Perinatal HIV exposure and infection and caregiver depressive symptoms

Survival is possible for children perinatally exposed to or infected by HIV in the post-combined antiretroviral therapy era and identifying factors affecting children's ability to thrive has public health significance. Caregiver mental health is one such factor to consider given its impact on child development, but previous work has not included a full complement of HIV exposure/infection groups within HIV-endemic settings. We compared depressive symptoms among caregivers of 3 groups of 6-10-year-olds in Uganda: children with perinatally acquired HIV infection (CPHIV, n = 102), children with perinatal HIV exposure, but no infection (CPHEU, n = 101), and children without perinatal HIV exposure or infection (CHUU, n = 103). The Hopkins Symptom Checklist was used to assess caregiver depressive symptoms. Generalized linear models were used to estimate group mean differences. Adjusted models included caregiver demographics, social support, and lifetime trauma. Depression symptoms were higher among CPHEU compared to CPHIV caregivers (model coefficient [B] = -3.5, 95%CI -5.3, -1.8). This finding was minimally attenuated following adjustment for covariates (B = -2.2, 95%CI -4.1, -0.4) and among biological mothers. At lower levels of social support and wealth, CPHEU caregivers reported higher levels of depression symptoms than CPHIV caregivers. Our findings point to unmet mental health needs among CPHEU caregivers.

Infant Temperament: Exploring The Potential Role of Maternal Dietary Choline and Folate Consumption During Pregnancy in a Michigan Pregnancy Cohort

Objectives

Choline and folate are important nutrients involved in fetal brain development, but relationships between diet and infant temperament—an outcome potentially related to neurobehavioral development—have not been widely explored. Our objective was to examine associations between maternal dietary choline and folate intake during pregnancy and infant temperament assessed at 9 months.

Methods

Participants from the Michigan Archive for Research on Child Health (MARCH) prospective pregnancy cohort were included in this analysis (n = 89, mean age [SD] = 30.4 ± 5.5 y). Maternal dietary intake was assessed in mid-pregnancy with the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24). Infant temperament was assessed by parent report using the Infant Behavior Questionnaire-Revised Very Short Form (IBQ-VSF) at the infant 9-month visit (range 8–16 months; mean [SD] 287 ± 31 days after birth). Participants were included if they had data from at least one ASA24 and the IBQ-VSF assessment. Where applicable, the average of two ASA24s was used (n = 45). For twins, infant data was randomly selected to include only one twin (n = 2 mother-child pairs). Independent t-tests were used to assess mean differences in nutrient intake by maternal sociodemographic characteristics. Pearson correlations were used to examine relationships between maternal nutrient consumption and infant temperament scores.

Results

Neither folate nor choline intake differed significantly by maternal age, education, marital status, or income. Choline intake varied by work status (418.76 ± 197.01 mg [not working/part-time] vs. 337.70 ± 150.34 mg [full-time], p = 0.033). Maternal choline intake was related to infant Positive Affect/Surgency, r = 0.213, p = 0.045; when data were limited to the subset with two ASA24s (n = 45), the relationship was no longer significant r = 0.262, p = 0.083. No significant relationships between maternal folate intake and infant temperament were observed.

Conclusions

Pregnancy dietary folate was not associated with parent-reported temperament at 9 months, but we observed an association between pregnancy dietary choline and Positive Affect/Surgency in infants. In addition to replicating these findings, more research is needed to examine the plausibility of associations reported here.

Funding Sources

Funded in part by a grant from the NIH ECHO program.

Maternal cytomegalovirus sero-positivity and autism symptoms in children

PROBLEM

Autism spectrum disorder (ASD) is one of the most commonly diagnosed neurodevelopmental disorders in the United States. While ASD can be significantly influenced by genetics, prenatal exposure to maternal infections has also been implicated in conferring risk. Despite this, the effects of several important maternal pathogens, such as cytomegalovirus (CMV) and herpes simplex virus 2 (HSV2), remain unknown.

METHOD OF STUDY

We tested whether maternal CMV and/or HSV2 sero-positivity was associated with ASD symptoms in children. ELISA was used to assay for CMV IgG and HSV2 IgG in serum from the mothers of 82 children whose ASD symptoms were assessed at 3-6 years of age using the Social Responsiveness Scale version 2 (SRS-2).

RESULTS

Associations between maternal viral serostatus and SRS-2 scores were estimated using linear regression with covariate adjustments. The children of mothers sero-positive for CMV, but not for HSV2, had SRS-2 scores 3.6-4.2 points higher, depending on the adjustment model, than sero-negative women, a significant finding, robust to several statistical adjustments.

CONCLUSION

Our results suggest that maternal CMV infections may influence ASD symptoms. These findings are being further evaluated in ongoing prospective studies with larger population samples.