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Toval CA, Darivemula SM, Wilson TD, Conklin JL, Young OM. Interventions to mitigate pregnancy-related mortality and morbidity in Black birthing people: a systematic review. Am J Obstet Gynecol MFM 2024; 6:101464. [PMID: 39147362 DOI: 10.1016/j.ajogmf.2024.101464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/30/2024] [Accepted: 07/30/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE To conduct a systematic review of interventions to improve perinatal outcomes to mitigate pregnancy-related mortality and morbidity in Black birthing people. DATA SOURCES We searched 5 databases from 2000 through the final search date of April 5, 2023: Cumulative Index of Nursing and Allied Health Literature Plus with Full Text (EBSCOhost), Embase (Elsevier), PubMed, and Scopus (Elsevier) and ClinicalTrials.gov. STUDY ELIGIBILITY CRITERIA Only quantitative studies were eligible including observational and randomized controlled trials. All participants in selected studies must identify as Black or study results must be stratified by race that includes Black birthing people. The study must (1) measure a perinatal outcome of interest (2) occur in the United States and (3) be written in the English language. Studies were excluded if they were published prior to 2000, not published in the English language, or did not meet the criteria above. STUDY APPRAISAL AND SYNTHESIS METHODS A data extraction template identified intervention type and perinatal outcome. Perinatal outcomes included but were not limited to: cardiovascular disorders, mortality, or preterm delivery. Interventions included: community programs, educational enhancement, individual counseling, medical intervention, or policy. Risk of bias was assessed using the Mixed Method Appraisal Tool. Three investigators assessed studies individually and group consensus was used for a final decision. RESULTS From 4,302 unique studies, 41 studies met inclusion criteria. Community programs such as the Supplemental Program for Women, Infants, and Children (WIC) and Healthy Start (n=17, 41.5%) were the most common interventions studied. Individual counseling closely followed (n=15, 36.6%). Medical interventions were not among the more commonly used intervention types (n=9, 21.9%). Most articles focused on preterm delivery (n=28, 68.3%). Few articles studied cardiovascular disorders (n=4, 9.8%) or hemorrhage (n=3, 7.3%). No articles studied pregnancy-related morbidity. CONCLUSIONS Despite current conversations on Black maternal mortality, there is currently limited literature examining interventions addressing perinatal morbidity and mortality in Black birthing people in the United States. These interventions do not address how to mitigate perinatal outcomes of interest. Patient-centered outcomes research is warranted to better understand as well as to resolve inequities related to Black maternal health.
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Affiliation(s)
- Christina A Toval
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC (Toval)
| | - Shilpa M Darivemula
- Division of General Obstetrics, Gynecology, and Midwifery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC (Darivemula)
| | - Tenisha D Wilson
- University of North Carolina at Chapel Hill, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Chapel Hill, NC (Wilson, Young)
| | - Jamie L Conklin
- University of North Carolina at Chapel Hill Health Sciences Library, Chapel Hill, NC (Conklin)
| | - Omar M Young
- University of North Carolina at Chapel Hill, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Chapel Hill, NC (Wilson, Young).
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Klootwijk A, Struijs J, Petrus A, Leemhuis M, Numans M, de Vries E. Do studies evaluating early-life policy interventions fully adhere to the critical conditions of difference-in-differences? A systematic review. BMJ Open 2024; 14:e083927. [PMID: 38760036 PMCID: PMC11103192 DOI: 10.1136/bmjopen-2024-083927] [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: 01/03/2024] [Accepted: 05/03/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVES To assess the reporting and methodological quality of early-life policy intervention papers that applied difference-in-differences (DiD) analysis. STUDY DESIGN Systematic review. DATA SOURCES Papers applying DiD of early-life policy interventions in high-income countries as identified by searching Medline, Embase and Scopus databases up to December, 2022. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS Studies evaluating policy interventions targeting expectant mothers, infants or children up to two years old and conducted in high income countries were included. We focused on seven critical conditions of DiD as proposed in a comprehensive checklist: data requirements, parallel trends, no-anticipation, standard statistical assumptions, common shocks, group composition and spillover. RESULTS The DiD included studies (n=19) evaluating early-life policy interventions in childhood development (n=4), healthcare utilisation and providers (n=4), nutrition programmes (n=3) and economic policies such as prenatal care expansion (n=8). Although none of the included studies met all critical conditions, the most reported and adhered to critical conditions were data requirements (n=18), standard statistical assumptions (n=11) and the parallel trends assumption (n=9). No-anticipation and spillover were explicitly reported and adhered to in two studies and one study, respectively. CONCLUSIONS This review highlights current deficiencies in the reporting and methodological quality of studies using DiD to evaluate early-life policy interventions. As the validity of study conclusions and consequent implications for policy depend on the extent to which critical conditions are met, this shortcoming is concerning. We recommend that researchers use the described checklist to improve the transparency and validity of their evaluations. The checklist should be further refined by adding order of importance or knock-out criteria and may also help facilitate uniform terminology. This will hopefully encourage reliable DiD evaluations and thus contribute to better policies relating to expectant mothers, infants and children.
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Affiliation(s)
- Anouk Klootwijk
- Department for Population Health and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, Netherlands
| | - Jeroen Struijs
- Department for Population Health and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, Netherlands
| | - Annelieke Petrus
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, Netherlands
| | - Marlin Leemhuis
- Department for Population Health and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Mattijs Numans
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, Netherlands
| | - Eline de Vries
- Department for Health Economics and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, Netherlands
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Glazer KB, Vieira L, Weber E, Stone J, Stern T, Bianco A, Wagner B, Nowlin S, Dolan SM, Howell EA, Janevic T. COVID-19 pandemic-related change in racial and ethnic disparities in exclusive breastmilk feeding during the delivery hospitalization: a differences-in-differences analysis. BMC Pregnancy Childbirth 2022; 22:225. [PMID: 35305590 PMCID: PMC8934049 DOI: 10.1186/s12884-022-04570-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Exclusive breastmilk feeding during the delivery hospitalization, a Joint Commission indicator of perinatal care quality, is associated with longer-term breastfeeding success. Marked racial and ethnic disparities in breastfeeding exclusivity and duration existed prior to COVID-19. The pandemic, accompanied by uncertainty regarding intrapartum and postpartum safety practices, may have influenced disparities in infant feeding practices. Our objective was to examine whether the first wave of the COVID-19 pandemic in New York City was associated with a change in racial and ethnic disparities in exclusive breastmilk feeding during the delivery stay. METHODS We conducted a cross-sectional study of electronic medical records from 14,964 births in two New York City hospitals. We conducted a difference-in-differences (DID) analysis to compare Black-white, Latina-white, and Asian-white disparities in exclusive breastmilk feeding in a pandemic cohort (April 1-July 31, 2020, n=3122 deliveries) to disparities in a pre-pandemic cohort (January 1, 2019-February 28, 2020, n=11,842). We defined exclusive breastmilk feeding as receipt of only breastmilk during delivery hospitalization, regardless of route of administration. We ascertained severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection status from reverse transcription-polymerase chain reaction tests from nasopharyngeal swab at admission. For each DID model (e.g. Black-white disparity), we used covariate-adjusted log binomial regression models to estimate racial and ethnic risk differences, pandemic versus pre-pandemic cohort risk differences, and an interaction term representing the DID estimator. RESULTS Exclusive breastmilk feeding increased from pre-pandemic to pandemic among white (40.8% to 46.6%, p<0.001) and Asian (27.9% to 35.8%, p=0.004) women, but not Black (22.6% to 25.3%, p=0.275) or Latina (20.1% to 21.4%, p=0.515) women overall. There was an increase in the Latina-white exclusive breastmilk feeding disparity associated with the pandemic (DID estimator=6.3 fewer cases per 100 births (95% CI=-10.8, -1.9)). We found decreased breastmilk feeding specifically among SARS-CoV-2 positive Latina women (20.1% pre-pandemic vs. 9.1% pandemic p=0.013), and no change in Black-white or Asian-white disparities. CONCLUSIONS We observed a pandemic-related increase in the Latina-white disparity in exclusive breastmilk feeding, urging hospital policies and programs to increase equity in breastmilk feeding and perinatal care quality during and beyond this health emergency.
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Affiliation(s)
- Kimberly B Glazer
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
- The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Luciana Vieira
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
- The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Ellerie Weber
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Joanne Stone
- The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Toni Stern
- The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Angela Bianco
- The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Brian Wagner
- The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Sarah Nowlin
- Center for Nursing Research & Innovation, Department of Nursing, Mount Sinai Hospital, New York, NY, USA
| | - Siobhan M Dolan
- The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Elizabeth A Howell
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Teresa Janevic
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
- The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
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Roman LA, Raffo JE, Strutz KL, Luo Z, Johnson ME, Meulen PV, Henning S, Baker D, Titcombe C, Meghea CI. The Impact of a Population-Based System of Care Intervention on Enhanced Prenatal Care and Service Utilization Among Medicaid-Insured Pregnant Women. Am J Prev Med 2022; 62:e117-e127. [PMID: 34702604 DOI: 10.1016/j.amepre.2021.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/09/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Enhanced prenatal/postnatal care home visiting programs for Medicaid-insured women have significant positive impacts on care and health outcomes. However, enhanced prenatal care participation rates are typically low, enrolling <30% of eligible women. This study investigates the impacts of a population-based systems approach on timely enhanced prenatal care participation and other healthcare utilization. METHODS This quasi-experimental, population-based, difference-in-differences study used linked birth certificates, Medicaid claims, and enhanced prenatal care data from complete statewide Medicaid birth cohorts (2009 to 2015), and was analyzed in 2019-2020. The population-based system intervention included cross-agency leadership and work groups, delivery system redesign with clinical-community linkages, increased enhanced prenatal care-Community Health Worker care, and patient empowerment. Outcomes included enhanced prenatal care participation and early participation, prenatal care adequacy, emergency department contact, and postpartum care. RESULTS Enhanced prenatal care (7.4 percentage points, 95% CI=6.3, 8.5) and first trimester enhanced prenatal care (12.4 percentage points, 95% CI=10.2, 14.5) increased among women served by practices with established clincial-community linkages, relative to that among the comparator group. First trimester enhanced prenatal care improved in the county (17.9, 95% CI=15.7, 20.0), emergency department contact decreased in the practices (-11.1, 95% CI= -12.3, -9.9), and postpartum care improved in the county (7.1, 95% CI=6.0, 8.2). Enhanced prenatal care participation for Black women served by the practices improved (4.4, 95% CI=2.2, 6.6) as well as early enhanced prenatal care (12.3, 95% CI=9.0, 15.6) and use of postpartum care (10.4, 95% CI=8.3, 12.4). CONCLUSIONS A population systems approach improved selected enhanced prenatal care participation and service utilization for Medicaid-insured women in a county population, those in practices with established clinical-community linkages, and Black women.
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Affiliation(s)
- Lee Anne Roman
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan.
| | - Jennifer E Raffo
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Kelly L Strutz
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Zhehui Luo
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | | | - Peggy Vander Meulen
- Strong Beginnings, Healthier Communities, Spectrum Health, Grand Rapids, Michigan
| | - Susan Henning
- Strong Beginnings, Healthier Communities, Spectrum Health, Grand Rapids, Michigan
| | - Dianna Baker
- Kent County Health Department, Grand Rapids, Michigan
| | | | - Cristian I Meghea
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan; Department of Public Health, Babes-Bolyai University, Cluj-Napoca, Romania
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