Adverse Pregnancy Outcomes Following the Assassination of John F. Kennedy in 1963

The impact of catastrophic events on the sex ratio at birth: A systematic review

OBJECTIVE

The impact of maternal stress on birth outcomes is well established in the scientific research. The sex ratio at birth (SRB), namely the ratio of male to female live births, shows significant alteration when mothers experience acute stress conditions, as proposed by the Trivers-Willard Hypothesis. We aimed to synthetize the literature on the relationship between two exogenous and catastrophic stressful events (natural disasters and epidemics) and SRB.

METHODS

A systematic search was run in Scopus, PubMed, Web of Science, and Cochrane Library, until March 9, 2023. The search produced 1336 articles and 25 articles met the inclusion criteria. We found seven case-control studies and 18 observational studies. Most of studies investigated the impact of earthquakes and other natural disasters. Only seven studies examined the effect of epidemics or pandemics.

RESULTS

The results of the studies seem inconsistent, as 16 studies found a decline in SRB, three found a rise, four did not record any change and two studies gave contradictory results. The period and population analyzed, the source of information, the method of variance analysis in the SRB, and the failure to assess confounding variables may have influenced the incongruence of the results.

CONCLUSION

Our findings contribute to improve the knowledge about the relationship between socio-ecological factors and SRB. Future studies should investigate the mechanisms by which this relationship impacts public health, in particular the health of pregnant women and their newborn, through an accurate and consistent methodology that also includes confounding factors.

Stress of Prematurity in the Experience of the COVID-19 Pandemic-Current State of Knowledge

Stress is a process that triggers various physiological, hormonal and psychological mechanisms in response to a threat, which significantly affects the health of an individual. The COVID-19 pandemic introduced a lot of social changes that required constant adaptation to unfavorable conditions. The aim of the study was to assess the impact of stress related to this pandemic on pregnant women, mothers of premature infants and their families, and on obstetric complications, particularly preterm birth. A comprehensive literature review was performed using electronic databases such as Pubmed, Science Direct and Google Scholar. Keywords such as: "prematurity"; "pregnancy"; "stress"; "COVID-19" and various combinations of the above were used. Maternal stress and anxiety increase the levels of corticotropin-releasing hormone (CRH) in the placenta, which in turn affects the incidence of preterm birth and many other related maternal and neonatal complications. In addition, it was found that SARS-CoV-2 infection may increase the risk of this phenomenon. The COVID-19 pandemic has adversely affected preterm birth rates and the mental health of mothers of preterm infants, exacerbating their negative experience of having a premature baby. More research is needed to demonstrate the long-term effects of COVID-19 stress on prematurity.

Modeling the Likelihood of Low Birth Weight: Findings from a Chicago-Area Health System

OBJECTIVE

This study presents a statistical model of the incidence of low birth weight (LBW) births in a large, Chicago-area hospital system. The study was undertaken to provide a strategic framework for future health system interventions.

METHODS

Administrative and electronic health records were matched to census Zip Code Tabulation Area (ZCTA) household poverty data for 42,681 births in 2016-2019 at seven system hospitals, serving a diverse patient population. A logistic regression model of LBW incidence was estimated to test the independent significance of maternal sociodemographic characteristics after controlling for clinical risk factors.

RESULTS

The incidence of LBW was 6.3% overall but 11.3% among non-Hispanic Black patients as compared to 5.1% among non-Hispanic White patients. LBW incidence ranged from 9.2% for patients from the poorest ZCTA (20% + poor households) compared to 5.6% of patients from the most affluent (< 5% poor) ZCTA. Nulliparous patients, patients with pre-existing chronic conditions, and patients with hypertensive disorders of pregnancy were significantly more likely to have LBW births. After controlling for clinical risk factors and poverty level, non-Hispanic Black patients were still over 80% more likely and to have a LBW birth.

DISCUSSION

Study findings reveal the joint effects of social and clinical risk factors. Findings profile our highest-risk populations for targeted interventions. Promising prenatal care redesign programs include pregnancy patient navigators, home and group visits, eHealth telemonitoring, improved mental health screening, and diversification of the maternity care workforce. Decreasing LBW births should be a national public health policy priority and will require major investments in the most impacted communities.