Background: Asthma is a serious chronic condition which affects up to 8% of pregnant women in the United States. While severe or poorly controlled asthma might significantly complicate pregnancy and harm both mother and fetus, adequate asthma therapy in pregnancy is challenging to accomplish due to safety concerns for the fetus. Objective: This dissertation aimed to evaluate: 1) the effect of maternal asthma control on adverse perinatal outcomes; 2) the effect of fetal sex on maternal asthma control in pregnancy; and 3) the safety of asthma controller mediations, leukotriene receptor antagonists (LTRA), in pregnancy. Methods: Subjects were participants of the Organization of Teratology Information Specialists Asthma Medications in Pregnancy Study. Information about maternal medication use, asthma control, demographic and lifestyle characteristics, pregnancy complications, and perinatal outcomes was prospectively collected from 1,165 pregnant women. Results: The incidence of preterm delivery was significantly higher among women with inadequate asthma symptom control (OR=1.93; 95% CI: 1.10; 3.40) and women requiring hospitalization(s) for asthma exacerbations during pregnancy (OR=2.29; 95% CI: 1.06; 4.94) independent of other risk factors. Asthmatic pregnant women carrying a girl had more hospitalizations for asthma during pregnancy and a tendency of having more unscheduled asthma clinic visits compared with women carrying a boy. Fetal sex did not influence the association between maternal asthma control and fetal growth. The birth prevalence of major structural anomalies in children born to LTRA users was significantly higher compared with non-asthmatic controls (p=0.007), but not different from the asthmatic comparison group (p=0.524). Furthermore, the birth defects in the LTRA group did not represent a consistent pattern. Use of LTRAs was not associated with large risks of other adverse perinatal outcomes. Conclusions: This study demonstrates a substantial risk posed by poorly controlled maternal asthma on preterm delivery. Pregnant asthmatic women carrying a girl might be more susceptible to asthma exacerbations, particularly early in pregnancy; however, all women with asthma should be carefully monitored for pregnancy-associated changes in asthma symptoms. LTRAs do not appear to be a major human teratogen; however, results should be interpreted with caution due to the relatively small number of women taking LTRAs

It has been known for over 4 decades that prenatal alcohol exposure (PAE) can adversely affect neurodevelopment and behavior (NDB). Yet, early detection of altered NDB due to PAE continues to present a major clinical challenge. Identification of altered NDB in the first 2 years of life, before higher-order cognitive processes develop, invites early interventions for affected children to improve long-term outcomes. Studies published in English from January of 1980 to July of 2018 were identified in PubMed/MEDLINE. The review focused on prospective birth cohort studies which used standardized NDB assessments in children up to 2 years of age, wherein PAE was the main exposure and NDB was the main outcome. NDB was categorized into the domains of neurocognitive, adaptive, and self-regulation based on the 2016 Updated Clinical Guidelines for Diagnosing fetal alcohol spectrum disorder. An initial search resulted in 1,867 articles for which we reviewed abstracts; 114 were selected for full-text review; and 3 additional abstracts were identified through review of references in eligible publications. Thirty-one publications met criteria and were included: of these, 24 reported neurocognitive outcomes, 24 reported adaptive behavior outcomes, and 12 reported outcomes in the domain of self-regulation. Although self-regulation was assessed in the fewest number of studies, 8/12 (75%) reported PAE-associated deficits. In contrast, results were mixed for the other 2 domains: 13/24 (54%) of the selected studies that included neurocognitive outcomes showed poorer performance following PAE, and 8/24 (33%) studies that assessed adaptive functioning found significant differences between PAE and comparison infants. There is considerable evidence to support the value of early-life assessments of infant NDB when PAE is known or suspected. More studies focusing on infant self-regulation, in particular, are needed to determine the utility of early evaluation of this critical developmental domain in infants with PAE.

There are significant barriers in engaging pregnant and postpartum women that are considered high-risk (e.g., those experiencing substance use and/or substance use disorders (SUD)) into longitudinal research studies. To improve recruitment and retention of this population in studies spanning from the prenatal period to middle childhood, it is imperative to determine ways to improve key research engagement factors. The current manuscript uses a qualitative approach to determine important factors related to recruiting, enrolling, and retaining high-risk pregnant and postpartum women. The current sample included 41 high-risk women who participated in focus groups or individual interviews. All interviews were analyzed to identify broad themes related to engaging high-risk pregnant and parenting women in a 10-year longitudinal research project. Themes were organized into key engagement factors related to the following: (1) recruitment strategies, (2) enrollment, and (3) retention of high-risk pregnant and parenting women in longitudinal research studies. Results indicated recruitment strategies related to ideal recruitment locations, material, and who should share research study information with high-risk participants. Related to enrollment, key areas disclosed focused on enrollment decision-making, factors that create interest in joining a research project, and barriers to joining a longitudinal research study. With regard to retention, themes focused on supports needed to stay in research, barriers to staying in research, and best ways to stay in contact with high-risk participants. Overall, the current qualitative data provide preliminary data that enhance the understanding of a continuum of factors that impact engagement of high-risk pregnant and postpartum women in longitudinal research with current results indicating the need to prioritize recruitment, enrollment, and retention strategies in order to effectively engage vulnerable populations in research.