Please note that some progress noted for scientific research themes may also address cross-cutting themes, even though they are not listed on this page.
Global Health
- Estimating prevalence of congenital disorders in South Africa (PMID: 39118354)
Limited data on the burden and scope of congenital disorders in South Africa makes it more difficult to identify factors that may place infants at risk. Researchers combined data from a pregnancy registry and an electronic health record system. More than 32,000 women were included, representing women with a pregnancy of more than 22 weeks gestation or who gave birth to an infant with a birth weight greater than 500 grams. Prevalence of congenital anomalies was 7.2 infants per 1,000 births using the strictest definition, and 9.2 infants per 1,000 births using a wider definition. Older women and women who had either pre-existing or gestational diabetes were more likely to have infants with congenital disorders. However, HIV, hypertension, and obesity were not associated with the risk of congenital disorders in this population. - Immune response for infants exposed to HIV (PMID: 38230936)
Infants who are exposed to HIV but uninfected have higher risk of problems from infections than infants who have not been exposed to HIV, possibly due to altered immunity. Because infant gut microbiota may influence immune development, researchers assessed the effects of HIV exposure on gut microbiota and immune response to tetanus vaccine for infants in South Africa and Nigeria. The scientists found that gut microbiota were more strongly influenced by geographical location and age than by HIV exposure. HIV exposure and gut microbiota were independently associated with tetanus vaccine response. These findings provide insight into the effect of HIV exposure, passive maternal antibody, and gut microbiota on infant vaccine responses.
Health Disparities
- Ethnic and racial differences in premenopausal hysterectomy (PMID: 37473411)
Black women who have not yet gone through menopause are more likely to get a hysterectomy than premenopausal White women in the United States. While hysterectomy is an effective treatment for gynecologic conditions such as fibroids and endometriosis, it is also a sterilizing procedure, leading to infertility. Researchers wondered whether the reason why Black women have a higher rate of premenopausal hysterectomy is because they are medically overtreated, receiving more extreme treatment than warranted by severity or before trying other less invasive options. The researchers looked at health records from more than 1,700 premenopausal Black, White, and Hispanic women in North Carolina who received a hysterectomy to treat a gynecological condition. The scientists compared the average severity of gynecologic symptoms (such as bleeding and pain) across racial and ethnic groups. They reasoned that if Black patients are more likely to receive a premenopausal hysterectomy because of overtreatment, their symptom severity scores would not be higher than White patients. However, the analysis found no evidence that Black patients are overtreated. In fact, Black and Hispanic patients had higher symptom severity than White patients. When comparing the number of less invasive treatments that had been tried prior to hysterectomy, the researchers found no difference between the groups. This led them to speculate that Black and Hispanic patients may instead be undertreated for gynecological conditions, since there was no evidence that their higher symptom severity led to a corresponding higher number of treatments that were tried. While it is also possible that differences in severity reflect differences in how medical staff document symptoms across racial and ethnic groups, this study paves the way for more research into understanding disparities in treatment for gynecological conditions. - Uterine fibroids of Black women have different gene expression profiles (PMID: 37686244)
Black women are more likely to have uterine fibroids as compared to White or Hispanic women. They are also likely to have more severe fibroids. Researchers explored how the expression of genes in the cells of uterine fibroids compared between races. They found many genes that were expressed differently in the fibroids of Black women as compared to White or Hispanic women. This suggests that the differences in uterine fibroid presence and severity between races may be rooted in the way genes are expressed in the uterus. - Increase in firearm-related deaths among rural Black youths (PMID: 38639410)
Firearm-related injuries have been the leading cause of death in youth in the United States since 2020, surpassing motor vehicle crashes. Researchers analyzed U.S. youth mortality data from the Centers for Disease Control and Prevention (CDC) from 1999-2022 to assess the characteristics of firearm-related deaths among Black youth, especially in rural areas. The study results showed that by 2022, one-third of all deaths of Black rural youths were firearm-related, and the rate of firearm deaths among Black rural youth was four times that of White rural youth. The data showed that black youth represent only 10% of the rural population, yet account for 30% of firearm deaths among rural youth. In 2022, Black rural youths equaled or surpassed the rate of firearm-related deaths among Black urban youths. A majority of these gun deaths of rural Black youths were homicides, and these deaths were concentrated in the South and were more common with older adolescents.
Infectious Diseases
- Breastfeeding initiation among people with hepatitis C virus (HCV) infection (PMID: 38176013)
According to the CDC, HCV infection is not a reason to avoid breastfeeding, and there is no evidence that HCV can be transmitted through breastfeeding. Researchers studied the factors associated with breastfeeding initiation among women with HCV infection during pregnancy. About 63% of study participants initiated breastfeeding or provided breast milk to their infants, with a median duration of 1.4 months. Those with HCV at any point during pregnancy were less likely to initiate breastfeeding compared with those with a sustained undetectable HCV viral load throughout pregnancy. Those with private insurance were more likely to initiate breastfeeding compared with those with public insurance or no insurance. - Performance of sepsis screening tools during pregnancy and postpartum hospital admissions (PMID: 38086052)
Without prompt treatment, sepsis can lead to tissue damage and organ failure. However, identifying maternal sepsis early can be challenging, in part because pregnancy-related changes such as a faster heart rate and a higher white blood cell count can mask signs of the condition. Screening tools can help health care providers identify which patients need further evaluation for sepsis. An effective screening strategy must both accurately detect patients with sepsis and have a low rate of false-positives when the test incorrectly identifies someone without sepsis as likely to have the condition. Researchers set out to evaluate the performance of five widely used sepsis screening tools to identify those that are best for assessing a person’s risk for maternal sepsis at different stages of pregnancy and the early postpartum period. Two of the five tools are considered “pregnancy-adjusted,” meaning that they account for the changes in heart rate, respiratory rate, and white blood cell counts that may occur during pregnancy. The scientists uncovered substantial variations in the performance of the five tools at different times during and after pregnancy. They found that, for patients admitted at less than 20 weeks of pregnancy or more than 3 days postpartum, non-pregnancy-adjusted tools were better at predicting sepsis than pregnancy-adjusted tools. However, between 20 weeks of pregnancy through 3 days postpartum, pregnancy-adjusted screening tools had the highest sensitivity and lowest false-positive rates. Based on their findings, the researchers suggest that health care providers use a pregnancy-adjusted sepsis screening tool between 20 weeks of pregnancy and 3 days postpartum. Before 20 weeks of pregnancy and after 3 days postpartum, providers should use a non-pregnancy-adjusted tool. The scientists stress that these screening tools should be part of a two-step process, in which those who screen positive are then further evaluated for sepsis. - COVID-19 vaccine provides moderate protection against long COVID in children (PMID: 37808803)
Researchers conducted a study estimating the vaccine effectiveness in preventing long COVID in children, because of the lack of research data on this subject with this age group. They used electronic health data from 17 health systems in 2 groups of patients, ages 5-11 years and 12-17 years. The results showed that vaccination against COVID-19 provided moderate protection against long COVID-19 in children. Older children/adolescents ages 12–17 saw more protection from long COVID, compared with children aged 5–11. The protective effect of the vaccine appeared to decrease over time.
Nutrition
- Preterm infants fed donor milk had fewer intestinal complications than formula-fed infants (PMID: 38497706)
Preterm birth—before 37 weeks—is the most common cause of infant death and the leading cause of long-term disability in children. Extremely preterm infants (born before 29 weeks) are at high risk for neurodevelopmental impairment and also for necrotizing enterocolitis (NEC), a life-threatening disorder in which the lining of the intestines becomes inflamed. Research shows that those fed breastmilk from their own mothers have better outcomes than those fed infant formula. However, milk from their mothers is not always available. In these cases, pasteurized human milk fortified with essential nutrients is often given to extremely preterm infants, but little research had been conducted on whether it is better than formula for infants’ neurodevelopment. Researchers randomly assigned 483 preterm or low birthweight infants whose mothers could produce little or no milk to receive formula or donated human milk. The infants fed donor milk had half the rate of NEC as those fed formula. This finding suggests that donor human milk, like maternal milk, can reduce the risk of NEC compared to formula. When the infants reached the equivalent of 22 to 26 months of development (corrected for their prematurity) they were tested with the Bayley Scales of Infant Development, a test used to identify children at risk of developmental delays. These scores did not differ significantly across groups. - Omega-3 supplements may help reduce schizotypal personality symptoms (PMID: 38300759)
Omega-3s are important components of cell membranes. Their levels are high in the eye and brain, and they also have many functions in the heart, blood vessels, lungs, and immune system. In previous studies among children in Africa, researchers found that improving children’s nutrition improved their brain functioning at age 11 and reduced symptoms of schizotypal personality in adolescence. Because the children in those studies ate more fish per week than the children in the control group, scientists theorized that omega-3s, high in certain fish, may have played a role. They sought to determine if supplementing American children’s diets with omega-3s could reduce schizotypal symptoms. They analyzed data from a previous study on omega-3 supplements in children ages 11 and 12. The researchers found that at the end of treatment, the group that received either the omega-3 supplement only and the group that received both the supplement and a behavioral therapy had significantly fewer schizotypal symptoms. However, differences between groups faded by 6 months, after treatment had ended. If these early results can be verified in other studies, then omega-3 supplementation in childhood could potentially be used to reduce the effects of schizotypal personality disorder in adolescence, when symptoms often become more pronounced.
Prevention
- Treatment timing for toddlers on the autism spectrum (PMID: 36922406)
In children with autism spectrum disorder (ASD), intervention before the age of 3 can have long-term benefits. Researchers set out to gather more information about when interventions for ASDs should begin. They conducted a randomized controlled trial, examining the effects of initiating intensive and individualized intervention at 18 versus 27 months of age. Children with ASD and their caregivers were randomly assigned to two groups. One group of families began an intensive 9-month intervention when the child with ASD was 18 months old, followed by a less intensive intervention at 27 months old. The other group of families received the interventions in reverse order: the less intensive intervention at 18 months followed by the more intensive intervention at 27 months. The intensive intervention involved an individualized program that provided multiple one-on-one sessions per week to coach parents on strategies to support their child’s social communication in everyday activities. In the less intensive intervention, once a week an instructor taught four to five families in a group setting about strategies to support their child’s social communication. Researchers found that toddlers who started the intensive, individualized intervention at 18 months showed greater gains in receptive and expressive language skills, social communication, and daily living skills compared to those who began at 27 months. Notably, this pattern was not found for the less intensive group intervention, meaning that the improvements did not simply reflect age-related development. Overall, this suggests that in children with ASD, earlier intervention within the toddler period may lead to greater improvements in targeted outcomes, but that this may be limited to intensive, individualized interventions. - Preterm infants protected by maternal COVID-19 vaccination (PMID: 38241046)
Pregnant individuals who are vaccinated against COVID-19 have lower rates of severe COVID-19 illness and pregnancy complications than unvaccinated pregnant people. COVID-19 vaccines protect against the disease by stimulating production of antibodies to the spike protein, which SARS-CoV-2 uses to infect cells. To learn more about how well anti-spike antibodies are transferred to preterm infants, researchers compared levels of anti-spike antibodies in: the blood of pregnant individuals with no history of COVID-19 infection who received mRNA vaccines and then gave birth; and the umbilical cord blood of these infants, who were born at term and preterm. The team also compared anti-spike antibody levels from those who had been vaccinated twice before delivery (including before pregnancy) and those who were vaccinated three or more times before delivery. The scientists found that preterm infants born to people who have been vaccinated for COVID-19 had roughly the same levels of antibodies to the spike protein of SARS-CoV-2 as term infants born to vaccinated people. Moreover, in all infants, antibodies to the spike protein were higher among those born to individuals who had received three or more vaccine doses before delivery, compared to those who had only two prior vaccine doses. The findings may help allay concerns that fewer antibodies might pass to preterm infants than term infants.
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