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Phibbs CS, Phibbs CM. Assessing the Infant Effects of Severe Maternal. J Pediatr 2024:114230. [PMID: 39142561 DOI: 10.1016/j.jpeds.2024.114230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Accepted: 08/09/2024] [Indexed: 08/16/2024]
Affiliation(s)
- Ciaran S Phibbs
- Health Economics Resource Center and Center for Implementation to Innovation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Department of Health Policy, Stanford University School of Medicine, Stanford, CA.
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Ukah UV, Côté-Corriveau G, Nelson C, Healy-Profitós J, Auger N. Risk of Adverse Neonatal Events in Pregnancies Complicated by Severe Maternal Morbidity. J Pediatr 2024; 273:114149. [PMID: 38880382 DOI: 10.1016/j.jpeds.2024.114149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 06/05/2024] [Accepted: 06/11/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To investigate the risk of adverse neonatal events after a pregnancy complicated by severe maternal morbidity. STUDY DESIGN We analyzed a population-based cohort of deliveries in Quebec, Canada, between 2006 and 2021. The main exposure measure was severe maternal morbidity, comprising life-threatening conditions such as severe hemorrhage, cardiac complications, and eclampsia. The outcome included adverse neonatal events such as very preterm birth (gestational age <32 weeks), bronchopulmonary dysplasia, hypoxic ischemic encephalopathy, and neonatal death. Using log-binomial regression models, we estimated adjusted relative risks (RRs) and 95% confidence intervals (CIs) for the association between severe maternal morbidity and adverse neonatal events. RESULTS Among 1 199 112 deliveries, 29 992 (2.5%) were complicated by severe maternal morbidity and 83 367 (7.0%) had adverse neonatal events. Severe maternal morbidity was associated with 2.96 times the risk of adverse neonatal events compared with no morbidity (95% CI 2.90-3.03). Associations were greatest for mothers who required assisted ventilation (RR 5.86, 95% CI 5.34-6.44), experienced uterine rupture (RR 4.54, 95% CI 3.73-5.51), or had cardiac complications (RR 4.39, 95% CI 3.98-4.84). Severe maternal morbidity was associated with ≥3 times the risk of neonatal death and hypoxic-ischemic encephalopathy and ≥10 times the risk of very preterm birth and bronchopulmonary dysplasia. CONCLUSIONS Severe maternal morbidity is associated with an elevated risk of adverse neonatal events. Better prevention of severe maternal morbidity may help reduce burden of severe neonatal morbidity.
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Affiliation(s)
- Ugochinyere Vivian Ukah
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Institut National de santé publique du Québec, Montreal, Quebec, Canada.
| | - Gabriel Côté-Corriveau
- Institut National de santé publique du Québec, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Department of Pediatrics, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Chantal Nelson
- Maternal and Infant Health Surveillance Section, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Jessica Healy-Profitós
- Institut National de santé publique du Québec, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Nathalie Auger
- Institut National de santé publique du Québec, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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Vanderlaan J, Shen JJ, McDonough IK. Validation of a measure of hospital maternal level of care for the United States. BMC Health Serv Res 2024; 24:286. [PMID: 38443900 PMCID: PMC10916325 DOI: 10.1186/s12913-024-10754-1] [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: 07/19/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Lack of a validated assessment of maternal risk-appropriate care for use in population data has prevented the existing literature from quantifying the benefit of maternal risk-appropriate care. The objective of this study was to develop a measure of hospital maternal levels of care based on the resources available at the hospital, using existing data available to researchers. METHODS This was a secondary data analysis. The sample was abstracted from the American Hospital Association Annual Survey Database for 2018. Eligibility was limited to short-term acute general hospitals that reported providing maternity services as measured by hospital reporting of an obstetric service level, obstetric services, or birthing rooms. We aligned variables in the database with the ACOG criteria for each maternal level of care, then built models that used the variables to measure the maternal level of care. In each iteration, the distribution of hospitals was compared to the distribution in the CDC Levels of Care Assessment Tool Validation Pilot, assessing agreement with the Wilson Score for proportions for each level of care. Results were compared to hospital self-report in the database and measurement reported with another published method. RESULTS The sample included 2,351 hospitals. AHA variables were available to measure resources that align with ACOG Levels 1, 2, and 3. Overall, 1219 (51.9%) of hospitals reported resources aligned with Maternal Level One, 816 (34.7%) aligned with maternal level two, and 202 (8.6%) aligned with maternal level Three. This method overestimates the prevalence of hospitals with maternal level one compared to the CDC measurement of 36.1% (Mean 52.9%; 95% CI47.2%-58.7%), and likely includes hospitals that would not qualify as level one if all resources required by the ACOG guidelines could be assessed. This method underestimates the prevalence of hospitals with maternal critical care services (Level 3 or 4) compared to CDC measure of 12.1% (Mean 8.1%; 95%CI 6.2% - 10.0%) but is an improvement over hospital self-report (24.7%) and a prior published method (32.3%). CONCLUSIONS This method of measuring maternal level of care allows researchers to investigate the value of perinatal regionalization, risk-appropriate care, and hospital differences among the three levels of care. This study identified potential changes to the American Hospital Association Annual Survey that would improve identification of maternal levels of care for research.
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Affiliation(s)
- Jennifer Vanderlaan
- University of Nevada Las Vegas School of Nursing, 4505 S. Maryland Parkway, Box 453018, Las Vegas, Nevada, 89154, USA.
| | - Jay J Shen
- School of Public Health, Center for Health Disparities and Research, University of Nevada Las Vegas, 4700 S. Maryland Parkway Suite #335, Las Vegas, Nevada, 89154, USA
| | - Ian K McDonough
- Department of Economics, Lee Business School, University of Nevada Las Vegas, 4505 S. Maryland Parkway, Box 6005, Las Vegas, Nevada, 89154, USA
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Ramisetty-Mikler S, Willis A, Tiwari C. Pre-pregnancy Weight and Racial-Ethnic Disparities in Pregnancy-Associated Conditions in the State of Georgia: A Population-Based Study. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01932-2. [PMID: 38378940 DOI: 10.1007/s40615-024-01932-2] [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: 09/25/2023] [Revised: 01/13/2024] [Accepted: 01/31/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION We investigate racial-ethnic disparities in pre-pregnancy obesity and pregnancy weight gain, which are known to increase the risk of pregnancy-associated conditions. METHODS We used 4-year (2017-2020) combined Georgia Pregnancy Risk Assessment Monitoring System data (N = 3208) to investigate racial-ethnic disparities in the incidence of gestational hypertension (GHT), gestational diabetes mellitus (GDM), and postpartum depression (PPD) and their associated risk with pre-pregnancy overweight/obesity after controlling for demographic and other confounders using regression modeling. The geographic distributions of hypertension and PPD rates at the county level were compared to the patterns of racial-ethnic populations and hospitals. RESULTS The PPD rates were higher among Asian (17.6), Hispanic (14.4), and Black (14.3); GDM was highest among Asian (16.0) mothers; and GHT was the highest among Black (11.7) followed by White mothers (9.0). Pre-pregnancy overweight and obese conditions increased the odds of hypertension in Black (2 ½ times) and White (> 3 ½ times) mothers. Premature birth increased the odds of hypertension (2-3 times) in all mothers. Pre-pregnancy weight also increased the odds of GDM (3-7 times) in these racial groups. Premature birth increases the odds twice as likely for PPD in Hispanic and White mothers. The convergence of high PPD and hypertension rates with high proportions of racial and ethnic minorities, and lack of hospital presence, indicates areas where healthcare interventions are required. CONCLUSIONS These findings underscore the importance of promoting a healthy pre-pregnancy weight to reduce the burden of maternal morbidity and pregnancy outcomes in general. More comprehensive prenatal monitoring using technological interventions for self-care has a great promise of being effective in maintaining a healthy pregnancy.
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Affiliation(s)
- Suhasini Ramisetty-Mikler
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, USA.
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, USA.
- Urban Life Building, Room 406, 140 Decatur St, Atlanta, GA, 30303, USA.
| | - Angelique Willis
- Department of Geosciences, Georgia State University, Atlanta, USA
| | - Chetan Tiwari
- Department of Geosciences, Georgia State University, Atlanta, USA
- Center for Disaster Informatics and Computational Epidemiology, Georgia State University, Atlanta, USA
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Temple JA, Varshney N. Using Prevention Research to Reduce Racial Disparities in Health Through Innovative Funding Strategies: The Case of Doula Care. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:108-118. [PMID: 36757659 PMCID: PMC11303420 DOI: 10.1007/s11121-023-01497-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 02/10/2023]
Abstract
Racial disparities in maternal birth outcomes are substantial even when comparing women with similar levels of education. While racial differences in maternal death at birth or shortly afterward have attracted significant attention from researchers, non-fatal but potentially life-threatening pregnancy complications are 30-40 times more common than maternal deaths. Black women have the worst maternal health outcomes. Only recently have health researchers started to view structural racism rather than race as the critical factor underlying these persistent inequities. We discuss the economic framework that prevention scientists can use to convince policymakers to make sustainable investments in maternal health by expanding funding for doula care. While a few states allow Medicaid to fund doula services, most women at risk of poor maternal health outcomes arising from structural racism lack access to culturally sensitive caregivers during the pre-and post-partum periods as well as during birth. We provide a guide to how research in health services can be more readily translated to policy recommendations by describing two innovative ways that cost-benefit analysis can help direct private and public funding to support doula care for Black women and others at risk of poor birth outcomes.
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Affiliation(s)
- Judy A Temple
- Humphrey School of Public Affairs and Human Capital Research Collaborative, University of Minnesota - Twin Cities, 301-19th Avenue South, MN, 55455, Minneapolis, USA.
| | - Nishank Varshney
- Humphrey School of Public Affairs and Human Capital Research Collaborative, University of Minnesota - Twin Cities, 301-19th Avenue South, MN, 55455, Minneapolis, USA
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Handley SC, Formanowski B, Passarella M, Kozhimannil KB, Leonard SA, Main EK, Phibbs CS, Lorch SA. Perinatal Care Measures Are Incomplete If They Do Not Assess The Birth Parent-Infant Dyad As A Whole. Health Aff (Millwood) 2023; 42:1266-1274. [PMID: 37669487 PMCID: PMC10901240 DOI: 10.1377/hlthaff.2023.00398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Measures of perinatal care quality and outcomes often focus on either the birth parent or the infant. We used linked vital statistics and hospital discharge data to describe a dyadic measure (including both the birth parent and the infant) for perinatal care during the birth hospitalization. In this five-state cohort of 2010-18 births, 21.6 percent of birth parent-infant dyads experienced at least one complication, and 9.6 percent experienced a severe complication. Severe infant complications were eight times more prevalent than severe birth parent complications. Among birth parents with a severe complication, the co-occurrence of a severe infant complication ranged from 2 percent to 51 percent, whereas among infants with a severe complication, the co-occurrence of a severe birth parent complication was rare, ranging from 0.04 percent to 5 percent. These data suggest that measures, clinical interventions, public reporting, and policies focused on either the birth parent or the infant are incomplete in their assessment of a healthy dyad. Thus, clinicians, administrators, and policy makers should evaluate dyadic measures, incentivize positive outcomes for both patients (parent and infant), and create policies that support the health of the dyad.
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Affiliation(s)
- Sara C Handley
- Sara C. Handley , Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | | | - Ciaran S Phibbs
- Ciaran S. Phibbs, Palo Alto Veterans Affairs Medical Center, Menlo Park, California; and Stanford University
| | - Scott A Lorch
- Scott A. Lorch, Children's Hospital of Philadelphia and University of Pennsylvania
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