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Symanski E, Whitworth KW, Mendez-Figueroa H, Aagaard KM, Moussa I, Alvarez J, Chardon Fabian A, Kannan K, Walker CL, Coarfa C, Suter MA, Salihu HM. The Maternal and Infant Environmental Health Riskscape study of perinatal disparities in greater Houston: rationale, study design and participant profiles. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1304717. [PMID: 38712340 PMCID: PMC11070492 DOI: 10.3389/frph.2024.1304717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 04/01/2024] [Indexed: 05/08/2024] Open
Abstract
Introduction The Maternal and Infant Environmental Health Riskscape (MIEHR) Center was established to address the interplay among chemical and non-chemical stressors in the biological, physical, social, and built environments that disproportionately impact perinatal health among Black pregnant people in a large and diverse urban area with documented disparities in the U.S. Methods The MIEHR cohort is recruiting non-Hispanic Black and non-Hispanic white pregnant people who deliver their infants at major obstetric hospitals in Houston, Texas. At enrollment, all participants are asked to provide urine samples for chemical [metals, cotinine, and polycyclic aromatic hydrocarbons (PAHs)] analyses and blood samples. A subset of the cohort is asked to provide oral and vaginal swabs, and fecal samples. Questionnaire and electronic health record data gather information about residential address history during pregnancy, pregnancy history and prenatal care, sociodemographic and lifestyle factors, experiences of discrimination and stress, and sources of social support. Using information on where a participant lived during their pregnancy, features of their neighborhood environment are characterized. We provide summaries of key individual- and neighborhood-level features of the entire cohort, as well as for Black and white participants separately. Results Between April 2021 and February 2023, 1,244 pregnant people were recruited. Nearly all participants provided urine samples and slightly less than half provided blood samples. PAH exposure patterns as assessed on 47% of participants thus far showed varying levels depending on metabolite as compared to previous studies. Additionally, analyses suggest differences between Black and white pregnant people in experiences of discrimination, stress, and levels of social support, as well as in neighborhood characteristics. Discussion Our findings to date highlight racial differences in experiences of discrimination, stress, and levels of support, as well as neighborhood characteristics. Recruitment of the cohort is ongoing and additional neighborhood metrics are being constructed. Biospecimens will be analyzed for metals and PAH metabolites (urine samples), miRNAs (plasma samples) and the microbiome (oral swabs). Once enrollment ends, formal assessments are planned to elucidate individual- and neighborhood-level features in the environmental riskscape that contribute to Black-White disparities in perinatal health.
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Affiliation(s)
- Elaine Symanski
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Kristina W. Whitworth
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Hector Mendez-Figueroa
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth, Houston, TX, United States
| | - Kjersti M. Aagaard
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Baylor College of Medicine & Texas Children’s Hospital, Houston, TX, United States
| | - Iman Moussa
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - Juan Alvarez
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - Adrien Chardon Fabian
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | | | - Cheryl L. Walker
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
- Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, TX, United States
| | - Cristian Coarfa
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
- Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, TX, United States
| | - Melissa A. Suter
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Baylor College of Medicine & Texas Children’s Hospital, Houston, TX, United States
| | - Hamisu M. Salihu
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
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Wood CT, Churchill ML, McGrath M, Aschner J, Brunwasser SM, Geiger S, Gogcu S, Hartert TV, Hipwell AE, Lee-Sarwar K, Lyall K, Moog NK, O'Connor TG, O'Shea TM, Smith PB, Wright RJ, Zhang X, Zimmerman E, Huddleston KC, Brown CL. Maternal stress and early childhood BMI among US children from the Environmental influences on Child Health Outcomes (ECHO) program. Pediatr Res 2023; 94:2085-2091. [PMID: 37479746 PMCID: PMC10938641 DOI: 10.1038/s41390-023-02750-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/11/2023] [Accepted: 07/09/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND We aimed to understand the association between maternal stress in the first year of life and childhood body mass index (BMI) from 2 to 4 years of age in a large, prospective United States-based consortium of cohorts. METHODS We used data from the Environmental influences on Child Health Outcomes program. The main exposure was maternal stress in the first year of life measured with the Perceived Stress Scale (PSS). The main outcome was the first childhood BMI percentile after age 2 until age 4 years. We used an adjusted linear mixed effects model to examine associations between BMI and PSS quartile. RESULTS The mean BMI percentile in children was 59.8 (SD 30) measured at 3.0 years (SD 1) on average. In both crude models and models adjusted for maternal BMI, age, race, ethnicity, infant birthweight, and health insurance status, no linear associations were observed between maternal stress and child BMI. CONCLUSIONS Among 1694 maternal-infant dyads, we found no statistically significant relationships between maternal perceived stress in the first year of life and child BMI after 2 through 4 years. IMPACT Although existing literature suggests relationships between parental stress and childhood BMI, we found no linear associations between maternal stress in the first year of life and childhood BMI at 2-4 years of age among participants in ECHO cohorts. Higher maternal stress was significantly associated with Hispanic ethnicity, Black race, and public health insurance. Our analysis of a large, nationally representative sample challenges assumptions that maternal stress in the first year of life, as measured by a widely used scale, is associated with offspring BMI.
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Affiliation(s)
- Charles T Wood
- Division of General Pediatrics and Adolescent Health and Duke Center for Childhood Obesity Research, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
| | - Marie L Churchill
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Monica McGrath
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Judy Aschner
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Steven M Brunwasser
- Department of Psychology, Rowan University, Glassboro, NJ, USA
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah Geiger
- Department of Kinesiology and Community Health, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Semsa Gogcu
- Division of Neonatology, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Tina V Hartert
- Departments of Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Allison E Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathleen Lee-Sarwar
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kristen Lyall
- AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
| | - Nora K Moog
- Department of Medical Psychology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas G O'Connor
- Department of Psychiatry, Psychology, Neuroscience, and Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | - T Michael O'Shea
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - P Brian Smith
- Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Rosalind J Wright
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Xueying Zhang
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily Zimmerman
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, USA
| | | | - Callie L Brown
- Division of General Pediatrics, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Sullivan BA, Doshi A, Chernyavskiy P, Husain A, Binai A, Sahni R, Fairchild KD, Moorman JR, Travers CP, Vesoulis ZA. Neighborhood Deprivation and Association With Neonatal Intensive Care Unit Mortality and Morbidity for Extremely Premature Infants. JAMA Netw Open 2023; 6:e2311761. [PMID: 37166800 PMCID: PMC10176121 DOI: 10.1001/jamanetworkopen.2023.11761] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/20/2023] [Indexed: 05/12/2023] Open
Abstract
Importance Socioeconomic status affects pregnancy and neurodevelopment, but its association with hospital outcomes among premature infants is unknown. The Area Deprivation Index (ADI) is a validated measure of neighborhood disadvantage that uses US Census Bureau data on income, educational level, employment, and housing quality. Objective To determine whether ADI is associated with neonatal intensive care unit (NICU) mortality and morbidity in extremely premature infants. Design, Setting, and Participants This retrospective cohort study was performed at 4 level IV NICUs in the US Northeast, Mid-Atlantic, Midwest, and South regions. Non-Hispanic White and Black infants with gestational age of less than 29 weeks and born between January 1, 2012, and December 31, 2020, were included in the analysis. Addresses were converted to census blocks, identified by Federal Information Processing Series codes, to link residences to national ADI percentiles. Exposures ADI, race, birth weight, sex, and outborn status. Main Outcomes and Measures In the primary outcome, the association between ADI and NICU mortality was analyzed using bayesian logistic regression adjusted for race, birth weight, outborn status, and sex. Risk factors were considered significant if the 95% credible intervals excluded zero. In the secondary outcome, the association between ADI and NICU morbidities, including late-onset sepsis, necrotizing enterocolitis (NEC), and severe intraventricular hemorrhage (IVH), were also analyzed. Results A total of 2765 infants with a mean (SD) gestational age of 25.6 (1.7) weeks and mean (SD) birth weight of 805 (241) g were included in the analysis. Of these, 1391 (50.3%) were boys, 1325 (47.9%) reported Black maternal race, 498 (18.0%) died before NICU discharge, 692 (25.0%) developed sepsis or NEC, and 353 (12.8%) had severe IVH. In univariate analysis, higher median ADI was found among Black compared with White infants (77 [IQR, 45-93] vs 57 [IQR, 32-77]; P < .001), those who died before NICU discharge vs survived (71 [IQR, 45-89] vs 64 [IQR, 36-86]), those with late-onset sepsis or NEC vs those without (68 [IQR, 41-88] vs 64 [IQR, 35-86]), and those with severe IVH vs those without (69 [IQR, 44-90] vs 64 [IQR, 36-86]). In a multivariable bayesian logistic regression model, lower birth weight, higher ADI, and male sex were risk factors for mortality (95% credible intervals excluded zero), while Black race and outborn status were not. The ADI was also identified as a risk factor for sepsis or NEC and severe IVH. Conclusions and Relevance The findings of this cohort study of extremely preterm infants admitted to 4 NICUs in different US geographic regions suggest that ADI was a risk factor for mortality and morbidity after adjusting for multiple covariates.
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Affiliation(s)
- Brynne A. Sullivan
- Division of Neonatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville
| | - Ayush Doshi
- currently a medical student at University of Virginia School of Medicine, Charlottesville
| | - Pavel Chernyavskiy
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville
| | - Ameena Husain
- Division of Newborn Medicine, Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | - Alexandra Binai
- Division of Newborn Medicine, Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | - Rakesh Sahni
- Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Karen D. Fairchild
- Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - J. Randall Moorman
- Division of Cardiology, Department of Medicine, University of Virginia School of Medicine, Charlottesville
| | - Colm P. Travers
- Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham
| | - Zachary A. Vesoulis
- Division of Newborn Medicine, Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
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Vaughan SE, Misra DP, Gohar J, Hyer S, Price M, Giurgescu C. The associations of objective and perceived neighborhood disadvantage with stress among pregnant black women. Public Health Nurs 2023; 40:372-381. [PMID: 36740747 PMCID: PMC10164036 DOI: 10.1111/phn.13177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/15/2022] [Accepted: 01/13/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Neighborhood disadvantage may impact risk of preterm birth through stress. Few studies have examined how neighborhood disadvantage relates to stress during pregnancy, especially for Black women. METHODS Secondary data analysis of 572 women in a prospective cohort in Detroit, MI and Columbus, OH. Participants completed questionnaires including the ROSS Neighborhood Disorder Scale, the crime subscale of the Perceived Neighborhood Scale (PNS), and the Perceived Stress Scale. An objective neighborhood disadvantage index (NDI) was created using principal components analysis after geocoding residential addresses and linking to Census data. RESULTS All models used logistic regression. Adjusted for maternal age and annual household income, perceived stress was positively associated with perceived neighborhood disorder (p < .01). In a separate model, perceived neighborhood crime was positively associated with perceived neighborhood disorder (p = .005). In a joint model adjusted for age and income, the association of disorder with stress was similar in magnitude (p < .01) but the association between crime and stress weakened. The NDI was not associated with perceived stress before or after adjustment for confounders. CONCLUSIONS Perceived neighborhood disadvantage may capture a different dimension than objective neighborhood disadvantage. Future studies should test stress as a pathway by which neighborhood environment increases risk of preterm birth.
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Affiliation(s)
- Sarah E. Vaughan
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Dawn P. Misra
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Jazib Gohar
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Suzanne Hyer
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Mercedes Price
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Carmen Giurgescu
- College of Nursing, University of Central Florida, Orlando, FL, USA
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Sroka AW, Mbayiwa K, Ilyumzhinova R, Meyer W, Fowle J, Gipson CJ, Norcott C, Hipwell AE, Keenan K. Depression screening may not capture significant sources of prenatal stress for Black women. Arch Womens Ment Health 2023; 26:211-217. [PMID: 36797547 DOI: 10.1007/s00737-023-01297-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
Exposure to stress during pregnancy, including depression, has a significant impact on maternal health. Black women experience varied stressors that impact pregnancy outcomes. Although the move to engage in universal screening of women for depression is a positive step toward improving women's health, it has been deployed without a comprehensive examination of its utility for capturing exposure to other stressors with known associations with perinatal and neonatal health problems for Black women such as discrimination stress. In the present study, we examine the overlap between several sources of stress and a positive screen on the Edinburgh Postnatal Depression Scale (EPDS) in Black pregnant women. Data were gathered from a study examining the effects of stress on prenatal health (N = 168). Discrimination stress, structural and systemic racism stress, perceived stress, and partner abuse were measured using standardized questionnaires during pregnancy. Using a score of ≥ 13 to indicate probable depression the sensitivity of the EPDS to identify women who experienced high levels of discrimination stress (41.7%), structural and systemic racism (39.5%), perceived stress (63.4%), and partner abuse (45.2%) was suboptimal. Lowering the threshold for a positive screen on the EPDS to a score of 10 improved sensitivity but did not solve the problem of under-identification of women whose health is at risk. The focus on depression screening for pregnant women should be re-considered. A screening toolkit that more rigorously and broadly assesses risk and need for support and intervention is needed to improve perinatal health outcomes for Black women.
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Affiliation(s)
- Anna W Sroka
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA
| | - Kimberley Mbayiwa
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA
| | - Rimma Ilyumzhinova
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA
| | - Willa Meyer
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA
| | - Jill Fowle
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA
| | - Cherrelle J Gipson
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA
| | - Candice Norcott
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA
| | - Alison E Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, Chicago, USA.
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Zierden HC, Marx-Rattner R, Rock KD, Montgomery KR, Anastasiadis P, Folts L, Bale TL. Extracellular vesicles are dynamic regulators of maternal glucose homeostasis during pregnancy. Sci Rep 2023; 13:4568. [PMID: 36941297 PMCID: PMC10027885 DOI: 10.1038/s41598-023-31425-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/11/2023] [Indexed: 03/23/2023] Open
Abstract
Homeostatic regulation of the maternal milieu during pregnancy is critical for maternal and fetal health. The placenta facilitates critical communication between maternal and fetal compartments, in part, through the production of extracellular vesicles (EVs). EVs enable tissue synchrony via cell-cell and long-distance communication and are at their highest circulating concentration during pregnancy. While much work has been done investigating how physiological challenges in pregnancy affect the fetus, the role of placental communication in maternal health has not been well examined. We previously identified placental O-glycosyl transferase (OGT), a glucose-sensing enzyme, as a target of maternal stress where OGT levels and activity affected the O-glycosylation of proteins critical for EV cargo loading and secretion. Here, we hypothesized that placental OGT plays an essential role in maternal homeostatic regulation during pregnancy via its regulation of maternal circulating EV concentrations. Our studies found that changes to key metabolic factors over the circadian cycle, including glucocorticoids, insulin, and glucose, were significantly associated with changes in circulating EV concentration. Targeting placental OGT in mice, we found a novel significant positive relationship between placental OGT and maternal circulating EV concentration that was associated with improving maternal glucose tolerance during pregnancy. Finally, an intravenous elevation in EVs, matching the concentration of EVs during pregnancy, shifted non-pregnant female glucose sensitivity, blunted glucose variance, and improved synchrony of glucose uptake. These data suggest an important and novel role for circulating EVs as homeostatic regulators important in maternal health during pregnancy.
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Affiliation(s)
- Hannah C Zierden
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Department of Chemical and Biomolecular Engineering, University of Maryland, College Park, MD, 20740, USA
| | - Ruth Marx-Rattner
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Kylie D Rock
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, 27695, USA
| | - Kristen R Montgomery
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Neuroscience Graduate Program, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Pavlos Anastasiadis
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, 21201, USA
| | - Lillian Folts
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Biomedical Sciences Graduate Program, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Tracy L Bale
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
- Center for Epigenetic Research in Child Health and Brain Development, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
- The Anschutz Foundation Endowed Chair in Women's Integrated Mental and Physical Health Research at the Ludeman Center, Aurora, CO, USA.
- Department of Psychiatry, University of Colorado School of Medicine, CU Anschutz Medical Campus, 12800 E. 19th Avenue, Aurora, CO, 80045, USA.
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Eick SM, Barr DB, Brennan PA, Taibl KR, Tan Y, Robinson M, Kannan K, Panuwet P, Yakimavets V, Ryan PB, Liang D, Dunlop AL. Per- and polyfluoroalkyl substances and psychosocial stressors have a joint effect on adverse pregnancy outcomes in the Atlanta African American Maternal-Child cohort. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 857:159450. [PMID: 36252672 PMCID: PMC9884463 DOI: 10.1016/j.scitotenv.2022.159450] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 05/19/2023]
Abstract
BACKGROUND African Americans (AAs) experience high rates of adverse pregnancy outcomes relative to Whites. Differential in utero exposure to environmental chemicals and psychosocial stressors may explain some of the observed health disparities, as exposures to per- and polyfluoroalkyl substances (PFAS) and experiences of discrimination have been linked to adverse birth outcomes. Few studies have examined chemicals and non-chemical stressors together as an exposure mixture, which may better reflect real-life exposure patterns. Here, we adapted methods designed for the analysis of exposure mixtures to examine joint effects of PFAS and psychosocial stress on birth outcomes among AAs. METHODS 348 participants from the Atlanta African American Maternal-Child cohort were included in this study. Four PFAS were measured in first trimester serum samples. Self-report questionnaires were administered during the first trimester and were used to assess psychosocial stress (perceived stress, depression, anxiety, gendered racial stress). Quantile g-computation and Bayesian kernel machine regression (BKMR) were used to estimate the joint effects between PFAS and psychosocial stressors on gestational age at delivery and birthweight for gestational age z-scores. All models were adjusted for maternal education, maternal age, parity, and any alcohol, tobacco and marijuana use. RESULTS Our analytic sample included a socioeconomically diverse group of pregnant women, with 79 % receiving public health insurance. In quantile g-computation models, a simultaneous one-quartile increase in all PFAS, perceived stress, depression, anxiety, and gendered racial stress was associated with a reduction in birthweight z-scores (mean %change per quartile increase = -0.24, 95 % confidence interval = -0.43, -0.06). BKMR similarly showed that increasing all exposures in the mixture was associated with a modest decrease in birthweight z-scores, but not a reduced length of gestation. DISCUSSION Using methods designed for analyzing exposure mixtures, we found that a simultaneous increase in in utero PFAS and psychosocial stressors was associated with reduced birthweight for gestational age z-scores.
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Affiliation(s)
- Stephanie M Eick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Dana Boyd Barr
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Kaitlin R Taibl
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Youran Tan
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Morgan Robinson
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Kurunthachalam Kannan
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA; Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Parinya Panuwet
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Volha Yakimavets
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - P Barry Ryan
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Donghai Liang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anne L Dunlop
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, GA, USA
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8
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Patel I, Dev A. What is prenatal stress? A scoping review of how prenatal stress is defined and measured within the context of food insecurity, housing instability, and immigration in the United States. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231191091. [PMID: 37596926 PMCID: PMC10440065 DOI: 10.1177/17455057231191091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/20/2023] [Accepted: 07/13/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Stress during pregnancy can lead to significant adverse outcomes for maternal mental health. Early evaluation of prenatal stress can help identify treatment needs and appropriate interventions. Disparities in the social determinants of health can contribute to stress, but what constitutes stress during pregnancy within the social determinants of health framework is poorly understood. OBJECTIVE To scope how prenatal stress is defined and measured among pregnant people exposed to three prominent social stressors in the United States: insecurity pertaining to food, housing, and immigration. ELIGIBILITY CRITERIA We included all studies that focused on stress during pregnancy in the context of food insecurity, housing instability, and immigration, given their recent policy focus due to the COVID-19 pandemic and ongoing political discourse, in addition to their importance in American College of Obstetricians and Gynecologists (ACOG's) social determinants of health screening tool. SOURCES OF EVIDENCE We searched PubMed, Scopus, and Web of Science for articles published between January 2012 and January 2022. CHARTING METHODS Using a piloted charting tool, we extracted relevant study information from the selected articles and analyzed the content pertaining to stress. RESULTS An initial search identified 1,023 articles, of which 24 met our inclusion criteria. None of the studies defined prenatal stress, and only one used the Prenatal Distress Questionnaire, a prenatal stress-specific tool to measure it. The Perceived Stress Scale was the most common instrument used in seven studies. Fifteen studies measured over 25 alternative exposures that researchers theorized were associated with stress, and 4 of the 15 studies did not explain the association between the measure and stress. CONCLUSIONS Our findings demonstrate a fundamental inconsistency in how prenatal stress is defined and measured in the context of social determinants of health, limiting the comparison of results across studies and the potential development of effective interventions to promote better maternal mental health.
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Affiliation(s)
- Ishani Patel
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL, USA
| | - Alka Dev
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Hanover, IL, USA
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Karvonen KL, Goronga F, McKenzie-Sampson S, Rogers EE. Racial disparities in the development of comorbid conditions after preterm birth: A narrative review. Semin Perinatol 2022; 46:151657. [PMID: 36153273 DOI: 10.1016/j.semperi.2022.151657] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite recognition and attempts to reduce racial disparities in perinatal outcomes, Black infants are still disproportionately represented among those who are born preterm. Postnatal investigations of racial disparities in comorbidities and outcomes after preterm birth are increasing, although their results and interpretations are conflicting. In the present review, we 1.) identify important methodological limitations of that literature 2.) summarize the conflicting literature investigating racial disparities, specifically Black-white differences, in postnatal comorbidities and outcomes after preterm birth 3.) describe mechanisms by which racism operates to contextualize our understanding to inform future work to actively reduce disparities in preterm birth and subsequently, its complications.
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Affiliation(s)
- Kayla L Karvonen
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States.
| | - Faith Goronga
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States
| | - Safyer McKenzie-Sampson
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Elizabeth E Rogers
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States
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