of delivery from June to December 2016. Twenty-one women living with HIV and 10 without HIV returned for a follow-up appointment at 12 weeks postpartum. The high mobility of this population presented major challenges to participant retention. Preliminary analyses revealed lower head circumference and elevated CCR2+ (% and median fluorescence intensity) on monocytes at birth among infants who were HEU compared to HUU. Maternal reports of food insecurity were associated with lower maternal nutrient intakes at 12 weeks postpartum and increased risk of stunting at birth for infants who were HEU, but not infants who were HUU. Conclusions Our small feasibility pilot study suggests that HEU may adversely affect infant development, and further, infants who are HEU may be even more vulnerable to the programming effects of suboptimal nutrition in utero and postnatally. This pilot and preliminary analyses have been used to inform our research questions and protocol in our ongoing, full-scale study.
Collapse
Affiliation(s)
- Marina White
- Department of Health Sciences, Carleton University, Ottawa, ON, K1S 5B6, Canada
| | - Ute D Feucht
- Paediatrics, University of Pretoria, Pretoria, GP 0002, South Africa.,Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, GP 0002, South Africa.,Maternal and Infant Health Care Strategies Unit, South African Medical Council, Pretoria, South Africa
| | - Eleanor Duffley
- Department of Health Sciences, Carleton University, Ottawa, ON, K1S 5B6, Canada
| | - Felicia Molokoane
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, GP 0002, South Africa.,Maternal and Infant Health Care Strategies Unit, South African Medical Council, Pretoria, South Africa.,Obstetrics and Gynaecology, University of Pretoria, Pretoria, GP, 0002, South Africa
| | - Chrisna Durandt
- South African Medical Research Council Extramural Unit for Stem Cell Research and Therapy, University of Pretoria, Pretoria, GP 0002, South Africa.,Institute for Cellular and Molecular Medicine, Department of Immunology, University of Pretoria, Pretoria, GP 0002, South Africa
| | - Edana Cassol
- Department of Health Sciences, Carleton University, Ottawa, ON, K1S 5B6, Canada
| | - Theresa Rossouw
- Institute for Cellular and Molecular Medicine, Department of Immunology, University of Pretoria, Pretoria, GP 0002, South Africa
| | - Kristin L Connor
- Department of Health Sciences, Carleton University, Ottawa, ON, K1S 5B6, Canada.
| |
Collapse
|
11
|
Rodriguez VJ, Zegarac M, La Barrie DL, Parrish MS, Matseke G, Peltzer K, Jones DL. Validation of the Bayley Infant Neurodevelopmental Screener Among HIV-Exposed Infants in Rural South Africa. J Acquir Immune Defic Syndr 2020; 85:507-516. [PMID: 33136752 DOI: 10.1097/qai.0000000000002479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Screening for developmental delays during critical periods of infant development is essential for early detection and intervention. Among high-risk infants in resource-limited settings, including those who are HIV exposed, there is a greater need for screening. This study expanded on previous analyses of the Bayley Infant Neurodevelopmental Screener (BINS) by providing psychometric properties to evaluate the appropriateness of using the BINS in a sample of HIV-exposed infants in rural South Africa. METHOD A total of 160 mothers with HIV, their infants, and their male partners were recruited. The BINS was administered to the infants, and their weights were recorded. Mothers completed measures of depression, intimate partner violence, male involvement, and adherence. Male partners reported their own involvement in perinatal care. RESULTS Results demonstrated support for a 5-factor structure consistent with previous transcultural adaptations of the BINS, demonstrating construct validity, and adequate reliability. Convergent validity was partially supported, as shown by associations with intimate partner violence and male involvement as reported by men and women and maternal adherence, although not with birth weight or maternal depression. The BINS showed adequate discriminating power, with only a few low-performing items. CONCLUSION In rural South Africa, a resource-limited setting, the BINS seems to be an adequate screening tool for developmental delays in children that may be used to identify those in need of intervention. Considering the high prevalence of delays identified in this study, antiretroviral therapy-exposed and HIV-exposed infants may benefit from further assessment to determine a need for intervention in community-based clinics.
Collapse
Affiliation(s)
- Violeta J Rodriguez
- Department of Psychology, University of Georgia, Athens, GA
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Miriam Zegarac
- Department of Psychology, University of Georgia, Athens, GA
| | | | - Manasi Soni Parrish
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Gladys Matseke
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
- Research and Innovation Chief-Directorate, National School of Government, Pretoria, South Africa
| | - Karl Peltzer
- Social Aspects of Public Health (SAPH) Research Programme, Human Sciences Research Council, Pretoria, South Africa
- Department of Psychology, University of the Free State, Bloemfontain, South Africa; and
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| |
Collapse
|
12
|
White M, Connor KL. In Utero HIV Exposure and the Early Nutritional Environment Influence Infant Neurodevelopment: Findings from an Evidenced Review and Meta-Analysis. Nutrients 2020; 12:nu12113375. [PMID: 33147767 PMCID: PMC7692402 DOI: 10.3390/nu12113375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 12/17/2022] Open
Abstract
The developing brain is especially vulnerable to infection and suboptimal nutrition during the pre- and early postnatal periods. Exposure to maternal human immunodeficiency virus (HIV) infection and antiretroviral therapies (ART) in utero and during breastfeeding can adversely influence infant (neuro) developmental trajectories. How early life nutrition may be optimised to improve neurodevelopmental outcomes for infants who are HIV-exposed has not been well characterised. We conducted an up-to-date evidence review and meta-analysis on the influence of HIV exposure in utero and during breastfeeding, and early life nutrition, on infant neurodevelopmental outcomes before age three. We report that exposure to maternal HIV infection may adversely influence expressive language development, in particular, and these effects may be detectable within the first three years of life. Further, while male infants may be especially vulnerable to HIV exposure, few studies overall reported sex-comparisons, and whether there are sex-dependent effects of HIV exposure on neurodevelopment remains a critical knowledge gap to fill. Lastly, early life nutrition interventions, including daily maternal multivitamin supplementation during the perinatal period, may improve neurodevelopmental outcomes for infants who are HIV-exposed. Our findings suggest that the early nutritional environment may be leveraged to improve early neurodevelopmental trajectories in infants who have been exposed to HIV in utero. A clear understanding of how this environment should be optimised is key for developing targeted nutrition interventions during critical developmental periods in order to mitigate adverse outcomes later in life and should be a priority of future research.
Collapse
|
13
|
Moraka NO, Moyo S, Smith C, Ibrahim M, Mayondi G, Leidner J, Powis KM, Cassidy AR, Kammerer B, Ajibola G, Williams PL, Weinberg A, Musonda R, Shapiro R, Gaseitsiwe S, Lockman S. Child HIV Exposure and CMV Seroprevalence in Botswana: No Associations With 24-Month Growth and Neurodevelopment. Open Forum Infect Dis 2020; 7:ofaa373. [PMID: 33072807 PMCID: PMC7539691 DOI: 10.1093/ofid/ofaa373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/18/2020] [Indexed: 11/23/2022] Open
Abstract
Background We sought to identify predictors of child cytomegalovirus (CMV) infection overall and by maternal HIV status and to assess associations of child CMV status with growth and neurodevelopmental outcomes at 24 months of age in Botswana. Methods Data and samples were used from the Botswana-based observational Tshipidi study (2010–2014), enrolling pregnant women living with and without HIV and following their infants through 2 years of age. Child plasma samples were tested at 18 months of age for anti-CMV immunoglobulin G (IgG). Associations were assessed between detectable anti-CMV IgG and growth (using the World Health Organization Child Growth Standards) and neurodevelopment (using the Bayley Scales of Infant and Toddler Development III and the Developmental Milestones Checklist) at 24 months of age. Results Of 317 children, 215 (68%) had detectable anti-CMV IgG at 18 months of age. Comparatively, 83% (n = 178) of HIV-unexposed uninfected (HUU) children had positive CMV serology vs 47% (n = 139) of HIV-exposed uninfected (HEU) children (P < .01); 100% of HUU vs 10.5% of HEU children breastfed. Child CMV infection was not associated with weight-for-age, weight-for-length, or length-for-age z-scores at 24 months. In HUU children, CMV infection was associated with smaller head circumference (P < .01). No difference was observed by child CMV status in any neurodevelopmental domain at 24 months. Conclusions We observed high CMV seropositivity in 18-month-old children in Botswana, with higher seropositivity among breastfed (HUU) children. Positive CMV serostatus was not associated with 24-month child growth or neurodevelopmental outcomes, with the exception of smaller head circumference among HUU CMV-positive children.
Collapse
Affiliation(s)
- Natasha O Moraka
- Research Laboratory Department, The Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Division of Medical Virology, Department of Pathology, Stellenbosch University Tygerberg, Cape Town, South Africa
| | - Sikhulile Moyo
- Research Laboratory Department, The Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Christiana Smith
- Pediatric Infectious Diseases, University of Colorado Denver, Denver, Colorado, USA
| | - Maryanne Ibrahim
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Gloria Mayondi
- Research Laboratory Department, The Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Jean Leidner
- Goodtables Data Consulting, Norman, Oklahoma, USA
| | - Kathleen M Powis
- Research Laboratory Department, The Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Paediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Adam R Cassidy
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Betsy Kammerer
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Gbolahan Ajibola
- Research Laboratory Department, The Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Paige L Williams
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Adriana Weinberg
- Pediatric Infectious Diseases, University of Colorado Denver, Denver, Colorado, USA
| | - Rosemary Musonda
- Research Laboratory Department, The Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Roger Shapiro
- Research Laboratory Department, The Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Harvard Medical School, Boston, Massachusetts, USA.,Division of Infectious Diseases, Beth Israel Deaconess Medical Centre, Boston, Massachusetts, USA
| | - Simani Gaseitsiwe
- Research Laboratory Department, The Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Shahin Lockman
- Research Laboratory Department, The Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
14
|
Gruver RS, Mall S, Kvalsvig JD, Knox JR, Mellins CA, Desmond C, Kauchali S, Arpadi SM, Taylor M, Davidson LL. Cognitive and Language Development at Age 4-6 Years in Children HIV-Exposed But Uninfected Compared to Those HIV-Unexposed and to Children Living With HIV. New Dir Child Adolesc Dev 2020; 2020:39-54. [PMID: 32618410 DOI: 10.1002/cad.20351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Perinatal HIV infection is associated with delayed neurocognitive development, but less is known about children perinatally HIV-exposed but uninfected (CHEU). We compared cognitive and language outcomes in 4-6-year old CHEU versus children HIV-unexposed and uninfected (CHUU) and children living with HIV (CLHIV). We enrolled 1,581 children (77% of the child population) in five communities in KwaZulu-Natal, South Africa. Children completed: Grover-Counter Scale of cognitive development, sub-scales of the Kaufman Assessment Battery for Children, Reynell Developmental Language Scales. HIV status of children and primary caregivers was determined by repeated rapid tests or report of prior testing. We conducted a cross-sectional multivariable linear regression on 922 dyads with complete data (257 CHEU, 627 CHUU, 38 CLHIV). On all outcome measures, CHEU and CHUU groups had comparable scores; CLHIV scored significantly lower. Emerging global progress toward the elimination of vertical HIV transmission may not only reduce mortality, but also positively impact child development.
Collapse
Affiliation(s)
- Rachel S Gruver
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Sumaya Mall
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jane D Kvalsvig
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Justin R Knox
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Chris Desmond
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Shuaib Kauchali
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Stephen M Arpadi
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.,Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Myra Taylor
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Leslie L Davidson
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.,Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, NY, USA
| |
Collapse
|
15
|
Eckard AR, Kirk SE, Hagood NL. Contemporary Issues in Pregnancy (and Offspring) in the Current HIV Era. Curr HIV/AIDS Rep 2020; 16:492-500. [PMID: 31630334 DOI: 10.1007/s11904-019-00465-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Although antiretroviral therapy (ART) has dramatically reduced mother to child transmission of HIV, data continue to mount that infants exposed to HIV in utero but are not infected (HEU) have serious negative health consequences compared to unexposed infants. This review evaluates recent literature on contemporary issues related to complications seen in pregnant women with HIV and their offspring. RECENT FINDINGS Current studies show that HEU infants are at a high risk of adverse outcomes, including premature birth, poor growth, neurodevelopmental impairment, immune dysfunction, infectious morbidity, and death. Etiologies for the observed clinical events and subclinical alterations are complex and multifactorial, and the long-term consequences of many findings are yet unknown. HEU infants have an unacceptable rate of morbidity and mortality from perinatal HIV and ART exposure, even in the modern ART era. Continual monitoring and reporting is imperative to protect this vulnerable population in our everchanging landscape of HIV treatment and prevention.
Collapse
Affiliation(s)
- Allison Ross Eckard
- Departments of Pediatrics and Medicine, Divisions of Infectious Diseases, Medical University of South Carolina, 135 Rutledge Ave., MSC 752, Charleston, SC, USA.
| | - Stephanie E Kirk
- Departments of Pediatrics and Medicine, Divisions of Infectious Diseases, Medical University of South Carolina, 135 Rutledge Ave., MSC 752, Charleston, SC, USA
| | - Nancy L Hagood
- Departments of Pediatrics and Medicine, Divisions of Infectious Diseases, Medical University of South Carolina, 135 Rutledge Ave., MSC 752, Charleston, SC, USA
| |
Collapse
|
16
|
Cassidy AR, Williams PL, Leidner J, Mayondi G, Ajibola G, Makhema J, Holding PA, Powis KM, Batlang O, Petlo C, Shapiro R, Kammerer B, Lockman S. In Utero Efavirenz Exposure and Neurodevelopmental Outcomes in HIV-exposed Uninfected Children in Botswana. Pediatr Infect Dis J 2019; 38:828-834. [PMID: 30985518 PMCID: PMC6629483 DOI: 10.1097/inf.0000000000002332] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Minimal data exist related to neurodevelopment after in utero exposure to Efavirenz (EFV). We sought to compare neurodevelopmental outcomes in HIV-exposed/uninfected (HEU) children with in utero exposure to EFV-based triple antiretroviral treatment (ART) versus non-EFV-based ART, and to examine whether timing of initial EFV exposure is associated with neurodevelopment deficits. METHODS Women living with HIV who had received EFV-based ART during pregnancy and whose HEU newborn participated in a prior study were reconsented for their HEU toddler to undergo neurodevelopmental testing at 24 months old. We administered the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III), Developmental Milestones Checklist (DMC) and Profile of Social Emotional Development (PSED). We compared outcomes to previously-collected data from a cohort of 24-month-old HEU children with in utero exposure to non-EFV-based ART. Adjusted general linear models were used to compare mean outcomes. RESULTS Our analysis included 493 HEU children (126 EFV-exposed, 367 EFV-unexposed). Adjusted mean scores for the EFV-exposed group were worse than the EFV-unexposed group on BSID-III Receptive Language (adjusted means = 21.5 vs. 22.5, P = 0.05), DMC Locomotor (30.7 vs. 32.0, P < 0.01) and Fine Motor scales (17.8 vs. 19.2, P < 0.01); and PSED (11.7 vs. 9.9, P = 0.02); but better on the DMC Language scale (17.6 vs. 16.5, P = 0.01). Earlier (vs. later) EFV exposure was associated with worse scores on the BSID-III Receptive Language scale (20.7 vs. 22.2, P = 0.02). CONCLUSIONS HEU children exposed in utero to EFV-based ART may be at higher risk for neurodevelopmental and social-emotional deficits than HEU children exposed to non-EFV-based ART.
Collapse
Affiliation(s)
- Adam R. Cassidy
- Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | - Gloria Mayondi
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Kathleen M. Powis
- Harvard Medical School, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Massachusetts General Hospital, Boston, MA, USA
| | - Oganne Batlang
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Chipo Petlo
- Ministry of Health and Wellness, Gaborone, Botswana
| | - Roger Shapiro
- Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Betsy Kammerer
- Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Shahin Lockman
- Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, USA
| |
Collapse
|
17
|
Pulli EP, Kumpulainen V, Kasurinen JH, Korja R, Merisaari H, Karlsson L, Parkkola R, Saunavaara J, Lähdesmäki T, Scheinin NM, Karlsson H, Tuulari JJ. Prenatal exposures and infant brain: Review of magnetic resonance imaging studies and a population description analysis. Hum Brain Mapp 2018; 40:1987-2000. [PMID: 30451332 DOI: 10.1002/hbm.24480] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 12/11/2022] Open
Abstract
Brain development is most rapid during the fetal period and the first years of life. This process can be affected by many in utero factors, such as chemical exposures and maternal health characteristics. The goal of this review is twofold: to review the most recent findings on the effects of these prenatal factors on the developing brain and to qualitatively assess how those factors were generally reported in studies on infants up to 2 years of age. To capture the latest findings in the field, we searched articles from PubMed 2012 onward with search terms referring to magnetic resonance imaging (MRI), brain development, and infancy. We identified 19 MRI studies focusing on the effects of prenatal environment and summarized them to highlight the recent advances in the field. We assessed population descriptions in a representative sample of 67 studies and conclude that prenatal factors that have been shown to affect brain metrics are not generally reported comprehensively. Based on our findings, we propose some improvements for population descriptions to account for plausible confounders and in time enable reliable meta-analyses to be performed. This could help the pediatric neuroimaging field move toward more reliable identification of biomarkers for developmental outcomes and to better decipher the nuances of normal and abnormal brain development.
Collapse
Affiliation(s)
- Elmo P Pulli
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Venla Kumpulainen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Jussi H Kasurinen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Riikka Korja
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Harri Merisaari
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Future Technologies, University of Turku, Turku, Finland.,Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Child Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Riitta Parkkola
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Jani Saunavaara
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Tuire Lähdesmäki
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Pediatric Neurology, University of Turku and Turku University Hospital, Turku, Finland
| | - Noora M Scheinin
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Jetro J Tuulari
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,Turku Collegium for Science and Medicine, University of Turku, Turku, Finland
| |
Collapse
|