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- Written by: Amna Umer, West Virginia University
Nearly 1 in 12 newborns in the United States in 2020 – or about 300,000 infants – were exposed to alcohol, opioids, marijuana or cocaine before they were born. Exposure to these substances puts these newborns at a higher risk for premature birth, low birth weight and a variety of physical and mental disabilities.
These substances can have direct and indirect consequences on fetal development. By crossing the placental barrier directly, they can cause abnormal development. And by affecting the mother’s organs, they can reduce blood flow to the placenta and damage the health of the growing fetus.
Considerable sociodemographic and geographic disparities exist in the U.S. regarding the rates of prenatal substance exposure. This includes in West Virginia, where I live, a rural Appalachian state struggling with extraordinary rates of substance use and an opioid crisis.
As an epidemiologist, I study the relationship between substance use during pregnancy and infant health outcomes. I am a member of the Project WATCH team, which is a long-standing, state-mandated surveillance and referral system in West Virginia funded by the West Virginia Department of Health. The surveillance system expanded in 2020 to include substance exposure data from all births in the state.
Staggering numbers
Our research work showed that between 2020 and 2022, prenatal substance exposure in West Virginia was nearly 50% higher, at 124 per 1,000 births, than the national rate of 80 per 1,000 births. This means that nearly 1 in 8 infants born in the state had exposure to substances during pregnancy.
We found that the rate of prenatal cannabis exposure in West Virginia was 80 per 1,000 births, similar to the national rate. However, the rates of opioid exposure, 44 per 1,000 births, and stimulant exposure, 21 per 1,000 births, during pregnancy were nearly 10 times higher than national rates. Additionally, 1 in 5 women in the study smoked, and 64% of the infants exposed to substances were also exposed to smoking during pregnancy.
There are many reasons why the numbers in West Virginia are staggering. Economic challenges, including poverty, low education and limited job opportunities, contribute to chronic stress, a known risk factor for substance use. Moreover, nearly half the population lives in rural areas with a limited number of hospitals and clinics. The geographic isolation limits access to health care and substance use treatment services. Finally, stigma and judgment within close-knit rural communities may discourage these mothers from seeking help.
Substance exposure and infant outcomes
Our earlier work demonstrated that alcohol consumption during pregnancy was associated with preterm birth, which is when a baby is born before the 37th week of pregnancy, and low birth weight, defined as babies born weighing less than 5 pounds, 8 ounces (2,500 grams).
Our more recent study has shown that prenatal opioid exposure is also associated with low birth weight, while stimulant exposure was associated with preterm birth.
Stimulants include cocaine, methamphetamines, ecstasy and prescription stimulants such as those used for the treatment of attention-deficit/hyperactivity disorder. Illicit or misuse of prescription stimulants have increased among pregnant women over the past decade.
While many national and statewide efforts have focused their attention on addressing the opioid crisis, the prevalence of prenatal stimulant use remains a growing and underrecognized epidemic in the U.S.
After alcohol, cannabis is the most common psychoactive substance used during pregnancy and its rate is increasing. This trend in cannabis use may be due to the increasing legality for medicinal or recreational purposes and the social acceptability that comes with it.
In addition, many people wrongly assume that cannabis is relatively safe and helps manage pregnancy-related conditions such as morning sickness, nausea, vomiting, weight gain and sleep difficulty.
However, a growing body of research, including our own, has shown that prenatal cannabis exposure is associated with adverse pregnancy outcomes, including low birth weight, preterm birth, stillbirth or hypertensive disorders of pregnancy.
In addition, using multiple substances during pregnancy poses a higher risk to infants than using a single substance. We found that compared to no substance exposure during pregnancy, the risk of low birth weight was twice with opioids alone, four times with concurrent exposure to opioids and stimulants, and almost six times with concurrent exposure to opioids, stimulants and cannabis.
Another adverse outcome that is associated with prenatal substance exposure, primarily to opioids, is a set of withdrawal symptoms experienced by the newborn known as neonatal abstinence syndrome. Symptoms include irritability, feeding difficulties, tremors and respiratory issues. The syndrome requires specialized care and attention in neonatal units and a prolonged stay in the hospital.
Alongside the rising prevalence of opioid use in pregnancy, a fivefold increase in incidence of infants with this condition has been documented over the past two decades. The highest rate has been observed in West Virginia, at 53 per 1,000 births. Other states with high rates include Maine, Vermont, Delaware and Kentucky, which are between three and four times the national average of 7.3 per 1,000 births.
Substance exposure in the womb and long-term outcomes
Research on long-term outcomes of infants exposed to substances in the womb is still evolving. Limited studies have shown an association between neonatal abstinence syndrome and long-term neurodevelopmental consequences that may develop as early as 6 months old and persist into adolescence. These include delays in learning and language skills, physical growth and motor skills, as well as difficulty in regulating behavior and emotions.
However, research on the long-term effects of prenatal alcohol exposure is well established. A broad range of deficits are referred to as fetal alcohol spectrum disorders. These include growth deficiency, developmental delay, craniofacial malformations, intellectual disabilities, behavior issues and emotional well-being. A recent study of first graders in the U.S. estimated that the prevalence of fetal alcohol spectrum disorders range from 1% to 5%, which means up to 1 in 20 school-age children may have this disorder.
With the changing landscape of substance use in the U.S., more research is needed to understand and establish the association between the various emerging types and forms of substance exposures and their lasting effects. But the findings are difficult to discern because of the influence of other environmental factors, preexisting medical conditions and social determinants of health.
Efforts to reduce harms
As a maternal and child health epidemiologist, I am fortunate to be part of the Project WATCH team that works closely with health care providers and policymakers.
As high-risk infants are identified through this program, its referral system notifies pediatricians of substance exposure and connects these families to early intervention services and home visitation programs.
These services include developmental testing, interventions appropriate to the child’s needs and case management during the first few years of life. The data also informs state-level strategies and initiatives to address the substance use crisis for this vulnerable population.
Amna Umer, Associate Professor of Pediatric Epidemiology, West Virginia University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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- Written by: Lake County News reports
Researchers have known that those who reach higher levels of schooling live longer than others, but they didn’t know to what extent until now.
What they found was that the risk of death drops by two percent with every additional year of education.
That means those who completed six years of primary school had a lower risk of death by an average of 13 percent. After graduating from secondary school, the risk of dying was cut by nearly 25 percent and 18 years of education lowered the risk by 34 percent.
Researchers also compared the effects of education to other risk factors such as eating a healthy diet, smoking, and drinking too much alcohol, and they found the health outcome to be similar.
For example, the benefit of 18 years of education can be compared to that of eating the ideal amount of vegetables, as opposed to not eating vegetables at all.
Not going to school at all is as bad for you as drinking five or more alcoholic drinks per day or smoking ten cigarettes a day for 10 years.
“Education is important in its own right, not just for its benefits on health, but now being able to quantify the magnitude of this benefit is a significant development,” said Dr. Terje Andreas Eikemo, co-author and head of Centre for Global Health Inequalities Research at the Norwegian University of Science and Technology, or NTNU.
While the benefits of education are greatest for young people, those older than 50 and even 70 years still benefit from the protective effects of education.
Researchers found no significant difference in the effects of education between countries that have reached different stages of development. This means that more years of education is just as effective in rich countries as in poor countries.
“We need to increase social investments to enable access to better and more education around the globe to stop the persistent inequalities that are costing lives,” said Mirza Balaj, co-lead author and postdoctoral fellow at NTNU’s Department of Sociology and Political Science. “More education leads to better employment and higher income, better access to healthcare, and helps us take care of our own health. Highly educated people also tend to develop a larger set of social and psychological resources that contribute to their health and the length of their lives.”
“Closing the education gap means closing the mortality gap, and we need to interrupt the cycle of poverty and preventable deaths with the help of international commitment,” said Claire Henson, co-lead author and researcher at Institute for Health Metrics and Evaluation, or IHME, at the University of Washington’s School of Medicine. “In order to reduce inequalities in mortality, it’s important to invest in areas that promote people’s opportunities to get an education. This can have a positive effect on population health in all countries.”
The study identified data from 59 countries and included over 10,000 data points collected from over 600 published articles. Most of the studies reviewed for this study were from high-income settings, highlighting the need for more research in low- and middle-income countries, particularly from sub-Saharan and north Africa where data are scarce.
“Our focus now should be on regions of the world where we know access to schooling is low, and where there is also limited research on education as a determinant of health,” said Dr. Emmanuela Gakidou, co-author and professor at IHME.
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- Written by: Lake County News reports
The state has surpassed 100,000 public and shared private electric vehicle chargers installed statewide, just weeks after unprecedented funding was approved to build a bigger, better network of charging and refueling infrastructure for zero-emission cars, trucks and buses — reported to be the most extensive network in the nation.
This is on top of more than 500,000 at-home chargers that Californians have installed for personal use.
Sales of zero-emission vehicles, or ZEV, have skyrocketed more than 1,000% in the last decade.
One in every four new cars sold last year in California were zero-emission. Last year, the state also surpassed its goal of selling 1.5 million zero-emission vehicles and its goal to install 10,000 fast chargers for electric vehicles — both ahead of schedule.
“No other state in the nation is doing as much as California to make our tailpipe-free future a reality,” said Gov. Gavin Newsom. “With more zero-emission vehicles sold last year than ever before and more than 100,000 public chargers installed, California dominates in this space.”
Building a bigger, better network
This milestone follows approval of a $1.9 billion investment plan that accelerates progress on the state’s electric vehicle charging and hydrogen refueling goals.
The plan details how the money will be spent with at least 50% dedicated to benefiting communities disproportionately impacted by pollution.
With this funding, the state expects to reach its goal of 250,000 public chargers in the next few years.
Also on Friday, Caltrans broke ground for a $450,000 Clean California transit project in Blythe that will transform a litter-strewn public space into a transportation hub that features a solar-powered EV charging station, among other things.
And last week, California celebrated the grand opening of a truck charging depot and 50 battery electric trucks, supported by $27 million in state funding.
The funding is part of the $48 billion dollar California Climate Commitment, which includes more than $10 billion for ZEVs and ZEV infrastructure.
The state has also received billions from the Biden-Harris Administration for clean transportation.
Last year, Gov. Gavin Newsom signed a bill to provide a dedicated source of funding for ZEV infrastructure through 2035.
On Thursday, Tesla announced that it opened its Supercharger network to non-Teslas for the first time, beginning with Ford, and will be opening to more in the coming months. This significantly expands public access to fast, reliable chargers in the state.
To improve the EV charging experience, the California Energy Commission (CEC) is developing first-in-the-world state regulations for charger reliability and reporting.
A stringent performance standard will apply to all new publicly funded infrastructure and the chargers will be required to disclose operational data to help drivers make more informed choices.
California’s ZEV record
Since the governor’s executive order in 2020 calling for a rule to require all new car sales to be zero-emission by 2035, ZEV sales have risen dramatically.
• 25% of all new cars sold in California last year were ZEVs, according to the California Energy Commission (CEC).
• 1,846,874 total ZEV sales to date.
• 34% of new ZEVs sold in the U.S. are sold in California, according to the Veloz EV Market Report.
• If California were a country, we’d rank 4th in EV sales behind China, the U.S. and Germany.
• Thousands of dollars in grants and rebates available for low-income Californians; learn more at www.ClimateAction.ca.gov.
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- Written by: Mara Johnson-Groh
After 16 years studying Earth’s highest clouds for the benefit of humanity — polar mesospheric clouds — from its orbit some 350 miles above the ground, NASA’s Aeronomy of Ice in the Mesosphere, or AIM, mission has come to an end.
Initially slated for a two-year mission, AIM was extended numerous times due to its high science return. While AIM has faced hurdles over the years — from software hiccups to hardware issues — an incredibly dedicated team kept the spacecraft running for much longer than anyone could have anticipated.
On March 13, 2023, the spacecraft’s battery failed following several years of declining performance. Multiple attempts to maintain power to the spacecraft were made, but no further data could be collected, so the mission has now ended.
“AIM was dedicated to studying the atmospheric region that borders between our atmosphere and space,” said AIM mission scientist Diego Janches, of NASA’s Goddard Space Flight Center in Greenbelt, Maryland. “AIM’s help understanding this region has been of critical importance to providing insights on how the lower atmosphere affects space weather.”
Known as night-shining or noctilucent clouds, they are seen at twilight in the summer months, typically at high latitudes near the North and South Poles. Before the mission, scientists knew these types of clouds varied with latitude, season, and solar activity, but didn’t know why.
This mission was launched to understand the variations and study why the clouds form and their links to climate change by measuring the thermal, chemical, and other properties of the environment in which the clouds form.
“NASA’s AIM has been an incredibly successful mission,” said Scott Bailey, AIM principal investigator and professor at Virginia Tech. “It has answered core questions that have helped us understand how noctilucent clouds and atmospheric gravity waves vary over time and location.”
Over the years, AIM made many big discoveries. Data from the mission has thus far led to nearly 400 peer-reviewed publications. This includes findings on how these clouds can be created by meteor smoke and water vapor from rocket exhaust, how events near Earth’s surface can trigger changes in the clouds, and how ice high in the atmosphere can cause mysterious radar echoes, which are created in certain regions of the atmosphere during the summer.
As the mission progressed, scientists realized AIM’s data could also be used to study undulations in the air called atmospheric gravity waves. These waves transfer momentum and energy as they travel through the atmosphere. They link weather events at Earth’s surface with atmospheric disturbances that occur far away from the initial event, including in the uppermost part of the atmosphere where they can disrupt GPS signals.
“We’ve had many difficulties, but we’ve still gotten an incredible amount of data from AIM because of our really excellent, heroic, and hardworking team that comes through every time,” Bailey said.
AIM’s first hurdles started only months after launch in 2007, when the telecommunication receiver started to malfunction intermittently. With a clever use of radio signals, the team was able to reprogram the spacecraft to communicate in Morse code, which allowed it to maintain communications even after the receiver stopped working.
While communication with the spacecraft became thousands of times slower than planned, AIM was still able to make its measurements and send home 99% of the data it collected.
Shortly thereafter, the spacecraft again encountered a mission-threatening issue. The spacecraft repeatedly sent itself into safe mode, which effectively shut down the spacecraft and required a time-consuming series of tasks to reboot.
But again, the engineers were able to upload new software to the spacecraft to circumvent the issue and keep AIM functional. The new software patch has prevented over a thousand such incidents on the spacecraft since.
In 2019, AIM’s battery started to decline, but through great effort and ingenuity, the mission operations team maintained the battery power, enabling the spacecraft to continue returning data. In early 2023, the battery experienced a significant drop-off in performance which meant the spacecraft could not regularly receive commands or collect data.
Unfortunately, this hardware issue was not one that could be repaired remotely, and the satellite finally ceased collecting data in March 2023.
“We’re saddened to see AIM reach the end of its lifetime, but it’s been amazing how long it has lasted,” Bailey said. “It’s given us more data and insight into noctilucent clouds and atmospheric gravity waves than we could ever have hoped for.”
Though the spacecraft has seen its last night-shining clouds, scientists will continue to study AIM’s data for years to come. As for the spacecraft itself, it will slowly lose orbital height and burn up upon atmospheric re-entry in 2026.
“There are still gigabytes upon gigabytes of AIM data to study,” said Cora Randall, AIM deputy principal investigator and senior research scientist at the Laboratory for Atmospheric and Space Physics in Boulder, Colorado. “And as our models and computational capabilities continue to improve, people will make many more discoveries using the AIM datasets.”
For more information about the mission, visit https://go.nasa.gov/3TgIDwD.
Mara Johnson-Groh works for NASA’s Goddard Space Flight Center in Greenbelt, Maryland.
