The relationship between the neighborhood built and social environment and hypertensive disorders of pregnancy: A scoping review

The Association of Food Security With Hypertensive Disorders of Pregnancy: A National Health Interview Survey Analysis

Food security is one of the most researched social determinants of health (SDoH), however, there is a lack of literature on the impact of food security on cardiovascular disease in pregnancy. The primary objective was to examine the association between food security with hypertensive disorders of pregnancy. We performed a cross-sectional analysis of 2019-2022 data from the National Health Interview Survey. The study population included women of childbearing age who were either pregnant or recently pregnant. Logistic regression models were developed to examine the association between food security and hypertensive disorders of pregnancy. Of the 1635 women included in the analysis, the rate of hypertensive disorders  of pregnancy was 11.1% and the rate of low and very low food security was 5.3% and 4.0%, respectively. The prevalence was 5.8% for hyperlipemia, 0.3% for cardiovascular disease, and 10.5% for diabetes mellitus. The odds of hypertensive disorders of pregnancy were statistically significantly increased among women with low food security compared to women with high food security (odds ratio [OR] 2.40, 95% confidence interval [CI]: 1.19-4.81) after adjusting for age, race, ethnicity, insurance status, body mass index, hyperlipidemia, diabetes mellitus, and cardiovascular disease. Further studies are needed to elucidate the causes of hypertensive disorders of pregnancy and interventions to address including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and food pantries, as it may be more feasible to address issues of food security among pregnant women.

Neighbourhood Deprivation and Gestational Diabetes Mellitus in Arizona From the AzPEARS Study

BACKGROUND

The maternal population residing in rural areas, tribal lands or near the United States-Mexico border are at high risk for adverse pregnancy complications, notably gestational diabetes mellitus (GDM). Few studies have considered the socioeconomic status (SES) attributes of neighbourhoods on maternal health during gestation. Given that the national and global rate of GDM is rising, this analysis moves beyond individual-level factors and investigates the role of neighbourhood deprivation on GDM risk.

OBJECTIVE

To investigate the relationship between neighbourhood deprivation and risk of GDM using Arizona state birth records.

METHODS

This population-based study of singleton live births (N = 481,113) utilised birth certificates from 2014 to 2020 from the AzPEARS study. Using American Community Survey (5-year data) linked to 2010 US Census tracts, a composite neighbourhood deprivation index (NDI) score (continuous and quartiles) was derived from 8 socioeconomic indicators. Risk ratios (RR) and 95% confidence intervals (95% CI) were used to examine the association between NDI and GDM risk, adjusting for maternal age, maternal education, race/ethnicity, parity, rurality, and birth year.

RESULTS

The state-wide incidence of GDM was 7.8% (n = 37,636) with variation by neighbourhoods (4% to 12%). GDM risk was highest for Native Americans (17.6%), Asian/Pacific Islanders (13.7%) and Hispanic/Latinas (8.3%). Compared to mothers living in areas with the lowest quartile of NDI, mothers living in neighbourhoods with the highest deprivation had an adjusted risk ratio of 1.21 for developing GDM (95% CI 1.18, 1.26).

CONCLUSIONS

We observed that neighbourhood deprivation was positively associated with a higher risk of GDM for each increase in quartile. These results suggest that NDI, a proxy for neighbourhood socioeconomic status, may contribute to GDM risk. Identifying high-risk neighbourhoods for place-based interventions targeting the most vulnerable birthing populations may be an effective strategy in the prevention of GDM.

Slavery, homeownership, and contemporary perinatal outcomes in the southeast: a test of mediation and moderation

The objective of this study was to estimate the effect of geographic variation in historic slavery on perinatal outcomes (chronic hypertension, hypertensive disorders of pregnancy [HDP], very preterm birth [VPTB], or very low birth weight birth [VLBW]) among Black people living in states where slavery was legal in 1860; and to test mediation by Black homeownership. We linked data on the proportion of enslaved residents from the 1860 Census to natality data on outcomes (2013-2021) using resident county. The percentage of Black residents in a county who owned their home was a potential mediator. We fit log binomial models to estimate risk ratios (RRs) representing total and controlled direct effects (accounting for Black homeownership) of the proportion enslaved on outcomes, accounting for potential confounding, using marginal structural models. Among 2 443 198 included births, 8.8% (213 829) experienced HDP, 4.1% (100 549) chronic hypertension, 3.3% (81 072) VPTB, and 2.6% (62 538) VLBW. There was an increase in chronic hypertension and VPTB risk, but not HDP or VLBW, in counties with a 10% greater proportion of enslaved residents in 1860 (adjusted RR [95% CI], chronic hypertension: 1.06 [1.02-1.1]; VPTB: 1.02 [1.00-1.05]; HDP: 1.00 [0.98-1.02]; and VLBW: 1.01 [1.00-1.03]). There was not evidence of mediation by Black homeownership. We conclude that historic slavery remains relevant for perinatal health.

Pre-gestational counselling for women living with CKD: starting from the bright side

Pregnancy in women living with chronic kidney disease (CKD) was often discouraged due to the risk of adverse maternal-fetal outcomes and the progression of kidney disease. This negative attitude has changed in recent years, with greater emphasis on patient empowerment than on the imperative 'non nocere'. Although risks persist, pregnancy outcomes even in advanced CKD have significantly improved, for both the mother and the newborn. Adequate counselling can help to minimize risks and support a more conscious and informed approach to those risks that are unavoidable. Pre-conception counselling enables a woman to plan the most appropriate moment for her to try to become pregnant. Counselling is context sensitive and needs to be discussed also within an ethical framework. Classically, counselling is more focused on risks than on the probability of a successful outcome. 'Positive counselling', highlighting also the chances of a favourable outcome, can help to strengthen the patient-physician relationship, which is a powerful means of optimizing adherence and compliance. Since, due to the heterogeneity of CKD, giving exact figures in single cases is difficult and may even be impossible, a scenario-based approach may help understanding and facing favourable outcomes and adverse events. Pregnancy outcomes modulate the future life of the mother and of her baby; hence the concept of 'post partum' counselling is also introduced, discussing how pregnancy results may modulate the long-term prognosis of the mother and the child and the future pregnancies.

Material Hardship, Protective Factors, Children's Special Health Care Needs, and the Health of Mothers and Fathers

BACKGROUND

Parents of children with special health care needs (CSHCN) are at risk of poorer health outcomes. Material hardships also pose significant health risks to parents. Little is known about how protective factors may mitigate these risks and if effects are similar between mothers and fathers.

METHODS

This was a cross-sectional survey study conducted using the US 2018/2019 National Survey of Children's Health, including parents of children 0 to 17 with income <200% of the federal poverty level. Separately, for parents of children with and without special health care needs (N-CSHCN), weighted logistic regression measured associations between material hardship, protective factors (family resilience, neighborhood cohesion, and receipt of family-centered care), and 2 outcomes: mental and physical health of mothers and fathers. Interactions were assessed between special health care needs status, material hardship, and protective factors.

RESULTS

Sample consisted of parents of 16,777 children; 4440 were parents of CSHCN. Most outcomes showed similar associations for both mothers and fathers of CSHCN and N-CSHCN: material hardship was associated with poorer health outcomes, and family resilience and neighborhood cohesion associated with better parental health outcomes. Family-centered care was associated with better health of mothers but not fathers. Interaction testing showed that the protective effects of family resilience were lower among fathers of CSHCN experiencing material hardship.

CONCLUSIONS

Family resilience and neighborhood cohesion are associated with better health outcomes for all parents, though these effects may vary by experience of special health care needs, parent gender, and material hardship.

Sunshine duration and risks of schizophrenia hospitalizations in main urban area: Do built environments modify the association?

BACKGROUND

Although studies have explored the relationship between sunshine duration and schizophrenia, the evidence was ambiguous. Different built environments may alter the effect of sunlight on schizophrenia, thus the purpose of this study was to investigate the effects of built environments on the sunshine duration-schizophrenia association.

MATERIALS AND METHODS

Daily schizophrenia hospitalizations data during 2017-2020 in Hefei's main urban area, China, and corresponding meteorological factors as well as ambient pollutants were collected. The impact of sunshine duration on schizophrenia admissions in urban areas was investigated using a generalized additive model combined with a distributed lagged nonlinear model. Additionally, the various modifying effects of different Building Density, Building Height, Normalized Vegetation Index, and Nighttime Light were also explored between sunshine duration and schizophrenia.

RESULTS

We observed that inadequate sunshine duration (<5.3 h) was associated with an increase in schizophrenia hospital admissions, with a maximum relative risk of 1.382 (95 % confidence interval (CI): 1.069-1.786) at 2.9 h. In turn, adequate sunshine duration reduced the risk of schizophrenia hospitalizations. Subgroup analyses indicated females and old patients were particularly vulnerable. In the case of insufficient sunshine duration, significant positive effects were noticed on schizophrenia risk at High-Building Density and High-Nighttime Light. Higher NDVI as well as Building Height were found to be associated with lower risks of schizophrenia.

CONCLUSIONS

Given that sunshine duration in various built environments might lead to distinct effects on schizophrenia hospitalizations. Our findings assist in identifying vulnerable populations that reside in particular areas, thus suggesting policymakers provide advice to mitigate the onset of schizophrenia by allocating healthcare resources rationally and avoiding adverse exposures to vulnerable populations timely.

Inclusion of Social and Structural Determinants of Health to Advance Understanding of their Influence on the Biology of Chronic Disease

Social Determinants of Health (SDOH) consider social, political, and economic factors that contribute to health disparities in patients and populations. The most common health-related SDOH exposures are food and housing insecurity, financial instability, transportation needs, low levels of education, and psychosocial stress. These domains describe risks that can impact health outcomes more than health care. Epidemiologic and translational research demonstrates that SDOH factors represent exposures that predict harm and impact the health of individuals. International and national guidelines urge health professionals to address SDOH in clinical practice and public health. The further implementation of these recommendations into basic and translational research, however, is lagging. Herein, we consider a precision health framework to describe how SDOH contributes to the exposome and exacerbates physiologic pathways that lead to chronic disease. SDOH factors are associated with various forms of stressors that impact physiological processes through epigenetic, inflammatory, and redox regulation. Many SDOH exposures may add to or potentiate the pathologic effects of additional environmental exposures. This overview aims to inform basic life science and translational researchers about SDOH exposures that can confound associations between classic biomedical determinants of disease and health outcomes. To advance the study of toxicology through either qualitative or quantitative assessment of exposures to chemical and biological substances, a more complete environmental evaluation should include SDOH exposures. We discuss common approaches to measure SDOH factors at individual and population levels and review the associations between SDOH risk factors and physiologic mechanisms that influence chronic disease. We provide clinical and policy-based motivation to encourage researchers to consider the impact of SDOH exposures on study results and data interpretation. With valid measures of SDOH factors incorporated into study design and analyses, future toxicological research may contribute to an evidence base that can better inform prevention and treatment options, to improve equitable clinical care and population health. © 2022 Wiley Periodicals LLC.

Genetic Variations in Metallothionein Genes and Susceptibility to Hypertensive Disorders of Pregnancy: A Case-Control Study

Background: The involvement of oxidative stress in the pathological process of hypertensive disorders of pregnancy (HDP) gives rise to the interest in exploring the association of genetic variations in antioxidant metallothionein (MT) genes with HDP susceptibility.

Methods: Seventeen single-nucleotide polymorphisms(SNPs) in MT genes were selected to conduct genotyping based on a case-control study consisting of 371 HDP cases (pregnancy with chronic hypertension (66), gestational hypertension (172), and preeclampsia or preeclampsia superimposed on chronic hypertension (133)) and 479 controls. The association between SNPs in MTs and the risk of HDP was estimated with unconditional logistic regression analysis and further tested with the false-positive report probability (FPRP) procedure. The joint effects of SNPs on the HDP risk were assessed by haplotype analysis.

Results: After the adjustment for age and pre-pregnancy body mass index (pre-BMI) in the logistic regress analysis and followed by the FPRP test, the genetic variation rs10636 (OR = 0.46, 95% CI: 0.30–0.71 for GG vs. CC, p = 0.000 and OR = 0.48, 95% CI: 0.32–0.73 for GG vs. CG/CC, p = 0.001) in MT2A was associated with gestational hypertension. Other four SNPs, that is, rs11076161 (OR = 1.89, 95% CI: 1.35–2.63 for GG vs. GA/AA, p = 0.000) in MT1A; rs7191779 (OR = 1.54, 95% CI: 1.11–2.13 for CC vs. CG/GG, p = 0.010) in MT1B; rs8044719 (OR = 0.57, 95% CI: 0.40–0.80 for GT vs. GG, p = 0.001) in MT1DP; and rs8052334 (OR = 1.52, 95% CI: 1.10–2.11 for TT vs. TC/CC, p = 0.012) in MT1B were significantly associated with the susceptibility of HDP. The haplotype analysis among 11, 10, 10, and seven SNPs in MT (MT1A, MT2A, MT1M, MT1B, and MT1DP) genes showed that eight (A-C-G-T-C-G-A-G-C-G-C, OR = 4.559; A-C-T-C-C-C-A-G-C-G-C, OR = 5.777; A-C-T-T-C-G-A-G-C-G-C, OR = 4.590; G-A-T-C-C-G-C-G-G-C-C, OR = 4.065; G-A-T-C-G-C-C-G-G-C-C, OR = 4.652; G-A-T-T-C-C-C-G-G-C-C, OR = 0.404; G-C-T-C-C-C-A-G-G-C-C, OR = 1.901; G-C-T-T-C-C-A-G-G-C-C, and OR = 3.810), five (C-G-A-T-C-A-C-C-G-G, OR = 2.032; C-G-A-T-C-G-C-C-G-G, OR = 2.077; G-A-C-T-C-A-C-C-T-G, OR = 0.564; G-G-A-G-C-A-C-C-G-G, OR = 5.466; G-G-A-T-T-A-G-C-G-G, and OR = 0.284), five (A-C-G-T-C-G-A-G-C-C, OR = 2.399; A-C-T-C-C-C-C-T-G-G, OR = 0.259; G-A-T-C-C-C-C-G-G-C, OR = 1.572; G-A-T-C-G-C-C-G-G-C, OR = 0.001; G-C-T-C-G-C-A-G-G-C, and OR = 2.512), and five (A-C-T-C-C-C-G, OR = 0.634; G-A-G-C-C-C-G, OR = 4.047; G-A-T-T-G-C-G, OR = 0.499; G-C-G-T-C-A-G, and OR = 7.299; G-C-T-C-C-A-G, OR = 1.434) haplotypes were significantly associated with pregnancy with chronic hypertension, gestational hypertension, preeclampsia, or preeclampsia superimposed on chronic hypertension and HDP.

Conclusion: These variant MT alleles and their combination patterns may be used as genetic markers for predicting HDP susceptibility.