Perinatal mortality and adverse pregnancy outcomes in a low-income rural population of women who smoke

Factors associated with spontaneous abortion: a systematic review

Abstract Objectives: to compile studies produced regardinggenetic and non-genetic risks factors associated with occurrence of spontaneous abortion. Methods: it talks about a systematic review article, with studies between January of 2008 to November of 2018 according to SciELO, PubMed, Lilacs and BVS. Results: in total, 567 articles were found. After applying the definedeligibility criteria, 44 articles made part of the review, being the majority published on Asia between 2008 and 2011, and 10 articles published on Brazil. Not genetic causes like sociodemographic factors and healthy state were among the most associated conditions of spontaneous abortion. Asiatic continent had predominance about the correlation of spontaneous abortion with factors related to life style like obesity, smoking and labor activities, on the other hand, in the Americas, causes related to sociodemographics factors like low pay and low studies are high-lighted. Conclusions: the risk factors change about the occurrence region, being important to make local studies capable of subsidize the implantation of public politics and to reduce abortions.

Electronic Monitoring Of Mom's Schedule (eMOMS™): Protocol for a feasibility randomized controlled trial to improve postpartum weight, blood sugars, and breastfeeding among high BMI women

Background

Overweight and obesity are major risk factors for gestational diabetes among U.S. women. Evidence suggests that longer duration of breastfeeding among women with a history of gestational diabetes is associated with lower incidence of developing type 2 diabetes after pregnancy. Women may potentially benefit from a lifestyle change program that includes breastfeeding education and support.

Purpose

To describe the design and justification of a combined breastfeeding, national Diabetes Prevention Program (DPP)-based feasibility randomized controlled trial, the electronic Monitoring Of Mom's Schedule (eMOMS^TM) study. eMOMS^TM compares the feasibility and efficacy of three interventions on six-month postpartum weight loss among women with a BMI ≥25.

Methods

The intervention is delivered via Facebook and includes three groups: DPP and breastfeeding (eMOMS1); DPP only (eMOMS2); and Usual Care (eMOMS3). Recruitment is ongoing at two clinical sites (rural and urban). A total of 72 women, 24 per group, will be randomly assigned to one of the three groups. It is anticipated that women in eMOMS1 will have greater weight loss and increased length of breastfeeding at three and six months postpartum compared to women in eMOMS2 and eMOMS3. Additional data will be collected on metabolic markers, anthropometrics, physical activity, nutrition, breastfeeding, and depression. Program cost will be compared to that of traditionally scheduled group meetings. Expected study completion date: October 2021.

Conclusions

This study has the potential to define a high impact, cost effective intervention that can improve public health by reducing negative health outcomes associated with gestational diabetes among an at-risk population.

Exploring the Linkage between Activity-Friendly Zoning, Inactivity, and Cancer Incidence in the United States

Background: Physical activity (PA) protects against cancer and enhances cancer survivorship. Given high inactivity rates nationwide, population-level physical activity facilitators are needed. Several authoritative bodies have recognized that zoning and planning helps create activity-friendly environments. This study examined the association between activity-friendly zoning, inactivity, and cancer in 478 of the most populous U.S. counties.Methods: County geocodes linked county-level data: cancer incidence and smoking (State Cancer Profiles), inactivity (Behavioral Risk Factor Surveillance System), 11 zoning measures (compiled by the study team), and covariates (from the American Community Survey and NAVTEQ). For each zoning measure, single mediation regression models and Sobel tests examined whether activity-friendly zoning was associated with reduced cancer incidence, and whether inactivity mediated those associations. All models were clustered on state with robust SEs and significance at the P < 0.05 level.Results: Zoning for crosswalks, bike-pedestrian connectivity, and bike-pedestrian trails/paths were associated with reduced cancer incidence (β between -0.71 and -1.27, P < 0.05), about 1 case per 100,000 for each 10 percentage-point increase in county population exposure to zoning. Except for crosswalks, each association was mediated by inactivity. However, county smoking attenuated these results, with only crosswalks remaining significant. Results were similar for males (with zoning for bike-pedestrian connectivity, street connectivity, and bike-pedestrian trails/paths), but not females, alone.Conclusions: Zoning can help to create activity-friendly environments that support decreased inactivity, and possibly reduced cancer incidence.Impact: Given low physical activity levels nationwide, cross-sectoral collaborations with urban planning can inform cancer prevention and public health efforts to decrease inactivity and cancer. Cancer Epidemiol Biomarkers Prev; 26(4); 578-86. ©2017 AACRSee all the articles in this CEBP Focus section, "Geospatial Approaches to Cancer Control and Population Sciences."

Evaluation of a midwife- and nurse-delivered 5 A's prenatal smoking cessation program

INTRODUCTION

West Virginia has the highest rate of prenatal smoking in the United States. The aim of this pilot study was to evaluate the implementation of the American College of Obstetricians and Gynecologists' 5 A's smoking cessation intervention among pregnant women being cared for by 5 A's-trained midwives working with a team of nurse researchers in an effort to reduce prenatal smoking exposure. The evidence-based 5 A's smoking cessation program has been recommended for use in prenatal care by health care providers.

METHODS

A pilot study was conducted evaluating the implementation of the 5 A's prenatal smoking cessation program for 35 women who smoked during pregnancy. The women received consistent messages to quit or reduce smoking from the midwives and were followed by the nurse research team via telephone with continued support, guidance, and strategic planning for tobacco exposure reduction.

RESULTS

Among the 35 women who enrolled in the study, 32 (91.4%) decreased smoking and 3 (8.6%) quit smoking by one month after the intervention. For those who continued to smoke, the average number of cigarettes smoked was reduced from 10 cigarettes per day at baseline to 8 cigarettes per day at one month, 7 cigarettes per day at 2 months, and 6 cigarettes per day by the end of pregnancy. The women further reduced their tobacco exposure by delaying the timing of initiating smoking in the morning and by increasing indoor smoking restrictions.

DISCUSSION

Midwives and nurses can be trained in the implementation of the evidence-based 5 A's smoking cessation program for incorporation into regular prenatal care of pregnant women who smoke. By guiding women in techniques aimed at reducing the amount and frequency of cigarette smoking, nurses and midwives facilitate a decrease in prenatal smoking exposure.

Characteristics associated with breastfeeding behaviors among urban versus rural women enrolled in the Kansas WIC program

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a public nutritional assistance program for low-income women and their children up to age five. This study provides insight into maternal characteristics associated with breastfeeding among urban versus rural women. A secondary analysis was conducted using the Pregnancy Nutrition Surveillance System dataset of women enrolled in the Kansas WIC program in 2011. Geographic residency status was obtained through application of the Census tract-based rural-urban commuting area codes. Descriptive variables included maternal demographics, health, and lifestyle behaviors. A multivariable binary logistic regression was used to obtain adjusted odds ratios with 95 % confidence intervals. The outcome variable was initiation of breastfeeding. A P value of ≤0.05 was considered statistically significant. The total sample size was 17,067 women. Statistically significant differences regarding socio-demographics, program participation, and health behaviors for urban and rural WIC participants were observed. About 74 % of all WIC mothers initiated breastfeeding. Urban women who were Hispanic, aged 18-19, high school graduates, household income >$10,000/year, and started early prenatal care were more likely to breastfeed. Urban and rural women who were non-Hispanic black with some high school education were less likely to breastfeed. Increased breastfeeding initiation rates are the result of a collaborative effort between WIC and community organizations. Availability of prenatal services to rural women is critical in the success of breastfeeding promotion. Findings help inform WIC program administrators and assist in enhancing breastfeeding services to the Kansas WIC population.

Magnitude of income-related disparities in adverse perinatal outcomes

BACKGROUND

To assess and compare multiple measurements of socioeconomic position (SEP) in order to determine the relationship with adverse perinatal outcomes across various contexts.

METHODS

A birth registry, the Nova Scotia Atlee Perinatal Database, was confidentially linked to income tax and related information for the year in which delivery occurred. Multiple logistic regression was used to examine odds ratios between multiple indicators of SEP and multiple adverse perinatal outcomes in 117734 singleton births between 1988 and 2003. Models for after tax family income were also adjusted for neighborhood deprivation to gauge the relative magnitude of effects related to SEP at both levels. Effects of SEP were stratified by single- versus multiple-parent family composition, and by urban versus rural location of residence.

RESULTS

The risk of small for gestational age and spontaneous preterm birth was higher across all the indicators of lower SEP, while risk for large for gestational age was lower across indicators of lower SEP. Higher risk of postneonatal death was demonstrated for several measures of lower SEP. Higher material deprivation in the neighborhood of residence was associated with increased risk for perinatal death, small for gestational age birth, and iatrogenic and spontaneous preterm birth. Family composition and urbanicity were shown to modify the association between income and some perinatal outcomes.

CONCLUSIONS

This study highlights the importance of understanding the definitions of SEP and the mechanisms that lead to the association between income and poor perinatal outcomes, and broadening the types of SEP measures used in some cases.

Puberty dysregulation and increased risk of disease in adult life: possible modes of action

Puberty is the developmental window when the final maturation of body systems is orchestrated by hormones; lifelong sex-related differences and capacity to interact with the environment are defined during this life stage. Increased incidence in a number of chronic, multifactorial diseases could be related to environmental exposures during puberty: however, insight on the susceptibility of the peripubertal period is still limited. The estrogen/androgen balance is a crucial axis in harmonizing the whole pubertal development, pointing out the significance of exposures to endocrine disruptors. Besides the reproductive system, endocrine-related perturbations may affect the maturation of skeleton, adipose tissues, brain, immune system, as well as cancer predisposition. Thus, risk assessment of environmental stressors should duly consider specific aspects of the pubertal window. Besides endocrine-related mechanisms, suggested research priorities include signaling molecules (e.g., kisspeptins, dopamine) as xenobiotic targets and disturbances of specific pubertal methylation processes potentially involved in neurobehavioral disorders and cancer risk in adulthood.