Objective: The purpose of this study is to assess whether childhood externalizing and internalizing behaviors predict substance use initiation during adolescence. Additionally, we examined whether there was effect measure modification by sex of the child on this association. Methods: This study is a secondary analysis using data from a prospective cohort study, the Fragile Families and Child Wellbeing Study. A multivariable log link regression analysis was used to estimate the risk of initiation of marijuana, cigarettes, and alcohol at age 15, based on internalizing and externalizing behaviors measured at age 9. Models were adjusted for child race/ethnicity, maternal age, maternal substance use during pregnancy, poverty level, and ACEs. Results: Out of 2935 children at age 9, 6.5% met the criteria for high externalizing score, and 3.6% met the criteria for high internalizing score. High externalizing score was a risk factor for marijuana (ARR= 1.57, CI= 1.10, 2.20) and cigarette use (ARR= 2.38, CI= 1.31, 4.17) initiation. High internalizing score decreased the risk of alcohol use initiation, after controlling for all confounding variables. There was no evidence of effect modification by child sex. Conclusion: These findings are of public health importance, as they add to the paucity of information on known risk factors for substance use initiation among adolescents. Additionally, these results can be used to help identify youth who may benefit from interventions designed to prevent adolescent substance use initiation.

Respiratory diseases such as asthma, wheeze and reduced lung function physically and economically burden many individuals, and have biologic underpinnings to the prenatal and childhood timeframes via fetal programming and epigenetic mechanisms. This dissertation studies risk and preventive factors for respiratory illnesses during three distinct timeframes: the prenatal period, infancy, and childhood/adolescence. By using data that oversampled immigrant Latino families, we were afforded additional opportunities to study race/ethnicity and nativity as a confounder or effect measure modifier, further tailoring our public health message to an important and growing population in our communities.

Our first study used longitudinal data from a population based nested case-control study in Los Angeles to analyze three different maternal stressors as well as paternal support during pregnancy to determine if these stressors carried differential risk of reported lifetime wheeze in the young offspring. We further examined whether Latina ethnicity modified those same associations. The risk of wheeze in the offspring was increased from high levels of pregnancy anxiety (aRR 1.40, 95% CI 1.07, 1.83), negative life events (aRR 1.36, 95% CI 1.06, 1.75), or low paternal support (aRR 1.41, 95% CI 1.02, 1.96). Additionally, the risk of lifetime wheeze was stronger in the offspring of Latina mothers than of White mothers for these same stressors.

Using data from the same sample in the second study, we assessed whether maternal nativity in a Latina population confounded or modified the association between exclusive breastfeeding and asthmatic symptoms. Using cross-sectional data restricted to Latinas, we found a 49% reduction in risk of asthmatic symptoms with >3 months of exclusive breastfeeding (aRR=0.51, 95% CI 0.28, 0.90). Foreign-born Latinas were more likely to initiate and continue breastfeeding for at least three months compared with US-born Latinas. We did not find evidence that maternal nativity confounded or modified the association, but rather predicted the woman’s breastfeeding behavior.

In the third study, using cross-sectional data from the Los Angeles Family and Neighborhood Survey (L.A.FANS-2, 2006/8, n=584), we analyzed whether various psychosocial stressors predicted lung function in youth ages 10-17 after adjusting for air pollution. No consistent results were seen between self-reported psychosocial stressors, caregiver stressors, or negative behaviors and lung function in youth. We observed a suggestion of reduced lung function in males from family fighting (FEV1: -156.2ml, 95% CI -327.8, 15.5), absence of a father in the house (FEV1: -176.2ml, 95% CI -322.7, -29.7) and the summary stress score (FEV1: -45.6ml, 95%CI -97.6, 6.3), which were all stronger in older males ages 15-17. Additionally, feeing unsafe at school was associated with reduced lung function in younger participants ages 10-14 (FEV1: -129.8ml, 95%CI -241.4, -18.2). None of the measures were associated with reduced lung function in females.

In conclusion, prenatal psychosocial stressors and breastfeeding behaviors are potentially modifiable, and are associated with respiratory illnesses. Further work is warranted looking at psychosocial stressors later in youth. Individually tailored messages, particularly to Latinas, who may have stronger effects from prenatal stressors or negative breastfeeding behavior by nativity status, should be a priority towards preventing childhood respiratory illnesses.

Background: Acetaminophen is the most commonly recommended over-the-counter drug during pregnancy yet is an endocrine-disrupting medication. This study’s objective was to evaluate the neurological effects of prenatal acetaminophen exposure, up to 48 months of age.Methods: In this prospective cohort study, 586 women in the UCSD MothertoBaby Study were surveyed throughout pregnancy and 600 children were followed between 12 and 48 months of age. Exposure was operationalized based on categorical exposure to acetaminophen (none, low, moderate, high). Four neurological scales (ASQ, MCHAT, WG, WS) were used to evaluate neurodevelopment. Results: ASQ gross motor scores for the low exposure group were significantly lower than those unexposed (β = -2.036, p = 0.0053, 95% CI(-5.30, -0.929)). Adjusted ASQ problem solving scores by quantile showed individuals in both the low (β = -2.471, p = 0.0402, 95% CI(-4.98,-0.113)) and high (β = -2.958, p = 0.0158, 95% CI(-5.67,-0.590)) groups had significantly lower scores than those unexposed. On the WS test, varying levels of acetaminophen exposure was associated with a higher risk of failure to use absent object production (moderate exposure RR = 1.103, 95% CI (1.03, 1.18)), possessive tense (low exposure RR = 1.24, 95% CI (1.02, 1.49)), and combine words proficiently (high exposure RR = 1.13, 95% CI (1.02, 1.26)), compared to those unexposed. Conclusion: Prenatal acetaminophen exposure was a risk factor for lower ASQ and Words & Sentences scores. Results did not show an association between acetaminophen and neurological outcomes on all scales, indicating the need for additional research.

Background: Pregnant individuals who have sustained injury are advised to seek immediate care and treatment regardless of injury severity, as these injuries can be life-threatening for both mother and fetus. Using a California administrative birth cohort, the present study aims to examine adverse birth outcomes associated with trauma-related injuries during pregnancy. Methods: We performed a retrospective study of pregnant individuals using data from an administrative birth cohort using data from 2016 through 2020, resulting in an analytical sample of 1, 910, 761 pregnant individuals. Poisson regression models were used to calculate unadjusted and adjusted risk ratios of adverse birth outcomes by the presence of injury diagnoses and by the top five prevalent injuries. The models were adjusted for maternal sociodemographic characteristics, tobacco use, alcohol use disorder, and substance abuse. Results: A total of 53, 692 individuals reported suffering traumatic injuries during pregnancy. Pregnant individuals who were poisoned during pregnancy were at a greater risk of giving birth to a baby prematurely (aRR=2.1, 95% CI: 1.9 to 2.2) or being admitted to the NICU (aRR= 2.1 (95% CI: 1.9 to 2.2) relative to the pregnant individuals who were not poisoned. Conclusion: Sustaining a traumatic injury during pregnancy is associated with an increased risk of adverse birth outcomes, particularly seen with preterm birth and NICU admission. However, we found no consistent pattern in the documented number of injury diagnoses sustained. Injury prevention programs and hospital guidelines on treating injured pregnant individuals may be beneficial for both mother and fetus in the event of a traumatic injury.

Background: Pregnant women are at higher risk for severe Coronavirus disease 2019 (COVID-19) infection, leading the Centers for Disease Control and Prevention (CDC) to recommend vaccination. However, the frequency of vaccine side effects in pregnant women with autoimmune inflammatory rheumatic diseases (AIIRD) remains unknown.Objective: We investigated the frequencies of short-term (≤ 7 days) adverse reactions following the initial COVID-19 vaccination ever received by pregnant women with AIIRD. Methods: A descriptive analysis of the incidence of side effects following the COVID-19 vaccination in pregnant women with AIIRD was conducted utilizing data from the MotherToBaby Study (MTB) registry, a prospective cohort study designed to assess the safety of drug and vaccine exposure during pregnancy. Results: Of 1413 participants who received dose 1 of the COVID-19 vaccine in pregnancy, 79 had AIIRD. There was no significant difference in the total number of adverse reactions between pregnant women with and without AIIRD (β = –0.01, 95% CI: –0.17, 0.17). Pregnant women with higher HAQ-DI in AIIRD had a significantly higher total number of systemic reactions (β = 0.56, 95% CI: 0.04, 1.10) than those with lower HAQ-DI, although the total number of adverse reactions was not significantly different (β = 0.27, 95% CI: –0.08, 0.62). Conclusion: We found no significant difference in the frequency of COVID-19 vaccine-related side effects between pregnant women with and without AIIRD. The results of this assessment may help provide information for pregnant women with AIIRD regarding COVID-19 vaccination.

Purpose: To determine if the COVID-19 pandemic was associated with changing trends in maternal depression, anxiety and stress levels among lactating women compared to pre-pandemic.Methods: Data originated from the UC San Diego Mommy’s Milk Study of breastfeeding mothers residing in the U.S or Canada (2016-2021). Participants were interviewed and completed a self-administered Edinburgh Postnatal Depression Scale (EPDS), Perceived Stress Scale (PSS-10) and State Trait Anxiety Inventory (STAI) questionnaire after childbirth during the time they were breastfeeding. Interrupted times-series analyses using regression models were used to investigate the change in different samples of women over time in EPDS, STAI and PSS-10 scores following the onset of the Covid-19 pandemic. All time points prior to March 1, 2020 were considered the “pre-COVID19” time period, and time points from March 1, 2020 and on were considered the “COVID19” time period. Models were adjusted for seasonality, and in sensitivity analyses, maternal parity and income. Results: During the 41 months prior to the onset of the COVID-19 pandemic, mean scores on all three measures remained consistent. Following the onset of the COVID-19 pandemic, mean scores on depression (b = 0.432, p = 0.003) and stress inventories (b = 0.731, p = 0.002) increased in a linear fashion in each month. Anxiety scores followed a similar pattern, but it did not reach statistical significance (p = 0.07). Results were essentially unchanged when adjusting for seasonality or maternal covariates. Conclusion: The increase in maternal depression and stress scores have public health implications and suggest that breastfeeding mothers are at high risk for mental health issues during the COVID-19 pandemic. These findings show the need for increased screening for postpartum women during the COVID-19 pandemic, and increased availability of mental health resources for postpartum women during the COVID-19 pandemic. Research has shown other catastrophic events affect maternal mental health in similar ways. (Harville, 2009) Therefore, beyond the COVID-19 pandemic, the findings of this study can be used for economic downfalls, other viral or bacteria outbreaks, and even natural disaster response strategies.

Few previous studies have evaluated the differential benefits of breastfeeding on infantneurodevelopment depending on the level of prenatal alcohol exposure (PAE). This study aims to identify if the association between breastfeeding and infant neurodevelopment is modified by pattern of PAE. The study sample included 392 Ukrainian infants born to pregnant mothers prospectively enrolled in a cohort study who reported various levels of prenatal alcohol consumption. Infant neurodevelopment was assessed at 6- and 12-months using the Bayley Scales of Infant Development II (BSID-II) Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI). Linear regression modeling with interaction terms and stratification by PAE group was used to determine the relationship between breastfeeding and infant neurodevelopment. When controlling for PAE and key covariates, breastfeeding had a positive significant association with the PDI and MDI at 6 months but not at 12 months. The interaction terms were significant at the 0.05 level for the MDI and PDI at 6- and 12-months, indicating a joint effect of PAE and breastfeeding on infant neurodevelopment that goes beyond the effects of PAE and breastfeeding alone. Infants exposed to high levels of PAE who were breastfed had the greatest mean increase in PDI and MDI scores at both 6- and 12-months compared to infants who were never breastfed. There is a significant joint effect of PAE and breastfeeding on infant neurodevelopment at 6- and 12-months. Infants exposed to high levels of PAE may experience the greatest benefits from breastfeeding, especially for durations of four months or longer.

Objective: Opioid prescription rates in North America have increased dramatically over the past two decades, but little is known about prenatal opioid use. The purpose of this study is to determine the prevalence of prescription opioid use among pregnant women in the U.S. and Canada, as well as the duration, timing, and indication of use and lastly, to provide a description of maternal characteristics of those who used opioids.

Methods: Data were collected between 2004-2018 from a prospective cohort of 1,035 women in the MotherToBaby Pregnancy Studies.

Results: Seven percent of women used any prescription opioids during pregnancy. Most used opioids to treat acute illnesses and injuries, during one trimester of pregnancy. Similar proportions of use were found across Trimesters 1, 2, and 3. There were a higher proportion of women with low SES, low educational attainment, overweight or obese BMI scores, a history of miscarriages, a history of terminated pregnancies, tobacco use, and co-occuring health conditions among women who used prescription opioids than in women who did not.

Conclusion: Prescription opioids were used in pregnancy, and more often by women with other factors that increase the risk of adverse pregnancy outcomes. These findings support the call for additional research to examine the risk of adverse pregnancy or birth outcomes associated with prenatal opioid use.

Background: Evidence demonstrating the association between social determinants of health and infant outcomes do not support causal conclusions. I aimed to characterize trends in ICD social code documentation, examine the association between maternal social risk factors and infant outcomes, and collect qualitative data to interpret quantitative trends.

Methods: Quantitative data was collected from a retrospective study of live-born births in California, 2007-2020. ICD codes were used to classify maternal homelessness, inadequate housing, food insecurity, and unemployment. Infant outcomes included prematurity, low birthweight, small for gestational age, NICU admission, emergency department admission, rehospitalization and death. I estimated risk ratios using log-linear Poisson regression adjusted for maternal race, payer, and education. Nine individual interviews with obstetric providers explored experiences screening and documenting social risks. Qualitative data was analyzed using an iterative and inductive thematic analysis guided by grounded theory.

Results: 6,089,327 pregnant person-infant pairs were included in analyses, 4,002 (65.7 per 100,000 live births) of whom had a documented health-related social need (HRSN). Infants with a maternal HRSN had a higher risk of prematurity (aRR 2.7, 95%CI 2.5, 2.9), low birthweight (aRR 2.7, 95%CI 2.5, 2.9), SGA (aRR 1.5, 95%CI 1.4, 1.6), NICU admission (aRR 3.5, 95%CI 3.2, 3.8), and infant death (aRR 3.0, 95%CI 2.5, 5.9). Screening and documentation practices were influence by institution-specific workflows and the presence of ancillary staff.

Conclusions: HRSNs are poorly documented and likely underestimate HRSN prevalence. Among those for whom documentation exists, infants with a maternal HRSN have an increased risk of morbidity and mortality.

Background

Objective

Methods

Results

Conclusion