Background: Polybrominated diphenyl ethers (PBDEs) are chemical additives used as flame retardants in commercial products. PBDEs are bioaccumulative and persistent and have been linked to several adverse health outcomes.Objectives: This study leverages an ongoing pregnancy cohort to measure PBDEs and PBDE metabolites in serum collected from an understudied population of pregnant women late in their third trimester. A secondary objective was to determine whether the PBDEs or their metabolites were associated with maternal thyroid hormones.Methods: One hundred forty pregnant women > 34 weeks into their pregnancy were recruited into this study between 2008 and 2010. Blood samples were collected during a routine prenatal clinic visit. Serum was analyzed for a suite of PBDEs, three phenolic metabolites (i.e., containing an –OH moiety), and five thyroid hormones.Results: PBDEs were detected in all samples and ranged from 3.6 to 694 ng/g lipid. Two hydroxylated BDE congeners (4´-OH-BDE 49 and 6-OH-BDE 47) were detected in > 67% of the samples. BDEs 47, 99, and 100 were significantly and positively associated with free and total thyroxine (T4) levels and with total triiodothyronine levels above the normal range. Associations between T4 and PBDEs remained after controlling for smoking status, maternal age, race, gestational age, and parity.Conclusions: PBDEs and OH-BDEs are prevalent in this cohort, and levels are similar to those in the general population. Given their long half-lives, PBDEs may be affecting thyroid regulation throughout pregnancy. Further research is warranted to determine mechanisms through which PBDEs affect thyroid hormone levels in developing fetuses and newborn babies.

Our work suggests that induction/augmentation during childbirth is associated with increased odds of autism diagnosis in childhood. While these results are interesting, further investigation is needed to differentiate among potential explanations of the association including underlying pregnancy conditions requiring the eventual need to induce/augment, the events of labor and delivery associated with induction/augmentation, and the specific treatments and dosing used to induce/augment labor (e.g., exogenous oxytocin and prostaglandins).

No abstract

Background: Aviation gasoline, commonly referred to as avgas, is a leaded fuel used in small aircraft. Recent concern about the effects of lead emissions from planes has motivated the U.S. Environmental Protection to consider regulating leaded avgas.Objective: In this study we investigated the relationship between lead from avgas and blood lead levels in children living in six counties in North Carolina.Methods: We used geographic information systems to approximate areas surrounding airports in which lead from avgas may be present in elevated concentrations in air and may also be deposited to soil. We then used regression analysis to examine the relationship between residential proximity to airports and North Carolina blood lead surveillance data in children 9 months to 7 years of age while controlling for factors including age of housing, socioeconomic characteristics, and seasonality.Results: Our results suggest that children living within 500 m of an airport at which planes use leaded avgas have higher blood lead levels than other children. This apparent effect of avgas on blood lead levels was evident also among children living within 1,000 m of airports. The estimated effect on blood lead levels exhibited a monotonically decreasing dose–response pattern, with the largest impact on children living within 500 m.Conclusions: We estimated a significant association between potential exposure to lead emissions from avgas and blood lead levels in children. Although the estimated increase was not especially large, the results of this study are nonetheless directly relevant to the policy debate surrounding the regulation of leaded avgas.

safe, but should remain a second-line therapy to be used only with refractory candidiasis. If oral fluconazole is needed, perhaps waiting until after 8 weeks' gestation, when embryogenesis is complete, could be reasonable. Overall, the evidence of potential harm does not appear to be strong enough to withhold curative therapy from symptomatic women.VMEN) Association of Autism With Induced or ABSTRACT Autism spectrum disorders encompass well-known behavioral and cognitive disturbances. Heritable and environmental factors may influence normal development or alter regulatory processes, with environmental factors perhaps exerting their effect during the prenatal and early postnatal periods. This study focused on the association between autism and labor induction or augmentation or both using a population-based data set of linked child educational and birth records from North Carolina to investigate whether birth induction/augmentation is associated with increased odds of being diagnosed with autism.Demographic and obstetric data were obtained from all recorded live births occurring in North Carolina. Information on autism diagnosis was extracted from statewide educational records. Birth records from 1990 to 1998 were linked with educational data from the 1997 to 1998 to 2007 to 2008 academic years for the entire state (match rate, 74.4%). An individual met special needs eligibility criteria by having deficits in 3 of the 4 areas: communication, social reciprocity, behavior, or sensory. During delivery, a mother was either not induced or augmented (reference), induced only, or augmented only, or both induced and augmented. The association between induction/augmentation was examined in a range of models with such specifications as (1) only induction/augmentation and infant sex; (2) adding standard maternallevel characteristics; (3) adding maternal medical conditions and health behaviors affecting the pregnancy; (4) expanding model 3 to control for events of labor and delivery; (5) adding to 4 an ordinal variable for child birth year; and (6) adding an interaction between infant sex and induction/augmentation. About 1.3% and 0.4% of male and female children had autism, respectively. For both sexes, the percentage of induced or augmented mothers was higher among children with autism compared with noncases. In model 1, a child whose mother was induced and augmented during delivery had 23% higher odds of being diagnosed as having autism than a child whose mother was neither induced nor augmented (odds ratio [OR], 1.23; 95% CI, 1.02Y1.47). The ORs for the induced-only and augmented-only categories were 1.10 (95% CI, 1.01Y1.19) and 1.15 (95% CI, 1.07Y1.24), respectively. Compared with girls, boys had increased odds of autism diagnosis (OR, 3.04; 95% CI, 2.86Y3.24). In models 2 to 4, including potential confounders related to socioeconomic status, maternal health, and pregnancy-related events/conditions did not significantly change the ORs for induction/augmentation from those in model 1. In model 5, a child whose mother was ...

Our methodology facilitates the estimation of additive-scale natural effects with binary outcomes. In this study, the total effect of racial segregation on preterm birth was partially mediated by poor-quality built environment.

Background: Ischemia with no obstructive coronary artery disease (INOCA) is common and has an adverse prognosis. We set out to describe the natural history of symptoms and ischemia in INOCA. Methods: CIAO-ISCHEMIA (Changes in Ischemia and Angina over One year in ISCHEMIA trial screen failures with INOCA) was an international cohort study conducted from 2014-2019 involving angina assessments (Seattle Angina Questionnaire [SAQ]) and stress echocardiograms 1-year apart. This was an ancillary study that included patients with history of angina who were not randomized in the ISCHEMIA trial. Stress-induced wall motion abnormalities were determined by an echocardiographic core laboratory blinded to symptoms, coronary artery disease (CAD) status and test timing. Medical therapy was at the discretion of treating physicians. The primary outcome was the correlation between changes in SAQ Angina Frequency score and change in echocardiographic ischemia. We also analyzed predictors of 1-year changes in both angina and ischemia, and compared CIAO participants with ISCHEMIA participants with obstructive CAD who had stress echocardiography before enrollment, as CIAO participants did. Results: INOCA participants in CIAO were more often female (66% of 208 vs. 26% of 865 ISCHEMIA participants with obstructive CAD, p<0.001), but the magnitude of ischemia was similar (median 4 ischemic segments [IQR 3-5] both groups). Ischemia and angina were not significantly correlated at enrollment in CIAO (p=0.46) or ISCHEMIA stress echocardiography participants (p=0.35). At 1 year, the stress echocardiogram was normal in half of CIAO participants and 23% had moderate or severe ischemia (≥3 ischemic segments). Angina improved in 43% and worsened in 14%. Change in ischemia over one year was not significantly correlated with change in angina (rho=0.029). Conclusions: Improvement in ischemia and improvement in angina were common in INOCA, but not correlated. Our INOCA cohort had a similar degree of inducible wall motion abnormalities to concurrently enrolled ISCHEMIA participants with obstructive CAD. Our results highlight the complex nature of INOCA pathophysiology and the multifactorial nature of angina. Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT02347215

Motivated by a study examining geographic variation in birth outcomes, we develop a spatial bivariate probit model for the joint analysis of preterm birth and low birth weight. The model uses a hierarchical structure to incorporate individual and areal-level information, as well as spatially dependent random effects for each spatial unit. Because rates of preterm birth and low birth weight are likely to be correlated within geographic regions, we model the spatial random effects via a bivariate conditionally autoregressive prior, which induces regional dependence between the outcomes and provides spatial smoothing and sharing of information across neighboring areas. Under this general framework, one can obtain region-specific joint, conditional, and marginal inferences of interest. We adopt a Bayesian modeling approach and develop a practical Markov chain Monte Carlo computational algorithm that relies primarily on easily sampled Gibbs steps. We illustrate the model using data from the 2007-2008 North Carolina Detailed Birth Record.