690 - The Environment Matters: Early Childhood Developmental Outcomes of Children with Prenatal Zika Virus Exposure

The 2016-17 Puerto Rico Zika virus (ZIKV) epidemic resulted in 4,134 pregnant women with laboratory-confirmed infection and 49 infants with birth defects by December 2017. In addition to microcephaly, follow-up evidence confirms developmental risks in exposed children without birth defects. Life course research indicates that the social environment exerts protective factors with influence on child health and developmental trajectories, while adversity during periods of heightened brain plasticity has been associated with negative consequences. Therefore, to support the health and developmental needs of children that endure ZIKV consequences, we need a better understanding of their immediate (home and neighborhood) social environment.


Objective:

The Pediatric Outcomes of Prenatal Zika Exposure cohort study aims to characterize the spectrum of disease and identify environmental correlates of ZIKV consequences on the developing brain.


Design/Methods:

Fifty-five children of mothers with ZIKV infection during pregnancy were assessed with the Bayley Scales of Infant Development (BSID) at 36 months. Mothers (n=53) completed the Ages and Stages Questionnaires-3 (ASQ-3) and environmental questionnaires (e.g., Perceived Neighborhood Scale and US Household Food Insecurity Survey) to explore home and neighborhood characteristics.


Results:

The mean maternal age was 30 years, most mothers were married or cohabitating (76%), and their families’ household annual income was < $15,000 (72%). Also, 51% were unemployed, and 23% had low education attainment (high school or less). The child’s mean age was 36.6 months, and 56% were female. Developmental delay in any domain was identified by the BSID in 39%, and 73% were identified at-risk in any domain by the ASQ-3. In adjusted regression models, children living in disadvantaged neighborhoods had significantly lower BSID language scores (B=-0.51, SE=0.26, p=0.05) than those living in the least disadvantaged neighborhoods. Those with food insecurity had significantly lower BSID cognitive (B=-1.62, SE=0.77, p=0.04), ASQ-3 communication (B=-1.73, SE=0.80, p=0.04), and ASQ-3 personal-social (B=-1.63, SE=0.54, p=0.005) scores than children with food security.


Conclusion(s):

Study findings contribute evidence about neighborhood disadvantage and food insecurity factors in the social environment of children at risk from ZIKV prenatal exposure, who also experience adverse social determinants of health with impact on their health and development. Public health and pediatric providers can access this information to protect these children and support their development.