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Cusick JA, Wellman CL, Demas GE. Maternal stress and the maternal microbiome have sex-specific effects on offspring development and aggressive behavior in Siberian hamsters (Phodopus sungorus). Horm Behav 2022; 141:105146. [PMID: 35276524 DOI: 10.1016/j.yhbeh.2022.105146] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
The gut microbiome, a community of commensal, symbiotic and pathogenic bacteria, fungi, and viruses, interacts with many physiological systems to affect behavior. Prenatal experiences, including exposure to maternal stress and different maternal microbiomes, are important sources of organismal variation that can affect offspring development. These physiological systems do not act in isolation and can have long-term effects on offspring development and behavior. Here we investigated the interactive effects of maternal stress and manipulations of the maternal microbiome on offspring development and social behavior using Siberian hamsters, Phodopus sungorus. We exposed pregnant females to either a social stressor, antibiotics, both the social stressor and antibiotics, or no treatment (i.e., control) over the duration of their pregnancy and quantified male and female offspring growth, gut microbiome composition and diversity, stress-induced cortisol concentrations, and social behavior. Maternal antibiotic exposure altered the gut microbial communities of male and female offspring. Maternal treatment also had sex-specific effects on aspects of offspring development and aggressive behavior. Female offspring produced by stressed mothers were more aggressive than other female offspring. Female, but not male, offspring produced by mothers exposed to the combined treatment displayed low levels of aggression, suggesting that alteration of the maternal microbiome attenuated the effects of prenatal stress in a sex-specific manner. Maternal treatment did not affect non-aggressive behavior in offspring. Collectively, our study offers insight into how maternal systems can interact to affect offspring in sex-specific ways and highlights the important role of the maternal microbiome in mediating offspring development and behavior.
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Affiliation(s)
- Jessica A Cusick
- Department of Biology, Utah Valley University, United States of America; Department of Biology, Indiana University, United States of America; Animal Behavior Program, Indiana University, United States of America.
| | - Cara L Wellman
- Animal Behavior Program, Indiana University, United States of America; Department of Psychological and Brain Sciences, Indiana University, United States of America; Program in Neuroscience, Indiana University, United States of America
| | - Gregory E Demas
- Department of Biology, Indiana University, United States of America; Animal Behavior Program, Indiana University, United States of America; Program in Neuroscience, Indiana University, United States of America
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Vladic Stjernholm Y, Vladic T, Marchini G. Progesterone Gel and Placebo Prolonged Pregnancy More Effectively Than Intravenous Tocolysis Alone in Women with Preterm Labor. Gels 2022; 8:272. [PMID: 35621570 PMCID: PMC9141710 DOI: 10.3390/gels8050272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 02/01/2023] Open
Abstract
The aim of this trial was to evaluate the effect of progesterone gel compared to placebo in prolonging pregnancy among women with preterm labor. Methods: A randomized controlled trial in Sweden in 2009−18. Women with early preterm labor were randomized to daily doses of progesterone gel 90 mg (n = 28) or placebo (n = 30) after standard intravenous tocolytics. Women with intravenous tocolytics alone (n = 29) served as controls. Results: The median latency to delivery was 68 (range 28−88) days with progesterone and 72 (range 9−90) days with placebo (p = 0.84), compared to 1 (range 1−2) day in the control group (progesterone and placebo vs. control p < 0.001). The rate of preterm birth before 34 weeks was 32% after progesterone and 37 % after placebo (p = 0.32) compared to 100 % in the control group (p < 0.001, respectively). The composite neonatal morbidity (p = 0.65) and neonatal intensive care unit admission (p = 0.12) were comparable between the progesterone and placebo groups and lower in these groups compared with neonates in the control group (p < 0.001, respectively). Conclusions: Progesterone gel and placebo were equally effective in prolonging pregnancy among women with early preterm labor, and both treatments were more effective than standard intravenous tocolysis alone. We hypothesize that the acidic placebo gel reinforced the biochemical barrier at the uterine cervix, which counteracts ascending pathogen invasion and subsequent inflammation, and thereby prevented preterm labor.
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Affiliation(s)
- Ylva Vladic Stjernholm
- Department of Women’s and Children’s Health, Karolinska University Hospital and Karolinska Institutet, Akademiska Stråket 14, 171 64 Stockholm, Sweden;
| | - Tomislav Vladic
- Department of Women’s and Children’s Health, Karolinska University Hospital and Karolinska Institutet, Akademiska Stråket 14, 171 64 Stockholm, Sweden;
| | - Giovanna Marchini
- Neonatal Unit, Astrid Lindgren’s Children’s Hospital, Eugeniavägen 23, 171 64 Solna, Sweden;
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Mitchell AM, Kowalsky JM, Christian LM, Belury MA, Cole RM. Perceived social support predicts self-reported and objective health and health behaviors among pregnant women. J Behav Med 2022; 45:589-602. [PMID: 35449357 DOI: 10.1007/s10865-022-00306-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/07/2022] [Indexed: 02/06/2023]
Abstract
Perinatal health and health behaviors play a crucial role in maternal and neonatal health. Data examining psychosocial factors which predict self-reported health and health behaviors as well as objective indicators downstream of health behaviors among pregnant women are lacking. In this longitudinal study design with 131 pregnant women, perceived social support was examined as a predictor of self-rated health and average levels of sleep quality, health-promoting and health-impairing behaviors, and red blood cell (RBC) polyunsaturated fatty acids across early, mid, and late pregnancy. Participants provided a blood sample and fatty acid methyl esters were analyzed by gas chromatography. Measures included the Multidimensional Scale of Perceived Social Support, Pittsburgh Sleep Quality Index, and Prenatal Health Behavior Scale. Regression models demonstrated that, after adjustment for income, race/ethnicity, age, relationship status, pre-pregnancy body mass index, greater social support was associated with better self-rated health (p = 0.001), greater sleep quality (p = 0.001), fewer health-impairing behaviors (p = 0.02), and higher RBC omega-3 fatty acids (p = 0.003). Associations among social support with health-promoting behaviors, RBC omega-6 fatty acids, or gestational weight gain were not significant. Findings underscore the benefits of perceived social support in the context of pregnancy. Examination of pathways that link social support with these outcomes will be meaningful in determining the ways in which perinatal psychosocial interventions may promote health.
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Affiliation(s)
- Amanda M Mitchell
- Department of Counseling and Human Development, College of Education and Human Development, University of Louisville, Woodford and Harriett Porter Building, 1905 South 1st Street, Louisville, KY, 40292, USA.
| | | | - Lisa M Christian
- Department of Psychiatry &, Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Martha A Belury
- Department of Human Nutrition, The Ohio State University, Columbus, OH, USA
| | - Rachel M Cole
- Department of Human Nutrition, The Ohio State University, Columbus, OH, USA
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Psychischer Stress – Implikationen für Schwangerschaftseintritt und -verlauf. GYNAKOLOGISCHE ENDOKRINOLOGIE 2022. [DOI: 10.1007/s10304-022-00443-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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55
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Masten Y, Song H, Esperat CR, McMurry LJ. A maternity care home model of enhanced prenatal care to reduce preterm birth rate and NICU use. Birth 2022; 49:107-115. [PMID: 34427349 DOI: 10.1111/birt.12579] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Centers for Medicare & Medicaid Services (CMS) funded 182 US health care sites to reduce preterm birth rates by enhancing prenatal care for at-risk women. As a funded site, the enhanced prenatal care maternity care home (MCH) model was implemented from 2013 to 2018 for 1042 Medicaid-eligible pregnant women. METHODS This retrospective study evaluated the impact of enhanced services on preterm birth risk reduction. Certified community health workers provided enhanced services from enrollment through six weeks postpartum. Participants attending enhanced intake and third-trimester prenatal visits comprised the Active Group (N = 632). Participants missing third-trimester visits, but participating in enhanced intake and postpartum visits, comprised the Inactive Group (N = 128). Lost Group participants attended only intake visits (N = 282). Data were collected through CMS-developed intake, third-trimester, postpartum, and exit forms. Descriptive analysis, analysis of variance, and the chi-square tests analyzed the impact of risk factors, participant characteristics, and program participation on birth outcomes. RESULTS Active Group compared with Inactive and Lost Group participants experienced significantly lower preterm birth rates (7.64% vs 22.48% and 15.82%, P < 0.001) and therefore a significantly lower NICU admission rate compared with Inactive and Lost Groups (2.82% vs 11.85% and 5.47%, P < 0.001). CONCLUSIONS The MCH model of enhanced prenatal care reduced preterm birth and NICU admission rates for Active Group participants. The Black Active Group participant preterm birth rate was not significantly different than other Active Group rates, but was lower than Black Inactive and Lost Group rates.
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Affiliation(s)
- Yondell Masten
- Texas Tech University Health Sciences Center School of Nursing, Lubbock, Texas, USA
| | - Huaxin Song
- Texas Tech University Health Sciences Center School of Nursing, Lubbock, Texas, USA
| | - Christina R Esperat
- Texas Tech University Health Sciences Center School of Nursing, Lubbock, Texas, USA
| | - Linda J McMurry
- Texas Tech University Health Sciences Center School of Nursing, Lubbock, Texas, USA.,Larry Combest Community Health and Wellness Center, Lubbock, Texas, USA
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56
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Zanardo V, Sandri A, Straface G. Trajectories of antenatal depression and increased odds of preterm birth. Am J Obstet Gynecol 2022; 226:278. [PMID: 34481772 DOI: 10.1016/j.ajog.2021.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/29/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Vincenzo Zanardo
- Division of Perinatal Medicine, Policlinico Abano Terme, 35031 Abano Terme, Italy.
| | - Andrea Sandri
- University of California San Diego School of Medicine, San Diego, CA
| | - Gianluca Straface
- Division of Perinatal Medcine, Policlinico Abano Terme, Abano Terme, Italy
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Ravi M, Bernabe B, Michopoulos V. Stress-Related Mental Health Disorders and Inflammation in Pregnancy: The Current Landscape and the Need for Further Investigation. Front Psychiatry 2022; 13:868936. [PMID: 35836664 PMCID: PMC9273991 DOI: 10.3389/fpsyt.2022.868936] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
Many studies have focused on psychoimmunological mechanisms of risk for stress-related mental health disorders. However, significantly fewer studies have focused on understanding mechanisms of risk for stress-related disorders during pregnancy, a period characterized by dramatic changes in both the innate and adaptive immune systems. The current review summarizes and synthesizes the extant literature on the immune system during pregnancy, as well as the sparse existing evidence highlighting the associations between inflammation and mood, anxiety, and fear-related disorders in pregnancy. In general, pregnant persons demonstrate lower baseline levels of systemic inflammation, but respond strongly when presented with an immune challenge. Stress and trauma exposure may therefore result in strong inflammatory responses in pregnant persons that increases risk for adverse behavioral health outcomes. Overall, the existing literature suggests that stress, trauma exposure, and stress-related psychopathology are associated with higher levels of systemic inflammation in pregnant persons, but highlight the need for further investigation as the existing data are equivocal and vary based on which specific immune markers are impacted. Better understanding of the psychoimmunology of pregnancy is necessary to reduce burden of prenatal mental illness, increase the likelihood of a successful pregnancy, and reduce the intergenerational impacts of prenatal stress-related mental health disorders.
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Affiliation(s)
- Meghna Ravi
- Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Brandy Bernabe
- Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States.,Emory National Primate Research Center, Atlanta, GA, United States
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Li X, Zhang C. Surfactant Protein (SP) induces preterm birth by promoting oxidative stress via upregulating Storkhead-Box Protein 1. Clinics (Sao Paulo) 2022; 77:100079. [PMID: 36087567 PMCID: PMC9468348 DOI: 10.1016/j.clinsp.2022.100079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/25/2022] [Indexed: 12/02/2022] Open
Abstract
Preterm birth is the leading cause of infant mortality. The mechanisms that instigate preterm birth remain elusive and this makes it difficult to predict or prevent preterm birth. In this study, the authors found that SP-A induced pathological damage to the placenta and promoted preterm birth. Through mechanism, SP-A promoted the expression of STOX1 which further promoted the oxidative stress in the placenta by inhibiting the activities of a series of antioxidant enzymes including SOD, CAT and GSH-Px. SP-A also induced dysregulation of arginine metabolism by inhibiting NOS2 and ARG2. Overexpression of STOX1 aggravated SP-A induced oxidative stress, pathological damage, and preterm birth, whereas knockdown of STOX1 alleviated SP-A induced oxidative stress, pathological damage and preterm birth. The present study uncovers that SP-A induces preterm birth by promoting oxidative stress via upregulating STOX1, which provides new targets for the prediction and prevention of preterm birth.
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Affiliation(s)
- Xiafang Li
- Department of Obstetrics, Ganzhou People's Hospital, Ganzhou, Jiangxi, China.
| | - Chunnian Zhang
- Department of Obstetrics and Gynecology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
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59
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Sanjuan PM, Fokas K, Tonigan JS, Henry MC, Christian K, Rodriguez A, Larsen J, Yonke N, Leeman L. Prenatal maternal posttraumatic stress disorder as a risk factor for adverse birth weight and gestational age outcomes: A systematic review and meta-analysis. J Affect Disord 2021; 295:530-540. [PMID: 34509068 PMCID: PMC10481878 DOI: 10.1016/j.jad.2021.08.079] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/29/2021] [Accepted: 08/25/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although not routinely assessed, prenatal posttraumatic stress disorder (PTSD) is associated with poor maternal mental health and mother-infant bonding. Prenatal PTSD may also be associated with birth weight and gestational age outcomes, but this remains unclear. This systematic review and meta-analysis investigated the association of prenatal PTSD with risk of low birth weight (LBW) or preterm birth (PTB) (dichotomous medically-defined cut-offs) or with birth weight (BW) or gestational age (GA) (continuous variables). METHODS A comprehensive literature search was conducted in Web of Science, MedLine, PubMed, and PsychInfo. Data were collected and processed according to Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Study quality was assessed with the Newcastle-Ottowa Quality Assessment Scale. Pooled effect sizes were estimated with random-effects models (correlation for continuous and odds ratios for dichotomous outcomes). RESULTS Sixteen studies with 51,470 participants (prenatal PTSD 8%) were included in 4 meta-analyses. Maternal prenatal PTSD was associated with higher risks of LBW (OR = 1.96; 95% CI, 1.26, 3.03; P = .003), PTB (OR = 1.42; 95% CI, 1.16, 1.73; P = .001), and reduced GA (r = -0.04; 95% CI, -0.06, -0.01; P = .002). LIMITATIONS Different designs across studies, variety of PTSD assessment practices, and a small pool of studies were noted. CONCLUSIONS Findings suggest prenatal PTSD presents increased risks of LBW, PTB, and reduced GA. Evidence of physical harm to neonates from prenatal PTSD provides a powerful rationale to increase prenatal PTSD screening and identify effective prenatal interventions to improve maternal and child outcomes.
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Affiliation(s)
- Pilar M Sanjuan
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, United States; Department of Family and Community Medicine, University of New Mexico School of Medicine, United States.
| | - Kathryn Fokas
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, United States
| | - J Scott Tonigan
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, United States
| | - Melissa C Henry
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, United States
| | - Korinna Christian
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, United States; Department of Family and Community Medicine, University of New Mexico School of Medicine, United States
| | - Andrea Rodriguez
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, United States
| | - Jessica Larsen
- University of New Mexico School of Medicine, United States
| | - Nicole Yonke
- Department of Family and Community Medicine, University of New Mexico School of Medicine, United States
| | - Lawrence Leeman
- Department of Family and Community Medicine, University of New Mexico School of Medicine, United States; Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, United States
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Association of State Gestational Age Limit Abortion Laws With Infant Mortality. Am J Prev Med 2021; 61:787-794. [PMID: 34364724 PMCID: PMC8608731 DOI: 10.1016/j.amepre.2021.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/27/2021] [Accepted: 05/11/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION A growing number of state legislatures have passed laws that restrict access to abortion care after a specified gestational age (gestational age limit laws). The impact of these laws on maternal and child population health outcomes and inequities is unknown. The objective of this study is to determine whether states that implement gestational age limit laws experience subsequent changes in rates of infant mortality. METHODS Using U.S. population‒based data from the National Center for Health Statistics Linked Infant Birth-Death Files (2005-2017), difference-in-differences models were estimated using multivariable linear regressions to compare the trends in infant mortality (all-cause and cause-specific rates) in states with gestational age limit laws with the trends in states without such laws. Models stratified by maternal racial/ethnic group explored racial heterogeneity in the law's impact. Data were analyzed in 2020. RESULTS This study included 16,232,133 births in states that enacted a gestation age limit abortion law and 36,472,309 births in states that did not from 2005 to 2017. In difference-in-difference analyses, gestational age limit laws were associated with 0.23 excess infant deaths per 1,000 live births (95% CI=0.09, 0.37, p<0.01). In cause-specific analyses, gestational age limit laws were associated with 0.10 additional infant deaths owing to congenital anomalies per 1,000 live births (95% CI=0.03, 0.17, p=0.01). Associations between gestational age limit laws and infant mortality in models stratified by maternal racial/ethnic group were not statistically significant. CONCLUSIONS On the basis of data from 2005 to 2017, states that enacted gestational age limit abortion laws subsequently experienced increased infant mortality rates.
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Hadebe R, Seed PT, Essien D, Headen K, Mahmud S, Owasil S, Fernandez Turienzo C, Stanke C, Sandall J, Bruno M, Khazaezadeh N, Oteng-Ntim E. Can birth outcome inequality be reduced using targeted caseload midwifery in a deprived diverse inner city population? A retrospective cohort study, London, UK. BMJ Open 2021; 11:e049991. [PMID: 34725078 PMCID: PMC8562498 DOI: 10.1136/bmjopen-2021-049991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES (1) To report maternal and newborn outcomes of pregnant women in areas of social deprivation in inner city London. (2) To compare the effect of caseload midwifery with standard care on maternal and newborn outcomes in this cohort of women. DESIGN Retrospective observational cohort study. SETTING Four council wards (electoral districts) in inner city London, where over 90% of residents are in the two most deprived quintiles of the English Index of Multiple Deprivation (IMD) (2019) and the population is ethnically diverse. PARTICIPANTS All women booked for antenatal care under Guys and St Thomas' National Health Service Foundation Trust after 11 July 2018 (when the Lambeth Early Action Partnership (LEAP*) caseload midwifery team was implemented) until data collection 18 June 2020. This included 523 pregnancies in the LEAP area, of which 230 were allocated to caseload midwifery, and 8430 pregnancies from other areas. MAIN OUTCOME MEASURES To explore if targeted caseload midwifery (known to reduce preterm birth) will improve important measurable outcomes (preterm birth, mode of birth and newborn outcomes). RESULTS There was a significant reduction in preterm birth rate in women allocated to caseload midwifery, when compared with those who received traditional midwifery care (5.1% vs 11.2%; risk ratio: 0.41; p=0.02; 95% CI 0.18 to 0.86; number needed to treat: 11.9). Caesarean section births were significantly reduced in women allocated to caseload midwifery care, when compared with traditional midwifery care (24.3% vs 38.0%; risk ratio: 0.64: p=0.01; 95% CI 0.47 to 0.90; number needed to treat: 7.4) including emergency caesarean deliveries (15.2% vs 22.5%; risk ratio: 0.59; p=0.03; 95% CI 0.38 to 0.94; number needed to treat: 10) without increase in neonatal unit admission or stillbirth. CONCLUSION This study shows that a model of caseload midwifery care implemented in an inner city deprived community improves outcome by significantly reducing preterm birth and birth by caesarean section when compared with traditional care. This data trend suggests that when applied to targeted groups (women in higher IMD quintile and women of diverse ethnicity) that the impact of intervention is greater.
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Affiliation(s)
- Ruth Hadebe
- Department of Women's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul T Seed
- Department of Women and Children's Health, King's College London, London, UK
| | - Diana Essien
- Department of Women's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kyle Headen
- Department of Women's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Saheel Mahmud
- King's College London School of Medicine, London, UK
| | - Salwa Owasil
- King's College London School of Medicine, London, UK
| | | | - Carla Stanke
- Public Health, National Childrens Bureau, London, UK
- Lambeth Early Action Partnership, London, UK
| | - Jane Sandall
- Department of Women and Children's Health, King's College London, London, UK
| | - Mara Bruno
- Department of Women's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nina Khazaezadeh
- Department of Women's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Eugene Oteng-Ntim
- Department of Women's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Women and Children's Health, King's College London, London, UK
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Stanhope KK, Comeau DL, Ulloa M, Leon JS, Suglia SF, Hogue CJR, Kramer MR. Perceptions of stress and resilience among Latina women enrolled in prenatal care in Metro Atlanta through an ecosocial lens. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:e348-e358. [PMID: 33756040 DOI: 10.1111/hsc.13359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/22/2021] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
Stress across the life course is highly prevalent, particularly among immigrant and racial/ethnic minority women who face adversities associated with structural and interpersonal racism. Understanding how women perceive and describe stress and resilience can provide cultural context to inform interventions to improve health among pregnant women facing adversity. The goal of this project was to examine how external stressors and coping strategies prior to and during pregnancy are reflected in Latina women's narratives about their lives through an Ecosocial framework. This mixed methods research study explores pregnant Latina women's psychosocial well-being before and during pregnancy based on Ecosocial theory. We conducted 111 surveys with Latina women receiving prenatal care in Atlanta, Georgia in 2017-2018. We conducted 24 in-depth interviews, chosen purposively from survey respondents, collecting narratives of stress and resilience over the course of pregnancy. We purposively sampled equal numbers of women who did and did not report an ongoing stressor in the survey. The survey and interview guide were focused on domains of stress, psychosocial being, coping and resilience. The majority of survey participants spoke Spanish (86%) and were born in Mexico (42%) or Guatemala (27%). Less than half (37%) reported ongoing stress, most commonly from a loved one's illness or work-related problem. The majority of women felt they should control emotional responses to external stressors during pregnancy to protect their baby's health. Women described motherhood and previous challenges as sources of maturity and improved coping. Familial financial and emotional support were perceived as critical to women's successful coping.
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Affiliation(s)
- Kaitlyn K Stanhope
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Dawn L Comeau
- Department of Behavior Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Monica Ulloa
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Juan S Leon
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shakira F Suglia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Carol J R Hogue
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Schachinger F, Farr S. The Effects of Preterm Birth on Musculoskeletal Health-Related Disorders. J Clin Med 2021; 10:5082. [PMID: 34768599 PMCID: PMC8584797 DOI: 10.3390/jcm10215082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/21/2022] Open
Abstract
Preterm birth is associated with various diseases and conditions which demand multidisciplinary medical care. Approximately 10% of all neonates are born prematurely with an increasing survival rate in almost all Western countries. This ongoing, yet desirable trend is creating new challenges for sufficient medical treatment regimens, which should be upheld throughout the patients' lives. Orthopedic surgeons are focused on musculoskeletal disorders and the improvement of patients' ability to cope with the challenges of everyday life. The most common conditions associated with preterm birth are cerebral palsy and a dysregulation of the calcium/phosphorus metabolism, which may lead to fractures. These diseases may vary greatly in their organic manifestation and clinical presentation. This demands multidisciplinary cooperation and parental support. Clinical management is aimed on the early enhancement of a patient's physical, as well as neurological condition, and to prevent the development of secondary musculoskeletal disorders. In this article, we give an overview of the current literature on the most common musculoskeletal disorders associated with preterm birth and critically discuss state of the art diagnostic standards and treatment algorithms.
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Affiliation(s)
| | - Sebastian Farr
- Department of Pediatric Orthopaedics and Foot and Ankle Surgery, Orthopaedic Hospital Speising, Speisingerstrasse 109, A-1130 Vienna, Austria;
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Lionetti F, Dellagiulia A, Prudentino G, Spinelli M, Pluess M, Fasolo M. Is premature birth an environmental sensitivity factor? A scoping review protocol. BMJ Open 2021; 11:e047015. [PMID: 34711591 PMCID: PMC8557285 DOI: 10.1136/bmjopen-2020-047015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 10/13/2021] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Globally, around 10% of children are born preterm and are more at risk of negative developmental outcomes. However, empirical evidences and theoretical reasoning also suggest that premature birth can be a susceptibility factor, increasing sensitivity to the environment for better and for worse. Because available findings are controversial, with the current scoping review we will explore if, based on the available literature, preterm birth can be seen as an environmental sensitivity (ES) factor. In doing so, we will consider a series of moderating variables, including the level of prematurity, the type of environment and the outcome investigated. Methodological aspects, as the type of measures used and study design, will be considered. METHODS AND ANALYSIS The scoping review will be conducted following the Joanna Briggs Institute Methodology guidelines. The report will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. We will perform the search between 15 January 2022 and 1 February 2022. Data will be chartered by independent reviewers. ETHICS AND DISSEMINATION Ethical approval is not required, as primary data will not be collected. This scoping review will be the first to explore whether prematurity is associated with an increased ES. This review can have important implications for tailoring prevention and intervention programmes. Results will be published in a peer-reviewed journal.
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Affiliation(s)
- Francesca Lionetti
- Department of Neurosciences, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | | | | | - Maria Spinelli
- Department of Neurosciences, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Michael Pluess
- Department of Biological and Experimental Psychology, Queen Mary University of London, London, UK
| | - Mirco Fasolo
- Department of Neurosciences, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
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Ornaghi S, Fumagalli S, Guinea Montalvo CK, Beretta G, Invernizzi F, Nespoli A, Vergani P. Indirect impact of SARS-CoV-2 pandemic on pregnancy and childbirth outcomes: A nine-month long experience from a university center in Lombardy. Int J Gynaecol Obstet 2021; 156:466-474. [PMID: 34669973 PMCID: PMC9087530 DOI: 10.1002/ijgo.13990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/19/2021] [Indexed: 01/23/2023]
Abstract
Objective To determine the impact on perinatal health of changes in social policies and obstetric care implemented to curb SARS‐CoV‐2 transmission. However, robust data on the topic are lacking since most of the studies has examined only the first few months of the outbreak. Methods A retrospective analysis of prospectively collected data on uninfected and asymptomatically infected women giving birth between March and November 2020 and in the same time frame of 2019 at our tertiary care center in Lombardy, northern Italy. Perinatal outcomes were compared according to the year (2019 versus 2020) and to the trimester (March–May, June–August, September–November) of childbirth, corresponding to the three phases of the pandemic (first wave, deceleration, second wave) and covering a 9‐month period. Results We identified increased rates of gestational diabetes mellitus, spontaneous preterm birth, and neuraxial analgesia in 2020 versus 2019, with different temporal distributions: gestational diabetes mellitus and spontaneous preterm birth were more prevalent during the deceleration and the second wave phase, whereas epidural analgesia was more prevalent during the first wave. Conclusion By assessing a prolonged time frame of the pandemic, we show that pandemic‐related control measures, as applied in Lombardy, impacted relevant perinatal outcomes of women giving birth at our center.
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Affiliation(s)
- Sara Ornaghi
- Department of Obstetrics and Gynecology, Unit of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Simona Fumagalli
- Department of Obstetrics and Gynecology, Unit of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | | | - Greta Beretta
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Francesca Invernizzi
- Department of Obstetrics and Gynecology, Unit of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Antonella Nespoli
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, Unit of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
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66
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Knudsen CK, Christesen AMS, Heuckendorff S, Fonager K, Johansen MN, Overgaard C. The risk of preterm birth in combinations of socioeconomic position and mental health conditions in different age groups: a Danish nationwide register-based cohort study. BMC Pregnancy Childbirth 2021; 21:696. [PMID: 34649508 PMCID: PMC8515728 DOI: 10.1186/s12884-021-04138-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background Inequality in preterm birth is a world-wide challenge that has proved difficult for maternity care services to meet. Reducing the inequality requires identification of pregnant women at particularly high risk of preterm birth in order to target interventions. Therefore, the aim was to estimate the risk of preterm birth in women with different combinations of socioeconomic position, mental health conditions, and age. Methods In this nationwide register-based cohort study, we included all first-time mothers that gave birth to a singleton liveborn infant in Denmark between 2000 and 2016. The absolute and relative risk of preterm birth (< 37 weeks of gestation) was examined in different combinations of educational level (high, intermediate, and low) and mental health conditions (no, minor, and moderate/severe) in three age strata (≤23, 24–30, and ≥ 31 years). We estimated the relative risk using Poisson regression with a robust error variance. As additive interaction can help identify subgroups where limited resources can be of best use, we measured the attributable proportion to assess the risk that is due to interaction of the different exposures. Results Of the 415,523 included first-time mothers, 6.3% gave birth prematurely. The risk of preterm birth increased with decreasing educational level and increasing severity of mental health conditions in all age strata, but most in women aged ≥31 years. The highest absolute risk was 12.9% [95% CI: 11.2;14.8%] in women aged ≥31 years with low education and moderate/severe mental health conditions resulting in a relative risk of 2.23 [95% CI: 1.93–2.58] compared to the unexposed reference group in that age strata. We found positive additive interaction between low education and mental health conditions in women aged 24–30 and ≥ 31 years and between age ≥ 31 years and combinations of mental health conditions and educational levels. Conclusion The inequality in preterm birth increased with increasing age. To reduce inequality in preterm birth focused attention on women with higher age further combined with lower educational levels and mental health conditions is essential. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04138-0.
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Affiliation(s)
- Camilla Klinge Knudsen
- Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, 9000, Aalborg, Denmark. .,Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
| | - Amanda Marie Somer Christesen
- Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, 9000, Aalborg, Denmark.,Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Signe Heuckendorff
- Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Aalborg University, Aalborg, Denmark
| | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Charlotte Overgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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67
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Cumulative life stressors and stress response to threatened preterm labour as birth date predictors. Arch Gynecol Obstet 2021; 305:1421-1429. [PMID: 34549310 DOI: 10.1007/s00404-021-06251-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/01/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Preterm birth represents one of the main causes of neonatal morbimortality and a risk factor for neurodevelopmental disorders. Appropriate predictive methods for preterm birth outcome, which consequently would facilitate prevention programs, are needed. We aim to predict birth date in women with a threatened preterm labour (TPL) based on stress response to TPL diagnosis, cumulative life stressors, and relevant obstetric variables. METHODS A prospective cohort of 157 pregnant women with TPL diagnosis between 24 and 31 weeks gestation formed the study sample. To estimate the stress response to TPL, maternal salivary cortisol, α-amylase levels, along with anxiety and depression symptoms were measured. To determine cumulative life stressors, previous traumas, social support, and family functioning were registered. Then, linear regression models were used to examine the effect of potential predictors of birth date. RESULTS Lower family adaptation, higher Body Mass Index (BMI), higher cortisol levels and TPL diagnosis week were the main predictors of birth date. Gestational week at TPL diagnosis showed a non-linear interaction with cortisol levels: TPL women with middle- and high-cortisol levels before 29 weeks of gestation went into imminent labour. CONCLUSION A combination of stress response to TPL diagnosis (salivary cortisol) and cumulative life stressors (family adaptation) together with obstetric factors (TPL gestational week and BMI) was the best birth date predictor. Therefore, a psychosocial therapeutic intervention program aimed to increase family adaptation and decrease cortisol levels at TPL diagnosis as well as losing weight, may prevent preterm birth in symptomatic women.
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68
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Robledo-Gil T, Kemet S, Pensak M, Cutler A, McNamara B, Kennedy HP, Lundsberg L, Gariepy A. " Un abrazo a la distancia": An Exploration of Spanish-Speaking Women's Experiences with Pregnancy and Social Isolation in an Urban U.S. Setting. HISPANIC HEALTH CARE INTERNATIONAL 2021; 20:107-114. [PMID: 34520260 DOI: 10.1177/15404153211041013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Research on Spanish-speaking Latina/Hispanic women's experiences during pregnancy is limited. Methods: We recruited women from urban, walk-in pregnancy testing clinics from June 2014 to June 2015. Women aged 16-44 years, at less than 24 weeks gestational age, who spoke either English or Spanish were eligible and completed an enrollment questionnaire and individual interview according to language preference. During qualitative interviews, we explored pregnancy intentions, initial reactions to a new pregnancy, and feelings about the impact of this pregnancy on relationships and daily life. Qualitative narrative content analysis was conducted using Atlas.ti software. Results: Among interviews with 31 Spanish-speaking Latina/Hispanic pregnant women, participants' average age was 28 years old with a mean gestational age of 7 weeks. We identified social isolation as the most common theme, characterized by four interwoven and overlapping subthemes: (1) sola-the experience of feeling alone; (2) familismo cercano-the importance of close relationships; (3) familismo lejano-overcoming long distance relationships; and (4) mi patria-preserving homeland cultural connectedness. Conclusions: Spanish-speaking Latina/Hispanic pregnant women described experiencing multiple aspects of social isolation. Language preference may suggest risk of social isolation, necessitating provider awareness and support initiatives to improve social support and lessen social isolation among newly pregnant, Spanish-speaking Latina women.
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Affiliation(s)
| | | | | | - Abigail Cutler
- Department of Obstetrics, 164556Gynecology and Reproductive Sciences, 25047Yale School of Medicine, New Haven, CT, USA
| | | | | | - Lisbet Lundsberg
- Department of Obstetrics, 164556Gynecology and Reproductive Sciences, 25047Yale School of Medicine, New Haven, CT, USA
| | - Aileen Gariepy
- Department of Obstetrics, 164556Gynecology and Reproductive Sciences, 25047Yale School of Medicine, New Haven, CT, USA
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Ruyak SL, Kivlighan KT. Perinatal Behavioral Health, the COVID-19 Pandemic, and a Social Determinants of Health Framework. J Obstet Gynecol Neonatal Nurs 2021; 50:525-538. [PMID: 34146480 PMCID: PMC8256336 DOI: 10.1016/j.jogn.2021.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 12/01/2022] Open
Abstract
The United States has greater prevalence of mental illness and substance use disorders than other developed countries, and pregnant women are disproportionately affected. The current global COVID-19 pandemic, through the exacerbation of psychological distress, unevenly affects the vulnerable population of pregnant women. Social distancing measures and widespread closures of businesses secondary to COVID-19 are likely to continue for the foreseeable future and to further magnify psychosocial risk factors. We propose the use of a social determinants of health framework to integrate behavioral health considerations into prenatal care and to guide the implementation of universal and comprehensive psychosocial assessment in pregnancy. As the most numerous and well-trusted health care professionals, nurses are ideally positioned to influence program and policy decisions at the community and regional levels and to advocate for the full integration of psychosocial screening and behavioral health into prenatal and postpartum care as core components.
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70
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Chuard C, Chuard‐Keller P. Baby bonus in Switzerland: Effects on fertility, newborn health, and birth-scheduling. HEALTH ECONOMICS 2021; 30:2092-2123. [PMID: 34076325 PMCID: PMC8453695 DOI: 10.1002/hec.4366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/15/2021] [Accepted: 05/18/2021] [Indexed: 06/12/2023]
Abstract
This paper studies the effect of birth allowances (so-called baby bonus) on fertility, newborn health, and birth-scheduling in Switzerland. Switzerland provides an optimal quasi-experiment: 11 out of 26 cantons introduced a baby bonus during the last 50 years at different points in time. To identify the effect of changes in the baby bonus, we employ an event study with control groups using several administrative data sets on births, stillbirths, and infant deaths in Switzerland from 1969 to 2017. While there is no evidence for birth-scheduling, we find, however, a sizable but only temporary increase in the fertility rate of 5.5% and a permanent but diminishing increase in the birth weight of 2.8%. The latter effect is particularly strong at the lower end of the birth weight distribution. Furthermore, we document substantial heterogeneity by citizenship of mothers.
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Affiliation(s)
| | - Patrick Chuard‐Keller
- University of St. GallenSwiss Institute for Empirical Economic ResearchSt. GallenSwitzerland
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71
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Bedaso A, Adams J, Peng W, Sibbritt D. The relationship between social support and mental health problems during pregnancy: a systematic review and meta-analysis. Reprod Health 2021; 18:162. [PMID: 34321040 PMCID: PMC8320195 DOI: 10.1186/s12978-021-01209-5] [Citation(s) in RCA: 127] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 07/19/2021] [Indexed: 01/11/2023] Open
Abstract
Background Pregnancy is a time of profound physical and emotional change as well as an increased risk of mental illness. While strengthening social support is a common recommendation to reduce such mental health risk, no systematic review or meta-analysis has yet examined the relationship between social support and mental problems during pregnancy. Methods The PRISMA checklist was used as a guide to systematically review relevant peer-reviewed literature reporting primary data analyses. PubMed, Psych Info, MIDIRS, SCOPUS, and CINAHL database searches were conducted to retrieve research articles published between the years 2000 to 2019. The Newcastle–Ottawa Scale tool was used for quality appraisal and the meta-analysis was conducted using STATA. The Q and the I2 statistics were used to evaluate heterogeneity. A random-effects model was used to pool estimates. Publication bias was assessed using a funnel plot and Egger’s regression test and adjusted using trim and Fill analysis. Result From the identified 3760 articles, 67 articles with 64,449 pregnant women were part of the current systematic review and meta-analysis. From the total 67 articles, 22 and 45 articles included in the narrative analysis and meta-analysis, respectively. From the total articles included in the narrative analysis, 20 articles reported a significant relationship between low social support and the risk of developing mental health problems (i.e. depression, anxiety, and self-harm) during pregnancy. After adjusting for publication bias, based on the results of the random-effect model, the pooled odds ratio (POR) of low social support was AOR: 1.18 (95% CI: 1.01, 1.41) for studies examining the relationship between low social support and antenatal depression and AOR: 1.97 (95% CI: 1.34, 2.92) for studies examining the relationship between low social support and antenatal anxiety. Conclusion Low social support shows significant associations with the risk of depression, anxiety, and self-harm during pregnancy. Policy-makers and those working on maternity care should consider the development of targeted social support programs with a view to helping reduce mental health problems amongst pregnant women. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01209-5. Pregnancy is a significant event for reproductive-age women. It is supplemented by hormonal changes and can represent a time of increased risk for the occurrence of mental illness like depression, anxiety and self-harm. Providing good social support for the pregnant mother reduce this risk and prevent pregnancy complication and adverse birth outcome. However, no systematic review and/or meta-analysis has explored the associations between social support and mental illness (depression, anxiety, self-harm) among pregnant women. Therefore, this systematic review and meta-analysis aimed to examine the association between social support and mental illness (anxiety, depression, and self-harm) during pregnancy. The review identified 67 relevant articles with 64,449 pregnant women, from PubMed, Psych Info, MIDIRS, SCOPUS, and CINAHL database. Of the total 67 articles, 22 articles included in the narrative review and 45 articles included in the meta-analysis. Among studies included in the narrative synthesis, a majority of them reported significant positive associations between low social support and antenatal depression, antenatal anxiety and self-harm during pregnancy. Further, the pooled estimates of the meta-analysis show that low social support had a significant positive association with antenatal depression (AOR: 1.18 (95% CI: 1.01, 1.41)) and antenatal anxiety (AOR: 1.97 (95% CI: 1.34, 2.92)). Therefore, maternal health professionals need to have discussions with pregnant women regarding the level and source of social support they receive. Maternal health professionals may also need to consider encouraging the social network of pregnant women to improve social support being given. Policy-makers and those working on maternity care should consider the development of targeted social support programs with a view to helping reduce mental health problems amongst pregnant women.
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Affiliation(s)
- Asres Bedaso
- College of Medicine and Health Sciences, School of Nursing, Hawassa University, Hawassa, Ethiopia. .,Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
| | - Jon Adams
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Wenbo Peng
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - David Sibbritt
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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Saur AM, Dos Santos MA. Risk factors associated with stress symptoms during pregnancy and postpartum: integrative literature review. Women Health 2021; 61:651-667. [PMID: 34311677 DOI: 10.1080/03630242.2021.1954132] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Stressful events during prenatal and postpartum have been associated with an increase in the susceptibility to the onset of various diseases, threatening mental and physical health of mother and baby. The aim of this study was to synthesize and analyze the literature related to risk factors associated with stress symptoms during pregnancy and immediate postpartum by means of an integrative review. The search was conducted from January 2013 to July 2020, consulting the following databases: PubMed, PsycINFO, CINAHL, Web of Science and LILACS. In total, 1,677 studies were identified, resulting in 38 articles included in this review. The risk factors most associated with stress in pregnancy and postpartum were related to emotional factors (including mental health, traumatic events and obstetric complications); social and economic factors; mother's health conditions and life style behaviors, and social support and partner related stress. The results are discussed under the light of the biopsychosocial model, which proposes that biological, psychological, and social domains should be considered in order to minimize psychosocial risk conditions. It is concluded that strategies to promote psychological care, education, additional social support and health behaviors should be considered to prevent adverse birth outcomes and to increase maternal well-being.
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Affiliation(s)
- Adriana Martins Saur
- Department of Psychology, University of São Paulo, Faculty of Philosophy, Sciences and Letters at Ribeirão Preto, Brazil
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Stampini V, Monzani A, Caristia S, Ferrante G, Gerbino M, De Pedrini A, Amadori R, Rabbone I, Surico D. The perception of Italian pregnant women and new mothers about their psychological wellbeing, lifestyle, delivery, and neonatal management experience during the COVID-19 pandemic lockdown: a web-based survey. BMC Pregnancy Childbirth 2021; 21:473. [PMID: 34210276 PMCID: PMC8246432 DOI: 10.1186/s12884-021-03904-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 05/27/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In response to the COVID-19 pandemic, drastic measures for social distancing have been introduced also in Italy, likely with a substantial impact in delicate conditions like pregnancy and puerperium. The study aimed to investigate the changes in lifestyle, access to health services, and mental wellbeing during the first Italian lockdown in a sample of Italian pregnant women and new mothers. METHODS We carried out a web-based survey to evaluate how pregnant women and new mothers were coping with the lockdown. We collected data about healthy habits (physical exercise and dietary habits), access to health services (care access, delivery and obstetric care, neonatal care, and breastfeeding), and mental wellbeing (psychological well-being and emotive support). Descriptive analysis was performed for both groups of participants, whereas a Poisson analysis was used to measure the association between some structural variables (age, education, socio-economic data, partner support, contact, free time, previous children, and pregnancy trimester) and anxiety or depression, difficulties in healthy eating and reduction in physical activity after lockdown started. Chi2 and Adjusted Prevalence Ratios were estimated only for pregnant women. RESULTS We included 739 respondents (response rate 85.8 %), 600 were pregnant (81.2 %), and 139 (18.8 %) had delivered during lockdown (new mothers). We found a high score for anxiety and depression in 62.8 % of pregnant women and 61.9 % of new mothers. During the lockdown, 61.8 % of pregnant women reduced their physical exercise, and 44.3 % reported eating in a healthier way. 94.0 % of new mothers reported to have breastfed their babies during the hospital stay. Regarding the perceived impact of restrictive measures on breastfeeding, no impact was reported by 56.1 % of new mothers, whereas a negative one by 36.7 %. CONCLUSIONS The high prevalence of anxiety and depressive symptoms in pregnant women and new mothers should be a public health issue. Clinicians might also recommend and encourage "home" physical exercise. On the other hand, about half of the sample improved their approach towards healthy eating and a very high breastfeeding rate was reported soon after birth: these data are an interesting starting point to develop new strategies for public health.
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Affiliation(s)
- Viviana Stampini
- Obstetrics and Gynecology Unit, Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy.
| | - Alice Monzani
- Division of Pediatric, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Silvia Caristia
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | | | - Martina Gerbino
- Obstetrics and Gynecology Unit, Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy
| | - Alberto De Pedrini
- Obstetrics and Gynecology Unit, Maggiore della Carità Hospital, Novara, Italy
| | - Roberta Amadori
- Obstetrics and Gynecology Unit, Maggiore della Carità Hospital, Novara, Italy
| | - Ivana Rabbone
- Division of Pediatric, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Daniela Surico
- Obstetrics and Gynecology Unit, Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy
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Abstract
When caring for women experiencing preterm labor and birth, nurses play a significant role as bedside experts, advocates, patient educators, and key members of the maternity care team. Enhanced expertise on clinical and professional knowledge of preterm labor and birth is crucial in prevention and treatment. As preterm birth rates continue to rise, perinatal nurses as well-informed clinical experts have the opportunity to offer innovative education, holistic assessments, and communication through shared decision-making models. Educating pregnant women about early recognition of preterm labor warning signs and symptoms allows for timely diagnosis, interventions, and treatment. Informed and collaborative nursing practice improves quality of clinical care based on individualized interactions. A clinical review of preterm labor and preterm birth is presented for perinatal nurses.
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Padmanabhan V, Song W, Puttabyatappa M. Praegnatio Perturbatio-Impact of Endocrine-Disrupting Chemicals. Endocr Rev 2021; 42:295-353. [PMID: 33388776 PMCID: PMC8152448 DOI: 10.1210/endrev/bnaa035] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Indexed: 02/07/2023]
Abstract
The burden of adverse pregnancy outcomes such as preterm birth and low birth weight is considerable across the world. Several risk factors for adverse pregnancy outcomes have been identified. One risk factor for adverse pregnancy outcomes receiving considerable attention in recent years is gestational exposure to endocrine-disrupting chemicals (EDCs). Humans are exposed to a multitude of environmental chemicals with known endocrine-disrupting properties, and evidence suggests exposure to these EDCs have the potential to disrupt the maternal-fetal environment culminating in adverse pregnancy and birth outcomes. This review addresses the impact of maternal and fetal exposure to environmental EDCs of natural and man-made chemicals in disrupting the maternal-fetal milieu in human leading to adverse pregnancy and birth outcomes-a risk factor for adult-onset noncommunicable diseases, the role lifestyle and environmental factors play in mitigating or amplifying the effects of EDCs, the underlying mechanisms and mediators involved, and the research directions on which to focus future investigations to help alleviate the adverse effects of EDC exposure.
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Affiliation(s)
| | - Wenhui Song
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
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76
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Adverse Pregnancy Outcomes Following the Assassination of John F. Kennedy in 1963. Matern Child Health J 2021; 25:1455-1464. [PMID: 34021436 DOI: 10.1007/s10995-021-03139-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Women exposed to stressful events during pregnancy are thought to be at increased risk of adverse birth outcomes. However, studies investigating stressful events are often unable to control for important confounders, such as behavioral and genetic characteristics, or to isolate the impact of the stressor from other secondary effects. We used a discordant-sibling design, which provides stronger inferences about causality, to examine whether a widespread stressor with limited impact on day-to-day life (John F. Kennedy assassination) resulted in an increased risk of adverse birth outcomes. METHODS Data were obtained from the Collaborative Perinatal Project, a prospective, multi-site cohort study conducted in the US from 1959 to 1965. Our analysis was restricted to singleton live births ≥24 weeks born before the assassination (n = 24,406) or in utero at the time (n = 5833). We also evaluated associations within siblings discordant for exposure (n = 1144). We used survival analysis to evaluate associations between exposure and preterm birth and marginal models to evaluate associations with birthweight and placental pathology. RESULTS First trimester exposure was associated with preterm birth (hazard ratio (HR): 1.17; 95% CI: 1.05, 1.31). In the discordant-sibling model, the point estimate was similar (HR: 1.22; 95% CI: 0.36, 4.06). Third trimester exposure was associated with increased odds of fetal acute inflammation in the placenta (odds ratio (OR): 1.34, 95% CI: 1.05, 1.71). CONCLUSIONS FOR PRACTICE First trimester exposure to an acute stressor was associated with preterm birth. We did not observe increased odds of placental pathology with first trimester exposure; however, stress may increase preterm birth risk through chronic placental inflammation, which was not evaluated in this sample.
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Stanhope KK, Suglia SF, Hogue CJR, Leon JS, Comeau DL, Kramer MR. Spatial Variation in Very Preterm Birth to Hispanic Women Across the United States: The Role of Intensified Immigration Enforcement. Ethn Dis 2021; 31:333-344. [PMID: 34045835 DOI: 10.18865/ed.31.s1.333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction Limited existing research suggests that immigration climate and enforcement practices represent a social determinant of health for immigrants, their families, and communities. However, national research on the impact of specific policies is limited. The goal of this article is to estimate the effect of county-level participation in a 287(g) immigration enforcement agreement on very preterm birth (VPTB, <32 weeks' gestation) rates between 2005-2016 among US-born and foreign-born Hispanic women across the United States. Methods We fit spatial Bayesian models to estimate the effect of local participation in a 287(g) program on county VPTB rates, accounting for variation by maternal nativity, county ethnic density, and controlling for individual specific Hispanic background and nativity and county-level confounders. Results While there was no global effect of county participation in a 287(g) program on county VPTB rates, rates were slightly increased in some counties, primarily in the Southeast (Virginia, North Carolina, South Carolina). Future Directions Future research should consider the mechanisms through which immigration policies and enforcement may impact health of both immigrants and wider communities.
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Affiliation(s)
- Kaitlyn K Stanhope
- Emory University School of Medicine, Gynecology and Obstetrics, Atlanta, GA
| | - Shakira F Suglia
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA
| | - Carol J R Hogue
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA
| | - Juan S Leon
- Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA
| | - Dawn L Comeau
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA
| | - Michael R Kramer
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA
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Mekonnen ZK, Oehlert JW, Eskenazi B, Shaw GM, Balmes JR, Padula AM. The relationship between air pollutants and maternal socioeconomic factors on preterm birth in California urban counties. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2021; 31:503-513. [PMID: 33859340 PMCID: PMC8134052 DOI: 10.1038/s41370-021-00323-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 03/19/2021] [Accepted: 03/19/2021] [Indexed: 05/27/2023]
Abstract
BACKGROUND Preterm birth is the leading cause of perinatal morbidity and mortality in the U.S. and disparities among racial and ethnic groups persist. While etiologies of preterm birth have not been fully elucidated, it is probable that environmental and social factors play a role. OBJECTIVE We hypothesized that there is an interactive association between exposure to fine particulate matter (PM2.5) or ozone (O3) and neighborhood socioeconomic factors that increase the risk of preterm birth. METHODS We conducted a retrospective study using geocoded birth certificate data between 2007 and 2011, daily ambient air quality data on PM2.5 and O3, and American Community Survey (2007-2011 5-year estimates) data to assess census tract-level socioeconomic factors in California urban counties. RESULTS Our study found a small positive association between maternal exposures to PM2.5 and O3 and preterm birth that varied by gestational exposure period. In mixed-effects models, we found an increase in the risk of preterm birth for a one-unit change in PM2.5 averaged across the entire pregnancy (AOR = 1.02, 95% CI: 1.01, 1.02) and O3 during 3-months pre-pregnancy (AOR = 1.03, 95% CI: 1.02, 1.04). Interaction between census tract-level factors and air pollutants showed an increase in the risk of preterm birth among mothers living in higher socioeconomic areas, though, a fixed cohort bias sensitivity analysis showed these associations were not significant. SIGNIFICANCE These findings substantiate previous studies that showed associations between air pollution and preterm birth, even as pollution levels have decreased. This study has important implications for policy decisions and may help inform research on potential mechanisms of preterm birth.
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Affiliation(s)
- Zesemayat K Mekonnen
- University of California Berkeley-University of California San Francisco Joint Medical Program, Berkeley, CA, USA
| | - John W Oehlert
- Department of Pediatrics, Division of Neonatology, Stanford University, Stanford, CA, USA
| | - Brenda Eskenazi
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Gary M Shaw
- Department of Pediatrics, Division of Neonatology, Stanford University, Stanford, CA, USA
| | - John R Balmes
- University of California Berkeley-University of California San Francisco Joint Medical Program, Berkeley, CA, USA
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Amy M Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
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Pampaka D, Papatheodorou SI, AlSeaidan M, Al Wotayan R, Wright RJ, Buring JE, Dockery DW, Christophi CA. Antenatal depressive symptoms and adverse perinatal outcomes. BMC Pregnancy Childbirth 2021; 21:313. [PMID: 33879069 PMCID: PMC8059279 DOI: 10.1186/s12884-021-03783-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 04/08/2021] [Indexed: 11/22/2022] Open
Abstract
Background The association of antenatal depression with adverse pregnancy, birth, and postnatal outcomes has been an item of scientific interest over the last decades. However, the evidence that exists is controversial or limited. We previously found that one in five women in Kuwait experience antenatal depressive symptoms. Therefore, the aim of this study was to examine whether antenatal depressive symptoms are associated with preterm birth (PTB), small for gestational age (SGA), or large for gestational age (LGA) babies in this population. Methods This was a secondary analysis based on data collected in the Transgenerational Assessment of Children’s Environmental Risk (TRACER) Study that was conducted in Kuwait. Logistic regression analysis was used to examine whether antenatal depressive symptoms assessed using the Edinburgh Depression Scale (EDS) were associated with preterm birth, small for gestational age, and large for gestational age babies. Results A total of 1694 women had complete information about the outcomes of interest. Women with depressive symptoms in pregnancy had increased, albeit non-significant, odds of having PTB (OR = 1.41; 95%CI: 0.81, 2.45), SGA babies (OR = 1.26; 0.80, 1.98), or LGA babies (OR = 1.27; 0.90, 1.79). Antenatal depressive symptoms had similar increased odds for the three outcomes even after adjusting for several covariates though none of these reached statistical significance. Conclusions In the present study, the depressive symptoms in pregnancy did not predict adverse birth outcomes, such as PTB, SGA, and LGA, which adds to the currently non-conclusive literature. However, further research is needed to examine these associations, as the available evidence is quite limited.
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Affiliation(s)
- Despina Pampaka
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, 95 Eirinis Street, 3041, Limassol, Cyprus
| | | | | | | | - Rosalind J Wright
- Department of Pediatrics & Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Julie E Buring
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Douglas W Dockery
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Costas A Christophi
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, 95 Eirinis Street, 3041, Limassol, Cyprus. .,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Imbalance between inflammatory and regulatory cord blood B cells following pre-term birth. J Reprod Immunol 2021; 145:103319. [PMID: 33848896 DOI: 10.1016/j.jri.2021.103319] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 02/08/2023]
Abstract
Preterm birth (PTB) is one of the most frequent pregnancy complications. It affects millions of babies each year worldwide and is associated with increased morbidity and mortality. PTB-associated alterations in the maternal immune response may have a direct effect on the developing fetal immune system. Having recently shown that B regulatory (Breg) cells are decreased in number and functionally impaired in maternal blood from women delivering preterm, we now addressed the question whether the adaptive immune system is also altered in cord blood (CB) after the onset of PTB. PTB was associated with increased concentrations of IL-6, TNF-α and IL-21 in CB and enhanced IL-6, but decreased IFN-γ and IL-4 in amniotic fluid (AF) samples compared to term delivery (TD). We found no differences in the frequency of CD19 + B cells, CD4 + T cells or CD4+Foxp3+CD25+ T regulatory (Treg) cells in CB cells in PTB vs TD. The frequency of CD86 + B cells was increased, while the percentage of CD24hiCD38hiCD19 + Breg and CD1dhiCD5+ Breg cells and the ability of B cells to convert into Breg cells was diminished in PTB compared to TD. CB B cells from PTB secreted more IL-6, TNF-α, IL-9 and IL-2 compared to B cells obtained from term samples. We conclude that, after PTB onset, a shift from immunoregulation towards inflammation takes place in CB cells that are reportedly representative of the fetal compartment. B cells have a substantial contribution herein. This phenomenon might account for the observed enhanced mortality and morbidity in prematurely born infants. Further studies will clarify how to employ this easy-to-obtain information for closely monitoring newborns at risk.
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Gerson KD, Mccarthy C, Ravel J, Elovitz MA, Burris HH. Effect of a Nonoptimal Cervicovaginal Microbiota and Psychosocial Stress on Recurrent Spontaneous Preterm Birth. Am J Perinatol 2021; 38:407-413. [PMID: 33032329 PMCID: PMC8026761 DOI: 10.1055/s-0040-1717098] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE While select cervicovaginal microbiota and psychosocial factors have been associated with spontaneous preterm birth, their effect on the risk of recurrence remains unclear. It is also unknown whether psychosocial factors amplify underlying biologic risk. This study sought to determine the effect of nonoptimal cervicovaginal microbiota and perceived stress on the risk of recurrent spontaneous preterm birth. STUDY DESIGN This was a secondary analysis of a prospective pregnancy cohort, Motherhood and Microbiome. The Cohen's Perceived Stress Scale (PSS-14) was administered and cervical swabs were obtained between 16 and 20 weeks of gestation. PSS-14 scores ≥30 reflected high perceived stress. We analyzed cervicovaginal microbiota using 16S rRNA sequencing and classified microbial communities into community state types (CSTs). CST IV is a nonoptimal cervicovaginal microbial community characterized by anaerobes and a lack of Lactobacillus. The final cohort included a predominantly non-Hispanic Black population of women with prior spontaneous preterm birth who had recurrent spontaneous preterm birth or term birth and had stress measurements (n = 181). A subanalysis was performed in the subset of these women with cervicovaginal microbiota data (n = 74). Multivariable logistic regression modeled adjusted associations between CST IV and recurrent spontaneous preterm birth, high stress and recurrent spontaneous preterm birth, as well as high stress and CST IV. RESULTS Among the 181 women with prior spontaneous preterm birth, 45 (24.9%) had high perceived stress. We did not detect a significant association between high stress and recurrent spontaneous preterm birth (adjusted odds ratio [aOR] 1.67, 95% confidence interval [CI]: 0.73-3.85). Among the 74 women with prior spontaneous preterm birth and cervicovaginal microbiota analyzed, 29 (39.2%) had CST IV; this proportion differed significantly among women with recurrent spontaneous preterm birth (51.4%) compared with women with term birth (28.2%) (p = 0.04). In models adjusted for race and marital status, the association between CST IV and recurrent spontaneous preterm birth persisted (aOR 3.58, 95% CI: 1.25-10.24). There was no significant interaction between stress and CST IV on the odds of spontaneous preterm birth (p = 0.328). When both stress and CST IV were introduced into the model, their associations with recurrent spontaneous preterm birth were slightly stronger than when they were in the model alone. The aOR for stress with recurrent spontaneous preterm birth was 2.02 (95% CI: 0.61-6.71) and for CST IV the aOR was 3.83 (95% CI: 1.30-11.33). Compared to women with neither of the two exposures, women with both high stress and CST IV had the highest odds of recurrent spontaneous preterm birth (aOR = 6.01, 95% CI: 1.002-36.03). CONCLUSION Among a predominantly non-Hispanic Black cohort of women with a prior spontaneous preterm birth, a nonoptimal cervicovaginal microbiota is associated with increased odds of recurrent spontaneous preterm birth. Adjustment for perceived stress may amplify associations between CST IV and recurrent spontaneous preterm birth. Identification of modifiable social or behavioral factors may unveil novel nonpharmacologic interventions to decrease recurrent spontaneous preterm birth among women with underlying biologic risk. KEY POINTS · CST IV, a nonoptimal microbiota, is associated with increased odds of recurrent spontaneous preterm birth.. · Adjustment for perceived stress amplified associations between CST IV and recurrent spontaneous preterm birth.. · Identification of modifiable psychosocial factors may unveil novel nonpharmacologic interventions to decrease recurrent preterm birth..
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Affiliation(s)
- Kristin D. Gerson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Clare Mccarthy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jacques Ravel
- Department of Microbiology and Immunology, Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michal A. Elovitz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Heather H. Burris
- Department of Pediatrics, University of Pennsylvania, Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Somerville K, Neal-Barnett A, Stadulis R, Manns-James L, Stevens-Robinson D. Hair Cortisol Concentration and Perceived Chronic Stress in Low-Income Urban Pregnant and Postpartum Black Women. J Racial Ethn Health Disparities 2021; 8:519-531. [PMID: 32613440 DOI: 10.1007/s40615-020-00809-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 11/25/2022]
Abstract
Black women are more likely to experience short- or long-term health consequences from their labor and delivery and die from pregnancy-related causes than White women. Similarly, infants born to Black women also have heightened health risks. Developing research suggests that a contributing factor to Black health disparities may be maternal chronic stress. A widely used biomarker for chronic stress is hair cortisol concentration (HCC). Few prior studies have explored the HCC of pregnant Black women or comprehensively examined perceived chronic stress in this population. Using a mixed-methods focus group framework, we assessed HCC and perceived chronic stress among low-income pregnant and postpartum Black women. Four focus groups were conducted (N = 24). The mean HCC for our pregnant Black participants was greater than pregnant White women in reviewed published studies. The high levels of stress evidenced at all pregnancy stages indicate that many of these women are experiencing chronic stress, which can contribute to higher Black maternal morbidity and mortality rates, and possibly infant mortality rates. From the open coding of the focus group transcripts, 4 themes emerged: chronic stress, experiences of racism, experiences of trauma, and negative thinking. Selective coding based on these themes revealed cumulative experiences of chronic stress, various traumatic experiences, and frequent encounters with racism. Negative thinking styles were observed across the 4 focus groups. More studies of HCC and perceived stress among pregnant Black women are encouraged. Findings suggest the need for tailored multi-level interventions given the layers of stressors present in this population.
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Affiliation(s)
- Keaton Somerville
- Department of Psychological Sciences, Kent State University, 600 Hilltop Drive, Kent, OH, 44242, USA.
| | - Angela Neal-Barnett
- Department of Psychological Sciences, Kent State University, 600 Hilltop Drive, Kent, OH, 44242, USA
| | - Robert Stadulis
- Department of Psychological Sciences, Kent State University, 600 Hilltop Drive, Kent, OH, 44242, USA
| | - Laura Manns-James
- Department of Midwifery and Women's Health, Frontier Nursing University, Versailles, KY, USA
| | - Diane Stevens-Robinson
- Department of Psychological Sciences, Kent State University, 600 Hilltop Drive, Kent, OH, 44242, USA
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Ecological Systems Affecting Urban Childbearing Puerto Rican Women in the City of Philadelphia. Matern Child Health J 2021; 25:929-937. [PMID: 33759042 DOI: 10.1007/s10995-021-03121-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The purpose of this study was to explore socio-ecological influences affecting the daily lives of urban, pregnant Puerto Rican women and factors negatively influencing their health seeking behaviors related to prenatal care. METHODS Qualitative, descriptive methods were used including individual interviews and focus groups to obtain maximum understanding of the women's lives. The interviews and focus groups were conducted using a semi-structured interview guide based on various components of the study's conceptual framework. Content analytic strategies included rigorous and systematic processes to increase trustworthiness: training, supervision, audits, electronic technologies, and ongoing input of the research team. RESULTS Factors on all levels of the study's conceptual framework compound the effects of stressors and restrictions on the lives of urban, childbearing Puerto Rican woman. The intersectionality of issues for Puerto Rican women can either mitigate or heighten the pressure on their daily lives. CONCLUSIONS This initial research sets the groundwork for further studies, such as narrative analysis, to better understand how to build appropriate and relevant interventions. Uncovering the women's stories gives them the opportunity to be a critical part of cross-sector partnerships towards the development of sustainable interventions.
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Korinek K, Ahmmad Z. The Racial Configuration of Parent Couples and Premature Birth: an Analysis of the Utah Population Database. J Racial Ethn Health Disparities 2021; 9:655-669. [PMID: 33754295 DOI: 10.1007/s40615-021-00997-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/21/2021] [Accepted: 02/11/2021] [Indexed: 11/28/2022]
Abstract
In this paper, we analyze detailed maternal and paternal race information in a 25-year time series of birth record data to consider racial inequities in premature births experienced by women of color and women within interracial parent couples. We analyze birth outcomes within Utah, a historically racially homogeneous state experiencing growing racial diversity and interracial marriage over the past two decades. Our analyses consider disparities in preterm birth according to maternal race and the interracial status of couples for all birth certificate records within the Utah Population Database from 1989 to 2015 (N = 1,148,818). Our results, consistent with a dyadic perspective on minority stress, indicate that maternal race and interracial parent-couple status are each significantly associated with heightened risk of premature birth. The odds of preterm birth are significantly greater among all four racialized groups in the analyses (African Americans, Asians, Native Americans, and Native Hawaiian or Pacific Islanders) as compared to White women. Furthermore, we find that mothers in mixed-race parent couples with either a white or a black father experience a greater risk of preterm birth than mothers parenting with a father of the same race. Our results suggest that in order to capture the complete perspective on racial-ethnic disparities in adverse birth outcomes, outcomes pivotal for subsequent health outcomes over the life course, it is critical to address racism's toxic effects across multiple levels of lived experience-from the individual level, to the parent dyad, to the local community and beyond.
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Affiliation(s)
- Kim Korinek
- University of Utah, Salt Lake City, UT, 84112, USA.
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Lee KS, Kim HI, Kim HY, Cho GJ, Hong SC, Oh MJ, Kim HJ, Ahn KH. Association of Preterm Birth with Depression and Particulate Matter: Machine Learning Analysis Using National Health Insurance Data. Diagnostics (Basel) 2021; 11:diagnostics11030555. [PMID: 33808913 PMCID: PMC8003604 DOI: 10.3390/diagnostics11030555] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 12/30/2022] Open
Abstract
This study uses machine learning and population data to analyze major determinants of preterm birth including depression and particulate matter. Retrospective cohort data came from Korea National Health Insurance Service claims data for 405,586 women who were aged 25–40 years and gave births for the first time after a singleton pregnancy during 2015–2017. The dependent variable was preterm birth during 2015–2017 and 90 independent variables were included (demographic/socioeconomic information, particulate matter, disease information, medication history, obstetric information). Random forest variable importance was used to identify major determinants of preterm birth including depression and particulate matter. Based on random forest variable importance, the top 40 determinants of preterm birth during 2015–2017 included socioeconomic status, age, proton pump inhibitor, benzodiazepine, tricyclic antidepressant, sleeping pills, progesterone, gastroesophageal reflux disease (GERD) for the years 2002–2014, particulate matter for the months January–December 2014, region, myoma uteri, diabetes for the years 2013–2014 and depression for the years 2011–2014. In conclusion, preterm birth has strong associations with depression and particulate matter. What is really needed for effective prenatal care is strong intervention for particulate matters together with active counseling and medication for common depressive symptoms (neglected by pregnant women).
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Affiliation(s)
- Kwang-Sig Lee
- AI Center, Korea University Anam Hospital, Seoul 02841, Korea; (K.-S.L.); (H.-I.K.)
| | - Hae-In Kim
- AI Center, Korea University Anam Hospital, Seoul 02841, Korea; (K.-S.L.); (H.-I.K.)
- School of Industrial Management Engineering, Korea University, Seoul 02841, Korea
- Department of Obstetrics & Gynecology, Korea University Anam Hospital, Seoul 02841, Korea;
| | - Ho Yeon Kim
- Department of Obstetrics & Gynecology, Korea University Ansan Hospital, Ansan 15355, Korea; (H.Y.K.); (H.J.K.)
| | - Geum Joon Cho
- Department of Obstetrics & Gynecology, Korea University Guro Hospital, Seoul 08308, Korea; (G.J.C.); (M.J.O.)
| | - Soon Cheol Hong
- Department of Obstetrics & Gynecology, Korea University Anam Hospital, Seoul 02841, Korea;
| | - Min Jeong Oh
- Department of Obstetrics & Gynecology, Korea University Guro Hospital, Seoul 08308, Korea; (G.J.C.); (M.J.O.)
| | - Hai Joong Kim
- Department of Obstetrics & Gynecology, Korea University Ansan Hospital, Ansan 15355, Korea; (H.Y.K.); (H.J.K.)
| | - Ki Hoon Ahn
- Department of Obstetrics & Gynecology, Korea University Anam Hospital, Seoul 02841, Korea;
- Correspondence: ; Tel.: +82-02-920-6777
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Racism, stress, and sense of personal control among Aboriginal Australian pregnant women. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1111/ap.12435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Shenassa ED, Widemann LG, Hunt CD. Antepartum Depression and Preterm Birth: Pathophysiology, Epidemiology, and Disparities due to structural racism. Curr Psychiatry Rep 2021; 23:14. [PMID: 33630175 DOI: 10.1007/s11920-021-01223-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Informed by the evidence of links between physiology of stress and parturition, we review recent epidemiologic evidence (2015-2020) of antenatal depression as a risk factor for preterm birth (PTB). We also explain racial/ethnic disparities in depression and preterm birth as a consequence of structural racism. RECENT FINDINGS Epidemiologic evidence is consistent in linking antepartum depression with an elevated risk of PTB. Antidepressant usage has been linked with an elevated risk of PTB. However, recent evidence suggests that severity of depression is the underlying driver of the elevated risk attributed to antidepressant usage. The number of depressive symptoms, as a proxy for severity of maternal stress, may be a more informative predictor of PTB than criterion based predictors. Across various study designs, measurement modalities, and populations, antenatal depression predicts an elevated risk of delivering preterm. The physiology of stress provides a plausible explanation for this observation. Excessive stress-induced elevations in maternal and then fetal HPA hormones can alter maternal and fetal homeostasis and hasten the timing of parturition. Antenatal depression and exposure to structural racism are two stressors that can trigger the maternal stress response. Chronically elevated levels of stress hormones among women of color in the USA provide a likely physiologic explanation for Black-White disparities in the risk of PTB. Focusing on the number of depressive symptoms as the more informative predictor of PTB raises several questions. We consider these questions as well as directions for future research in the context of recent advances in the field.
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Affiliation(s)
- Edmond D Shenassa
- Maternal & Child Health Program, Department of Family Science; and Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA. .,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA. .,Department of Epidemiology & Biostatistics, School of Medicine, University of Maryland, Baltimore, MD, USA.
| | - Lea G Widemann
- Maternal & Child Health Program, Department of Family Science; and Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
| | - Cole D Hunt
- Maternal & Child Health Program, Department of Family Science; and Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
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Tingleff T, Räisänen S, Vikanes Å, Sandvik L, Laine K. Association between maternal country of birth and preterm birth: A population-based register study of 910,752 deliveries. Scand J Public Health 2021; 49:904-913. [PMID: 33588641 PMCID: PMC8573627 DOI: 10.1177/1403494821992894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Aims: The aim of this study was to analyse associations between maternal country of birth and preterm birth among women giving birth in Norway. Methods: A population-based register study was conducted employing official national databases in Norway. All singleton births, with neonates without major anomalies, between 1999 and 2014 were included (N=910,752). We estimated odds ratios (ORs) for extremely preterm birth (<28 weeks gestation), very preterm birth (28–33 weeks gestation) and late preterm birth (34–36 weeks gestation) by maternal country of birth. We conducted multivariable regression analyses, adjusting for maternal, obstetric and socio-economic confounders. Results: For extremely preterm births (0.4% of the study population), women with an unknown country of birth (adjusted OR (aOR)=3.09; 95% confidence interval (CI) 2.26–4.22) and women born in sub-Saharan Africa (aOR=1.66; CI 1.40–1.96) had the highest ORs compared to Norwegian-born women. For very preterm births (1.2% of the study population), women with an unknown country of birth (aOR=1.72; CI 1.36–2.18) and women born in South Asia (aOR=1.48; CI 1.31–1.66) had the highest ORs. For late preterm births (3.8% of the study population), women born in East Asia Pacific/Oceania (aOR=1.33; CI 1.25–1.41) and South Asia (aOR=1.30; CI 1.21–1.39) had the highest ORs. Conclusions: After adjusting for maternal, obstetric and socio-economic risk factors, maternal country of birth remained significantly associated with preterm birth. Women with an unknown country of birth and women born in sub-Saharan Africa were found to be at increased risk of extremely preterm birth.
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Affiliation(s)
- Tiril Tingleff
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- Tiril Tingleff, Faculty of Medicine, University of Oslo, Pb 4965, Nydalen, 0424 Oslo, Norway. E-mail:
| | | | | | - Leiv Sandvik
- Department of Obstetrics, Oslo University Hospital, Norway
| | - Katariina Laine
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- Department of Obstetrics, Oslo University Hospital, Norway
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89
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McMillian-Bohler J, Richard-Eaglin A. Uprooting Racism: The Role of Nurses in Cultivating Improved Maternal Outcomes for Black and African American Women. Creat Nurs 2021; 27:61-65. [DOI: 10.1891/crnr-d-20-00066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
After controlling for education, socioeconomic status, and genetic factors, Black and African American patients in the United States are three to four times more likely to die in childbirth than are White patients. The literature is replete with strategies to improve maternal outcomes for Black and African American patients. Existing strategies focus on addressing poverty and individual risk factors to reduce maternal mortality, yet maternal outcomes are not improving for these patients in the United States. Recent literature suggests that a nuanced approach that considers the effects of individual and structural racism could improve maternal outcomes, especially for Black and African American patients. As nurses comprise the largest component of the health-care system, their collective power and influence can provide a powerful tool for dismantling structural racism. Some important concepts to consider regarding the care of the Black and African American population are cultural intelligence (CQ), allostatic load, and humanitarian ethos. By developing CQ and consistently including the four CQ capabilities (drive/motivation, knowledge/cognition, strategy/metacognition, and behavior/action) in all aspects of practice, nurses can help to uproot racism and cultivate experience to improve maternal health outcomes for Black and African American patients.
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90
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Naurin E, Markstedt E, Stolle D, Enström D, Wallin A, Andreasson I, Attebo B, Eriksson O, Martinsson K, Elden H, Linden K, Sengpiel V. Pregnant under the pressure of a pandemic: a large-scale longitudinal survey before and during the COVID-19 outbreak. Eur J Public Health 2021; 31:7-13. [PMID: 33231625 PMCID: PMC7717243 DOI: 10.1093/eurpub/ckaa223] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND One of the groups that is most vulnerable to the COVID-19 pandemic is pregnant women. They cannot choose to refrain from care; they and their children are at risk of severe complications related to the virus; and they lose comfort and support as clinics prohibit their partners and as societal restrictions demand isolation from friends and relatives. It is urgent to study how this group is faring during the pandemic and we focus here on their health-related worries. METHODS A longitudinal survey at a Swedish hospital starting 6 months before (16 September 2019) and continuing during the COVID-19 outbreak (until 25 August 2020). A total of 6941 pregnant women and partners of diverse social backgrounds were recruited. Ninety-six percent of birth-giving women in the city take early ultrasounds where recruitment took place. Sixty-two percent of the women with an appointment and fifty-one percent of all partners gave consent to participate. RESULTS Pregnant women experienced dramatically increased worries for their own health, as well as for their partner's and their child's health in the beginning of the pandemic. The worries remained at higher than usual levels throughout the pandemic. Similar, but less dramatic changes were seen among partners. CONCLUSIONS There is a need for heightened awareness of pregnant women's and partners' health-related worries as a consequence of the COVID-19 pandemic. Related feelings, such as anxiety, have been linked to adverse pregnancy outcome and might have long-term effects. The healthcare system needs to prepare for follow-up visits with these families.
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Affiliation(s)
- Elin Naurin
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Elias Markstedt
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden.,Society, Opinion and Media Institute, University of Gothenburg, Gothenburg, Sweden
| | - Dietlind Stolle
- Department of Political Science, McGill University, Montreal, Canada
| | - Daniel Enström
- Society, Opinion and Media Institute, University of Gothenburg, Gothenburg, Sweden
| | - Anton Wallin
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Ingrid Andreasson
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Birgitta Attebo
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Ottilia Eriksson
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Klara Martinsson
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Helen Elden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Verena Sengpiel
- Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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91
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Martoccio TL, Senehi N, Brophy-Herb HE, Miller AL, Contreras D, Horodynski MA, Peterson KE, Lumeng JC. Temperament, socioeconomic adversity, and perinatal risk as related to preschoolers' BMI. Health Psychol 2021; 40:135-144. [PMID: 33315417 PMCID: PMC8363046 DOI: 10.1037/hea0001052] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Disparities in childhood obesity necessitate identification of risk-protective and risk- augmenting factors for young children experiencing socioeconomic adversity born with perinatal risk. Temperamental reactivity is a biological marker of susceptibility to environmental characteristics. This study tested whether temperamental reactivity moderated the relation between socioeconomic risk and children's body mass index (BMI). METHOD This study examined 100 Head Start preschoolers (Mage = 4.07 years, SD = 0.56) with perinatal risk, defined as preterm birth (PT, <37 weeks gestation) or low birth weight (LBW, <2500g). Anthropometric measurements were collected from children and parents. Parents completed questionnaires on family level demographics and household food insecurity to create a cumulative socioeconomic risk variable. Parents also completed the Children's Behavior Questionnaire to assess preschoolers' temperamental reactivity. RESULTS Results supported a differential susceptibility hypothesis such that preschoolers' temperamental reactivity significantly moderated the relation between socioeconomic risk and child BMI z-score (BMIz). Higher BMIz was observed in highly reactive children exposed to higher socioeconomic risk. Alternatively, lower exposure to socioeconomic risk was related to lower BMIz for highly reactive children. CONCLUSIONS Findings suggest that highly reactive PT/LBW preschoolers are differentially susceptible to early socioeconomic adversity in a for better or for worse manner regarding BMIz. Thus, consideration of temperament as a marker of biological sensitivity to context may be necessary to inform obesity prevention for PT/LBW preschoolers from low-income families. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Tiffany L. Martoccio
- Department of Human Development and Quantitative Methodology, University of Maryland College Park
| | - Neda Senehi
- Department of Psychiatry, University of Colorado Anschutz Medical Campus
| | | | - Alison L. Miller
- Center for Human Growth and Development, University of Michigan
- Department of Health Behavior and Health Education, University of Michigan School of Public Health
| | | | | | - Karen E. Peterson
- Center for Human Growth and Development, University of Michigan
- Department of Nutritional Sciences, University of Michigan School of Public Health
| | - Julie C. Lumeng
- Center for Human Growth and Development, University of Michigan
- Department of Nutritional Sciences, University of Michigan School of Public Health
- Department of Pediatrics, University of Michigan Medical School
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92
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MacDonald-Ramos K, Vega-Sánchez R. Maternal adiposity is associated with inflammatory gene expression in leukocytes at term human pregnancy: A pilot study. Mol Genet Genomic Med 2020; 9:e1570. [PMID: 33305914 PMCID: PMC8077112 DOI: 10.1002/mgg3.1570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/19/2020] [Accepted: 11/20/2020] [Indexed: 11/14/2022] Open
Abstract
Background Human labor is associated with an inflammatory process that takes place at the maternal–fetal interface, where leukocytes infiltrate and contribute to the local production of effector molecules such as cytokines, chemokines, MMPs, etc. This process may be altered by a low‐grade chronic inflammation, characteristic of obesity, resulting in adverse pregnancy outcomes. In this cross‐sectional pilot study, we analyzed the relationship between maternal adiposity and inflammation‐related gene expression in leukocytes from six healthy women with term pregnancies without labor. Methods We estimated maternal adiposity and examined the relative expression of 211 inflammation‐related genes in maternal peripheral blood leukocytes (MAT), placental intervillous blood leukocytes (PLA), and choriodecidual leukocytes (CHD) by real‐time qPCR. Finally, we analyzed the correlation between maternal adiposity and gene expression. Results Participants’ adiposity ranged from 27.6% to 61.1% (n = 6). The expression of 23 genes significantly differed (p < 0.05) in MAT, PLA, and CHD leukocytes, most of which code for chemokines and proinflammatory cytokines. Importantly, increasing maternal adiposity correlated (r > 0.7) mostly positively with the expression of genes related to activation, migration, infiltration, and proinflammation in MAT (36 genes) and PLA (31 genes). In contrast, in CHD leukocytes maternal adiposity correlated only negatively with seven genes, involved in migration and infiltration. Conclusion Our findings suggest that during term pregnancy, increased maternal adiposity may enhance the priming of peripheral leukocytes, while in choriodecidua it may alter leukocyte recruitment and proinflammatory activity. Maternal adiposity must be considered an important variable in further studies that analyze inflammation‐related gene expression in pregnant women.
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Affiliation(s)
- Karla MacDonald-Ramos
- Department of Nutrition and Bioprogramming, Instituto Nacional de Perinatologia, Mexico City, Mexico
| | - Rodrigo Vega-Sánchez
- Department of Nutrition and Bioprogramming, Instituto Nacional de Perinatologia, Mexico City, Mexico
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93
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kassaw C, Pandey D. The prevalence of general anxiety disorder and its associated factors among women's attending at the perinatal service of Dilla University referral hospital, Dilla town, Ethiopia, April, 2020 in Covid pandemic. Heliyon 2020; 6:e05593. [PMID: 33294715 PMCID: PMC7701184 DOI: 10.1016/j.heliyon.2020.e05593] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/06/2020] [Accepted: 11/20/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Coronavirus is rapidly increasing in Ethiopia, and the number of perinatal service users at the hospital decreased due to the fear of contracting the virus. The mental health of a pregnant mother is vital for preventing pregnancy and birth-related complications. This study aimed to determine the magnitude and associated factors of General anxiety disorder among perinatal service users in Dilla University referral hospital, Dilla, Ethiopia. METHODS A hospital-based cross-sectional study was conducted among 178 respondents from April 6 - May 6, 2020. The sampling technique of this study was Consecutive sampling. Data were collected using a structured interview. General anxiety disorder (GAD-7) was used to determine the outcome variable. Logistic regression analysis and adjusted odd ratio at 95% CI and p < 0.05 was used to determine the statistically significant association between general anxiety disorder and its predictors. RESULT A total of 178 respondents with a 100% response rate were enrolled in the study. The mean income of respondents was 1500 (±700) Ethiopian birr. The overall prevalence of general anxiety disorder (GAD) was 32.2%. Living in Rural area [AOR = 0.48; 95% CI: (0.25-0.9) P = 0.02∗], Primary level of education [AOR = 0.41; 95%CI:(0.21-0.75), P = 0.03∗], poor social support [AOR = 4.3995%CI:(2.29-12.53), P = 0.001∗∗] and primigravida [AOR = 3.05; 95% CI: (1.53-6.08), P = 0.001∗∗] were variables significantly associated with general anxiety disorder at 95% confidence interval, p < 0.05. CONCLUSIONS This study found that nearly one-third of the respondents had general anxiety disorder. Therefore, working on the mental health impact of the pandemic among perinatal service users is an urgent solution to promote their physical, mental, and psychological health of a mother and her baby.
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Affiliation(s)
- Chalachew kassaw
- Department of Psychiatry, College of Health Science, Dilla University, P.O. Box 419, Dilla, Ethiopia
| | - Digvijay Pandey
- Department of Technical Education, IET, Lucknow 226021, India
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Melnyk BM, Gennaro S, Szalacha LA, Hoying J, O'Connor C, Cooper A, Gibeau A. Randomized controlled trial of the COPE-P intervention to improve mental health, healthy lifestyle behaviors, birth and post-natal outcomes of minority pregnant women: Study protocol with implications. Contemp Clin Trials 2020; 98:106090. [PMID: 32745703 PMCID: PMC7686149 DOI: 10.1016/j.cct.2020.106090] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Emotionally distressed pregnant minority women experience multiple adverse outcomes, including pre-eclampsia, preterm birth, operative deliveries and low birth weight. Although the United States Preventive Services Task Force recommends screening in pregnant women, many practices do not screen because efficacious interventions and systems are not in place to treat them. AIM Purpose of this randomized controlled trial (RCT) is to test a group delivered manualized cognitive-behavioral skills building intervention entitled COPE-P versus an attention control program on the mental health, birth and postpartum outcomes of minority pregnant women experiencing depressive, anxiety and stress symptoms. METHODS Design is a longitudinal randomized block RCT with repeated measures (beginning with screening prior to 18 weeks, group prenatal care in both groups from 16 + 1 to 31 + 1 weeks and ending at 6 months postpartum) at two study sites (New York city and Columbus, Ohio). Race/ethnicity is being blocked to ensure equal numbers of Hispanic and Black women. 384 women are being recruited from antenatal clinics if they are: between 18 and 40 years; in an uncomplicated singleton pregnancy <18 weeks; and self-identify as Black or Hispanic. Valid and reliable measures are being used to assess healthy lifestyle behaviors and mental health outcomes immediately following the interventions, six - eight weeks postpartum and at the children's six-month well baby visit. Birth and delivery outcomes also are being assessed. CONCLUSION If found to be efficacious, the COPE-P intervention could be a key solution to managing those with emotional distress and improving their outcomes.
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Affiliation(s)
- Bernadette Mazurek Melnyk
- Health Promotion and Wellness, The Ohio State University, the Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, College of Nursing, Pediatrics & Psychiatry, College of Medicine, The Ohio State University, 1585 Neil Ave, Columbus, OH 43210, United States of America.
| | - Susan Gennaro
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, United States of America
| | - Laura A Szalacha
- Research Methodology and Biostatistics Core, USF Health Morsani College of Medicine, College of Nursing, University of South Florida, United States of America
| | - Jacqueline Hoying
- Consumer Core, the Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, The Ohio State University College of Nursing, Columbus, OH, United States of America
| | - Caitlin O'Connor
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, United States of America
| | - Andrea Cooper
- The Ohio State University College of Nursing, Columbus, OH, United States of America
| | - Anne Gibeau
- Midwifery, Jacobi Medical Center, Bronx, NY, United States of America
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95
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Musa A, Chojenta C, Loxton D. The association between intimate partner violence and low birth weight and preterm delivery in eastern Ethiopia: Findings from a facility-based study. Midwifery 2020; 92:102869. [PMID: 33152597 DOI: 10.1016/j.midw.2020.102869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the associations between intimate partner violence during pregnancy and low birth weight and preterm birth among women who gave birth in public hospitals in Harari region, eastern Ethiopia. DESIGN A cross-sectional study was conducted among women who gave birth in public hospitals in Harari region. PARTICIPANTS Women aged 16-45 years who gave birth in hospitals from November 2018 to April 2019. SETTING Two public hospitals in Harari regional state, eastern Ethiopia MEASUREMENT: Intimate partner violence was measured using a questionnaire adapted from the World Health Organization Multi-Country Study on Women's Health and Domestic Violence against Women. Binary and multiple logistic regression was performed to establish the association between intimate partner violence and low birth weight and preterm birth. Both crude and adjusted odds ratios with 95% confidence intervals were calculated. The level of significance was set at a p-value of <0.05. RESULTS In this study, 39% of women reported experiencing partner violence during their most recent pregnancy. The prevalence of preterm birth and low birth weight were found to be 18.9% and 12.01%, respectively. After adjusting for potential confounders, women who experienced any intimate partner violence during pregnancy were 1.62 times (AOR = 1.62, 95%CI= 1.22, 2.78) more likely to give birth prematurely and 1.37 times (AOR= 1.37, 95%CI=1.73, 2.57) more likely to have a low birth weight infant relative to women who did not experience intimate partner violence during pregnancy. CONCLUSION AND IMPLICATIONS FOR PRACTICE The results underscore the need for including intimate partner violence prevention as an important strategy to reduce child mortality and morbidity. Screening pregnant women for intimate partner violence and providing support for women who have experienced violence might be helpful in tackling prematurity and low birth weight.
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Affiliation(s)
- Abdulbasit Musa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.
| | - Catherine Chojenta
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.
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96
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Nepomnaschy PA, Rowlands A, Prescivalli Costa AP, Salvante KG. Socio-Ecological Challenges as Modulators of Women's Reproductive Trajectories. ANNUAL REVIEW OF ANTHROPOLOGY 2020. [DOI: 10.1146/annurev-anthro-102317-045930] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Amenorrhea, anovulatory cycles, miscarriages, and other reproductive outcomes are often seen as pathological. Life history theory, in contrast, treats those outcomes as adaptations that helped women optimize the timing of reproductive ventures across our evolutionary history. Women's bodies adjust their reproductive strategies in response to socio-ecological conditions, a process mediated by the hypothalamic-pituitary-adrenal axis (HPAA). Here, we review the links between socio-ecological conditions, HPAA activity, and the pace of women's reproductive transitions such as puberty, age at first birth, interbirth interval, and perimenopause. We also discuss the HPAA's role as a modulator of reproductive function: It not only suppresses it but may also prime women's bodies for future reproductive ventures. We conclude by reviewing challenges and opportunities within our subfield, including the need for transdisciplinary teams to develop longitudinal studies to improve our understanding of women's reproductive trajectories and outcomes from the moment they are conceived.
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Affiliation(s)
- Pablo A. Nepomnaschy
- Maternal and Child Health Laboratory, Faculty of Health Sciences; and Crawford Laboratory of Evolutionary Studies, Department of Biological Sciences, Faculty of Science, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada;, , ,
| | - Amanda Rowlands
- Maternal and Child Health Laboratory, Faculty of Health Sciences; and Crawford Laboratory of Evolutionary Studies, Department of Biological Sciences, Faculty of Science, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada;, , ,
| | - Ana Paula Prescivalli Costa
- Maternal and Child Health Laboratory, Faculty of Health Sciences; and Crawford Laboratory of Evolutionary Studies, Department of Biological Sciences, Faculty of Science, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada;, , ,
| | - Katrina G. Salvante
- Maternal and Child Health Laboratory, Faculty of Health Sciences; and Crawford Laboratory of Evolutionary Studies, Department of Biological Sciences, Faculty of Science, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada;, , ,
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97
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Nabi G, Siddique R, Xiaoyan W, Ullah R, Xue M, Khan S. COVID-19 induced psychosocial stressors during gestation: possible maternal and neonatal consequences. Curr Med Res Opin 2020; 36:1633-1634. [PMID: 32844690 DOI: 10.1080/03007995.2020.1815003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ghulam Nabi
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory of Animal Physiology, Biochemistry and Molecular Biology of Hebei Province, College of Life Sciences, Hebei Normal University, Shijiazhuang, China
| | - Rabeea Siddique
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Medical Key Laboratory of Translational Cerebrovascular Diseases, Zhengzhou, China
| | - Wang Xiaoyan
- Child Health Department, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rahim Ullah
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengzhou Xue
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Medical Key Laboratory of Translational Cerebrovascular Diseases, Zhengzhou, China
| | - Suliman Khan
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Medical Key Laboratory of Translational Cerebrovascular Diseases, Zhengzhou, China
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98
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Zheng HT, Zhang HY, Chen ST, Li MY, Fu T, Yang ZM. The detrimental effects of stress-induced glucocorticoid exposure on mouse uterine receptivity and decidualization. FASEB J 2020; 34:14200-14216. [PMID: 32918762 DOI: 10.1096/fj.201902911rr] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 11/11/2022]
Abstract
Glucocorticoids (GCs), stress-induced steroid hormones, are released by adrenal cortex and essential for stress adaptation. Recently, there has been renewed interest in the relationship between GCs and pregnancy following the discovery that glucocorticoid receptor is necessary for implantation. It has been widely recognized that stress is detrimental to pregnancy. However, effects of stress-induced GC exposure on uterine receptivity and decidualization are still poorly understood. This study aims to explore the effects of GCs exposure on uterine receptivity, decidualization, and their underlying mechanisms in mice. Single prolonged stress (SPS) and corticosterone (Cort) injection models were used to analyze effects of GC exposure on early pregnancy, respectively. SPS or Cort injection inhibits embryo implantation by interfering Lif signaling and stimulating the uterine deposition of collagen types I, III, and IV on day 4 of pregnancy. Uterine decidualization is also attenuated by SPS or Cort injection through suppressing Cox-2 expression. Cort-induced collagen disorder also suppresses decidualization through regulating mesenchymal-epithelial transition. Our data should shed lights for a better understanding for the effects of GCs on embryo implantation for clinical research.
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Affiliation(s)
- Hong-Tao Zheng
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Hai-Yi Zhang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Si-Ting Chen
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Meng-Yuan Li
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Tao Fu
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Zeng-Ming Yang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
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99
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Preterm birth and the future risk of orthopedic fracture. Pediatr Res 2020; 88:466-472. [PMID: 31968355 DOI: 10.1038/s41390-020-0771-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/06/2019] [Accepted: 12/11/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Preterm birth occurs during a critical period of bone mineralization. We assessed whether preterm birth increases the risk of childhood fracture. METHODS We analyzed a cohort of 788,903 infants born between 2006 and 2016 in Quebec, Canada. The exposure was preterm birth (<37 weeks). The outcome was any future hospitalization for fracture before 2018. We estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association of prematurity with fractures in adjusted Cox regression models. We determined if the risk of facture varied by the child's age. RESULTS The incidence of fracture hospitalizations was higher in preterm children than in term children (17.9 vs. 15.3 per 10,000 person-years). Compared with term, preterm children had 1.27 times the risk of femur fracture hospitalization (95% CI 1.01-1.60) and 2.27 times the risk of assault-related fractures (95% CI 1.37-3.76). Preterm children had 2.20 times the risk of femur fracture between 6 and 17 months of age (95% CI 1.45-3.35). CONCLUSIONS Preterm birth is associated with an increased risk of hospitalization for femur fractures and assault-related fractures. Associations are stronger before 18 months of age. Families of preterm children may benefit from counseling and support for fracture prevention during early childhood.
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100
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Watkins DJ, Torres Zayas HR, Vélez Vega CM, Rosario Z, Welton M, Agosto Arroyo LD, Cardona N, Díaz Reguero ZJ, Santos Rivera A, Huerta-Montañez G, Brown P, Alshawabkeh A, Cordero JF, Meeker JD. Investigating the impact of Hurricane Maria on an ongoing birth cohort in Puerto Rico. POPULATION AND ENVIRONMENT 2020; 42:95-111. [PMID: 33746324 PMCID: PMC7967016 DOI: 10.1007/s11111-020-00345-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Prior to Hurricane Maria, Puerto Rico already had 200+ hazardous waste sites, significant contamination of water resources, and among the highest rates of preterm birth in the US. To address these issues, the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) Center was formed in 2010 to investigate prenatal environmental exposures, particularly phthalates, and adverse birth outcomes. Recent work from the PROTECT study confirms that in utero exposure to certain phthalates is associated with shorter gestation and increased risk of preterm birth. However, previous research also suggests that pregnant women who experience a natural disaster such as Hurricane Maria are at higher risk of adverse birth outcomes, but it is unknown whether this is due to stress, hazardous exposures, or a combination of factors. Thus, the aim of this analysis was to characterize hurricane-related changes in phthalate exposures and experiences within the PROTECT cohort. Among 176 participants who were pregnant during or within 5 months after Maria, 122 completed a questionnaire on hurricane-related experiences. Questionnaire results and biomarkers of exposure suggest that participants did not have regular access to fresh foods and water during hurricane recovery, and almost half reported structural damage to their home. In addition, biomarker concentrations of phthalates commonly used in food packaging were higher among participants post-hurricane, while phthalates commonly used in personal care products were lower compared to pre-hurricane levels. Hurricane-related increases in phthalate exposure, as well as widespread structural damage, food and water shortages, and long-term absence of electricity and cell phone service, likely increased the risk of adverse birth outcomes among this already vulnerable population.
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Affiliation(s)
- Deborah J. Watkins
- University of Michigan, Department of Environmental Health Sciences - Ann Arbor, Michigan
| | | | - Carmen M. Vélez Vega
- University of Puerto Rico - Medical Sciences Campus, School of Public Health – San Juan, PR
| | - Zaira Rosario
- University of Puerto Rico - Medical Sciences Campus, School of Public Health – San Juan, PR
| | - Michael Welton
- University of Georgia, College of Public Health, University of Georgia, Department of Epidemiology and Biostatistics – Athens, GA
| | - Luis D. Agosto Arroyo
- University of Puerto Rico - Medical Sciences Campus, School of Public Health – San Juan, PR
| | - Nancy Cardona
- University of Puerto Rico - Medical Sciences Campus, School of Public Health – San Juan, PR
| | | | - Amailie Santos Rivera
- University of Puerto Rico - Medical Sciences Campus, School of Public Health – San Juan, PR
| | - Gredia Huerta-Montañez
- University of Puerto Rico - Medical Sciences Campus, School of Public Health – San Juan, PR
| | - Phil Brown
- Northeastern University, Social Science Environmental Health Research Institute – Boston, MA
| | - Akram Alshawabkeh
- Northeastern University, Department of Civil and Environmental Engineering – Boston, MA
| | - José F. Cordero
- University of Georgia, College of Public Health, University of Georgia, Department of Epidemiology and Biostatistics – Athens, GA
| | - John D. Meeker
- University of Michigan, Department of Environmental Health Sciences - Ann Arbor, Michigan
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