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Jelliffe-Pawlowski LL, Baer RJ, Oltman S, McKenzie-Sampson S, Afulani P, Amsalu R, Bell AJ, Blebu B, Blackman KC, Chambers CD, Costello J, Fuchs J, Garay O, Karvonen KL, Kuppermann M, Lyndon A, McCulloch CE, Ong G, Ponting C, Rand L, Rogers EE, Ryckman KK, Spellen S, Subramaniam A, Swander L, Taylor KD, Williams S, Tabb KM. Risk and Protective Factors for Preterm Birth Among Racial, Ethnic, and Socioeconomic Groups in California. JAMA Netw Open 2024; 7:e2435887. [PMID: 39331393 PMCID: PMC11437386 DOI: 10.1001/jamanetworkopen.2024.35887] [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: 03/04/2024] [Accepted: 07/26/2024] [Indexed: 09/28/2024] Open
Abstract
Importance Preterm birth (PTB) (gestational age <37 weeks) is a major cause of infant mortality and morbidity in the US and is marked by racial and ethnic and socioeconomic inequities. Further research is needed to elucidate the association of risk and protective factors with trends in PTB rates and with related inequities. Objective To describe the association of PTB rates with inequities as well as related risk and protective factors over the past decade in a US population-based cohort. Design, Setting, and Participants This retrospective cohort study of singleton live births in California from January 1, 2011, to December 31, 2022, was conducted using vital statistics records and hospital records. The cohort included births with a gestational age of 22 to 44 weeks. Main Outcomes and Measures Preterm birth rates by racial and ethnic group and by public and nonpublic insurance (considered as a proxy for socioeconomic status) were studied across years. Log-linear regression (relative risks with 95% CIs) was used to evaluate risk and protective factors within groups. Associations of PTB rates with risk and protective factors were assessed. Results This study included 5 431 018 singleton live births to individuals who identified as American Indian or Alaska Native (0.3%), Asian (14.2%), Black (4.9%), Hispanic (47.8%), or White (27.0%). A total of 43.1% of births were to individuals with public health insurance. From 2011 to 2022, the overall PTB rate increased from 6.8% to 7.5% (change [SE], 10.6% [0.6%]; z score of 18.5; P < .001). Differences in PTB rates and associated changes were observed for racial and ethnic groups and insurance groups. For example, 2022 PTB rates ranged from 5.8% among White individuals with nonpublic insurance to 11.3% among Black individuals with public health insurance. From 2011 to 2022, PTB rates decreased from 9.1% to 8.8% (change [SE], -3.5% [4.2]; z score of -0.8; P = .42) among Black individuals with nonpublic insurance, whereas they increased from 6.4% to 9.5% (change [SE], 49.8% [16.0%]; z score of 3.1; P = .002) among American Indian or Alaska Native individuals with nonpublic insurance. Increases in some risk factors (eg, preexisting diabetes, sexually transmitted infections, mental health conditions) were observed in most groups, and decreases in some protective factors (eg, participation in the California Women, Infants, and Children program) (P for trend < .001 from 2011 to 2021) were observed mostly in low-income groups. Conclusions and Relevance In this cohort study of singleton live births in California, PTB rates increased in many groups. Persistent racial and ethnic and socioeconomic inequities were also observed. Changes in risk and protective factors provided clues to patterns of PTB. These data point to an urgent need to address factors associated with PTB at both the individual and population levels.
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Affiliation(s)
- Laura L. Jelliffe-Pawlowski
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Global Health Sciences, University of California, San Francisco
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- San Diego Study of Outcomes in Mothers and Infants, University of California San Diego, La Jolla
- EGG Healthy Pregnancy, San Francisco, California
| | - Rebecca J. Baer
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- San Diego Study of Outcomes in Mothers and Infants, University of California San Diego, La Jolla
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
- Department of Pediatrics, University of California San Diego, La Jolla
| | - Scott Oltman
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Global Health Sciences, University of California, San Francisco
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
| | - Safyer McKenzie-Sampson
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Patience Afulani
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Global Health Sciences, University of California, San Francisco
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
| | - Ribka Amsalu
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - April J. Bell
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Family Community Medicine, University of California, San Francisco
| | - Bridgette Blebu
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Kacie C.A. Blackman
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Health Sciences, California State University, Northridge
| | - Christina D. Chambers
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- San Diego Study of Outcomes in Mothers and Infants, University of California San Diego, La Jolla
- Department of Pediatrics, University of California San Diego, La Jolla
| | - Jean Costello
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- San Francisco Department of Public Health, San Francisco, California
| | - Jonathan Fuchs
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- San Francisco Department of Public Health, San Francisco, California
| | - Odessa Garay
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Biology, San Francisco State University, San Francisco, California
| | - Kayla L. Karvonen
- California Preterm Birth Initiative, University of California, San Francisco
- Department of Pediatrics, University of California, San Francisco
| | - Miriam Kuppermann
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Audrey Lyndon
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Rory School of Nursing, New York University, New York, New York
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
| | - Giannina Ong
- California Preterm Birth Initiative, University of California, San Francisco
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Carolyn Ponting
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Psychiatry, University of California, San Francisco
| | - Larry Rand
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Elizabeth E. Rogers
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Health Sciences, California State University, Northridge
| | - Kelli K. Ryckman
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington
| | - Solaire Spellen
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Akila Subramaniam
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Departmment of Obstetrics and Gynecology, University of Alabama at Birmingham
| | - Louie Swander
- Department of Health Sciences, California State University, Northridge
| | - Kelly D. Taylor
- Department of Global Health Sciences, University of California, San Francisco
- California Preterm Birth Initiative, University of California, San Francisco
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- Department of Medicine, University of California, San Francisco
| | - Schyneida Williams
- Department of Pediatrics, University of California, San Francisco
- Black Women’s Health and Livelihood Initiative, University of California, San Francisco
| | - Karen M. Tabb
- Healthy Outcomes of Pregnancy for Everyone Research Consortium, University of California, San Francisco
- School of Social Work, University of Illinois Urbana-Champaign, Urbana
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Chan JKN, Lee KCK, Correll CU, So YK, Chan CY, Wong CSM, Cheung KW, Seto MTY, Lin J, Chang WC. Adverse obstetric and neonatal outcomes associated with maternal schizophrenia-spectrum disorders and prenatal antipsychotic use: a meta-analysis of 37,214,330 pregnancy deliveries and propensity-score weighted population-based cohort study assessing confounder dependency of risk estimates. Mol Psychiatry 2024:10.1038/s41380-024-02723-1. [PMID: 39223277 DOI: 10.1038/s41380-024-02723-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 08/19/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
Studies demonstrated increased obstetric and neonatal complications in women with schizophrenia-spectrum disorder (SSD), but most inadequately addressed confounders and rarely considered antipsychotic effects. We conducted a meta-analysis and a population-based cohort study evaluating associations of adverse obstetric/neonatal outcomes with SSD and prenatal antipsychotic use. In the meta-analysis, we searched four databases from inception to October-31-2023 and generated pooled risk estimates using random-effect models. In the cohort study, we identified women aged 15-50 years with SSD-diagnosis from electronic-heath-record database of public healthcare-services who delivered first/singleton children between 2003 and 2018 in Hong Kong. Propensity-score weighted regression-analyses incorporating important confounders including maternal pre-existing and gestational morbidities, substance/alcohol abuse, and psychotropic use, were performed to assess risk of adverse obstetric/neonatal outcomes in SSD-women versus non-SSD-women, and subsequently treated-SSD and untreated-SSD subgroups to disentangle effects of SSD from antipsychotic exposure. The meta-analysis (studies = 18, women = 37,214,330, including 42,926 SSD-women) found significant associations of SSD with 12 of 17 analyzed negative obstetric/neonatal outcomes (with pooled relative risk ranged:1.12-2.10), including placental complications, induced labor, Caesarean delivery, fetal distress, stillbirth, preterm birth, small-for-gestational-age, low birth weight, low APGAR scores, neonatal and post-neonatal deaths. However, the cohort study (466,358 women, including 804 SSD-women) revealed that elevated risk of most study outcomes in unadjusted-models were markedly-attenuated or became non-significant in propensity-score weighted adjusted-models, except index-delivery hospitalization ≥7 days (odds ratio [OR] = 1.76 [95% CI = 1.33-2.34]), preterm birth (OR = 1.48 [95% CI = 1.09-2.00]) and neonatal special-care admission (OR = 1.65 [95% CI = 1.35-2.01]). Apart from higher neonatal special-care admission in treated-SSD than untreated-SSD women (OR = 1.75 [95% CI = 1.23-2.52]), no significant between-group differences emerged in other outcomes. In sum, elevated risk of most obstetric/neonatal complications reported in SSD-women might largely be explained by maternal physical comorbidities, substance/alcohol use disorders and other confounders. Interventions targeting modifiable maternal risk factors should be incorporated in prenatal care for SSD-women to minimize avoidable adverse outcomes.
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Affiliation(s)
- Joe Kwun Nam Chan
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Krystal Chi Kei Lee
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Yuen Kiu So
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ching Yui Chan
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Corine Sau Man Wong
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ka Wang Cheung
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Mimi Tin-Yan Seto
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jessie Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Wing Chung Chang
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China.
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Baer RJ, Bandoli G, Jelliffe-Pawlowski LL, Rhee KE, Chambers CD. Adverse live-born pregnancy outcomes among pregnant people with anorexia nervosa. Am J Obstet Gynecol 2024; 231:248.e1-248.e14. [PMID: 38008148 DOI: 10.1016/j.ajog.2023.11.1242] [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: 09/07/2023] [Revised: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Previous findings related to the association of adverse pregnancy outcomes with anorexia nervosa are mixed. OBJECTIVE This study aimed to investigate the association of adverse live-born pregnancy outcomes with anorexia nervosa using adjustment modeling accounting for confounding factors, and a mediation analysis addressing the contribution of underweight prepregnancy body mass index and gestational weight gain to those outcomes. STUDY DESIGN The sample included California live-born singletons with births between 2007 and 2021. The administrative data set contained birth certificates linked to hospital discharge records. Anorexia nervosa diagnosis during pregnancy was obtained from International Classification of Diseases codes on hospital discharge records. Adverse pregnancy outcomes examined included gestational diabetes, gestational hypertension, preeclampsia, anemia, antepartum hemorrhage, premature rupture of membranes, premature labor, cesarean delivery, oligohydramnios, placenta previa, chorioamnionitis, placental abruption, severe maternal morbidity, small for gestational age, large for gestational age, low birthweight, and preterm birth (by timing and indication). Risk of each adverse outcome was calculated using Poisson regression models. Unadjusted risk of each adverse outcome was calculated, and then the risks were adjusted for demographic factors. The final adjusted model included demographic factors, anxiety, depression, substance use, and smoking. A mediation analysis was performed to estimate the excess risk of adverse outcomes mediated by underweight prepregnancy body mass index and gestational weight gain below the American College of Obstetricians and Gynecologists recommendation. RESULTS The sample included 241 pregnant people with a diagnosis of anorexia nervosa and 6,418,236 pregnant people without an eating disorder diagnosis. An anorexia nervosa diagnosis during pregnancy was associated with many adverse pregnancy outcomes in unadjusted models (relative risks ranged from 1.65 [preeclampsia] to 3.56 [antepartum hemorrhage]) in comparison with people without an eating disorder diagnosis. In the final adjusted models, birthing people with an anorexia nervosa diagnosis were more likely to have anemia, preterm labor, oligohydramnios, severe maternal morbidity, a small for gestational age or low-birthweight infant, and preterm birth between 32 and 36 weeks with spontaneous preterm labor (adjusted relative risks ranged from 1.43 to 2.55). Underweight prepregnancy body mass index mediated 7.78% of the excess in preterm births and 18.00% of the excess in small for gestational age infants. Gestational weight gain below the recommendation mediated 38.89% of the excess in preterm births and 40.44% of the excess in low-birthweight infants. CONCLUSION Anorexia nervosa diagnosis during pregnancy was associated with a number of clinically important adverse pregnancy outcomes in comparison with people without an eating disorder diagnosis. Adjusting for anxiety, depression, substance use, and smoking during pregnancy decreased this risk. A substantial percentage of the excess risk of adverse outcomes was mediated by an underweight prepregnancy body mass index, and an even larger proportion of excess risk was mediated by gestational weight gain below the recommendation. This information is important for clinicians to consider when caring for patients with anorexia nervosa. Considering and treating anorexia nervosa and comorbid conditions and counseling patients about mediating factors such as preconception weight and gestational weight gain may improve live-born pregnancy outcomes among people with anorexia nervosa.
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Affiliation(s)
- Rebecca J Baer
- Department of Pediatrics, University of California San Diego, San Diego, CA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA.
| | - Gretchen Bandoli
- Department of Pediatrics, University of California San Diego, San Diego, CA
| | - Laura L Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Kyung E Rhee
- Department of Pediatrics, University of California San Diego, San Diego, CA
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Abe N, Baer RJ, Jelliffe-Pawlowski L, Chambers CD, Bandoli G. Maternal Mental Health Diagnoses and Infant Emergency Department Use, Hospitalizations, and Death. Acad Pediatr 2024; 24:451-460. [PMID: 38103588 DOI: 10.1016/j.acap.2023.11.021] [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: 05/08/2023] [Revised: 11/12/2023] [Accepted: 11/18/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The period surrounding childbirth is a uniquely vulnerable time for women and their mental health. We sought to describe the association between maternal mental health diagnoses in the year prior and after birth and infant Emergency Department (ED) utilization, hospitalization, and death. METHODS We studied mothers who gave singleton live birth in California (2011-2017) and their infants using linked infant birth and death certificates and maternal and infant discharge records. Maternal mental health diagnoses in the year before and after birth were identified using International Classification of Diseases (ICD) codes. We abstracted infant ED visits, hospitalizations, discharge diagnoses, deaths, and causes of death. Log-linear regression was used to compare relative risks of infant outcomes between mothers with and without mental health diagnoses, adjusting for maternal variables. RESULTS Of the 3,067,069 mother-infant pairs, 85,047 (2.8%) mothers had at least one mental health diagnosis in the year before and after birth. Infants of mothers with mental health diagnoses were more likely to visit the ED (aRR 1.2, CI:1.1-1.2), have three or more ED visits (aRR 1.4, CI:1.3-1.4), be hospitalized (aRR 1.1, CI:1.04-1.1), and die (aRR 1.7, CI:1.6-1.8) in the first year of life. These infants were also more likely to be diagnosed with accidental injuries, nonaccidental trauma, and non-specific descriptive diagnosis (fussiness/fatigue/brief resolved unexplained event). CONCLUSION This large administrative cohort study showed associations between maternal mental health diagnoses and infant acute ED visits, hospitalization, and death. This study underscores the urgent need to understand what is driving these findings and how to mitigate this risk.
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Affiliation(s)
- Naomi Abe
- Department of Pediatrics (N Abe, RJ Baer, CD Chambers, and G Bandoli), University of California San Diego School of Medicine, La Jolla, Calif; Division of Emergency Medicine (N Abe), Rady Children's Hospital San Diego, San Diego, Calif.
| | - Rebecca J Baer
- Department of Pediatrics (N Abe, RJ Baer, CD Chambers, and G Bandoli), University of California San Diego School of Medicine, La Jolla, Calif
| | - Laura Jelliffe-Pawlowski
- Department of Epidemiology and Biostatistics (L Jelliffe-Pawlowski), University of California San Francisco
| | - Christina D Chambers
- Department of Pediatrics (N Abe, RJ Baer, CD Chambers, and G Bandoli), University of California San Diego School of Medicine, La Jolla, Calif; Herbert Wertheim School of Public Health and Human Longevity Science (CD Chambers), University of California San Diego, La Jolla, Calif
| | - Gretchen Bandoli
- Department of Pediatrics (N Abe, RJ Baer, CD Chambers, and G Bandoli), University of California San Diego School of Medicine, La Jolla, Calif
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Trends in antenatal depression and suicidal ideation diagnoses among commercially insured childbearing individuals in the United States, 2008-2018. J Affect Disord 2023; 320:263-267. [PMID: 36179783 PMCID: PMC9675712 DOI: 10.1016/j.jad.2022.09.120] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/04/2022] [Accepted: 09/25/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Antenatal depression and suicidal ideation represent serious pregnancy-related complications, yet comprehensive estimates of the prevalence and predictors of these diagnoses among birthing people remain unclear. OBJECTIVE This study aimed to characterize trends in the prevalence of depression and suicidal ideation diagnoses identified among pregnant individuals prior to giving birth. METHODS This study included 536,647 individuals aged 15-44 years continuously enrolled in a single commercial health insurance plan for one year before childbirth from 2008 to 2018. The primary outcomes included depression or suicidal ideation based on identification of the relevant ICD-9 and ICD-10 diagnosis codes during pregnancy. RESULTS Rates (95 % CIs) of depression increased by 39 % from 540 (520-560) per 10,000 individuals in 2008 to 750 (730-770) per 10,000 individuals in 2018. Suicidal ideation increased by 100 % from 15 (12-18) per 10,000 individuals in 2008 to 44 (39-50) per 10,000 individuals in 2018. Black birthing people experiencing the sharpest proportional increases. CONCLUSIONS The prevalence of depression and suicidal ideation occurring during pregnancy substantially increased over a ten-year period. Further, suicidal ideation diagnosis increased the most for among Black birthing people compared to all groups, resulting in a need for future studies in this area to determine the reasons for an increase in diagnosis and any change in resulting treatment of follow up.
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Vanes LD, Murray RM, Nosarti C. Adult outcome of preterm birth: Implications for neurodevelopmental theories of psychosis. Schizophr Res 2022; 247:41-54. [PMID: 34006427 DOI: 10.1016/j.schres.2021.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 12/22/2022]
Abstract
Preterm birth is associated with an elevated risk of developmental and adult psychiatric disorders, including psychosis. In this review, we evaluate the implications of neurodevelopmental, cognitive, motor, and social sequelae of preterm birth for developing psychosis, with an emphasis on outcomes observed in adulthood. Abnormal brain development precipitated by early exposure to the extra-uterine environment, and exacerbated by neuroinflammation, neonatal brain injury, and genetic vulnerability, can result in alterations of brain structure and function persisting into adulthood. These alterations, including abnormal regional brain volumes and white matter macro- and micro-structure, can critically impair functional (e.g. frontoparietal and thalamocortical) network connectivity in a manner characteristic of psychotic illness. The resulting executive, social, and motor dysfunctions may constitute the basis for behavioural vulnerability ultimately giving rise to psychotic symptomatology. There are many pathways to psychosis, but elucidating more precisely the mechanisms whereby preterm birth increases risk may shed light on that route consequent upon early neurodevelopmental insult.
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Affiliation(s)
- Lucy D Vanes
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, King's College London, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Chiara Nosarti
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, King's College London, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Edvardsson K, Hughes E, Copnell B, Mogren I, Vicendese D, Gray R. Severe mental illness and pregnancy outcomes in Australia. A population-based study of 595 792 singleton births 2009-2016. PLoS One 2022; 17:e0264512. [PMID: 35226688 PMCID: PMC8884496 DOI: 10.1371/journal.pone.0264512] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 02/14/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Women with Severe Mental Illness (SMI) may have more complex pregnancies and pregnancy outcomes that require different care and management, but this has not been extensively studied. The aim of this study was to explore associations between SMI and adverse maternal and infant outcomes in the state of Victoria, Australia. METHODS Our sample included all reported live singleton births in Victoria 2009-2016 (N = 595 792). Associations between SMI and adverse pregnancy outcomes were explored using Odds Ratios (OR), adjusted for sociodemographic and lifestyle factors, and co-morbidities, including any other mental illness. RESULTS Of all singleton births, 2046 (0.34%) were to a mother diagnosed with a SMI. We found evidence of an association between SMI and a range of adverse maternal and infant outcomes. Compared to women without SMI, women with a SMI had higher adjusted odds of being admitted to a High Dependency Unit or Intensive Care Unit (aOR 1.83, 1.37-2.43), having gestational diabetes mellitus (1.57, 1.34-1.84), undergoing an unplanned caesarean section (1.17, 1.02-1.33), induction of labour (1.17, 1.05-1.30) and postpartum haemorrhage (1.15, 1.03-1.29). Newborns of women with SMI had higher adjusted odds of being admitted to Special Care Nursery (aOR 1.61, 1.43-1.80), a low Apgar score at 5 minutes (1.50, 1.19-1.90), preterm birth (1.40, 1.20-1.63), and low birthweight (1.26, 1.06-1.49). CONCLUSION Women with SMI are at higher risk for a range of adverse maternal and infant outcomes and are a population that may benefit from targeted early identification and enhanced antenatal care.
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Affiliation(s)
- Kristina Edvardsson
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia
| | - Elizabeth Hughes
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
- Faculty of Medicine and Health, School of Healthcare, University of Leeds, Leeds, United Kingdom
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
| | - Ingrid Mogren
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia
- Department of Clinical sciences, Obstetrics and Gynaecology, Umea University, Umea, Sweden
| | - Don Vicendese
- The Department of Mathematics and Statistics, La Trobe University, Bundoora, Victoria, Australia
- The Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
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Baer RJ, Chambers BD, Coleman-Phox K, Flowers E, Fuchs JD, Oltman SP, Scott KA, Ryckman KK, Rand L, Jelliffe-Pawlowski LL. Risk of early birth by body mass index in a propensity score-matched sample: A retrospective cohort study. BJOG 2022; 129:1704-1711. [PMID: 35133077 DOI: 10.1111/1471-0528.17120] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/20/2021] [Accepted: 01/22/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Evaluate the risk of preterm (<37 weeks) or early term birth (37 or 38 weeks) by body mass index (BMI) in a propensity score-matched sample. DESIGN Retrospective cohort analysis. SETTING California, USA. POPULATION Singleton live births from 2011-2017. METHODS Propensity scores were calculated for BMI groups using maternal factors. A referent sample of women with a BMI between 18.5 and <25.0 kg/m2 was selected using exact propensity score matching. Risk ratios for preterm and early term birth were calculated. MAIN OUTCOME MEASURES Early birth. RESULTS Women with a BMI <18.5 kg/m2 were at elevated risk of birth of 28-31 weeks (relative risk [RR] 1.2, 95% CI 1.1-1.4), 32-36 weeks (RR 1.3, 95% CI 1.2-1.3), and 37 or 38 weeks (RR 1.1, 95% CI 1.1-1.1). Women with BMI ≥25.0 kg/m2 were at 1.2-1.4-times higher risk of a birth <28 weeks and were at reduced risk of a birth between 32 and 36 weeks (RR 0.8-0.9) and birth during the 37th or 38th week (RR 0.9). CONCLUSION Women with a BMI <18.5 kg/m2 were at elevated risk of a preterm or early term birth. Women with BMI ≥25.0 kg/m2 were at elevated risk of a birth <28 weeks. Propensity score-matched women with BMI ≥30.0 kg/m2 were at decreased risk of a spontaneous preterm birth with intact membranes between 32 and 36 weeks, supporting the complexity of BMI as a risk factor for preterm birth.
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Affiliation(s)
- Rebecca J Baer
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA.,The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, USA
| | - Brittany D Chambers
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Kimberly Coleman-Phox
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Elena Flowers
- Departments of Nursing and Institute for Human Genomics, University of California, San Francisco, California, USA
| | - Jonathan D Fuchs
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, USA.,San Francisco Department of Public Health, San Francisco, California, USA
| | - Scott P Oltman
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Karen A Scott
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, USA
| | - Kelli K Ryckman
- Departments of Epidemiology and Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Larry Rand
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Laura L Jelliffe-Pawlowski
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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9
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Schizophrenia pregnancies should be given greater health priority in the global health agenda: results from a large-scale meta-analysis of 43,611 deliveries of women with schizophrenia and 40,948,272 controls. Mol Psychiatry 2022; 27:3294-3305. [PMID: 35804094 PMCID: PMC9264309 DOI: 10.1038/s41380-022-01593-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/12/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022]
Abstract
Women with schizophrenia and their newborns are at risk of adverse pregnancy, delivery, neonatal and child outcomes. However, robust and informative epidemiological estimates are lacking to guide health policies to prioritise and organise perinatal services. For the first time, we carried out a systematic review and meta-analysis to synthesise the accumulating evidence on pregnancy, delivery, neonatal complications, and infant mortality among women with schizophrenia and their newborns (N = 43,611) vs. controls (N = 40,948,272) between 1999 and 2021 (26 population-based studies from 11 high-income countries) using random effects. Women with schizophrenia had higher odds (OR) of gestational diabetes (2.35, 95% CI: [1.57-3.52]), gestational hypertension, pre-eclampsia/eclampsia (OR 1.55, 95% CI: [1.02-2.36]; 1.85, 95% CI: [1.52-2.25]), antepartum and postpartum haemorrhage (OR 2.28, 95% CI: [1.58-3.29]; 1.14, 95% CI: [1.04-1.24]), placenta abruption, threatened preterm labour, and premature rupture of membrane (OR 2.20, 95% CI: [2.02-2.39]; 2.91, 95% CI: [1.57-5.40]; 1.29, 95% CI: [1.06-1.58]), c-section (OR 1.33, 95% CI: [1.22-1.45]), foetal distress (OR 1.80, 95% CI: [1.43-2.26]), preterm and very preterm delivery (OR 1.79, 95% CI: [1.62-1.98]; 2.31, 95% CI: [1.78-2.98]), small for gestational age and low birth weight (OR 1.63, 95% CI: [1.48-1.80]; 1.75, 95% CI: [1.46-2.11]), congenital malformations (OR 1.86, 95% CI: [1.71-2.03]), and stillbirths (OR 2.06, 95% CI: [1.83-2.31]). Their newborns had higher odds of neonatal death (OR 1.41, 95% CI: [1.03-1.94]), post-neonatal death (OR 2.87, 95% CI: [2.11-3.89]) and infant mortality (OR 2.33, 95% CI: [1.81-3.01]). This large-scale meta-analysis confirms that schizophrenia is associated with a substantially increased risk of very preterm delivery, stillbirth, and infant mortality, and metabolic risk in mothers. No population-based study has been carried out in low- and middle-income countries in which health problems of women with schizophrenia are probably more pronounced. More research is needed to better understand the complex needs of women with schizophrenia and their newborns, determine how care delivery could be optimised, and define best practices. Study registration: PROSPERO CRD42020197446.
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10
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Fabre C, Pauly V, Baumstarck K, Etchecopar-Etchart D, Orleans V, Llorca PM, Blanc J, Lancon C, Auquier P, Boyer L, Fond G. Pregnancy, delivery and neonatal complications in women with schizophrenia: a national population-based cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2021; 10:100209. [PMID: 34806069 PMCID: PMC8589714 DOI: 10.1016/j.lanepe.2021.100209] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Existing studies evaluating the association between schizophrenia and complications associated with pregnancy, delivery and neonatal outcomes are based on data prior to 2014 and have reported heterogeneous results. The objective of our study was to determine whether pregnant women with schizophrenia were at increased risk of pregnancy, delivery and neonatal complications compared with women without severe mental disorders. Methods We performed a population-based cohort study of all singleton deliveries in France between Jan. 1, 2015, and Dec. 31, 2019. We divided this population into cases (i.e., women with schizophrenia) and controls (i.e., women without a diagnosis of severe mental disorder). Cases and controls were matched (1:4) inside the same hospital and the same year by age, social deprivation, parity, smoking, alcohol and substance addictions, malnutrition, obesity, and comorbidities. Univariate and multivariate models with odds ratios and 95% confidence intervals (ORs [95% CIs]) were used to estimate the association between schizophrenia and 24 pregnancy, delivery and neonatal outcomes. Findings Over 5 years, 3,667,461 singleton deliveries were identified, of which 3,108 occurred in women with schizophrenia. Compared to controls, women with schizophrenia were found to be older; have more frequent smoking, alcohol and substance addictions; suffer from obesity, diabetes and chronic obstructive pulmonary disease; and often be hospitalized in tertiary maternity hospitals. Compared to matched controls, women with schizophrenia had more pregnancy complications (adjusted OR=1.41[95%CI 1.31-1.51]) (i.e., gestational diabetes, gestational hypertension, genito-urinary infection, intrauterine growth retardation and threatened preterm labour). They had more delivery complications (aOR=1.18[95%CI 1.09 1.29]) with more still births/medical abortions (aOR=2.17[95%CI 1.62-2.90]) and caesarean sections (aOR=1.15[95%CI 1.05-1.25]). Newborns of women with schizophrenia had more neonatal complications (aOR=1.38[95%CI 1.27-1.50]) with more born preterm (aOR=1.64[95%CI1.42 -1.90]), small for gestational age (aOR=1.34[95%CI 1.19-1.50]) and low birth weight (aOR=1.75[95%CI 1.53-2.00]). Interpretation Our results highlight the importance of health disparities between pregnant women with and without schizophrenia, as well as in their newborns. Our study calls for health policy interventions during and before pregnancy, including proportionate intensified care to the level of needs, effective case management and preventive and social determinant approaches. Funding No funding.
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Affiliation(s)
- Cyprien Fabre
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.,Department of Medical Information, Assistance Publique - Hôpitaux Marseille, Marseille, France.,Department of Epidemiology and Health Economics, Assistance Publique - Hôpitaux Marseille, Marseille, France
| | - Vanessa Pauly
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.,Department of Medical Information, Assistance Publique - Hôpitaux Marseille, Marseille, France
| | - Karine Baumstarck
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | | | - Veronica Orleans
- Department of Medical Information, Assistance Publique - Hôpitaux Marseille, Marseille, France
| | - Pierre-Michel Llorca
- Department of Psychiatry, CHU Clermont-Ferrand, Clermont-Ferrand, France.,FondaMental Fondation, Creteil, France
| | - Julie Blanc
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.,Department of Obstetrics and Gynaecology, APHM, Nord Hospital, Marseille, France
| | - Christophe Lancon
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.,Department of Psychiatry, Assistance Publique - Hôpitaux Marseille, Marseille, France
| | - Pascal Auquier
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.,Department of Epidemiology and Health Economics, Assistance Publique - Hôpitaux Marseille, Marseille, France
| | - Laurent Boyer
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.,Department of Medical Information, Assistance Publique - Hôpitaux Marseille, Marseille, France.,Department of Epidemiology and Health Economics, Assistance Publique - Hôpitaux Marseille, Marseille, France.,FondaMental Fondation, Creteil, France
| | - Guillaume Fond
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.,Department of Medical Information, Assistance Publique - Hôpitaux Marseille, Marseille, France.,Department of Epidemiology and Health Economics, Assistance Publique - Hôpitaux Marseille, Marseille, France.,Department of Obstetrics and Gynaecology, APHM, Nord Hospital, Marseille, France.,FondaMental Fondation, Creteil, France
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11
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Shenassa ED, Widemann LG, Hunt CD. Antepartum Depression and Preterm Birth: Pathophysiology, Epidemiology, and Disparities due to structural racism. Curr Psychiatry Rep 2021; 23:14. [PMID: 33630175 DOI: 10.1007/s11920-021-01223-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Informed by the evidence of links between physiology of stress and parturition, we review recent epidemiologic evidence (2015-2020) of antenatal depression as a risk factor for preterm birth (PTB). We also explain racial/ethnic disparities in depression and preterm birth as a consequence of structural racism. RECENT FINDINGS Epidemiologic evidence is consistent in linking antepartum depression with an elevated risk of PTB. Antidepressant usage has been linked with an elevated risk of PTB. However, recent evidence suggests that severity of depression is the underlying driver of the elevated risk attributed to antidepressant usage. The number of depressive symptoms, as a proxy for severity of maternal stress, may be a more informative predictor of PTB than criterion based predictors. Across various study designs, measurement modalities, and populations, antenatal depression predicts an elevated risk of delivering preterm. The physiology of stress provides a plausible explanation for this observation. Excessive stress-induced elevations in maternal and then fetal HPA hormones can alter maternal and fetal homeostasis and hasten the timing of parturition. Antenatal depression and exposure to structural racism are two stressors that can trigger the maternal stress response. Chronically elevated levels of stress hormones among women of color in the USA provide a likely physiologic explanation for Black-White disparities in the risk of PTB. Focusing on the number of depressive symptoms as the more informative predictor of PTB raises several questions. We consider these questions as well as directions for future research in the context of recent advances in the field.
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Affiliation(s)
- Edmond D Shenassa
- Maternal & Child Health Program, Department of Family Science; and Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA. .,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA. .,Department of Epidemiology & Biostatistics, School of Medicine, University of Maryland, Baltimore, MD, USA.
| | - Lea G Widemann
- Maternal & Child Health Program, Department of Family Science; and Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
| | - Cole D Hunt
- Maternal & Child Health Program, Department of Family Science; and Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
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12
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Atkinson KD, Nobles CJ, Kanner J, Männistö T, Mendola P. Does maternal race or ethnicity modify the association between maternal psychiatric disorders and preterm birth? Ann Epidemiol 2020; 56:34-39.e2. [PMID: 33393465 DOI: 10.1016/j.annepidem.2020.10.009] [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: 03/02/2020] [Revised: 10/04/2020] [Accepted: 10/20/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Preterm birth risk has been linked to maternal racial and ethnic background, particularly African American heritage; however, the association of maternal race and ethnicity with psychiatric disorders and preterm birth has received relatively limited attention. METHODS The Consortium on Safe Labor (2002-2008) is a nationwide U.S. cohort study with 223,394 singleton pregnancies. Clinical data were obtained from electronic medical records, including maternal diagnoses of psychiatric disorders. Relative risk (RR) and 95% confidence intervals (CI) were estimated for the association between maternal psychiatric disorders and preterm birth (<37 completed weeks) using log-binomial regression with generalized estimating equations. The interaction effect of maternal psychiatric disorders with race and ethnicity was also evaluated. RESULTS Non-Hispanic White (RR, 1.42; 95% CI, 1.35-1.49), Hispanic (RR, 1.44; 95% CI, 1.29-1.60), and non-Hispanic Black (RR, 1.21, 95% CI, 1.13-1.29) women with any psychiatric disorder were at increased risk for delivering preterm infants, compared with women without any psychiatric disorder. However, non-Hispanic Black women with any psychiatric disorder, depression, bipolar disorder, and schizophrenia had a significantly lower increase in preterm birth risk than non-Hispanic White women. CONCLUSIONS Despite the significant association between maternal psychiatric disorders and preterm birth risk, psychiatric disorders did not appear to contribute to racial and ethnic disparities in preterm birth.
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Affiliation(s)
| | - Carrie J Nobles
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Jenna Kanner
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Tuija Männistö
- Northern Finland Laboratory Centre NordLab, Oulu, Finland; Department of Clinical Chemistry, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; National Institute for Health and Welfare, Oulu, Finland
| | - Pauline Mendola
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
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13
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Marshall CA, Jomeen J, Huang C, Martin CR. The Relationship between Maternal Personality Disorder and Early Birth Outcomes: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165778. [PMID: 32785040 PMCID: PMC7460127 DOI: 10.3390/ijerph17165778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 02/06/2023]
Abstract
(1) Background: Women with personality disorder are at risk of social and emotional problems which impact deleteriously on everyday functioning. Moreover, a personality disorder diagnosis has been established to have an adverse impact upon pregnancy outcomes and child health. Understanding this impact is critical to improving both maternal and child outcomes. This systematic review and meta-analysis will evaluate the contemporary evidence regarding these relationships. (2) Methods: Prospero and Cochrane were searched for any systematic reviews already completed on this topic. Academic Search Premier, CINAHL Complete, MEDLINE, PsycARTICLES, PsycINFO via the EBSCO host, and the Web of Science Core Collection were searched to include research articles published between 1980 and 2019. A total of 158 records were identified; 105 records were screened by reviewing the abstract; 99 records were excluded; 6 full text articles were assessed for eligibility; 5 records were included in the review. (3) Results: All the included studies reported on preterm birth. The meta-analysis indicates significant risk of preterm birth in women with personality disorder (overall odds ratio (OR) 2.62; CI 2.24–3.06; p < 0.01). Three studies reported on low birth weight, with the meta-analysis indicating a raised risk of low birth weight of the babies born to women with personality disorder (overall OR 2.00 CI 1.12–3.57 (p = 0.02)). Three studies reported on appearance, pulse, grimace, activity, and respiration (APGAR) score, with the meta-analysis of OR’s indicating a risk of low APGAR score in women with personality disorder (overall OR 2.31; CI 1.17–4.55; p = 0.02). (4) Conclusions: The infants of women with personality disorder are at elevated risk of preterm birth, low birth weight and low APGAR score.
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Affiliation(s)
- Claire A. Marshall
- Perinatal Mental Health Liaison Team, Humber Teaching NHS Foundation Trust, Hull HU2 8TD, UK;
| | - Julie Jomeen
- School of Health and Human Sciences, Southern Cross University, Lismore, NSW 2480, Australia;
| | - Chao Huang
- Hull York Medical School, University of Hull, Hull HU6 7RX, UK;
| | - Colin R. Martin
- Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull HU6 7RX, UK
- Correspondence:
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14
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Bandoli G, Singh N, Strouse J, Baer RJ, Donovan BM, Feuer SK, Nidey N, Ryckman KK, Jelliffe-Pawlowski LL, Chambers CD. Mediation of Adverse Pregnancy Outcomes in Autoimmune Conditions by Pregnancy Complications: A Mediation Analysis of Autoimmune Conditions and Adverse Pregnancy Outcomes. Arthritis Care Res (Hoboken) 2020; 72:256-264. [PMID: 31373768 PMCID: PMC7351244 DOI: 10.1002/acr.24037] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/30/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Autoimmune conditions are associated with an increased risk of adverse pregnancy complications and outcomes, suggesting that pregnancy complications may mediate the excess risk. We performed a causal mediation analysis to quantify the mediated effects of autoimmune conditions on adverse pregnancy outcomes. METHODS We queried a California birth cohort created from linked birth certificates and hospital discharge summaries. From 2,963,888 births, we identified women with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), psoriasis, and inflammatory bowel disease (IBD). Pregnancy complications included preeclampsia/hypertension, gestational diabetes mellitus, and infection in pregnancy. Adverse pregnancy outcomes were preterm birth, cesarean delivery, and small for gestational age. We performed a mediation analysis to estimate the total effects of each autoimmune condition and adverse pregnancy outcome and the indirect effects through pregnancy complications. RESULTS All 4 autoimmune conditions were associated with preterm birth and cesarean delivery, and RA, SLE, and IBD were associated with offspring that were small for gestational age. The strongest mediator of RA, SLE, and psoriasis was preeclampsia/hypertension, accounting for 20-33% of the excess risk of preterm births and 10-19% of excess cesarean deliveries. Gestational diabetes mellitus and infections generally mediated <10% of excess adverse pregnancy outcomes. Of the 4 autoimmune conditions, selected pregnancy complications mediated the least number of adverse pregnancy outcomes among women with IBD. CONCLUSION We found evidence that some excess risk of adverse pregnancy outcomes is mediated through pregnancy complications, particularly preeclampsia/hypertension. Quantifying excess risk and associated pathways provides insight into the underlying etiologies of adverse pregnancy outcomes and can inform intervention strategies.
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Affiliation(s)
- Gretchen Bandoli
- Departments of Pediatrics and Family Medicine & Public Health, University of California San Diego
| | - Namrata Singh
- Division of Allergy, Immunology and Rheumatology, University of Iowa Hospitals and Clinics and Iowa City VA Medical Center, Iowa City, Iowa 52246
| | - Jennifer Strouse
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Rebecca J. Baer
- California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, CA
| | | | - Sky K. Feuer
- California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, CA
| | | | | | - Laura L. Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, CA
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA
| | - Christina D. Chambers
- Departments of Pediatrics and Family Medicine & Public Health, University of California San Diego
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15
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Südekum L, Redlich A, Radusch A, Seeger S, Kropf S, Zhou L, Costa SD, Jorch G, Rissmann A. The impact of neuropsychiatric disease on fetal growth: a case-control study. Arch Gynecol Obstet 2019; 300:1591-1600. [PMID: 31696368 DOI: 10.1007/s00404-019-05361-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: 06/13/2019] [Accepted: 10/25/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the impact of depression, epilepsy and drug abuse during pregnancy on delivery and fetal outcome. Due to the worldwide increasing prevalence of neurological and psychiatric diseases and drug abuse, the number of affected pregnant women is increasing. METHODS A large-scale retrospective case-control analysis of pregnancies affected by depression, epilepsy or drug abuse with and without medication was conducted in two German perinatal centres between 2013 and 2017. The case group consisted of 706 pregnant women who had a diagnosis of depression, epilepsy or drug abuse vs. 12,574 pregnant women without neuropsychiatric diagnosis (control group). The analysis included the rate of intrauterine growth restriction, birth weight and length, neonatal head circumference. RESULTS Significant differences in the subgroups were found in the parameters intrauterine growth restriction, birth weight, length and head circumference. Women with epilepsy were affected less often than women with depression and substance abuse. Major differences were found in the group of women with substance abuse. Negative associations were found within the non-pharmacologically managed disease group itself compared to women exposed to medication. CONCLUSION The present results demonstrated a negative association between maternal neurological or psychiatric disease and pregnancy outcome in the examined parameters. However, the non-pharmacologically treated maternal disease was identified as a risk factor itself.
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Affiliation(s)
- Lara Südekum
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke-University Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - Anke Redlich
- Department of Obstetrics and Gynaecology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Anja Radusch
- Department of Gynaecology and Obstetrics, Perinatal Centre, St. Elisabeth and St. Barbara Halle, Halle/Saale, Germany
| | - Sven Seeger
- Department of Gynaecology and Obstetrics, Perinatal Centre, St. Elisabeth and St. Barbara Halle, Halle/Saale, Germany
| | - Siegfried Kropf
- Institute for Biometry and Medical Informatics, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Ligang Zhou
- Department of Neonatology, Chongqing Maternal and Child Health Hospital, Chongqing, China
| | - Serban-Dan Costa
- Department of Obstetrics and Gynaecology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Gerhard Jorch
- Department of Paediatrics, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke-University Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany.
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16
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Associations between unstable housing, obstetric outcomes, and perinatal health care utilization. Am J Obstet Gynecol MFM 2019; 1:100053. [PMID: 33345843 DOI: 10.1016/j.ajogmf.2019.100053] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND While there is a growing interest in addressing social determinants of health in clinical settings, there are limited data on the relationship between unstable housing and both obstetric outcomes and health care utilization. OBJECTIVE The objective of the study was to investigate the relationship between unstable housing, obstetric outcomes, and health care utilization after birth. STUDY DESIGN This was a retrospective cohort study. Data were drawn from a database of liveborn neonates linked to their mothers' hospital discharge records (2007-2012) maintained by the California Office of Statewide Health Planning and Development. The analytic sample included singleton pregnancies with both maternal and infant data available, restricted to births between the gestational age of 20 and 44 weeks, who presented at a hospital that documented at least 1 woman as having unstable housing using the International Classification of Diseases, ninth edition, codes (n = 2,898,035). Infants with chromosomal abnormalities and major birth defects were excluded. Women with unstable housing (lack of housing or inadequate housing) were identified using International Classification of Diseases, ninth edition, codes from clinical records. Outcomes of interest included preterm birth (<37 weeks' gestational age), early term birth (37-38 weeks gestational age), preterm labor, preeclampsia, chorioamnionitis, small for gestational age, long birth hospitalization length of stay after delivery (vaginal birth, >2 days; cesarean delivery, >4 days), emergency department visit within 3 months and 1 year after delivery, and readmission within 3 months and 1 year after delivery. We used exact propensity score matching without replacement to select a reference population to compare with the sample of women with unstable housing using a one-to-one ratio, matching for maternal age, race/ethnicity, parity, prior preterm birth, body mass index, tobacco use during pregnancy, drug/alcohol abuse during pregnancy, hypertension, diabetes, mental health condition during pregnancy, adequacy of prenatal care, education, and type of hospital. Odds of an adverse obstetric outcome were estimated using logistic regression. RESULTS Of 2794 women with unstable housing identified, 83.0% (n = 2318) had an exact propensity score-matched control. Women with an unstable housing code had higher odds of preterm birth (odds ratio, 1.2, 95% confidence interval, 1.0-1.4, P < .05), preterm labor (odds ratio, 1.4, 95% confidence interval, 1.2-1.6, P < .001), long length of stay (odds ratio, 1.6, 95% confidence interval, 1.4-1.8, P < .001), emergency department visits within 3 months (odds ratio, 2.4, 95% confidence interval, 2.1-2.8, P < .001) and 1 year after birth (odds ratio, 2.7, 95% confidence interval, 2.4-3.0, P < .001), and readmission within 3 months (odds ratio, 2.7, 95% confidence interval, 2.2-3.4, P < .0014) and 1 year after birth (odds ratio, 2.6, 95% confidence interval, 2.2-3.0, P < .001). CONCLUSION Unstable housing documentation is associated with adverse obstetric outcomes and high health care utilization. Housing and supplemental income for pregnant women should be explored as a potential intervention to prevent preterm birth and prevent increased health care utilization.
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Ross KM, Dunkel Schetter C, McLemore MR, Chambers BD, Paynter RA, Baer R, Feuer SK, Flowers E, Karasek D, Pantell M, Prather AA, Ryckman K, Jelliffe-Pawlowski L. Socioeconomic Status, Preeclampsia Risk and Gestational Length in Black and White Women. J Racial Ethn Health Disparities 2019; 6:1182-1191. [PMID: 31368002 DOI: 10.1007/s40615-019-00619-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/11/2019] [Accepted: 07/16/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Higher socioeconomic status (SES) has less impact on cardio-metabolic disease and preterm birth risk among Black women compared to White women, an effect called "diminishing returns." No studies have tested whether this also occurs for pregnancy cardio-metabolic disease, specifically preeclampsia, or whether preeclampsia risk could account for race-by-SES disparities in birth timing. METHODS A sample of 718,604 Black and White women was drawn from a population-based California cohort of singleton births. Education, public health insurance status, gestational length, and preeclampsia diagnosis were extracted from a State-maintained birth cohort database. Age, prenatal care, diabetes diagnosis, smoking during pregnancy, and pre-pregnancy body mass index were covariates. RESULTS In logistic regression models predicting preeclampsia risk, the race-by-SES interaction (for both education and insurance status) was significant. White women were at lower risk for preeclampsia, and higher SES further reduced risk. Black women were at higher risk for preeclampsia, and SES did not attenuate risk. In pathway analyses predicting gestational length, an indirect effect of the race-by-SES interaction was observed. Among White women, higher SES predicted lower preeclampsia risk, which in turn predicted longer gestation. The same was not observed for Black women. CONCLUSIONS Compared to White women, Black women had increased preeclampsia risk. Higher SES attenuated risk for preeclampsia among White women, but not for Black women. Similarly, higher SES indirectly predicted longer gestational length via reduced preeclampsia risk among White women, but not for Black women. These findings are consistent with diminishing returns of higher SES for Black women with respect to preeclampsia.
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Affiliation(s)
- Kharah M Ross
- Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, #355, 3820 24th Ave, Calgary, AB, T3B 2X9, Canada.
| | | | - Monica R McLemore
- Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Brittany D Chambers
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Randi A Paynter
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
| | - Rebecca Baer
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA.,Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Sky K Feuer
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Elena Flowers
- Department of Physiological Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Deborah Karasek
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Matthew Pantell
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Aric A Prather
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Kelli Ryckman
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Laura Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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18
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Beckert RH, Baer RJ, Anderson JG, Jelliffe-Pawlowski LL, Rogers EE. Maternal anemia and pregnancy outcomes: a population-based study. J Perinatol 2019; 39:911-919. [PMID: 30967656 DOI: 10.1038/s41372-019-0375-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/10/2019] [Accepted: 03/15/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study aims to describe adverse maternal and neonatal outcomes in women diagnosed with anemia in pregnancy. STUDY DESIGN This was a retrospective cohort study of California live births from 2007-2012, linked to maternal and infant hospital discharge records. Relative risks of adverse maternal and neonatal outcomes were calculated for women with and without anemia. RESULTS Anemic mothers were more likely to be diagnosed with hypertension, diabetes, placental abruption, or chorioamnionitis, or require a blood transfusion or admission to the intensive care unit (aRRs 1.2-6.8). Infants born to anemic mothers were more likely to be born preterm (8.9% versus 6.5%), but not more likely to suffer morbidities associated with prematurity. CONCLUSION In a population-based study, the diagnosis of anemia in pregnancy carries a higher risk of peri-partum, intra-partum, and post-partum complications for the mother, and a higher risk of preterm birth for the infant.
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Affiliation(s)
- Rachael H Beckert
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.
| | - Rebecca J Baer
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA.,California Preterm Birth Initiative, University of California San Francisco, San Francisco, California, USA
| | - James G Anderson
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Laura L Jelliffe-Pawlowski
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth E Rogers
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
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19
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Association between maternal serious mental illness and adverse birth outcomes. J Perinatol 2019; 39:737-745. [PMID: 30850757 PMCID: PMC6503973 DOI: 10.1038/s41372-019-0346-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/25/2019] [Accepted: 02/04/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the contribution of serious mental illness (SMI) and specific risk factors (comorbidities and substance use) to the risk of adverse birth outcomes. STUDY DESIGN This cross-sectional study uses maternal delivery records in the Healthcare Cost and Utilization Project Nationwide/National Inpatient Sample (HCUP-NIS) to estimate risk factor prevalence and relative risk of adverse birth outcomes (e.g., preeclampsia, preterm birth, and fetal distress) in women with SMI. RESULTS The relative risk of adverse gestational (1.15, 95% CI: 1.13-1.17), obstetric (1.07, 1.06-1.08), and fetal (1.24, 1.21-1.26) outcomes is increased for women with SMI. After adjusting for risk factors, the risk is significantly reduced but remains elevated for all three adverse outcome categories (gestational: 1.08, 1.06-1.09; obstetric: 1.03, 1.02-1.05; fetal: 1.12, 1.09-1.14). CONCLUSIONS Maternal serious mental illness is independently associated with increased risk for adverse birth outcomes. However, approximately half of the excess risk is attributable to comorbidities and substance use.
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20
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Strouse J, Donovan BM, Fatima M, Fernandez-Ruiz R, Baer RJ, Nidey N, Forbess C, Bandoli G, Paynter R, Parikh N, Jeliffe-Pawlowski L, Ryckman KK, Singh N. Impact of autoimmune rheumatic diseases on birth outcomes: a population-based study. RMD Open 2019; 5:e000878. [PMID: 31168407 PMCID: PMC6525602 DOI: 10.1136/rmdopen-2018-000878] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/04/2019] [Accepted: 03/27/2019] [Indexed: 11/05/2022] Open
Abstract
Objectives Autoimmune rheumatic diseases (ARDs) affect women of childbearing age and have been associated with adverse birth outcomes. The impact of diseases like ankylosing spondylitis and psoriatic arthritis (PsA) on birth outcomes remains less studied to date. Our objective was to evaluate the impact of ARDs on preterm birth (PTB), congenital anomalies, low birth weight (LBW) and small for gestational age (SGA), in a large cohort of women. Methods We conducted a propensity score-matched analysis to predict ARD from a retrospective birth cohort of all live, singleton births in California occurring between 2007 and 2012. Data were derived from birth certificate records linked to hospital discharge International Classification of Diseases, ninth revision codes. Results We matched 10 244 women with a recorded ARD diagnosis (rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), antiphospholipid syndrome, PsA); ankylosing spondylitis and juvenile idiopathic arthritis (JIA) to those without an ARD diagnosis. The adjusted OR (aOR) of PTB was increased for women with any ARD (aOR 1.93, 95% CI 1.78 to 2.10) and remained significant for those with RA, SLE, PsA and JIA. The odds of LBW and SGA were also significantly increased among women with an ARD diagnosis. ARDs were not associated with increased odds of congenital anomalies. Conclusion Consistent with prior literature, we found that women with ARDs are more likely to have PTB or deliver an SGA infant. Some reassurance is provided that an increase in congenital anomalies was not found even in this large cohort.
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Affiliation(s)
- Jennifer Strouse
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Brittney M Donovan
- Internal Medicine, Vanderbilty University Medical Center, Iowa City, Iowa, USA
| | - Munazza Fatima
- Internal Medicine, Iowa City VA Medical Center, Iowa City, Iowa, USA
| | | | - Rebecca J Baer
- Pediatrics, University of California San Diego Health System, San Diego, California, USA
| | - Nichole Nidey
- Epidemiology, University of Iowa, Iowa City, Iowa, USA
| | - Chelsey Forbess
- Internal Medicine, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Gretchen Bandoli
- Pediatrics, University of California San Diego Health System, San Diego, California, USA
| | - Randi Paynter
- Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Nisha Parikh
- Internal Medicine, Div of Cardiology, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Laura Jeliffe-Pawlowski
- Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA
| | | | - Namrata Singh
- Rheumatology, Iowa City VA Medical Center, Iowa City, Iowa, USA
- Rheumatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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21
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Fu G, Zhang W, Dai J, Liu J, Li F, Wu D, Xiao Y, Shah C, Sweeney JA, Wu M, Lui S. Increased Peripheral Interleukin 10 Relate to White Matter Integrity in Schizophrenia. Front Neurosci 2019; 13:52. [PMID: 30792621 PMCID: PMC6374337 DOI: 10.3389/fnins.2019.00052] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/21/2019] [Indexed: 02/05/2023] Open
Abstract
Background: Schizophrenia is characterized by the disruption of microstructural white matter (WM) integrity, while the pathogenesis remains unclear. Inflammation has been associated with the WM pathology in schizophrenia. Interleukin 10 (IL-10) has been proven to be related to schizophrenia in both animal and human models. The aim of this study was to explore whether peripheral IL-10 was associated with microstructural WM integrity in schizophrenia. Methods: A total of 47 patients with schizophrenia (SZ) and 49 healthy controls (HC) underwent diffusion tensor imaging and venous blood sampling. Tract-based spatial statistics was conducted to explore the differences in fractional anisotropy (FA), radial diffusivity (RD), mean diffusivity (MD), and axial diffusivity (AD) between patients and controls. A quantitative chemiluminescence assay was performed to measure peripheral IL-10 levels. General linear regression analysis using a stepwise method was applied to examine the relationship between peripheral IL-10 and diffusion measures. Results: Compared with the HC, peripheral IL-10 levels were higher and a significant reduction of FA and AD, and increase of RD and MD were observed in SZ (corrected p < 0.05). A regression analysis revealed that peripheral IL-10 was negatively correlated with FA in the right posterior thalamic radiation and left inferior fronto-occipital fasciculus, in SZ (β = -0.51, p = 0.01; β = -0.47, p = 0.02, respectively) but not in HC (β = -0.01, p = 0.95; β = -0.003, p = 0.98, respectively), and the differences in regression curves were significant (z = 2.50, p = 0.01; z = 2.37, p = 0.02, respectively). IL-10 was negatively connected with MD in the right parietal arcuate fasciculus (β = -0.40, p = 0.048) and body of the corpus callosum (β = -0.43, p = 0.03) in SZ, while not in HC. The magnitude of correlation in the patient and control group was different (z = 2.48, p = 0.01 and z = 2.61, p < 0.01, respectively). In addition, IL-10 was positively correlated with RD in the right parietal arcuate fasciculus in patients (β = 0.45, p = 0.04) but not in HC (β = 0.26, p = 0.94), but the correlation coefficients were not significant (z = 0.98, p = 0.32). Conclusion: Our findings demonstrated that elevated peripheral IL-10 levels were associated with the disruption of microstructural WM integrity in schizophrenia, supporting the notion that inflammation plays a regulatory role in the pathology of microstructural WM and is associated with schizophrenia.
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Affiliation(s)
- Gui Fu
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Wenjing Zhang
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Dai
- The Fourth People's Hospital of Chengdu, Sichuan, China
| | - Jieke Liu
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Fei Li
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Dongsheng Wu
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yuan Xiao
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Chandan Shah
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - John A Sweeney
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, United States
| | - Min Wu
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Su Lui
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
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Baer RJ, Chambers CD, Ryckman KK, Oltman SP, Rand L, Jelliffe-Pawlowski LL. High risk of spontaneous preterm birth among infants with gastroschisis. Am J Med Genet A 2018; 179:37-42. [PMID: 30549407 DOI: 10.1002/ajmg.a.60675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/28/2018] [Accepted: 10/10/2018] [Indexed: 11/07/2022]
Abstract
We examined the association between gastroschisis and preterm birth (PTB, <37 weeks) by subtype. The sample was drawn from singleton live births in California from 2007 to 2012 contained in a birth cohort file maintained by the California Office of Statewide Health Planning and Development (n = 2,891,965; 1,421 with gastroschisis). Relative risks (RRs) and 95% confidence intervals (CIs) were calculated for PTB by gestational age (<34, 34-36, and any <37 weeks) and by type (spontaneous labor with intact membranes, preterm premature rupture of the membranes [PPROM], provider initiated) and were adjusted for maternal characteristics. Over 44.5% of infants with gastroschisis were born preterm because of spontaneous etiologies; notably, 8.4% of infants with gastroschisis were born <34 weeks because of spontaneous etiologies (adjusted RRs 9.1-12.2). Overall, 53.7% of infants with gastroschisis were born preterm compared with only 6.9% of infants without gastroschisis (adjusted RR 15.2, 95% CI 13.6-19.5) and are at particularly high risk of spontaneous PTB. Nearly 9% of infants with gastroschisis delivered <34 weeks, regardless of preterm etiology, indicating that these infants are at great risk for PTB morbidities in addition to the complications from gastroschisis.
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Affiliation(s)
- Rebecca J Baer
- Department of Pediatrics, University of California San Diego, La Jolla, California.,California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
| | - Christina D Chambers
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Kelli K Ryckman
- Departments of Epidemiology and Pediatrics, University of Iowa, Iowa City, Iowa
| | - Scott P Oltman
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California.,Departments of Epidemiology and Pediatrics, University of Iowa, Iowa City, Iowa.,Department of Epi and Biostats, University of California San Francisco, San Francisco, California
| | - Larry Rand
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
| | - Laura L Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California.,Departments of Epidemiology and Pediatrics, University of Iowa, Iowa City, Iowa.,Department of Epi and Biostats, University of California San Francisco, San Francisco, California
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23
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Baer RJ, Altman MR, Oltman SP, Ryckman KK, Chambers CD, Rand L, Jelliffe-Pawlowski LL. Maternal factors influencing late entry into prenatal care: a stratified analysis by race or ethnicity and insurance status. J Matern Fetal Neonatal Med 2018; 32:3336-3342. [PMID: 29631462 DOI: 10.1080/14767058.2018.1463366] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: Examine factors influencing late (> sixth month of gestation) entry into prenatal care by race/ethnicity and insurance payer. Methods: The study population was drawn from singleton live births in California from 2007 to 2012 in the birth cohort file maintained by the California Office of Statewide Health Planning and Development, which includes linked birth certificate and mother and infant hospital discharge records. The sample was restricted to infants delivered between 20 and 44 weeks gestation. Logistic regression was used to calculate relative risks (RR) and 95% confidence intervals (CI) for factors influencing late entry into prenatal care. Maternal age, education, smoking, drug or alcohol abuse/dependence, mental illness, participation in the Women, Infants and Children's program and rural residence were evaluated for women entering prenatal care > sixth month of gestation compared with women entering < fourth month. Backwards stepwise logistic regression was used to create final multivariable models of risk and protective factors for late prenatal care entry for each race or ethnicity and insurance payer. Results: The sample included 2,963,888 women. The percent of women with late entry into prenatal care was consistently higher among women with public versus private insurance. Less than 1% of white non-Hispanic and Asian women with private insurance entered prenatal care late versus more than 4% of white non-Hispanic and black women with public insurance. After stratifying by race or ethnicity and insurance status, women less than 18 years of age were more likely to enter prenatal care late, with young Asian women with private insurance at the highest risk (15.6%; adjusted RR 7.4, 95%CI 5.3-10.5). Among all women with private insurance, > 12-year education or age >34 years at term reduced the likelihood of late prenatal care entry (adjusted RRs 0.5-0.7). Drugs and alcohol abuse/dependence and residing in a rural county were associated with increased risk of late prenatal care across all subgroups (adjusted RRs 1.3-3.8). Participation in the Women, Infants, and Children's program was associated with decreased risk of late prenatal care for women with public insurance (adjusted RRs 0.6-0.7), but increased risk for women with private insurance (adjusted RRs 1.4-2.1). Conclusions: The percent of women with late entry into prenatal care was consistently higher among women with public insurance. Younger women, women with <12-year education, those who used drugs or alcohol or resided in rural counties were more likely to enter prenatal care late, with Asian women <18 years at especially high risk. Participation in the Women, Infants, and Children's program and maternal age >34 years at delivery increased the likelihood of late prenatal care for some subgroups of women and decreased the likelihood for others. These findings can inform institutional factors influencing late prenatal care, especially among lower income women, and may assist efforts aimed at encouraging earlier entry into prenatal care. Rationale: Optimal prenatal care includes initiation before the 14th week of gestation. Beginning care in the first trimester provides an opportunity for sonographic pregnancy dating or confirmation with best accuracy, which can later prove critical for management of preterm labor, maternal or fetal complications, or prolonged pregnancy. In order to improve maternal and infant health by increasing the number of women seeking prenatal care in the first trimester, it is important to examine the drivers for late entry. Here, we examine factors influencing late (> sixth month of gestation) entry into prenatal care by race/ethnicity and insurance payer. We found the percent of women with late entry into prenatal care was consistently higher among women with public insurance. Younger women, women with <12-year education, those who used drugs or alcohol or resided in rural counties were more likely to enter prenatal care late, with Asian women <18 years at especially high risk. These findings can inform institutional factors influencing late prenatal care, especially among lower income women, and may assist efforts aimed at encouraging earlier entry into prenatal care.
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Affiliation(s)
- Rebecca J Baer
- a Department of Pediatrics , University of California , San Diego , CA , USA.,b California Preterm Birth Initiative, University of California , San Francisco , CA , USA
| | - Molly R Altman
- b California Preterm Birth Initiative, University of California , San Francisco , CA , USA.,c Department of Family Health Care Nursing , University of California , San Francisco , CA , USA
| | - Scott P Oltman
- b California Preterm Birth Initiative, University of California , San Francisco , CA , USA.,d Department of Epidemiology & Biostatistics , University of California , San Francisco , CA , USA
| | - Kelli K Ryckman
- e Departments of Epidemiology and Pediatrics , University of Iowa , Iowa City , IA , USA
| | | | - Larry Rand
- b California Preterm Birth Initiative, University of California , San Francisco , CA , USA.,f Department of Obstetrics, Gynecology, and Reproductive Sciences , University of California , San Francisco , California , USA
| | - Laura L Jelliffe-Pawlowski
- b California Preterm Birth Initiative, University of California , San Francisco , CA , USA.,d Department of Epidemiology & Biostatistics , University of California , San Francisco , CA , USA
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Shaw JG, Nelson DA, Shaw KA, Woolaway-Bickel K, Phibbs CS, Kurina LM. Deployment and Preterm Birth Among US Army Soldiers. Am J Epidemiol 2018; 187:687-695. [PMID: 29370332 DOI: 10.1093/aje/kwy003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 01/03/2018] [Indexed: 01/26/2023] Open
Abstract
With increasing integration of women into combat roles in the US military, it is critical to determine whether deployment, which entails unique stressors and exposures, is associated with adverse reproductive outcomes. Few studies have examined whether deployment increases the risk of preterm birth; no studies (to our knowledge) have examined a recent cohort of servicewomen. We therefore used linked medical and administrative data from the Stanford Military Data Repository for all US Army soldiers with deliveries between 2011 and 2014 to estimate the associations of prior deployment, recency of deployment, and posttraumatic stress disorder with spontaneous preterm birth (SPB), adjusting for sociodemographic, military-service, and health-related factors. Of 12,877 deliveries, 6.1% were SPBs. The prevalence was doubled (11.7%) among soldiers who delivered within 6 months of their return from deployment. Multivariable discrete-time logistic regression models indicated that delivering within 6 months of return from deployment was strongly associated with SPB (adjusted odds ratio = 2.1, 95% confidence interval: 1.5, 2.9). Neither multiple past deployments nor posttraumatic stress disorder was significantly associated with SPB. Within this cohort, timing of pregnancy in relation to deployment was identified as a novel risk factor for SPB. Increased focus on servicewomen's pregnancy timing and predeployment access to reproductive counseling and effective contraception is warranted.
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Affiliation(s)
- Jonathan G Shaw
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - D Alan Nelson
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - Kate A Shaw
- Department of Obstetrics and Gynecology, School of Medicine, Stanford University, Stanford, California
| | | | - Ciaran S Phibbs
- VA Palo Alto Health Care System, US Department of Veterans Affairs, Palo Alto, California
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Lianne M Kurina
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
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25
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Abstract
OBJECTIVE To test the hypothesis that sleep disorder diagnosis would be associated with increased risk of preterm birth and to examine risk by gestational age, preterm birth type, and specific sleep disorder (insomnia, sleep apnea, movement disorder, and other). METHODS In this observational study, participants were from a cohort of nearly 3 million women in California between 2007 and 2012. Inclusion criteria were women with singleton neonates liveborn between 20 and 44 weeks of gestation without chromosomal abnormalities or major structural birth defects linked to a hospital discharge database maintained by the California Office of Statewide Health Planning and Development and without mental illness during pregnancy. Sleep disorder was defined based on International Classification of Diseases, 9th Revision, Clinical Modification diagnostic code (n=2,265). Propensity score matching was used to select a referent population at a one-to-one ratio. Odds of preterm birth were examined by gestational age (less than 34 weeks, 34-36 weeks, and less than 37 weeks of gestation) and type (spontaneous, indicated). RESULTS Prevalence of preterm birth (before 37 weeks of gestation) was 10.9% in the referent group compared with 14.6% among women with a recorded sleep disorder diagnosis. Compared with the referent group, odds (95% CI, P value, percentage) of preterm birth were 1.3 (1.0-1.7, P=.023, 14.1%) for insomnia and 1.5 (1.2-1.8, P<.001, 15.5%) for sleep apnea. Risk varied by gestational age and preterm birth type. Odds of preterm birth were not significantly increased for sleep-related movement disorders or other sleep disorders. CONCLUSION Insomnia and sleep apnea were associated with significantly increased risk of preterm birth. Considering the high prevalence of sleep disorders during pregnancy and availability of evidence-based nonpharmacologic interventions, current findings suggest that screening for severe presentations would be prudent.
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