Problem/Condition: Autism spectrum disorder (ASD). Period Covered: 2016. Description of System: The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance program that provides estimates of the prevalence of ASD among children aged 8 years whose parents or guardians live in 11 ADDM Network sites in the United States

OBJECTIVE -Numerous studies in the U.S. and elsewhere have reported an increased risk of gestational diabetes mellitus (GDM) among women who are overweight or obese compared with lean or normal-weight women. Despite the number and overall consistency of studies reporting a higher risk of GDM with increasing weight or BMI, the magnitude of the association remains uncertain. This meta-analysis was conducted to better estimate this risk and to explore differences across studies. We used a Bayesian model to perform the meta-analysis and meta-regression. We included cohort-designed studies that reported obesity measures reflecting pregnancy body mass, that had a normal-weight comparison group, and that presented data allowing a quantitative measurement of risk. RESEARCH DESIGN AND METHODSRESULTS -Twenty studies were included in the meta-analysis. The unadjusted ORs of developing GDM were 2.14 (95% CI 1.82-2.53), 3.56 (3.05-4.21), and 8.56 (5.07-16.04) among overweight, obese, and severely obese compared with normal-weight pregnant women, respectively. The meta-regression analysis found no evidence that these estimates were affected by selected study characteristics (publication date, study location, parity, type of data collection [retrospective vs. prospective], and prevalence of GDM among normal-weight women).CONCLUSIONS -Our findings indicate that high maternal weight is associated with a substantially higher risk of GDM.

Despite numerous studies reporting an increased risk of cesarean delivery among overweight or obese compared with normal weight women, the magnitude of the association remains uncertain. Therefore, we conducted a meta-analysis of the current literature to provide a quantitative estimate of this association. We identified studies from three sources: (i) a PubMed search of relevant articles published between January 1980 and September 2005; (ii) reference lists of publications selected from the search; and (iii) reference lists of review articles published between 2000 and 2005. We included cohort designed studies that reported obesity measures reflecting pregnancy body mass, had a normal weight comparison group, and presented data allowing a quantitative measurement of risk. We used a Bayesian random effects model to perform the meta-analysis and meta-regression. Thirty-three studies were included. The unadjusted odd ratios of a cesarean delivery were 1.46 [95% confidence interval (CI): 1.34-1.60], 2.05 (95% CI: 1.86-2.27) and 2.89 (95% CI: 2.28-3.79) among overweight, obese and severely obese women, respectively, compared with normal weight pregnant women. The meta-regression found no evidence that these estimates were affected by selected study characteristics. Our findings provide a quantitative estimate of the risk of cesarean delivery associated with high maternal body mass.

KIM, SHIN Y., PATRICIA M. DIETZ, LUCINDA ENGLAND, BRIAN MORROW, AND WILLIAM M. CALLAGHAN. Trends in pre-pregnancy obesity in nine states, 1993states, -2003states, . Obesity. 200715:986 -993. Objective: Pre-pregnancy obesity poses risks to both pregnant women and their infants. This study used a large population-based data source to examine trends, from 1993 through 2003, in the prevalence of pre-pregnancy obesity among women who delivered live infants. Research Methods and Procedures:Data from the Pregnancy Risk Assessment Monitoring System in nine states were analyzed for trends in pre-pregnancy obesity (BMI Ͼ 29.0 kg/m 2 ) overall and by maternal demographic and behavioral characteristics. Pre-pregnancy BMI was calculated from self-reported weight and height on questionnaires administered after delivery, and demographic characteristics were taken from linked birth certificates. The sample of 66,221 births was weighted to adjust for survey design, non-coverage, and non-response, and it is representative of all women delivering a live birth in each particular state. The sampled births represented 18.5% of all births in the United States. Results: Pre-pregnancy obesity increased 69.3% during the study period, from 13.0% in 1993 to 1994 to 22.0% in 2002 to 2003. The percentage increase ranged from 45% to 105% for individual states. Subgroups of women with the highest prevalence of obesity in 2002 to 2003 were those who were 20 to 29 years of age, black, had three or more children, had a high school education, enrolled in Women, Infants, and Children, or were non-smokers. However, all subgroups of women examined experienced at least a 43% increase in pre-pregnancy obesity over this time period. Discussion: The prevalence of pre-pregnancy obesity is increasing among women in these nine states, and this trend has important implications for all stages of reproductive health care.

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Background-Depression is often undiagnosed and untreated. It is not clear if differences exist in the diagnosis and treatment of depression among pregnant and nonpregnant women. We sought to estimate the prevalence of undiagnosed depression, treatment by modality, and treatment barriers by pregnancy status among U.S. reproductive-aged women.Methods-We identified 375 pregnant and 8,657 nonpregnant women 18-44 years of age who met criteria for past-year major depressive episode (MDE) from 2005-2009 nationally representative data. Chi-square statistics and adjusted prevalence ratios (aPR) were calculated.Results-MDE in pregnant women (65.9%) went undiagnosed more often than in nonpregnant women (58.6%) (aPR 1.1, 95% confidence interval [CI] 1.0-1.3). Half of depressed pregnant (49.6%) and nonpregnant (53.7%) women received treatment (aPR 1.0, 95% CI 0.90-1.1), with prescription medication the most common form for both pregnant (39.6%) and nonpregnant (47.4%) women. Treatment barriers did not differ by pregnancy status and were cost (54.8%), opposition to treatment (41.7%), and stigma (26.3%).Conclusions-Pregnant women with MDE were no more likely than nonpregnant women to be diagnosed with or treated for their depression. IntroductionDepression is a leading cause of global disability and the second leading cause of global disease burden among people 15-44 years of age. 1 Women are disproportionately affected, as they are almost twice as likely as men to report lifetime history of major depressive episode (MDE). 2,3 Depression affects 8%-16% of U.S. reproductive-aged women 2,4-6 and © Mary Ann Liebert, Inc. HHS Public Access MeasuresMajor depressive episode-MDE was assessed using nine questions about MDE symptoms, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 24 A respondent met DSM-IV criteria for past-year MDE if she reported experiencing ≥5 symptoms nearly every day in the same 2-week period in the past 12 months, with at least 1 of the 5 symptoms being depressed mood or loss of interest or pleasure in daily Women also self-reported whether a doctor or other medical professional had told them that they had depression in the past year, which was asked separately from MDE symptoms and is referred to hereafter as having a clinical diagnosis of depression.Mental health treatment-Three NSDUH questions assessed past-year treatment.Respondents were asked: "During the past 12 months, did you take any prescription medication that was prescribed for you to treat a mental or emotional condition? During the past 12 months, did you receive any outpatient treatment or counseling for any problem you were having with your emotions, nerves, or mental health? During the past 12 months, have you stayed overnight or longer in a hospital or other facility to receive treatment or counseling for any problem you were having with your emotions, nerves, or mental health? Mental health treatment was defined as receiving prescription medication, counseling, or inpatient care in the past year.Res...

Approximately one in seven women was identified with and treated for depression during 39 weeks before through 39 weeks after pregnancy, and more than half of these women had recurring indicators for depression.