The prenatal period is critical for auditory development; thus, prenatal influences on auditory development may significantly impact long-term hearing ability. While previous studies identified a protective effect of carotenoids on adult hearing, the impact of these nutrients on hearing outcomes in neonates is not well understood. The purpose of this study is to investigate the relationship between maternal and umbilical cord plasma retinol and carotenoid concentrations and abnormal newborn hearing screen (NHS) results. Mother–infant dyads (n = 546) were enrolled at delivery. Plasma samples were analyzed using HPLC and LC–MS/MS. NHS results were obtained from medical records. Statistical analysis utilized Mann–Whitney U tests and logistic regression models, with p ≤ 0.05 considered statistically significant. Abnormal NHS results were observed in 8.5% of infants. Higher median cord retinol (187.4 vs. 162.2 μg/L, p = 0.01), maternal trans-β-carotene (206.1 vs. 149.4 μg/L, p = 0.02), maternal cis-β-carotene (15.9 vs. 11.2 μg/L, p = 0.02), and cord trans-β-carotene (15.5 vs. 8.0 μg/L, p = 0.04) were associated with abnormal NHS. Significant associations between natural log-transformed retinol and β-carotene concentrations and abnormal NHS results remained after adjustment for smoking status, maternal age, and corrected gestational age. Further studies should investigate if congenital metabolic deficiencies, pesticide contamination of carotenoid-rich foods, maternal hypothyroidism, or other variables mediate this relationship.

Objectives Omega-3 (n-3) polyunsaturated fatty acids (PUFAs) are essential in fetal growth and development and have been shown to modulate inflammatory processes throughout the lifespan. Previous studies have demonstrated that individuals with lower socioeconomic status (SES) may be at risk for low intake of n-3 PUFAs, however, no research has compared the concentrations of these nutrients present in maternal and cord serum between markers of SES. The purpose of this study is to assess the relationship between markers of SES and levels of n-3 PUFAs in maternal and cord serum in a group of patients delivering at a Midwest Academic Medical Center. Methods An IRB-approved study enrolled mother-infant pairs (n = 55) at the time of delivery for collection of maternal and cord serum samples. n-3 PUFA levels quantified included Eicosapentaenoic acid (EPA), Docosahexaenoic acid (DHA), and total n-3 PUFAs. Markers of SES include private vs public insurance, income ≤ 150% of the poverty line vs > 150%, and college degree earners vs no college degree. The Mann-Whitney U test was used to assess differences in n-3 PUFA levels between SES groups. A P < 0.05 was considered statistically significant. Results Median gestational age at delivery was 39.3 weeks. Significantly higher nutrient levels were present in college-educated mothers vs less than college-educated mothers in median maternal EPA (9.44 µg/mL vs 5.13 µg/mL, p = 0.010), cord EPA (1.88 µg/mL vs 1.40 µg/mL, p = 0.011), cord DHA (37.96 µg/mL vs 32.80 µg/mL, p = 0.014), and total cord n-3 PUFAs (44.23 µg/mL vs 39.34 µg/mL, p = 0.024). Median cord EPA levels were significantly higher in those with private insurance compared to public (1.79 µg/mL, 1.18 µg/mL, p = 0.022). Additionally, median cord EPA levels were significantly higher in those > 150% the poverty line (1.79 µg/mL, 1.10 µg/mL, p = 0.030). Conclusions Our findings suggest that individuals with lower SES may be at risk for lower serum levels of n-3 PUFAs in pregnancy, which could increase their susceptibility to adverse birth and pregnancy outcomes. Future studies should focus on replicating these results in a larger, more heterogeneous sample and should consider analyzing additional markers of SES. Funding Sources UNMC Pediatrics Department; Child Health Research Institute.

Objectives Vitamin E is a fat-soluble nutrient with four isoforms: α-, β-, δ-, and γ-tocopherol. These isoforms differentially modulate inflammation and are related to important perinatal outcomes such as preterm delivery and Apgar scores. Understanding the dietary consumption of these isoforms and their respective prevalence in biological samples is an important component to optimize nutritional recommendations. The purpose of this study is to compare tocopherol isoform proportions among maternal, cord, and neonatal plasma; maternal breast milk; and maternal dietary intake. Methods Samples of maternal breast milk and maternal, cord, and neonatal plasma were obtained within 1 month following delivery for maternal-infant dyads (N = 17) from the neonatal intensive care unit. Maternal dietary intake was assessed using the Harvard Willett Food Frequency Questionnaire. Relative proportions of α-, δ-, and γ-tocopherol in each sample type were measured and median tocopherol concentrations were compared using Kruskal-Wallis tests. A p-value < 0.05 was statistically significant. Results Total tocopherol concentrations were significantly different across sample groups (P < 0.001). Concentrations were highest in maternal serum, followed by neonatal serum, maternal breast milk, and umbilical cord serum. In all samples, α-tocopherol had the highest relative proportion, followed by γ- and δ-tocopherol, respectively. Compared to all biological samples, the dietary intake proportion of γ-tocopherol was significantly higher (P < 0.001), while the proportion of α-tocopherol was significantly lower (p = 0.04). Conclusions We observed significant differences in tocopherol concentrations across related biological samples, with maternal plasma containing the highest concentration and umbilical cord plasma the lowest. Mothers also consumed significantly higher percentages of γ-tocopherol than those found in both their plasma and breast milk. This suggests that proportions of individual tocopherol isoforms are influenced by factors other than dietary intake. Additional research should explore these associations in a larger cohort and analyze the effects of supplementation on tocopherol concentrations. Funding Sources UNMC Pediatrics Department; Child Health Research Institute.

Objectives Maternal obesity produces inflammation, which may result in adverse pregnancy outcomes such as preterm birth. Polyunsaturated fatty acids (PUFA), including omega-6 (n-6) and omega-3 (n-3) fatty acids, regulate inflammation and may mitigate the negative effects of inflammation. Previous studies report higher n-6 and lower n-3 PUFA concentration in early to mid-pregnancy for individuals with higher pre-pregnancy BMI (pBMI). However, the relationship between PUFA concentration at delivery and pBMI are not well understood. The purpose of this study is to determine the relationship between pBMI and maternal plasma, umbilical cord plasma, and placental PUFA concentrations, as well as PUFA intrauterine transfer percentage (IUTP). Methods Following IRB approval, maternal plasma, umbilical cord plasma, and placental samples were collected at delivery from 55 maternal-infant dyads. IUTPs for each PUFA (linoleic acid (LA), α-linolenic acid (ALA), arachidonic acid (AA), docosapentaenoic acid (DPA), docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA)) were calculated as [cord blood]/[maternal blood] × 100. Spearman's correlations assessed relationships between PUFA levels, PUFA IUTP, and pBMI. Linear regression models were adjusted for smoking status. A p-value < 0.05 was considered statistically significant. Results The mean pBMI for our cohort was 28.7 kg/m2. Preceding pregnancy, 21% of mothers were normal or underweight, 36% overweight, and 43% obese. Maternal LA (R = −0.3, p = 0.03), maternal DHA (R = −0.27, p = 0.04), and placental EPA (R = −0.42, p = 0.02) were significantly correlated with maternal pBMI. After adjusting for smoking status, no correlations remained significant. PUFA cord levels and PUFA IUTP were not correlated to pBMI. Conclusions To our knowledge, this is the first study exploring relationships between pBMI and PUFA levels at delivery. Our findings contrast with previous research reporting correlations between PUFA levels and pBMI in early to mid-pregnancy. The effects of pBMI on PUFA status may be most prominent early in pregnancy. Future research should explore the relationship between pBMI and PUFA levels across all stages of pregnancy. Funding Sources UNMC Pediatrics Department; Child Health Research Institute.

Background The currently recommended HIV testing algorithm begins with a 4th generation antigen/antibody (Ag/Ab) combination immunoassay, which allows for early detection of HIV. However, this assay’s high sensitivity can result in false positives that must be distinguished from acute infections via an HIV nucleic acid test (NAT). At our medical center, HIV NATs are recommended in the lab report for anyone with a positive p24Ag component on the screening assay, but they are not done reflexively by the lab as it requires a different blood tube. Thus, difficulties arise in obtaining the NAT, such as providers failing to order the test or patients failing to return for another blood draw, jeopardizing the diagnosis of early HIV. Methods We conducted a retrospective chart review of adult patients at a Midwest academic medical center with a positive p24Ag on the HIV-1/2 Ag/Ab combination assay between Jan. 1, 2017 and Feb. 21, 2021. We assessed if appropriate confirmatory testing was performed, identified barriers to missed opportunities for confirmatory testing, and used t-tests and Fisher’s exact tests to evaluate differences between those who did and did not receive confirmatory testing. Results Of 37 people with a positive p24Ag on the HIV Ag/Ab immunoassay, 6 (17%) did not have an HIV NAT performed within 30 days of their positive screening test. Of these 6 cases, the ordering provider did not acknowledge the need for a confirmatory test in 3 cases, the patient did not return for the test in 1 case, and other factors prevented follow-up in 2 cases. Of those who had an HIV NAT ordered, 7 (23%) had a positive HIV NAT. Younger age was significantly associated with completion of appropriate confirmatory testing (p=0.05), but other factors including sex, race, insurance status, having a primary care provider, specialty of ordering provider, encounter location, and test indication were not. Conclusion Our review identified multiple missed opportunities for confirmatory HIV testing following a positive p24Ag component on the HIV screening test. Provider lack of knowledge/awareness of the need for appropriate testing was the most common barrier. A quality improvement initiative will be undertaken to minimize future risk of missed opportunities for confirmatory testing. Disclosures Paul D. Fey, PhD, BioFire: Advisor/Consultant|BioFire: Grant/Research Support|Merck: Grant/Research Support Sara H. Bares, MD, Gilead Sciences: Expert Testimony|GSK ViiV Healthcare: Grant/Research Support|Janssen: Grant/Research Support.