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Deepak V, El-Balawi L, Harris LK. Placental Drug Delivery to Treat Pre-Eclampsia and Fetal Growth Restriction. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2311165. [PMID: 38745536 DOI: 10.1002/smll.202311165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/23/2024] [Indexed: 05/16/2024]
Abstract
Pre-eclampsia and fetal growth restriction (FGR) continue to cause unacceptably high levels of morbidity and mortality, despite significant pharmaceutical and technological advances in other disease areas. The recent pandemic has also impacted obstetric care, as COVID-19 infection increases the risk of poor pregnancy outcomes. This review explores the reasons why it lacks effective drug treatments for the placental dysfunction that underlies many common obstetric conditions and describes how nanomedicines and targeted drug delivery approaches may provide the solution to the current drug drought. The ever-increasing range of biocompatible nanoparticle formulations available is now making it possible to selectively deliver drugs to uterine and placental tissues and dramatically limit fetal drug transfer. Formulations that are refractory to placental uptake offer the possibility of retaining drugs within the maternal circulation, allowing pregnant individuals to take medicines previously considered too harmful to the developing baby. Liposomes, ionizable lipid nanoparticles, polymeric nanoparticles, and adenoviral vectors have all been used to create efficacious drug delivery systems for use in pregnancy, although each approach offers distinct advantages and limitations. It is imperative that recent advances continue to be built upon and that there is an overdue investment of intellectual and financial capital in this field.
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Affiliation(s)
- Venkataraman Deepak
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9WL, UK
- St Mary's Hospital, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK
| | - Lujain El-Balawi
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
| | - Lynda K Harris
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9WL, UK
- St Mary's Hospital, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
- Olson Center for Women's Health, Department of Obstetrics and Gynecology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
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2
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Gimbel LA, Weingarten SJ, Smid MC, Hoffman MC. Maternal mental health as a major contributor to maternal mortality. Semin Perinatol 2024; 48:151943. [PMID: 39095259 DOI: 10.1016/j.semperi.2024.151943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Perinatal mental health conditions affect up to 20 % of pregnant or postpartum individuals, and nearly 15 % of pregnant individuals meet criteria for substance use disorder (SUD). All providers taking care of pregnant or postpartum individuals will encounter patients in these scenarios. Maternal Mortality Review Committees (MMRCs) have determined maternal mental health conditions, including SUD, to be the leading cause of preventable maternal death during pregnancy or in the first year postpartum. Lessons learned from MMRCs to prevent these deaths include the recommendation that screening and identification of mental health conditions need to be linked with evidence-based, patient-centered, and accessible treatments. Obstetricians and gynecologists, midwives, family medicine providers, and pediatricians, are in unique positions not only to screen and diagnose, but also to treat individuals with mental health concerns, including SUD, during pregnancy and postpartum.
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Affiliation(s)
- Lauren A Gimbel
- Department of Obstetrics and Gynecology, University of Utah Health, 30 North Mario Capecchi Dr., Level 5 South, Salt Lake City, UT 84132, USA.
| | - Sarah J Weingarten
- Department of Obstetrics and Gynecology, Weill Cornell Medicine at NewYork-Presbyterian Hospital, New York, NY, USA
| | - Marcela C Smid
- Department of Obstetrics and Gynecology, University of Utah Health, 30 North Mario Capecchi Dr., Level 5 South, Salt Lake City, UT 84132, USA
| | - M Camille Hoffman
- Departments of Obstetrics & Gynecology and Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
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3
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Rattan J, Bartlett TR, Blanchard C, Tipre M, Amiri A, Baskin ML, Sinkey R, Turan JM. The Relationship Between Provider and Patient Racial Concordance and Receipt of Postpartum Care. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02164-0. [PMID: 39269565 DOI: 10.1007/s40615-024-02164-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 08/23/2024] [Accepted: 08/29/2024] [Indexed: 09/15/2024]
Abstract
Access to postpartum care (PPC) varies in the US and little data exists about whether patient factors may influence receipt of care. Our study aimed to assess the effect of provider-patient racial concordance on Black patients' receipt of PPC. We conducted a cross-sectional study analyzing over 24,000 electronic health records of childbirth hospitalizations at a large academic medical center in Alabama from January 2014 to March 2020. The primary outcome variable was whether a Black patient with a childbirth hospitalization had any type of PPC visit within 12 weeks after childbirth. We used a generalized estimating equation (GEE) logistic regression model to assess the relationship between provider-patient racial concordance and receipt of PPC. Black patients with Black main providers of prenatal or childbirth care had significantly higher adjusted odds of receiving PPC (adj. OR 2.26, 95% CI 1.65-3.09, p < .001) compared to Black patients with non-Black providers. White patients who had White providers did not have statistically significantly different odds of receiving PPC compared to those with non-White providers after adjustment (adj. OR 0.88, 95% CI 0.68-1.14). Although these results should be interpreted with caution given the low number of Black providers in this sample, our findings suggest that in one hospital system in Alabama, Black birthing people with a racially concordant main prenatal and delivery care provider may have an increased likelihood of getting critical PPC follow-up.
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Affiliation(s)
- Jesse Rattan
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - T Robin Bartlett
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Christina Blanchard
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Meghan Tipre
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Azita Amiri
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- College of Nursing, University of Alabama in Huntsville, Huntsville, AL, USA
| | - Monica L Baskin
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rachel Sinkey
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Janet M Turan
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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DeMartino J, Katsuki MY, Ansbro MR. Diversity, Equity, and Inclusion: Obstetrics and Gynecologist Hospitalists' Impact on Maternal Mortality. Obstet Gynecol Clin North Am 2024; 51:539-558. [PMID: 39098780 DOI: 10.1016/j.ogc.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
Obstetrics and gynecology hospitalists play a vital role in reducing maternal morbidity and mortality by providing immediate access to obstetric care, especially in emergencies. Their presence in hospitals ensures timely interventions and expert management, contributing to better outcomes for mothers and babies. This proactive approach can extend beyond hospital walls through education, advocacy, and community outreach initiatives aimed at improving maternal health across diverse settings.
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Affiliation(s)
- Julianne DeMartino
- University Hospitals MacDonald Women's Hospital, 2101 Adelbert Road, Cleveland, OH 44106, USA.
| | - Monique Yoder Katsuki
- Cleveland Clinic Foundation, Obstetric and Gynecologic Institute, 9500 Euclid Avenue/A81, Cleveland, OH 44195, USA
| | - Megan R Ansbro
- Cleveland Clinic Foundation, Obstetric and Gynecologic Institute, 9500 Euclid Avenue/A81, Cleveland, OH 44195, USA
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Thompson-Lastad A, Harrison JM, Taiwo TK, Williams C, Parimi M, Wilborn B, Chao MT. Postpartum care for parent-infant dyads: A community midwifery model. Birth 2024; 51:637-648. [PMID: 38590170 PMCID: PMC11323162 DOI: 10.1111/birt.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/23/2024] [Accepted: 03/16/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Postpartum health is in crisis in the United States, with rising pregnancy-related mortality and worsening racial inequities. The World Health Organization recommends four postpartum visits during the 6 weeks after childbirth, yet standard postpartum care in the United States is generally one visit 6 weeks after birth. We present community midwifery postpartum care in the United States as a model concordant with World Health Organization guidelines, describing this model of care and its potential to improve postpartum health for birthing people and babies. METHODS We conducted semi-structured interviews with 34 community midwives providing care in birth centers and home settings in Oregon and California. A multidisciplinary team analyzed data using reflexive thematic analysis. RESULTS A total of 24 participants were Certified Professional Midwives; 10 were certified nurse-midwives. A total of 14 midwives identified as people of color. Most spoke multiple languages. We describe six key elements of the community midwifery model of postpartum care: (1) multiple visits, including home visits; typically five to eight over six weeks postpartum; (2) care for the parent-infant dyad; (3) continuity of personalized care; (4) relationship-centered care; (5) planning and preparation for postpartum; and (6) focus on postpartum rest. CONCLUSION The community midwifery model of postpartum care is a guideline-concordant approach to caring for the parent-infant dyad and may address rising pregnancy-related morbidity and mortality in the United States.
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Affiliation(s)
- Ariana Thompson-Lastad
- Osher Center for Integrative Health, University of California, San Francisco, California, USA
- Department of Family and Community Medicine, University of California, San Francisco, California, USA
| | - Jessica M. Harrison
- Osher Center for Integrative Health, University of California, San Francisco, California, USA
| | | | - Chanda Williams
- Osher Center for Integrative Health, University of California, San Francisco, California, USA
| | - Mounika Parimi
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Briana Wilborn
- Department of Family Health Care Nursing (*alum), School of Nursing, University of California, San Francisco, California, USA
| | - Maria T. Chao
- Osher Center for Integrative Health, University of California, San Francisco, California, USA
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, California, USA
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Stolte A, Bruckner TA. Data collection and accessibility in the post-Dobbs era. Paediatr Perinat Epidemiol 2024; 38:635-637. [PMID: 39054736 DOI: 10.1111/ppe.13107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 07/14/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Allison Stolte
- Department of Health, Society, and Behavior, University of California, Irvine, California, USA
| | - Tim A Bruckner
- Department of Health, Society, and Behavior, University of California, Irvine, California, USA
- Center for Population, Inequality, and Policy, University of California, Irvine, California, USA
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Jarlenski M, Kennedy S, Johnson A, Hale C, D'Angelo Z, Nedhari A, Coffee G, Chappell-McPhail M, Green K, Méndez DD, Goetschius LG, Gareau S, Ashford K, Barnes AJ, Ahrens KA, Zivin K, Mosley E, Tang L. Study protocol: a mixed-methods study of the implementation of doula care to address racial health equity in six state Medicaid programs. Health Res Policy Syst 2024; 22:98. [PMID: 39118099 PMCID: PMC11308708 DOI: 10.1186/s12961-024-01185-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/22/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Racial inequities in severe maternal morbidity (SMM) and mortality constitute a public health crisis in the United States. Doula care, defined as care from birth workers who provide culturally appropriate, non-clinical support during pregnancy and postpartum, has been proposed as an intervention to help disrupt obstetric racism as a driver of adverse pregnancy outcomes in Black and other birthing persons of colour. Many state Medicaid programs are implementing doula programs to address the continued increase in SMM and mortality. Medicaid programs are poised to play a major role in addressing the needs of these populations with the goal of closing the racial gaps in SMM and mortality. This study will investigate the most effective ways that Medicaid programs can implement doula care to improve racial health equity. METHODS We describe the protocol for a mixed-methods study to understand how variation in implementation of doula programs in Medicaid may affect racial equity in pregnancy and postpartum health. Primary study outcomes include SMM, person-reported measures of respectful obstetric care, and receipt of evidence-based care for chronic conditions that are the primary causes of postpartum mortality (cardiovascular, mental health, and substance use conditions). Our research team includes doulas, university-based investigators, and Medicaid participants from six sites (Kentucky, Maryland, Michigan, Pennsylvania, South Carolina and Virginia) in the Medicaid Outcomes Distributed Research Network (MODRN). Study data will include policy analysis of doula program implementation, longitudinal data from a cohort of doulas, cross-sectional data from Medicaid beneficiaries, and Medicaid healthcare administrative data. Qualitative analysis will examine doula and beneficiary experiences with healthcare systems and Medicaid policies. Quantitative analyses (stratified by race groups) will use matching techniques to estimate the impact of using doula care on postpartum health outcomes, and will use time-series analyses to estimate the average treatment effect of doula programs on population postpartum health outcomes. DISCUSSION Findings will facilitate learning opportunities among Medicaid programs, doulas and Medicaid beneficiaries. Ultimately, we seek to understand the implementation and integration of doula care programs into Medicaid and how these processes may affect racial health equity. Study registration The study is registered with the Open Science Foundation ( https://doi.org/10.17605/OSF.IO/NXZUF ).
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Affiliation(s)
- Marian Jarlenski
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, 130 DeSoto St, A619, Pittsburgh, PA, 15261, United States of America.
- Center for Innovative Research On Gender Health Equity, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
| | - Susan Kennedy
- AcademyHealth, Washington, DC, United States of America
| | | | - Caroline Hale
- AcademyHealth, Washington, DC, United States of America
| | - Zoe D'Angelo
- AcademyHealth, Washington, DC, United States of America
| | - Aza Nedhari
- Mamatoto Village, Washington, DC, United States of America
| | - Gerria Coffee
- Genesis Birth Services, Williamsport, PA, United States of America
- PA Doula Commission, Landsdowne, PA, United States of America
| | | | - Kiddada Green
- Black Mothers' Breastfeeding Association, Detroit, MI, United States of America
| | - Dara D Méndez
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States of America
- Center for Health Equity, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States of America
| | - Leigh G Goetschius
- The Hilltop Institute, University of Maryland, Baltimore County, Baltimore, MD, United States of America
| | - Sarah Gareau
- Institute for Families in Society, College of Social Work, University of South Carolina, Columbia, SC, United States of America
| | - Kristin Ashford
- College of Nursing, University of Kentucky, Lexington, United States of America
| | - Andrew J Barnes
- Health Policy, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Katherine A Ahrens
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, ME, United States of America
| | - Kara Zivin
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Elizabeth Mosley
- Center for Innovative Research On Gender Health Equity, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Lu Tang
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States of America
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McGovern T, Memaj I, Garbers S. US abortion restrictions are causing widespread harm. BMJ 2024; 386:q1729. [PMID: 39117443 DOI: 10.1136/bmj.q1729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Affiliation(s)
- Terry McGovern
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Ira Memaj
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Samantha Garbers
- Department of Public Health and Health Sciences, Northeastern University Bouvé College of Health Sciences, Boston, MA, USA
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Joseph KS, Lisonkova S, Boutin A, Muraca GM, Razaz N, John S, Sabr Y, Chan WS, Mehrabadi A, Brandt JS, Schisterman EF, Ananth CV. Why improved surveillance is critical for reducing maternal deaths in the United States: a response to the American College of Obstetricians and Gynecologists. Am J Obstet Gynecol 2024; 231:e87-e92. [PMID: 38729595 DOI: 10.1016/j.ajog.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/02/2024] [Accepted: 05/05/2024] [Indexed: 05/12/2024]
Affiliation(s)
- K S Joseph
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada; School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada.
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada; School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Amélie Boutin
- Faculty of Medicine, Department of Pediatrics, Université Laval and Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Québec City, Canada
| | - Giulia M Muraca
- Departments of Obstetrics and Gynecology and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Neda Razaz
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sid John
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Yasser Sabr
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Wee-Shian Chan
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Azar Mehrabadi
- Perinatal Epidemiology Research Unit, Departments of Obstetrics and Gynaecology and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Justin S Brandt
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY
| | - Enrique F Schisterman
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Cande V Ananth
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Cardiovascular Institute of New Jersey and Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; Environmental and Occupational Health Sciences Institute, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
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10
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Hameed AB, Tarsa M, Graves CR, Grodzinsky A, Thiel De Bocanegra H, Wolfe DS. Universal Cardiovascular Disease Risk Assessment in Pregnancy: Call to Action JACC: Advances Expert Panel. JACC. ADVANCES 2024; 3:101055. [PMID: 39372368 PMCID: PMC11450966 DOI: 10.1016/j.jacadv.2024.101055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/25/2024] [Accepted: 05/07/2024] [Indexed: 10/08/2024]
Abstract
The United States has the highest maternal mortality rate among developed countries, with cardiovascular disease (CVD) being one of the leading causes of maternal deaths. Diagnosing CVD during pregnancy may be challenging as symptoms of normal pregnancy overlap with those of CVD. Delays in recognition and response to the diagnosis of CVD is a missed opportunity for timely intervention to improve maternal outcomes. Implementing universal CVD risk assessment for all pregnant and postpartum patients across clinical care settings presents a pivotal opportunity to address this issue. Integrating a validated risk assessment tool into routine obstetric care, clinicians, including obstetricians, primary care, and emergency healthcare providers, can enhance awareness of cardiovascular risk and facilitate early CVD diagnosis. Consensus among stakeholders underscores the importance of screening and education on cardiovascular health strategies for pregnant and postpartum patients to reduce CVD-related maternal mortality. This comprehensive approach offers a pathway to identify at-risk individuals and intervene promptly, potentially saving lives and advancing maternal healthcare equity.
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Affiliation(s)
- Afshan B. Hameed
- Maternal-Fetal Medicine, Obstetrics & Gynecology, Cardiology, University of California, Irvine, California, USA
| | - Maryam Tarsa
- Division of Maternal-Fetal Medicine, University of California, San Diego, California, USA
| | - Cornelia R. Graves
- Division of Maternal-Fetal Medicine, University of Tennessee, Nashville, Tennessee, USA
| | - Anna Grodzinsky
- Cardiology, Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Heike Thiel De Bocanegra
- Maternal-Fetal Medicine, Obstetrics & Gynecology, Cardiology, University of California, Irvine, California, USA
| | - Diana S. Wolfe
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
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Zahid S, Jha S, Kaur G, Jung YH, Minhas AS, Hays AG, Michos ED. PARCCS: A Machine Learning Risk-Prediction Model for Acute Peripartum Cardiovascular Complications During Delivery Admissions. JACC. ADVANCES 2024; 3:101095. [PMID: 39135918 PMCID: PMC11318475 DOI: 10.1016/j.jacadv.2024.101095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 08/15/2024]
Abstract
Background Maternal mortality in the United States remains high, with cardiovascular (CV) complications being a leading cause. Objectives The purpose of this paper was to develop the PARCCS (Prediction of Acute Risk for Cardiovascular Complications in the Peripartum Period Score) for acute CV complications during delivery. Methods Data from the National Inpatient Sample (2016-2020) and International Classification of Diseases, Tenth Revision codes to identify delivery admissions were used. Acute CV/renal complications were defined as a composite of pre-eclampsia/eclampsia, peripartum cardiomyopathy, renal complications, venous thromboembolism, arrhythmias, and pulmonary edema. A risk prediction model, PARCCS, was developed using machine learning consisting of 14 variables and scored out of 100 points. Results Of the 2,371,661 pregnant patients analyzed, 7.0% had acute CV complications during delivery hospitalization. Patients with CV complications had a higher prevalence of comorbidities and were more likely to be of Black race and lower income. The PARCCS variables included electrolyte imbalances (13 points [p]), age (3p for age <20 years), cesarean delivery (4p), obesity (5p), pre-existing heart failure (28p), multiple gestations (4p), Black race (2p), gestational hypertension (3p), low income (1p), gestational diabetes (2p), chronic diabetes (6p), prior stroke (22p), coagulopathy (5p), and nonelective admission (2p). Using the validation set, the performance of the model was evaluated with an area under the receiver-operating characteristic curve of 0.68 and a 95% CI of 0.67 to 0.68. Conclusions PARCCS has the potential to be an important tool for identifying pregnant individuals at risk of acute peripartum CV complications at the time of delivery. Future studies should further validate this score and determine whether it can improve patient outcomes.
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Affiliation(s)
- Salman Zahid
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Shikha Jha
- Division of Cardiovascular Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Gurleen Kaur
- Department of Medicine, Brigham, and Women's Hospital, Boston, USA
| | - Youn-Hoa Jung
- Division of Cardiac Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anum S. Minhas
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Allison G. Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erin D. Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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12
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Stanhope KK, Stallworth T, Forrest AD, Vuncannon D, Juarez G, Boulet SL, Geary F, Dunlop AL, Blake SC, Green VL, Jamieson DJ. Planning for the forgotten fourth trimester of pregnancy: A parallel group randomized control trial to test a postpartum planning intervention vs. standard prenatal care. Contemp Clin Trials 2024; 143:107586. [PMID: 38838985 PMCID: PMC11283948 DOI: 10.1016/j.cct.2024.107586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 04/24/2024] [Accepted: 05/28/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Black and brown birthing people experience persistent disparities in adverse maternal health outcomes, partially due to inadequate perinatal care. The goal of this study is to design and evaluate a patient-centered intervention for obstetric patients with one or more cardiometabolic risk factors for severe maternal morbidity [gestational diabetes, diabetes mellitus, hypertensive disorders of pregnancy (chronic hypertension, preeclampsia, eclampsia, or gestational hypertension), or preconception obesity (BMI > 30)] to promote postpartum visit attendance. METHODS To address identified unmet needs for postpartum support and barriers to postpartum care, we developed 20 thematic postpartum planning modules, each with corresponding patient educational materials, community resources, care coordination protocols, and clinician support tools (decision aids, electronic medical record prompts and fields). During prenatal care encounters, a research coordinator delivers the educational content (in English or Spanish), facilitates the participant's planning and shared decision-making, provides the participant with resources, and documents decisions in the electronic medical record. We will randomize 320 eligible patients with a 1:1 ratio to the intervention or standard prenatal care and evaluate the impact on postpartum visit attendance at 4-12 weeks and secondary outcomes (postpartum mental health, perceived future maternal and cardiometabolic risk, contraceptive use, primary care use, readmission, and patient satisfaction with care). DISCUSSION Through engagement with patients and community stakeholders, we developed a guideline-based, locally tailored intervention to address drivers of engagement with postpartum care for high-risk obstetric patients. If demonstrated to be effective, the educational materials and electronic medical record based-tool can be adapted to other settings. TRIAL REGISTRATION This trial was registered on ClinicalTrials.gov (NCT05430815) on June 23, 2022.
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Affiliation(s)
- Kaitlyn K Stanhope
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States; Emory University Rollins School of Public Health, Department of Epidemiology, 1518 Clifton Road NE Office 3023, Atlanta, Georgia, United States.
| | - Taé Stallworth
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States
| | - Alexandra D Forrest
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States
| | - Danielle Vuncannon
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States
| | - Gabriela Juarez
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States
| | - Sheree L Boulet
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States
| | - Franklyn Geary
- Morehouse School of Medicine, Department of Obstetrics and Gynecology, Atlanta, Georgia, United States
| | - Anne L Dunlop
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States
| | - Sarah C Blake
- Emory University Rollins School of Public Health, Department of Health Policy and Management, Atlanta, Georgia, United States
| | - Victoria L Green
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States
| | - Denise J Jamieson
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States; University of Iowa, School of Medicine, Johnson County, Iowa, United States
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Mokashi M, Boulineaux C, Janiak E, Boozer M, Neill S. Abortion Stigma as a Barrier to Mifepristone Use among Obstetrician-Gynecologists in Alabama for Early Pregnancy Loss. South Med J 2024; 117:504-509. [PMID: 39094802 DOI: 10.14423/smj.0000000000001717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
OBJECTIVES The objective of our study was to identify and characterize barriers to mifepristone use among obstetrician-gynecologists (OB-GYNs) for early pregnancy loss in a southern US state. METHODS In this qualitative study, we conducted semistructured interviews with 19 OB-GYNs in Alabama who manage early pregnancy loss. The interviews explored participants' knowledge of and experience with mifepristone use for miscarriage management and abortion, along with barriers to and facilitators of clinical mifepristone use. The interviews were coded by multiple study staff using inductive and deductive thematic coding. RESULTS Nearly all of the interviewees identified abortion-related stigma as a barrier to mifepristone use. Interviewees often attributed stigma to a lack of knowledge about the clinical use of mifepristone for early pregnancy loss. The stigmatization of mifepristone due to its association with abortion was related to religious and political objections. Many interviewees also described stigma associated with misoprostol use. Although providers believed that mifepristone use for abortion would not be accepted in their practice, most believed that mifepristone could be used successfully for miscarriage management after practice-wide education on its use. CONCLUSIONS Mifepristone is strongly associated with abortion stigma among OB-GYNs in Alabama, which is a barrier to its use for miscarriage management. Interventions to decrease abortion stigma and associated stigma surrounding mifepristone are needed to optimize early pregnancy loss care.
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Affiliation(s)
- Mugdha Mokashi
- From the Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Elizabeth Janiak
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Margaret Boozer
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham
| | - Sara Neill
- Department of Obstetrics, Gynecology, and Reproductive Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Le Goff A, Jeffries Hein R, Hart AN, Roberson I, Landecker HL. Anticipating in vitro gametogenesis: Hopes and concerns for IVG among diverse stakeholders. Stem Cell Reports 2024; 19:933-945. [PMID: 38848715 PMCID: PMC11252480 DOI: 10.1016/j.stemcr.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 06/09/2024] Open
Abstract
In vitro gametogenesis (IVG), the reconstitution of germ cell development in vitro, is an emerging stem cell-based technology with profound implications for reproductive science. Despite researchers' long-term goals for future clinical applications, little is currently known about the views of IVG held by the stakeholders potentially most affected by its introduction in humans. We conducted focus groups and interviews with 80 individuals with lived experience of infertility and/or LGBTQ+ family formation in the US, two intersecting groups of potential IVG users. Respondents expressed hope that IVG would lead to higher reproductive success than current assisted reproductive technology (ART), alleviate suffering associated with ART use, and promote greater social inclusion, while expressing concerns predominantly framed in terms of equity and safety. These findings underscore the importance of sustained engagement with stakeholders with relevant experience to anticipate the implications of IVG for research and clinical translation.
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Affiliation(s)
- Anne Le Goff
- The Institute for Society and Genetics, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Robbin Jeffries Hein
- The Institute for Society and Genetics, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Ariel N Hart
- Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Sociology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Isaias Roberson
- Department of Molecular, Cell and Developmental Biology, Los Angeles, CA 90095, USA; Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, Los Angeles, CA 90095, USA; Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA 90095, USA; Center for Reproductive Science, Health, and Education, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Hannah L Landecker
- The Institute for Society and Genetics, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Sociology, University of California, Los Angeles, Los Angeles, CA 90095, USA; Center for Reproductive Science, Health, and Education, University of California, Los Angeles, Los Angeles, CA 90095, USA.
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Reed T, Patil C, Kershaw KN, Crooks N, Jeremiah R, Park C. Prevalence of Hypertensive Disorders of Pregnancy and Gestational Diabetes Mellitus by Race and Ethnicity in Illinois, 2018 to 2020. MCN Am J Matern Child Nurs 2024:00005721-990000000-00057. [PMID: 38865102 DOI: 10.1097/nmc.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
PURPOSE Use administrative discharge data from 2018 to 2020 to determine if there are differences in the prevalence of hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) by race and ethnicity in Illinois. STUDY DESIGN AND METHODS This retrospective cross-sectional study used administrative discharge records from all patients who had live births in Illinois over a 3-year period; 2018, 2019, 2020. Multivariate analyses were performed to control for covariates and determine if associations vary by race and ethnicity for HDP and GDM. RESULTS A total of 287,250 discharge records were included. Multivariate analyses showed that after adjusting for covariates, non-Hispanic Black women had 1.60 increased odds of HDP compared to non-Hispanic White women (OR, 1.60; 95% CI, 1.55-1.65). Hispanic women (OR, 1.45; 95% CI, 1.40-1.50), Asian/Pacific Islander women (OR, 2.07; 95% CI, 1.97-2.17), and American Indian/Alaska Native women (OR, 1.43; 95% CI, 1.17-1.74) had an increased odds of GDM compared to non-Hispanic White women. CLINICAL IMPLICATIONS Women of color were at increased odds for HDP and GDM in Illinois. To eliminate poor maternal outcomes in women of color at risk for HDP and GDM, more culturally congruent health equity practices, policies, and comprehensive care interventions must be adopted.
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Alam S, Nandi U, Scarborough S, McNeill E, Callison K, Shi L, Gamble A. Maternal Health Legislation Enacted in Three Southeastern States in the United States Between 2018-2023: Policy Surveillance. JOURNAL OF THE MISSISSIPPI STATE MEDICAL ASSOCIATION 2024; 65:https://jmsma.scholasticahq.com/article/119016-maternal-health-legislation-enacted-in-three-southeastern-states-in-the-united-states-between-2018-2023-policy-surveillance. [PMID: 39055995 PMCID: PMC11270647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Background Maternal mortality and morbidity rates in the Southeastern states of the US are among the highest in the nation. Arkansas, Mississippi, and Louisiana are ranked first, second and fifth, respectively, in maternal mortality. This retrospective policy surveillance systematically documents legislation enacted to address maternal health disparities and ameliorate maternal health. Methods The Maternal and Child Health Legislative Database of the National Conference of State Legislators was searched for all legislation relating to maternal health in Arkansas, Louisiana, and Mississippi between 2018-2023. Two reviewers independently identified the laws passed by year and state and cross-checked to verify results. The legislative screening process is documented on a modified PRISMA flow diagram. Data extracted included the specific maternal health population targeted, the general health area addressed by the bill, and the directive of the bill. Results 126 pieces of legislation were identified using the database (41 AR, 12 MS, and 73 LA). There were no duplicates identified; 2 laws were identified outside of the database (1 AR, 1 MS). All 128 legislation titles and summaries were screened and laws pertaining to issues other than maternal health were excluded (28 AR, 9 MS, and 48 LA). 43 full text bills were retrieved and reviewed in their entirety to assess eligibility for inclusion. 40 pieces of legislation were included (11 AR, 4 MS, and 25 LA) in this policy surveillance. Discussion Louisiana enacted the most laws targeting and addressing maternal health, while Mississippi enacted the least. The legislation enacted addresses a broad range of health aspects, such as maternal mental health, incarcerated pregnant population reproductive health, and postpartum Medicaid coverage extension. Together with the task forces, committees, and study commissions created, the legislation enacted has the potential to address current inequities and improve maternal health outcomes in this vulnerable population by increasing access to and/or utilization of care, extending duration and/or type of evidence-based care available, and decreasing racial disparities in maternal health with the eventual goal of rooting out preventable morbidity and mortality.
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Affiliation(s)
- Sabrina Alam
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center
| | - Utsav Nandi
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center
- Department of Emergency Medicine, University of Mississippi Medical Center
| | | | - Emma McNeill
- Department of Emergency Medicine, University of Mississippi Medical Center
- Department of Data Science, John D. Bower School of Population Health, University of Mississippi Medical Center
| | - Kevin Callison
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Murphy Institute for Political Economy, Tulane University
| | - Lizheng Shi
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Murphy Institute for Political Economy, Tulane University
| | - Abigail Gamble
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center
- Department of Preventive Medicine, John D. Bower School of Population Health, University of Mississippi Medical Center
- Myrlie Evers-Williams Institute for the Elimination of Health Disparities, University of Mississippi Medical Center
- Implementation Science Lab, John D. Bower School of Population Health, University of Mississippi Medical Center
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Mayne GB, Ghidei L. The impact of devaluing Women of Color: stress, reproduction, and justice. Birth 2024; 51:245-252. [PMID: 38695278 DOI: 10.1111/birt.12825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 04/11/2024] [Indexed: 05/18/2024]
Abstract
This commentary is in response to the Call for Papers put forth by the Critical Midwifery Studies Collective (June 2022). We argue that due to a long and ongoing history of gendered racism, Women of Color are devalued in U.S. society. Devaluing Women of Color leads maternal healthcare practitioners to miss and even dismiss distress in Women of Color. The result is systematic underdiagnosis, undertreatment, and the delivery of poorer care to Women of Color, which negatively affects reproductive outcomes generally and birth outcomes specifically. These compounding effects exacerbate distress in Women of Color leading to greater distress. Stress physiology is ancient and intricately interwoven with healthy pregnancy physiology, and this relationship is a highly conserved reproductive strategy. Thus, where there is disproportionate or excess stress (distress), unsurprisingly, there are disproportionate and excess rates of poorer reproductive outcomes. Stress physiology and reproductive physiology collide with social injustices (i.e., racism, discrimination, and anti-Blackness), resulting in pernicious racialized maternal health disparities. Accordingly, the interplay between stress and reproduction is a key social justice issue and an important site for theoretical inquiry and birth equity efforts. Fortunately, both stress physiology and pregnancy physiology are highly plastic-responsive to the benefits of increased social support and respectful maternity care. Justice means valuing Women of Color and valuing their right to have a healthy, respected, and safe life.
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Affiliation(s)
- Gabriella B Mayne
- Department of Health and Behavioral Sciences, University of Colorado, Denver, Colorado, USA
| | - Luwam Ghidei
- Reproductive Specialists of the Carolinas, Charlotte, North Carolina, USA
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Ward ZJ, Atun R, King G, Dmello BS, Goldie SJ. Global maternal mortality projections by urban/rural location and education level: a simulation-based analysis. EClinicalMedicine 2024; 72:102653. [PMID: 38800798 PMCID: PMC11126824 DOI: 10.1016/j.eclinm.2024.102653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 05/29/2024] Open
Abstract
Background Maternal mortality remains a challenge in global health, with well-known disparities across countries. However, less is known about disparities in maternal health by subgroups within countries. The aim of this study is to estimate maternal health indicators for subgroups of women within each country. Methods In this simulation-based analysis, we used the empirically calibrated Global Maternal Health (GMatH) microsimulation model to estimate a range of maternal health indicators by subgroup (urban/rural location and level of education) for 200 countries/territories from 1990 to 2050. Education levels were defined as low (less than primary), middle (less than secondary), and high (completed secondary or higher). The model simulates the reproductive lifecycle of each woman, accounting for individual-level factors such as family planning preferences, biological factors (e.g., anemia), and history of maternal complications, and how these factors vary by subgroup. We also estimated the impact of scaling up women's education on projected maternal health outcomes compared to clinical and health system-focused interventions. Findings We find large subgroup differences in maternal health outcomes, with an estimated global maternal mortality ratio (MMR) in 2022 of 292 (95% UI 250-341) for rural women and 100 (95% UI 84-116) for urban women, and 536 (95% UI 450-594), 143 (95% UI 117-174), and 85 (95% UI 67-108) for low, middle, and high education levels, respectively. Ensuring all women complete secondary school is associated with a large impact on the projected global MMR in 2030 (97 [95% UI 76-120]) compared to current trends (167 [95% UI 142-188]), with especially large improvements in countries such as Afghanistan, Chad, Madagascar, Niger, and Yemen. Interpretation Substantial subgroup disparities present a challenge for global maternal health and health equity. Outcomes are especially poor for rural women with low education, highlighting the need to ensure that policy interventions adequately address barriers to care in rural areas, and the importance of investing in social determinants of health, such as women's education, in addition to health system interventions to improve maternal health for all women. Funding John D. and Catherine T. MacArthur Foundation, 10-97002-000-INP.
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Affiliation(s)
- Zachary J. Ward
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Rifat Atun
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Gary King
- Institute for Quantitative Social Sciences, Harvard University, Cambridge, MA, USA
| | - Brenda Sequeira Dmello
- Maternal and Newborn Healthcare, Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), Dar Es Salaam, Tanzania
| | - Sue J. Goldie
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
- Global Health Education and Learning Incubator, Harvard University, Cambridge, MA, USA
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Grahn P, Gissler M, Nietosvaara Y, Kaijomaa M. Ethnic background as a risk factor for permanent brachial plexus birth injury: A population-based study. Acta Obstet Gynecol Scand 2024; 103:1201-1209. [PMID: 38470173 PMCID: PMC11103133 DOI: 10.1111/aogs.14817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Brachial plexus birth injury is the most common birth injury causing permanent disability in Finland. This study aimed to assess risk factors of a permanent brachial plexus birth injury and calculate the incidence. MATERIAL AND METHODS This is a retrospective population-based study including all deliveries between 2006 and 2022 in Southern Finland. The number of children born, obstetric data, and migrant status were gathered from the registries of the Finnish Institute for Health and Welfare, and Statistics Finland. Race of the mothers of children with a permanent brachial plexus birth injury was recorded. The severity of permanent brachial plexus birth injury was assessed using the 3-month Toronto test score. A lower score was indicative of a more severe injury (scored 0-10). RESULTS One hundred of the 298 428 children born during the 17-year study period sustained a permanent brachial plexus birth injury (0.34 per 1000). Mothers of children with a permanent brachial plexus birth injury had a higher body mass index (29 vs. 24 kg/m2) and their pregnancies were more often complicated by diabetes (28% vs. 12%), shoulder dystocia (58% vs. 0.3%), and/or assisted deliveries (45% vs. 10%) compared with all other mothers (p < 0.001). Thirty two of the 52 725 children born to migrant mothers had a permanent brachial plexus birth injury (0.61 per 1000). The incidence of permanent brachial plexus birth injury was 5.7 times higher among children of Black migrants from Africa (18/11 738, 1.53 per 1000) compared with children of native mothers (0.27 per 1000). Black mothers had a higher body mass index at the start of pregnancy (29 vs. 26 kg/m2, p = 0.02) compared with Caucasians. Children of Black mothers had a more severe injury compared with all others (p = 0.007) with a mean 3-month Toronto test score of 4.2 (range 0.0-6.5, SD ±1.6) vs. 5.6 (range 0.0-9.3, SD ±2.2). CONCLUSIONS Shoulder dystocia and assisted delivery are the most important risk factors for a permanent brachial plexus birth injury. Black race was associated with a higher rate and a more severe permanent brachial plexus birth injury.
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Affiliation(s)
- Petra Grahn
- Department of Pediatric Orthopedics and Traumatology, New Children's HospitalHelsinki University Hospital, University of HelsinkiHelsinkiFinland
| | - Mika Gissler
- Department of Knowledge BrokersTHL Finnish Institute for Health and WelfareHelsinkiFinland
- Region StockholmAcademic Primary Health Care CenterStockholmSweden
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - Yrjänä Nietosvaara
- Department of Pediatric Orthopedics and Traumatology, New Children's HospitalHelsinki University Hospital, University of HelsinkiHelsinkiFinland
- Department of Pediatric SurgeryKuopio University Hospital, University of Eastern FinlandKuopioFinland
| | - Marja Kaijomaa
- Department of Obstetrics and Gynecology, Women's HospitalHelsinki University Hospital, University of HelsinkiHelsinkiFinland
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Jalil S, Elfeki MA, Kiefer MK, Kuo YF, Singal AK. Waitlist and posttransplant outcomes of pregnancy-related acute liver failure in the United States. Liver Transpl 2024; 30:573-581. [PMID: 38108820 DOI: 10.1097/lvt.0000000000000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023]
Abstract
Data on the liver transplant (LT) outcomes of women with acute liver failure (ALF) due to liver diseases unique to pregnancy (P-ALF) are limited. Using United Network of Organ Sharing (UNOS) data (1987-2021), we analyzed waitlist and post-LT outcomes of ALF in women of childbearing age comparing P-ALF versus ALF due to liver diseases not unique to pregnancy. Baseline characteristics were compared between groups at the time of listing for LT. Of 3542 females aged 16-43 years and listed for LT for ALF, 84 (2%) listed for P-ALF were less likely to be Black (11 vs. 21%, p =0.033), have lower international normalized ratio (2.74 vs. 4.53 p <0.002), but more likely to have respiratory failure (56% vs. 41%, p <0.005), be on pressors (58% vs. 43%, p <0.005), and require dialysis (23% vs. 10%, p <0.001). The cumulative 90-day waitlist mortality (WLM) was lower in P-ALF vs. ALF due to liver diseases not unique to pregnancy (7.4 vs. 16.6%, p <0.001). Posttransplant survival rates at 5 years were similar (82% vs. 79%, p =0.89). In a Fine and Gray regression model controlled for listing year and Model for End-Stage Liver Disease score, 90-day WLM was lower in P-ALF with a sub-HR of 0.42 (95% CI: 0.19-0.94, p =0.035). Of 84 women with P-ALF and listed for LT, 45 listed for hemolysis-elevated liver enzymes-low platelets (HELLP) versus 39 for acute fatty liver of pregnancy had higher 90-day WLM (19.3% vs. 5.7% p <0.005). The 90-day WLM was about 10-fold higher in HELLP versus acute fatty liver of pregnancy with a sub-HR of 9.97 (95% CI: 1.64-60.55, p =0.013). In this UNOS database analysis of ALF among women of childbearing age, the waitlist outcome is better in women with P-ALF compared to women with ALF due to liver diseases not unique to pregnancy. Among women with P-ALF, the 90-day WLM is worse for HELLP versus acute fatty liver of pregnancy. Further studies are needed to improve the management of HELLP and prevent the development of ALF in this subgroup population.
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Affiliation(s)
- Sajid Jalil
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mohamed A Elfeki
- Department of Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
- Department of Medicine, Avera McKennan University Hospital and Transplant Institute, Sioux Falls, Sioux Falls, SD, USA
| | - Miranda K Kiefer
- Department of Medicine, Maternal Fetal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Yong-Fang Kuo
- Department of Biostatistics, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ashwani K Singal
- Department of Medicine, University of Louisville, Louisville, KY, USA
- Department of Medicine, Trager Transplant Center, Jewish Hospital, Louisville, Kentucky, USA
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Vousden N, Bunch K, Kenyon S, Kurinczuk JJ, Knight M. Impact of maternal risk factors on ethnic disparities in maternal mortality: a national population-based cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2024; 40:100893. [PMID: 38585675 PMCID: PMC10998184 DOI: 10.1016/j.lanepe.2024.100893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 04/09/2024]
Abstract
Background Ethnic disparities in maternal mortality are consistently reported. This study aimed to investigate the contribution of known risk factors including age, socioeconomic status, and medical comorbidities to observed ethnic disparities in the United Kingdom (UK). Methods A cohort of all women who died during or up to six weeks after pregnancy in the UK 2009-2019 were identified through national surveillance. No single denominator population included data on all risk factors, therefore we used logistic regression modelling to compare to 1) routine population birth and demographic data (2015-19) (routine data comparator) and 2) combined control groups of four UK Obstetric Surveillance System studies (UKOSS) control comparator)). Findings There were 801 maternal deaths in the UK between 2009 and 2019 (White: 70%, Asian: 13%, Black: 12%, Chinese/Other: 3%, Mixed: 2%). Using the routine data comparator (n = 3,519,931 maternities) to adjust for demographics, including social deprivation, women of Black ethnicity remained at significantly increased risk of maternal death compared with women of white ethnicity (adjusted OR 2.43 (95% Confidence Interval 1.92-3.08)). The risk was greatest in women of Caribbean ethnicity (aOR 3.55 (2.30-5.48)). Among women of White ethnicity, risk of mortality increased as deprivation increased, but women of Black ethnicity had greater risk irrespective of deprivation. Using the UKOSS control comparator (n = 2210), after multiple adjustments including smoking, body mass index, and comorbidities, women of Black and Asian ethnicity remained at increased risk (aOR 3.13 (2.21-4.43) and 1.57 (1.16-2.12) respectively). Interpretation Known risk factors do not fully explain ethnic disparities in maternal mortality. The impact of socioeconomic deprivation appears to differ between ethnic groups. Funding This research is funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Maternal and Neonatal Health and Care, PR-PRU-127-21202.
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Affiliation(s)
- Nicola Vousden
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Kathryn Bunch
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Sara Kenyon
- Institute of Applied Health Research, University of Birmingham, UK
| | - Jennifer J. Kurinczuk
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Marian Knight
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
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Sharma BB, Pennell C, Sharma B, Smith R. Reducing maternal mortality in low- and middle-income countries: the Nepalese approach of helicopter retrieval. Am J Obstet Gynecol 2024; 230:473-475. [PMID: 38431464 DOI: 10.1016/j.ajog.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 03/05/2024]
Abstract
Ninety-four percent of global maternal deaths occur in low- and middle-income countries (LMICs). The UN has a goal of reducing maternal deaths to <70 per 100,000 live births by 2030, but progress is minimal. Maternal deaths in LMICs are associated with 3 delays in the care of women with obstetrical emergencies: 1) in the family of the woman realizing that her life is at risk, 2) in the transport of the woman to a hospital, and 3) in providing care after arrival at the hospital. These 3 delays function like links in a chain, and failure of any link leads to maternal death. LMICs have characteristics that make it likely that the chain will break. Women in LMICs frequently have low standing, and cultural beliefs often lead to delay in the recognition of obstetrical emergencies. LMICs are characterized by poor roads and long distances to hospitals leading to transport delays. Cultural and other factors also lead to treatment delays when a woman reaches a suitably-equipped and staffed hospital. Nepal has addressed these delays and reduced maternal mortality. Firstly, we have reported in the Journal the use of culturally acceptable approaches to improving the knowledge about antenatal care in remote villages. In the case of Nepal, singing songs related to maternal care proved to be a highly effective strategy. We now report that the government of Nepal has repurposed military helicopters to overcome the tyranny of poor roads to allow rapid transport of women with obstetrical emergencies to a small number of fully-equipped and staffed hospitals. As of June 2023, this service has successfully retrieved 625 women in four and half years. The Nepalese government has included questions on maternal mortality in the 2021 national census, followed by a verbal autopsy. These data indicate a fall in the maternal mortality ratio from 239 in 2016 to 151 in 2021. The efficiency of the triage service continues to improve, suggesting that maternal mortality will continue to fall. This may provide a model that can be implemented in other LMICs and highlights factors that may be responsible for recent increases in the US maternal mortality ratio.
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Affiliation(s)
| | - Craig Pennell
- The University of Newcastle Hunter Medical Research Institute, New South Wales, Australia
| | - Biraj Sharma
- The University of Newcastle Hunter Medical Research Institute, New South Wales, Australia
| | - Roger Smith
- Mothers and Babies Research Centre, The University of Newcastle Hunter Medical Research Institute, Hunter Medical Research Institute, New South Wales, Australia.
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Witcraft SM, Johnson E, Eitel AE, Moreland AD, King C, Terplan M, Guille C. Listening to Black Pregnant and Postpartum People: Using Technology to Enhance Equity in Screening and Treatment of Perinatal Mental Health and Substance Use Disorders. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01989-z. [PMID: 38605223 DOI: 10.1007/s40615-024-01989-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024]
Abstract
Perinatal mood and anxiety disorders (PMADs), perinatal substance use disorders (PSUDs), and intimate partner violence (IPV) are leading causes of pregnancy-related deaths in the United States. Screening and referral for PMADs, PSUDs and IPV is recommended, however, racial disparities are prominent: Black pregnant and postpartum people (PPP) are less likely to be screened and attend treatment compared to White PPP. We conducted qualitative interviews to better understand the experience of Black PPP who used a text/phone-based screening and referral program for PMADs/PSUDs and IPV-Listening to Women and Pregnant and Postpartum People (LTWP). We previously demonstrated that LTWP led to a significant reduction in racial disparities compared to in-person screening and referral, and through the current study, sought to identify facilitators of PMAD/PSUD symptom endorsement and treatment attendance. Semi-structured interviews were conducted with 68 Black PPP who were or had been pregnant within the last 24 months, and who either had or did not have a PMAD or PSUD. Participants were enrolled in LTWP and provided feedback on their experience. Using a grounded theory approach, four themes emerged: usability, comfort, necessity, and recommendations. Ease of use, brevity, convenience, and comfort in discussing mental health and substance use via text were highlighted. Need for a program like LTWP in Black communities was discussed, given the reduction in perceived judgement and access to trusted information and resources for PMADs/PSUDs, which may lessen stigma. These qualitative findings illuminate how technology-based adaptations to behavioral health screening and referral can reduce perceived negative judgment and facilitate identification and referral to treatment, thereby more adequately meeting needs of Black PPP.
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Affiliation(s)
- Sara M Witcraft
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, 67 President Street, MSC 861, 29425, Charleston, SC, USA.
| | - Emily Johnson
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, MSC 160, 29425, Charleston, SC, USA
| | - Anna E Eitel
- College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 617, 29425, Charleston, SC, USA
| | - Angela D Moreland
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, 67 President Street, MSC 861, 29425, Charleston, SC, USA
| | - Courtney King
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, 67 President Street, MSC 861, 29425, Charleston, SC, USA
| | - Mishka Terplan
- Friends Research Institute, 1040 Park Avenue, Ste. 103, 21201, Baltimore, MD, USA
| | - Constance Guille
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, 67 President Street, MSC 861, 29425, Charleston, SC, USA
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston South Carolina, 171 Ashley Ave, 29425, Charleston, SC, USA
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24
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Saigh J, Roche L, Longacre ML. Doula Services and Birth Outcomes: A Scoping Review. MCN Am J Matern Child Nurs 2024; 49:101-106. [PMID: 38403908 DOI: 10.1097/nmc.0000000000000986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND Doulas offer support and advice to some women during the childbirth process, however access to doula care is not available to all due to availability and cost. METHODS This scoping review synthesizes literature related to the use of doula services and the experiences and outcomes of those who used the services. Eligibility criteria included peer-reviewed studies conducted in the United States and published between 2010 and 2022 that specified use of doulas and assessed maternal experiences and outcomes. Articles were accessed through PubMed, Google Scholar, and PsycInfo. RESULTS Nineteen articles met the criteria and were included in the review. Findings across eligible articles included qualitative analyses related to psychosocial aspects of experience and quantitative findings on birth experience, complications, breastfeeding initiation, and emotional health. DISCUSSION Findings suggest having doula support can improve experiences and outcomes. However, further implementation and evaluation is needed as well as greater access to doula services among the childbearing population who are historically marginalized and minoritized.
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25
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Nardella D. Pumps: A Possible Tool to Promote More Equitable Lactation Outcomes. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2024; 97:99-106. [PMID: 38559458 PMCID: PMC10964822 DOI: 10.59249/mwyw7163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Pregnant individuals and infants in the US are experiencing rising morbidity and mortality rates. Breastfeeding is a cost-effective intervention associated with a lower risk of health conditions driving dyadic morbidity and mortality, including cardiometabolic disease and sudden infant death. Pregnant individuals and infants from racial/ethnic subgroups facing the highest risk of mortality also have the lowest breastfeeding rates, likely reflective of generational socioeconomic marginalization and its impact on health outcomes. Promoting breastfeeding among groups with the lowest rates could improve the health of dyads with the greatest health risk and facilitate more equitable, person-centered lactation outcomes. Multiple barriers to lactation initiation and duration exist for families who have been socioeconomically marginalized by health and public systems. These include the lack of paid parental leave, increased access to subsidized human milk substitutes, and reduced access to professional and lay breastfeeding expertise. Breast pumps have the potential to mitigate these barriers, making breastfeeding more accessible to all interested dyads. In 2012, The Patient Protection and Affordable Care Act (ACA) greatly expanded access to pumps through the preventative services mandate, with a single pump now available to most US families. Despite their near ubiquitous use among lactating individuals, little research has been conducted on how and when to use pumps appropriately to optimize breastfeeding outcomes. There is a timely and critical need for policy, scholarship, and education around pump use given their widespread provision and potential to promote equity for those families facing the greatest barriers to achieving their personal breastfeeding goals.
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Affiliation(s)
- Deanna Nardella
- National Clinician Scholars Program, Department of
Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Pediatrics, Yale School of Medicine, New
Haven, CT, USA
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26
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Florio KL, Williams EM, White D, Daming T, Hostetter S, Schrufer-Poland T, Gray R, Schmidt L, Grodzinsky A, Lee J, Rader V, Swearingen K, Nelson L, Patel N, Magalski A, Gosch K, Jones P, Fu Z, Spertus JA. Validation of a noninvasive cardiac output monitor in maternal cardiac disease: comparison of NICOM and transthoracic echocardiogram. Am J Obstet Gynecol MFM 2024; 6:101312. [PMID: 38342307 DOI: 10.1016/j.ajogmf.2024.101312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND The physiological changes to the cardiovascular system during pregnancy are considerable and are more pronounced in those with cardiac disease. In the general population, noninvasive hemodynamic monitoring is a valid alternative to pulmonary artery catheterization, which poses risk in the pregnant population. There is limited data on noninvasive cardiac output monitoring in pregnancy as an alternative to pulmonary artery catheterization. OBJECTIVE We sought to compare transthoracic echocardiography with a noninvasive cardiac output monitor (NICOM, Cheetah Medical) in pregnant patients with and without cardiac disease. STUDY DESIGN This was a prospective, open-label validation study that compared 2-dimensional transthoracic echocardiography with NICOM estimations of cardiac output in each trimester of pregnancy and the postpartum period. Participants with and without cardiac disease with a singleton gestation were included. NICOM estimations of cardiac output were derived from thoracic bioreactance and compared with 2-dimensional transthoracic echocardiography for both precision and accuracy. A mean percentage difference of ±30% between the 2 devices was considered acceptable agreement between the 2 measurement techniques. RESULTS A total of 58 subjects were enrolled; 36 did not have cardiac disease and 22 had cardiac disease. Heart rate measurements between the 2 devices were strongly correlated in both groups, whereas stroke volume and cardiac output measurements showed weak correlation. When comparing the techniques, the NICOM device overestimated cardiac output in the control group in all trimesters and the postpartum period (mean percentage differences were 50.3%, 52.7%, 48.1%, and 51.0% in the first, second, and third trimesters and the postpartum period, respectively). In the group with cardiac disease, the mean percentage differences were 31.9%, 29.7%, 19.6%, and 35.2% for the respective timepoints. CONCLUSION The NICOM device consistently overestimated cardiac output when compared with 2-dimensional transthoracic echocardiography at all timepoints in the control group and in the first trimester and postpartum period for the cardiovascular disease group. The physiological changes of pregnancy, specifically the mean chest circumference and total body water, may alter the accuracy of the cardiac output measurement by the NICOM device as they are currently estimated. Although NICOM has been validated for use in the critical care setting, there is insufficient data to support its use in pregnancy.
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Affiliation(s)
- Karen L Florio
- Department of Obstetrics and Gynecology, University of Missouri, Columbia MO (Dr Florio); Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Kansas City, MO (Drs Florio, Williams, Daming, Hostetter, Schrufer-Poland, and Patel); Division of Women's and Children's, Saint Luke's Hospital of Kansas City, Kansas City, MO (Dr Florio, Ms White, Ms Gray, Ms Swearingen, and Ms Nelson).
| | - Emily M Williams
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Kansas City, MO (Drs Florio, Williams, Daming, Hostetter, Schrufer-Poland, and Patel)
| | - Darcy White
- Division of Women's and Children's, Saint Luke's Hospital of Kansas City, Kansas City, MO (Dr Florio, Ms White, Ms Gray, Ms Swearingen, and Ms Nelson)
| | - Tara Daming
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Kansas City, MO (Drs Florio, Williams, Daming, Hostetter, Schrufer-Poland, and Patel); Department of Maternal-Fetal Medicine, Mercy Hospital of Saint Louis, Saint Louis, MO (Dr Daming)
| | - Sarah Hostetter
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Kansas City, MO (Drs Florio, Williams, Daming, Hostetter, Schrufer-Poland, and Patel); Department of Maternal Fetal Medicine, Mercy Hospital of Springfield, Springfield, MO (Dr Hostetter)
| | - Tabitha Schrufer-Poland
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Kansas City, MO (Drs Florio, Williams, Daming, Hostetter, Schrufer-Poland, and Patel); AdventHealth High Risk Pregnancy Consultants, Orlando, FL (Dr Schrufer-Poland)
| | - Rebecca Gray
- Division of Women's and Children's, Saint Luke's Hospital of Kansas City, Kansas City, MO (Dr Florio, Ms White, Ms Gray, Ms Swearingen, and Ms Nelson)
| | - Laura Schmidt
- Mid-America Heart Institute, Saint Luke's Hospital of Kansas City, Kansas City, MO (Drs Schmidt, Grodzinsky, Lee, Rader, and Magalski, Ms Gosch, Mr Jones, and Drs Fu and Spertus); Department of Cardiology, University of Missouri-Kansas City, Kansas City, MO (Drs Schmidt, Grodzinsky, Lee, Rader, Magalski, and Spertus)
| | - Anna Grodzinsky
- Mid-America Heart Institute, Saint Luke's Hospital of Kansas City, Kansas City, MO (Drs Schmidt, Grodzinsky, Lee, Rader, and Magalski, Ms Gosch, Mr Jones, and Drs Fu and Spertus); Department of Cardiology, University of Missouri-Kansas City, Kansas City, MO (Drs Schmidt, Grodzinsky, Lee, Rader, Magalski, and Spertus)
| | - John Lee
- Mid-America Heart Institute, Saint Luke's Hospital of Kansas City, Kansas City, MO (Drs Schmidt, Grodzinsky, Lee, Rader, and Magalski, Ms Gosch, Mr Jones, and Drs Fu and Spertus); Department of Cardiology, University of Missouri-Kansas City, Kansas City, MO (Drs Schmidt, Grodzinsky, Lee, Rader, Magalski, and Spertus)
| | - Valerie Rader
- Mid-America Heart Institute, Saint Luke's Hospital of Kansas City, Kansas City, MO (Drs Schmidt, Grodzinsky, Lee, Rader, and Magalski, Ms Gosch, Mr Jones, and Drs Fu and Spertus); Department of Cardiology, University of Missouri-Kansas City, Kansas City, MO (Drs Schmidt, Grodzinsky, Lee, Rader, Magalski, and Spertus)
| | - Kathleen Swearingen
- Division of Women's and Children's, Saint Luke's Hospital of Kansas City, Kansas City, MO (Dr Florio, Ms White, Ms Gray, Ms Swearingen, and Ms Nelson)
| | - Lynne Nelson
- Division of Women's and Children's, Saint Luke's Hospital of Kansas City, Kansas City, MO (Dr Florio, Ms White, Ms Gray, Ms Swearingen, and Ms Nelson)
| | - Neil Patel
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Kansas City, MO (Drs Florio, Williams, Daming, Hostetter, Schrufer-Poland, and Patel); Department of Obstetrics and Gynecology, University of Kentucky, Lexington KY (Dr Patel)
| | - Anthony Magalski
- Mid-America Heart Institute, Saint Luke's Hospital of Kansas City, Kansas City, MO (Drs Schmidt, Grodzinsky, Lee, Rader, and Magalski, Ms Gosch, Mr Jones, and Drs Fu and Spertus); Department of Cardiology, University of Missouri-Kansas City, Kansas City, MO (Drs Schmidt, Grodzinsky, Lee, Rader, Magalski, and Spertus)
| | - Kensey Gosch
- Mid-America Heart Institute, Saint Luke's Hospital of Kansas City, Kansas City, MO (Drs Schmidt, Grodzinsky, Lee, Rader, and Magalski, Ms Gosch, Mr Jones, and Drs Fu and Spertus)
| | - Philip Jones
- Mid-America Heart Institute, Saint Luke's Hospital of Kansas City, Kansas City, MO (Drs Schmidt, Grodzinsky, Lee, Rader, and Magalski, Ms Gosch, Mr Jones, and Drs Fu and Spertus)
| | - Zhuxuan Fu
- Mid-America Heart Institute, Saint Luke's Hospital of Kansas City, Kansas City, MO (Drs Schmidt, Grodzinsky, Lee, Rader, and Magalski, Ms Gosch, Mr Jones, and Drs Fu and Spertus)
| | - John A Spertus
- Mid-America Heart Institute, Saint Luke's Hospital of Kansas City, Kansas City, MO (Drs Schmidt, Grodzinsky, Lee, Rader, and Magalski, Ms Gosch, Mr Jones, and Drs Fu and Spertus); Department of Cardiology, University of Missouri-Kansas City, Kansas City, MO (Drs Schmidt, Grodzinsky, Lee, Rader, Magalski, and Spertus)
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Lee R, Brandt JS, Joseph K, Ananth CV. Pregnancy-associated mortality due to cardiovascular disease: Impact of hypertensive disorders of pregnancy. Paediatr Perinat Epidemiol 2024; 38:204-215. [PMID: 38375930 PMCID: PMC10978238 DOI: 10.1111/ppe.13055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Reported rates of maternal mortality in the United States have been staggeringly high and increasing, and cardiovascular disease (CVD) is a chief contributor to such deaths. However, the impact of hypertensive disorders of pregnancy (HDP) on the short-term risk of cardiovascular death is not well understood. OBJECTIVES To evaluate the association between HDP (chronic hypertension, gestational hypertension, preeclampsia, eclampsia, and superimposed preeclampsia) and pregnancy-associated mortality rates (PMR) from all causes, CVD-related causes both at delivery and within 1 year following delivery. METHODS We used the Nationwide Readmissions Database (2010-2018) to examine PMRs for females 15-54 years old. International Classification of Disease 9 and 10 diagnosis codes were used to identify pregnancy-associated deaths due to HDP and CVD. Discrete-time Cox proportional hazards regression models were used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for mortality at delivery (0 days) and at <30, <60, <90, <180, and <365 days after delivery in relation to HDP. RESULTS Of 33,417,736 hospital deliveries, the rate of HDP was 11.0% (n = 3,688,967), and the PMR from CVD was 6.4 per 100,000 delivery hospitalisations (n = 2141). Compared with normotensive patients, HRs for CVD-related PMRs increased with HDP severity, reaching over 58-fold for eclampsia patients. HRs were higher for stroke-related (1.2 to 170.9) than heart disease (HD)-related (0.99 to 39.8) mortality across all HDPs. Except for gestational hypertension, the increased risks of CVD mortality were evident at delivery and persisted 1 year postpartum for all HDPs. CONCLUSIONS HDPs are strong risk factors for pregnancy-associated mortality due to CVD at delivery and within 1 year postpartum; the risks are stronger for stroke than HD-related PMR. While absolute PMRs are low, this study supports the importance of extending postpartum care beyond the traditional 42-day postpartum visit for people whose pregnancies are complicated by hypertension.
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Affiliation(s)
- Rachel Lee
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Justin S. Brandt
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Grossman School of Medicine, New York University, New York, NY, USA
| | - K.S. Joseph
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children’s and Women’s Hospital and Health Centre of British Columbia, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Cande V. Ananth
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Cardiovascular Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Thadhani R, Cerdeira AS, Karumanchi SA. Translation of mechanistic advances in preeclampsia to the clinic: Long and winding road. FASEB J 2024; 38:e23441. [PMID: 38300220 DOI: 10.1096/fj.202301808r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/30/2023] [Accepted: 01/09/2024] [Indexed: 02/02/2024]
Abstract
As one of the leading causes of premature birth and maternal and infant mortality worldwide, preeclampsia remains a major unmet public health challenge. Preeclampsia and related hypertensive disorders of pregnancy are estimated to cause >75 000 maternal and 500 000 infant deaths globally each year. Because of rising rates of risk factors such as obesity, in vitro fertilization and advanced maternal age, the incidence of preeclampsia is going up with rates ranging from 5% to 10% of all pregnancies worldwide. A major discovery in the field was the realization that the clinical phenotypes related to preeclampsia, such as hypertension, proteinuria, and other adverse maternal/fetal events, are due to excess circulating soluble fms-like tyrosine kinase-1 (sFlt-1, also referred to as sVEGFR-1). sFlt-1 is an endogenous anti-angiogenic protein that is made by the placenta and acts by neutralizing the pro-angiogenic proteins vascular endothelial growth factor (VEGF) and placental growth factor (PlGF). During the last decade, this work has spawned a new era of molecular diagnostics for early detection of this condition. Antagonizing sFlt-1 either by reducing production or blocking its actions has shown salutary effects in animal models. Further, in early-stage human studies, the therapeutic removal of sFlt-1 from maternal circulation has shown promise in delaying disease progression and improving outcomes. Recently, the FDA approved the first molecular test for preterm preeclampsia (sFlt-1/PlGF ratio) for clinical use in the United States. Measuring serum sFlt-1/PlGF ratio in the acute hospital setting may aid short-term management, particularly regarding step-up or step-down of care, decision to transfer to settings better equipped to manage both the mother and the preterm neonate, appropriate timing of administration of steroids and magnesium sulfate, and in expectant management decisions. The test itself has the potential to save lives. Furthermore, the availability of a molecular test that correlates with adverse outcomes has set the stage for interventional clinical trials testing treatments for this disorder. In this review, we will discuss the role of circulating sFlt-1 and related factors in the pathogenesis of preeclampsia and specifically how this discovery is leading to concrete advances in the care of women with preeclampsia.
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Affiliation(s)
- Ravi Thadhani
- Woodruff Health Sciences Center, Emory University School of Medicine, Atlanta, Georgia, USA
- Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ana Sofia Cerdeira
- Nuffield Department of Women's Health and Reproductive Research, University of Oxford, Oxford, UK
- Fetal Maternal Medicine Unit, Queen Charlotte's and Chelsea Hospital, London, UK
| | - S Ananth Karumanchi
- Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
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29
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Varner CE, Ray JG. Pallier la fragmentation des soins en début de grossesse au Canada. CMAJ 2024; 196:E172-E173. [PMID: 38346784 PMCID: PMC10861264 DOI: 10.1503/cmaj.231568-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Affiliation(s)
- Catherine E Varner
- Rédactrice adjointe, JAMC (Varner); Institut de médecine d'urgence Schwartz/Reisman (Varner); Département de médecine d'urgence (Varner), Système de santé Sinaï, Département de médecine familiale et communautaire, Université de Toronto; ICES Central (Ray); Centre de recherche Keenan (Ray), Institut du savoir Li Ka Shing, Hôpital St. Michael; départements de médecine, d'obstétrique et gynécologie (Ray), Hôpital St. Michael, Toronto, Ont
| | - Joel G Ray
- Rédactrice adjointe, JAMC (Varner); Institut de médecine d'urgence Schwartz/Reisman (Varner); Département de médecine d'urgence (Varner), Système de santé Sinaï, Département de médecine familiale et communautaire, Université de Toronto; ICES Central (Ray); Centre de recherche Keenan (Ray), Institut du savoir Li Ka Shing, Hôpital St. Michael; départements de médecine, d'obstétrique et gynécologie (Ray), Hôpital St. Michael, Toronto, Ont
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30
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DeBruin DA. Fetal Personhood and the Boundless Responsibilities of Pregnant Persons. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:33-36. [PMID: 38295245 DOI: 10.1080/15265161.2024.2296778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
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31
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Scott MA, Matt I, Tak CR. Access to on-campus contraception on college and university campuses in North Carolina. J Am Pharm Assoc (2003) 2024; 64:301-306. [PMID: 37844734 DOI: 10.1016/j.japh.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Unintended pregnancies occur more frequently in college students and negatively affect health outcomes and educational attainment. This study examined access to on-campus contraceptives at all 4-year colleges and universities in North Carolina (NC). METHODS This institutional review board-exempt study evaluated availability of on-campus contraceptives including condoms; hormonal contraceptives including pills, patches, and vaginal rings; medroxyprogesterone injections; implants; intrauterine devices; and emergency contraception via website review. Institutions were stratified by characteristics including size, location, type (e.g., public, private, religious affiliation, historically black colleges and universities, women's colleges), and presence of a student health pharmacy. Comparisons were made using chi-square test or Fisher's exact test. RESULTS Fifty-four 4-year colleges and universities were identified. A plurality or the majority of schools were considered small (41%) and urban (48%) and had a religious affiliation (61%). Thirty-three percent of colleges and universities had an on-campus pharmacy. The most frequent contraceptives offered were condoms (43%), oral contraceptives (33%), and medroxyprogesterone injections (22%). Emergency contraception was available at approximately one-third of colleges and universities. Six percent of institutions provided a full range of contraceptive methods. Contraceptives were offered more frequently at large, public, urban institutions, whereas religious institutions and smaller institutions were less likely to offer contraceptives. CONCLUSION Access to on-campus contraception for college students in NC is lacking, and the vast majority of institutions did not provide a full range of contraceptives. Policy measures, such as enhancing reproductive health services at student health centers or increasing contraception availability directly through pharmacies, are needed to improve access for college students.
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Brown-Kaiser C, Vyas A. Subjective Well-Being and Burnout Among the Maternal and Child Health Workforce. J Prim Care Community Health 2024; 15:21501319241263443. [PMID: 38884455 PMCID: PMC11185010 DOI: 10.1177/21501319241263443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/18/2024] Open
Abstract
OBJECTIVES This study investigates burnout and subjective well-being among the Maternal and Child Health (MCH) workforce, considering recent events such as the Dobbs decision, the maternal mortality crisis, and the COVID-19 pandemic. METHODS An anonymous web-based, cross-sectional survey was conducted among 313 MCH professionals in the United States. Data were collected using validated measures, including the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and the Oxford Happiness Questionnaire (OHQ) short scale. Sociodemographic characteristics and factors associated with burnout and subjective well-being were examined using univariate statistics and multivariable models. RESULTS Analysis revealed moderate levels of burnout among MCH professionals, particularly in emotional exhaustion. However, subjective well-being levels were relatively high. After controlling for covariates, significant associations were found between subjective well-being and burnout dimensions, as well as sociodemographic factors such as sex and race. CONCLUSIONS The study's findings indicate that higher subjective well-being is significantly associated with lower burnout, emotional exhaustion, and higher personal accomplishment. Variations in burnout and well-being are also influenced by sociodemographic factors such as age, sex, race, and occupation. Tailored interventions addressing the specific needs of MCH professionals are essential for building a resilient workforce. Organizational reforms and legislative measures are crucial for fostering supportive workplace environments and ensuring access to care and services amidst workforce challenges.
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Affiliation(s)
| | - Amita Vyas
- George Washington University, Washington, DC, USA
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33
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Fraser D. Lessons From Langa. Neonatal Netw 2024; 43:4-5. [PMID: 38267091 DOI: 10.1891/nn-2023-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
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Mohottige D, Boulware LE. Uncovering the Role of Kidney Disease and Its Care in the US Maternal Health Equity Crisis. JAMA Netw Open 2023; 6:e2346239. [PMID: 38064221 DOI: 10.1001/jamanetworkopen.2023.46239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Affiliation(s)
- Dinushika Mohottige
- Institute for Health Equity Research, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, New York
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Division of Data-Driven and Digital Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - L Ebony Boulware
- Wake Forest University School of Medicine, Winston Salem, North Carolina
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35
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Altshuler AL. How Is the Dobbs Ruling Affecting U.S. Adolescents? J Adolesc Health 2023; 73:969-970. [PMID: 37980080 DOI: 10.1016/j.jadohealth.2023.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 11/20/2023]
Affiliation(s)
- Anna Lea Altshuler
- Department of Obstetrics, Midwifery and Gynecology Alameda Health System, San Francisco, California
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Affiliation(s)
- Catherine E Varner
- Deputy editor, CMAJ (Varner); Schwartz/Reisman Emergency Medicine Institute (Varner); Department of Emergency Medicine (Varner), Sinai Health, Department of Family & Community Medicine, University of Toronto; ICES Central (Ray); Keenan Research Centre (Ray), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital, Toronto, Ont
| | - Joel G Ray
- Deputy editor, CMAJ (Varner); Schwartz/Reisman Emergency Medicine Institute (Varner); Department of Emergency Medicine (Varner), Sinai Health, Department of Family & Community Medicine, University of Toronto; ICES Central (Ray); Keenan Research Centre (Ray), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital, Toronto, Ont
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37
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Fleszar LG, Johnson CO, Roth GA. US Trends in Maternal Mortality by Racial and Ethnic Group-Reply. JAMA 2023; 330:1800-1801. [PMID: 37962656 DOI: 10.1001/jama.2023.17550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Affiliation(s)
- Laura G Fleszar
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Catherine O Johnson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
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38
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Rossen LM, Hoyert D, Branum AM. US Trends in Maternal Mortality by Racial and Ethnic Group. JAMA 2023; 330:1799-1800. [PMID: 37962660 PMCID: PMC10754215 DOI: 10.1001/jama.2023.17547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Affiliation(s)
- Lauren M. Rossen
- National Center for Health Statistics, Centers for Disease
Control and Prevention, Hyattsville, Maryland
| | - Donna Hoyert
- National Center for Health Statistics, Centers for Disease
Control and Prevention, Hyattsville, Maryland
| | - Amy M. Branum
- National Center for Health Statistics, Centers for Disease
Control and Prevention, Hyattsville, Maryland
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39
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Pecker LH, Boghossian NS, Saade G. US Trends in Maternal Mortality by Racial and Ethnic Group. JAMA 2023; 330:1799. [PMID: 37962661 DOI: 10.1001/jama.2023.17544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Affiliation(s)
- Lydia H Pecker
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nansi S Boghossian
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | - George Saade
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
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40
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Mitta S, Gross CP, Simon MA. Screening for Hypertensive Disorders of Pregnancy in the US-A New Hypertensive Urgency. JAMA Intern Med 2023; 183:1185-1186. [PMID: 37725383 DOI: 10.1001/jamainternmed.2023.4723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Affiliation(s)
- Srilakshmi Mitta
- Division of Obstetric and Consultative Medicine, Department of Medicine, Women & Infants Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cary P Gross
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center, New Haven, Connecticut
| | - Melissa A Simon
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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41
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Scott K, Gregory EF, Burris HH. Family Leave and Maternal Mortality in the US-Reply. JAMA 2023; 330:1387-1388. [PMID: 37815570 DOI: 10.1001/jama.2023.14936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Affiliation(s)
- Kristan Scott
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Emily F Gregory
- Division of General Pediatrics, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Heather H Burris
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia
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42
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Fiscella K, Epstein RM. Why the United States needs a multifaceted definition of health. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad048. [PMID: 38756742 PMCID: PMC10986254 DOI: 10.1093/haschl/qxad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/09/2023] [Accepted: 09/18/2023] [Indexed: 05/18/2024]
Abstract
How health is conceived and operationalized is an unrecognized contributor to poor health outcomes in the United States. The United States lacks an explicit definition of health, yielding a de facto, implicit biomedical definition in research and in health care that contrasts with how many people define health for themselves. This biomedical conceptualization has led to the development of lifesaving drugs, vaccines, and procedures, but has also resulted in critical underinvestment in people across their lives, beginning in early childhood, in behavioral, environmental, and social determinants. This underinvestment across the entire lifespan in people's health traps the United States in a vicious cycle of chronic disease and unsustainable health care costs. A movement towards holistic definitions of health represents an escape by defining health in more meaningful terms that reflect people's early development, agency, functioning, adaptive capacity, well-being, and lifelong development-that is, the capability for every person to thrive. Adopting and implementing a multifaceted, holistic health definition by federal research and health agencies could transform and humanize health in the United States and advance health equity.
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Affiliation(s)
- Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY 14620, United States
| | - Ronald M Epstein
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY 14620, United States
- Department of Oncology, University of Rochester School of Medicine and Dentistry,Rochester, NY 14620, United States
- Department of Medicine (Palliative Care), University of Rochester School of Medicine and Dentistry,Rochester, NY 14620, United States
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43
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Galbraith A, Flanagin A, Carroll AE, Ayanian JZ, Bonow RO, Bressler N, Christakis D, Disis MLN, Inouye SK, Josephson A, Öngür D, Piccirillo JF, Shinkai K, Bibbins-Domingo K. JAMA Network Call for Papers on Health and the 2024 US Election. JAMA 2023; 330:923-924. [PMID: 37594877 DOI: 10.1001/jama.2023.14719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
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44
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Girardi G, Longo M, Bremer AA. Social determinants of health in pregnant individuals from underrepresented, understudied, and underreported populations in the United States. Int J Equity Health 2023; 22:186. [PMID: 37674167 PMCID: PMC10483713 DOI: 10.1186/s12939-023-01963-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 07/13/2023] [Indexed: 09/08/2023] Open
Abstract
Women represent the cornerstone of a family's overall health. Therefore, supporting women's health, particularly in pregnancy, is important to promote public health. Emerging data highlight the contribution of social determinants of health (SDOH) on pregnancy outcomes in understudied, underrepresented, and underreported (U3) populations. Importantly, women are uniquely affected by and more vulnerable to adverse outcomes associated with SDOH. The maternal mortality rate has also increased significantly in the United States, especially among U3 individuals. Factors such as access to safe food, housing and environment, access to education and emergency/health services, and stressors such as interpersonal racism, poverty, unemployment, residential segregation, and domestic violence may make women from U3 populations more vulnerable to adverse reproductive health outcomes. Despite progress in promoting women's health, eliminating social and health disparities in pregnant individuals remains an elusive goal in U3 populations. Moreover, chronic exposure to excessive social/cultural stressors may have a physiologic cost leading to pregnancy complications such as miscarriages, preterm birth, and preeclampsia. Thus, the identification of SDOH-related factors that drive differences in pregnancy-related complications and deaths and the implementation of prevention strategies to address them could reduce disparities in pregnancy-related mortality in U3 populations.
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Affiliation(s)
- Guillermina Girardi
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
| | - Monica Longo
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Andrew A Bremer
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, USA
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45
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Onambele L, Guillen-Aguinaga S, Guillen-Aguinaga L, Ortega-Leon W, Montejo R, Alas-Brun R, Aguinaga-Ontoso E, Aguinaga-Ontoso I, Guillen-Grima F. Trends, Projections, and Regional Disparities of Maternal Mortality in Africa (1990-2030): An ARIMA Forecasting Approach. EPIDEMIOLOGIA 2023; 4:322-351. [PMID: 37754279 PMCID: PMC10528291 DOI: 10.3390/epidemiologia4030032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/03/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
With the United Nations Sustainable Development Goals (SDG) (2015-2030) focused on the reduction in maternal mortality, monitoring and forecasting maternal mortality rates (MMRs) in regions like Africa is crucial for health strategy planning by policymakers, international organizations, and NGOs. We collected maternal mortality rates per 100,000 births from the World Bank database between 1990 and 2015. Joinpoint regression was applied to assess trends, and the autoregressive integrated moving average (ARIMA) model was used on 1990-2015 data to forecast the MMRs for the next 15 years. We also used the Holt method and the machine-learning Prophet Forecasting Model. The study found a decline in MMRs in Africa with an average annual percentage change (APC) of -2.6% (95% CI -2.7; -2.5). North Africa reported the lowest MMR, while East Africa experienced the sharpest decline. The region-specific ARIMA models predict that the maternal mortality rate (MMR) in 2030 will vary across regions, ranging from 161 deaths per 100,000 births in North Africa to 302 deaths per 100,000 births in Central Africa, averaging 182 per 100,000 births for the continent. Despite the observed decreasing trend in maternal mortality rate (MMR), the MMR in Africa remains relatively high. The results indicate that MMR in Africa will continue to decrease by 2030. However, no region of Africa will likely reach the SDG target.
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Affiliation(s)
- Luc Onambele
- School of Health Sciences, Catholic University of Central Africa, Yaoundé 1110, Cameroon;
| | - Sara Guillen-Aguinaga
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
| | - Laura Guillen-Aguinaga
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
- Department of Nursing, Suldal Sykehjem, 4230 Sands, Norway
| | - Wilfrido Ortega-Leon
- Department of Surgery, Medical and Social Sciences, University of Alcala de Henares, 28871 Alcalá de Henares, Spain;
| | - Rocio Montejo
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, 413 46 Gothenburg, Sweden;
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, 413 46 Gothenburg, Sweden
| | - Rosa Alas-Brun
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
| | | | - Ines Aguinaga-Ontoso
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
- Area of Epidemiology and Public Health, Healthcare Research Institute of Navarre (IdiSNA), 31008 Pamplona, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, 46980 Madrid, Spain
| | - Francisco Guillen-Grima
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
- Area of Epidemiology and Public Health, Healthcare Research Institute of Navarre (IdiSNA), 31008 Pamplona, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, 46980 Madrid, Spain
- Department of Preventive Medicine, Clínica Universidad de Navarra, 31008 Pamplona, Spain
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Galbraith A, Flanagin A, Carroll AE, Ayanian JZ, Bonow RO, Bressler N, Christakis D, Disis MLN, Inouye SK, Josephson A, Öngür D, Piccirillo JF, Shinkai K, Bibbins-Domingo K. JAMA Network Call for Papers on Health and the 2024 US Election. JAMA Psychiatry 2023:2808637. [PMID: 37594887 DOI: 10.1001/jamapsychiatry.2023.3277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
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47
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Galbraith A, Flanagin A, Carroll AE, Ayanian JZ, Bonow RO, Bressler N, Christakis D, Disis MLN, Inouye SK, Josephson A, Öngür D, Piccirillo JF, Shinkai K, Bibbins-Domingo K. JAMA Network Call for Papers on Health and the 2024 US Election. JAMA Ophthalmol 2023:2808662. [PMID: 37594881 DOI: 10.1001/jamaophthalmol.2023.4021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
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48
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Galbraith A, Flanagin A, Carroll AE, Ayanian JZ, Bonow RO, Bressler N, Christakis D, Disis MLN, Inouye SK, Josephson A, Öngür D, Piccirillo JF, Shinkai K, Bibbins-Domingo K. JAMA Network Call for Papers on Health and the 2024 US Election. JAMA Intern Med 2023:2808638. [PMID: 37594891 DOI: 10.1001/jamainternmed.2023.4474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
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49
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Galbraith A, Flanagin A, Carroll AE, Ayanian JZ, Bonow RO, Bressler N, Christakis D, Disis MLN, Inouye SK, Josephson A, Öngür D, Piccirillo JF, Shinkai K, Bibbins-Domingo K. JAMA Network Call for Papers on Health and the 2024 US Election. JAMA Neurol 2023:2808773. [PMID: 37594882 DOI: 10.1001/jamaneurol.2023.3068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
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50
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Galbraith A, Flanagin A, Carroll AE, Ayanian JZ, Bonow RO, Bressler N, Christakis D, Disis MLN, Inouye SK, Josephson A, Öngür D, Piccirillo JF, Shinkai K, Bibbins-Domingo K. JAMA Network Call for Papers on Health and the 2024 US Election. JAMA Otolaryngol Head Neck Surg 2023:2808700. [PMID: 37594890 DOI: 10.1001/jamaoto.2023.2746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
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