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Adams A, Dongarwar D, Shay L, Baroni M, Williams E, Ehieze P, Wilson R, Awoseyi A, Salihu HM. Social Determinants of Health and Risk of Stillbirth in the United States. Am J Perinatol 2024; 41:e477-e485. [PMID: 36055282 DOI: 10.1055/s-0042-1756141] [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] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Our aim was to evaluate the impact of social determinants of health (SDoH) risk factors on stillbirth among pregnancy-related hospitalizations in the United States. STUDY DESIGN We conducted a cross-sectional analysis of delivery-related hospital discharges using annualized data (2016-2017) from the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. The International Classification of Diseases, 10th Revision ICD-10-CM codes were used to select women with singleton stillbirth. Z-codes were utilized to identify SDoH risk factors and their subtypes. The association between SDoH risk factors and stillbirth was assessed using survey logistic regression models. RESULTS We analyzed 8,148,646 hospitalizations, out of which 91,140 were related to stillbirth hospitalizations, yielding a stillbirth incidence of 1.1%. An increased incidence was observed for non-Hispanic (NH) Blacks (1.7%) when compared with NH Whites (1.0%). The incidence of stillbirth was greater in hospitalizations associated with SDoH risk factors compared with those without risk factors [2.0% vs. 1.1% (p <0.001)]. Among patients with SDoH risk factors, the rate of stillbirth was highest in those designated as NH other (3.0%). Mothers that presented with SDoH risk factors had a 60% greater risk of stillbirth compared with those without (odds ratio [OR] = 1.61 [95% confidence interval (CI) = 1.33-1.95], p < 0.001). The SDoH issues that showed the most significant risk for stillbirth were: occupational risk (OR = 7.05 [95% CI: 3.54-9.58], p < 0.001), upbringing (OR = 1.87 [95% CI: 1.23-2.82], p < 0.001), and primary support group and family (OR = 5.45 [95% 3.84-7.76], p < 0.001). CONCLUSION We found pregnancies bearing SDoH risk factors to be associated with a 60% elevated risk for stillbirth. Future studies should target a variety of risk reduction strategies aimed at modifiable SDoH risk factors that can be widely implemented at both the population health level as well as in the direct clinical setting. KEY POINTS · Health disparities exist in stillbirth rates, especially among NH Black women.. · Social determinants of health risk factors increase the risk of stillbirth.. · There is a need for further study on the impact of specific SDoH risk factors on stillbirth risk..
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Affiliation(s)
- April Adams
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Deepa Dongarwar
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
| | - Lena Shay
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Mariana Baroni
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
| | - Eunique Williams
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
| | - Priscilla Ehieze
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
| | - Rhanna Wilson
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
| | - Alexia Awoseyi
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
| | - Hamisu M Salihu
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
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Escañuela Sánchez T, Linehan L, O'Donoghue K, Byrne M, Meaney S. Facilitators and barriers to seeking and engaging with antenatal care in high-income countries: A meta-synthesis of qualitative research. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3810-e3828. [PMID: 36240064 PMCID: PMC10092326 DOI: 10.1111/hsc.14072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/18/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Inadequate attendance to antenatal care has been associated with negative maternal and fetal outcomes, including stillbirth. This study aimed to identify facilitators and barriers to antenatal care attendance. A systematic search was conducted in March 2019 and updated in January 2021. Qualitative studies involving pregnant or post-partum women up to 12 months from high-income countries that provided data about facilitators and barriers to antenatal care attendance were sought. Meta-ethnography was used to inform this meta-synthesis. Fifteen studies were included in the analysis. Findings indicate that inadequate antenatal care attendance is influenced at different levels. Aspects like sociodemographic factors, difficulties navigating the health system, administrative delays, lack of flexibility and tailored care, constant change of carer and communication issues also act as barriers. These issues affect women's access to knowledge and the formation of women's beliefs and feelings towards seeking care. On the contrary, having a positive attitude towards the pregnancy, encountering empathetic healthcare professionals and availing of social support acted as facilitators. The reasons why women seek or delay attending antenatal care are multifactorial and can be explained using the Social Determinants of Health Framework. Any response needs to be taken across all levels of influence and not just focused on the individual. A better understanding of the barriers and facilitators to antenatal care might contribute to informing intervention or policy development addressing this issue.
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Affiliation(s)
- Tamara Escañuela Sánchez
- Pregnancy Loss Research Group, Department of Obstetrics and GynaecologyCork University Maternity Hospital, University College CorkCorkIreland
- INFANT Centre, Cork University HospitalUniversity College CorkCorkIreland
| | - Laura Linehan
- Pregnancy Loss Research Group, Department of Obstetrics and GynaecologyCork University Maternity Hospital, University College CorkCorkIreland
- INFANT Centre, Cork University HospitalUniversity College CorkCorkIreland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and GynaecologyCork University Maternity Hospital, University College CorkCorkIreland
- INFANT Centre, Cork University HospitalUniversity College CorkCorkIreland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, NUI GalwayNational University of IrelandGalwayIreland
| | - Sarah Meaney
- Pregnancy Loss Research Group, Department of Obstetrics and GynaecologyCork University Maternity Hospital, University College CorkCorkIreland
- National Perinatal Epidemiology Centre (NPEC), Department of Obstetrics and GynaecologyCork University Maternity Hospital, University College CorkCorkIreland
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Harville EW, Wallace ME, Theall KP. Eviction as a social determinant of pregnancy health: County-level eviction rates and adverse birth outcomes in the United States. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5579-e5587. [PMID: 36065610 DOI: 10.1111/hsc.13983] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/10/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
Access to housing is an important manifestation of structural racism and discrimination, and birth outcomes show wide health disparities, but few studies have examined eviction and birth outcomes. This multilevel study merged data from the Eviction Lab on 2015 eviction judgements and records with the National Center for Health Statistics natality dataset. The analytic sample included 2,950,965 births across 5924 counties in 45 states. Outcomes of interest were low birthweight (<2500 g; LBW) and preterm birth (<37 weeks gestation; PTB). We fit generalised estimating equations to account for clustering within county and a logistic distribution to estimate the odds ratio of LBW or PTB associated with the county-level eviction rate, with control for individual- and county-level characteristics. Results were calculated separately for non-Hispanic white, non-Hispanic black and Hispanic mothers. After adjustment for covariates, living in the counties in the highest quartile of eviction was associated with a 12-13% increased odds of LBW. The magnitude of association with PTB was not as large. Non-Hispanic black women were more likely to live in counties in the highest quartile of eviction rate (43%, vs. 23% for white women and 23% for Hispanic women) or filing rate (44%, vs. 23% for white and 18% for Hispanic). The association between eviction rate and LBW/PTB was strongest for black women, while there was essentially no association among Hispanic women. Housing instability may be a key social determinant of poor birth outcomes and should be considered in state and local maternal and child health policy and programming.
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Affiliation(s)
- Emily W Harville
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Maeve E Wallace
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Katherine P Theall
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Carbone L, Trinchillo MG, Di Girolamo R, Raffone A, Saccone G, Iorio GG, Gabrielli O, Maruotti GM. COVID
‐19 vaccine and pregnancy outcomes: a systematic review and meta‐analysis. Int J Gynaecol Obstet 2022; 159:651-661. [PMID: 35810414 PMCID: PMC9349529 DOI: 10.1002/ijgo.14336] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/23/2022] [Accepted: 07/07/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Luigi Carbone
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II Naples Italy
| | - Maria Giuseppina Trinchillo
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II Naples Italy
| | - Raffaella Di Girolamo
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II Naples Italy
| | - Antonio Raffone
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero‐Universitaria di Bologna. S. Orsola Hospital, University of Bologna Bologna Italy
| | - Gabriele Saccone
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II Naples Italy
| | - Giuseppe Gabriele Iorio
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II Naples Italy
| | - Olimpia Gabrielli
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II Naples Italy
| | - Giuseppe Maria Maruotti
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II Naples Italy
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Wright ML, Dunlop AL, Dunn AB, Mitchell RM, Wissel EF, Corwin EJ. Factors Associated with Vaginal Lactobacillus Predominance Among African American Women Early in Pregnancy. J Womens Health (Larchmt) 2022; 31:682-689. [PMID: 34448602 PMCID: PMC9133973 DOI: 10.1089/jwh.2021.0148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: Vaginal Lactobacillus is considered protective of some adverse reproductive health outcomes, including preterm birth. However, factors that increase or decrease the likelihood of harboring Lactobacillus in the vaginal microbiome remain largely unknown. In this study, we sought to identify risk and protective factors associated with vaginal Lactobacillus predominance within a cohort of pregnant African American women. Materials and Methods: Vaginal microbiome samples were self-collected by African American women (N = 436) during their 8-14th week of pregnancy. Sociodemographic information and measures of health behaviors, including substance use, antibiotic exposure, sexual practices, frequency of vaginal intercourse, and the use of vaginal products, were collected through participant self-report. The V3-V4 region of the 16S rRNA gene was targeted for amplification and sequencing using Illumina HiSeq, with bacterial taxonomy assigned using the PECAN classifier. Univariate and a series of multivariate logistic regression models identified factors predictive of diverse vaginal microbiota or Lactobacillus predominance. Results: Participants who used marijuana in the past 30 days (aOR 1.80, 95% CI 1.08-2.98) were more likely to have diverse non-Lactobacillus-predominant vaginal microbiota, as were women not living with their partners (aOR 1.90, 95% CI 1.20-3.01). Cohabitating or marijuana usage were not associated with type of Lactobacillus (non-iners Lactobacillus vs. Lactobacillus iners) predominance (aOR 1.11, 95% CI 0.52-2.38 and aOR 0.56, 95% CI 0.21-1.47, respectively). Conclusions: Living with a partner is conducive to vaginal Lactobacillus predominance. As such, cohabitation may be in important covariate to consider in vaginal microbiome studies.
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Affiliation(s)
- Michelle L. Wright
- School of Nursing, The University of Texas at Austin, Austin, Texas, USA
- Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Anne L. Dunlop
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Alexis B. Dunn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Rebecca M. Mitchell
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
- Department of Computer Science, College of Arts and Sciences, Emory University, Atlanta, Georgia, USA
| | - Emily F. Wissel
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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Hispanic Ethnicity, Nativity and the Risk of Stillbirth. J Immigr Minor Health 2022; 24:1379-1386. [PMID: 35044554 DOI: 10.1007/s10903-022-01332-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
The objective of this study was to examine stillbirth risk by nativity and Hispanic ethnicity. We analyzed births and fetal deaths among women of Hispanic origin within gestational ages of 20-42 weeks from the 2014-2019 Birth and Fetal Death. Foreign-born Hispanic mothers were 8% less likely (HR 0.92, 95% CI 0.90-0.95) to experience stillbirth than their counterparts. Stratified by ethnicity, foreign-born Mexican and Central/South American women had a lower risk of stillbirth (HR 0.85, 95% CI 0.81-0.88 and HR 0.68, 95% CI 0.63-0.75, respectively) while foreign-born Puerto Rican women were more likely to experience stillbirth (HR 1.37, 95% CI 1.24-1.51) than their native-born counterparts. While overall foreign-born Hispanic mothers were less likely to experience stillbirth than native-born Hispanic mothers, this differed depending on ethnicity. Counseling regarding risk of stillbirth among Hispanic women should take into consideration nativity and country of origin as influential factors.
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Adane AA, Bailey HD, Marriott R, Farrant BM, White SW, Shepherd CCJ. Disparities in severe neonatal morbidity and mortality between Aboriginal and non-Aboriginal births in Western Australia: a decomposition analysis. J Epidemiol Community Health 2021; 75:1187-1194. [PMID: 34006585 DOI: 10.1136/jech-2020-214507] [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: 05/06/2020] [Revised: 05/05/2021] [Accepted: 05/08/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The health disadvantages faced by Australian Aboriginal peoples are evidenced in early life, although few studies have focused on the reasons for population-level inequalities in more severe adverse outcomes. This study aimed to examine the scale of disparity in severe neonatal morbidity (SNM) and mortality between Aboriginal and non-Aboriginal births and quantify the relative contributions of important maternal and infant factors. METHOD A retrospective cohort study with singleton live births (≥32 weeks' gestation) was conducted using Western Australia linked whole population datasets, from 1999 to 2015. Aboriginal status was determined based on the mothers' self-reported ethnic origin. An Australian validated indicator was adapted to identify neonates with SNM. The Oaxaca-Blinder method was employed to calculate the contribution of each maternal and infant factor to the disparity in SNM and mortality. RESULTS Analyses included 425 070 births, with 15 967 (3.8%) SNM and mortality cases. The disparity in SNM and mortality between Aboriginal and non-Aboriginal births was 2.9 percentage points (95% CI 2.6 to 3.2). About 71% of this gap was explained by differences in modelled factors including maternal area of residence (23.8%), gestational age (22.2%), maternal age (7.5%) and antenatal smoking (7.2%). CONCLUSIONS There is a considerable disparity in SNM and mortality between Aboriginal and non-Aboriginal births in Western Australia with the majority of this related to differences in maternal sociodemographic factors, antenatal smoking and gestational age. Public health programmes targeting these factors may contribute to a reduction in early life health differentials and benefit Aboriginal population health through the life course.
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Affiliation(s)
- Akilew A Adane
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia .,Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Murdoch, Western Australia, Australia
| | - Helen D Bailey
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Rhonda Marriott
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Murdoch, Western Australia, Australia
| | - Brad M Farrant
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Scott W White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Nedlands, Western Australia, Australia.,Maternal Fetal Medicine Service, King Edward Memorial Hospital for Women Perth, Subiaco, Western Australia, Australia
| | - Carrington C J Shepherd
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia.,Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Murdoch, Western Australia, Australia.,Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
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Stafford IA, Turrentine MA, Ostovar-Kermani T, Moustafa ASZ, Berra A, Sangi-Haghpeykar H. Disparities between US Hispanic and non-Hispanic women in obesity-related perinatal outcomes: a prospective cohort study. J Matern Fetal Neonatal Med 2021; 35:6172-6179. [PMID: 33843401 DOI: 10.1080/14767058.2021.1909559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Mortality figures and national health surveillance data have demonstrated that Hispanics have a 24% lower risk of all-cause mortality compared to their non-Hispanic counterparts despite increased rates of obesity and related illnesses. OBJECTIVE The aim of this study is to evaluate if this paradox exists for obesity-related perinatal outcomes in otherwise low-risk Hispanic women. MATERIALS AND METHODS A prospective cohort study of low-risk women across all BMI classes with a singleton, non-anomalous term pregnancy admitted in active labor or undergoing induction of labor between May 2014 and April 2017. All demographic, obstetric, and neonatal outcomes were recorded, and the body mass index (BMI) closest to delivery was used for analysis. Data including composites of adverse maternal and neonatal outcomes were compared across BMI classes and between individuals of Hispanic and non-Hispanic ethnicity. Women with antenatal complications, prior cesarean delivery, and cesarean for non-reassuring fetal status were excluded. RESULTS Of the 11,369 women who met inclusion criteria, 6303 (55%) were Hispanic. Eight percent of Hispanic women were normal weight (BMI: 18.5-24.9), 34% were overweight (BMI: 25-29.9), and 58% were obese (BMI > 30). Fourteen percent of non-Hispanic women were normal weight, 42% were overweight, and 44% were obese. The majority (65%) of women were multiparous. Rate of induction and birthweight increased across BMI for Hispanic and non-Hispanic groups, however the route of delivery was not significantly different (p = .22, 0.16, respectively). Although the association between BMI and composite perinatal complications did not differ by BMI class and ethnicity, the newborns of non-Hispanic women were more likely to be admitted to the neonatal intensive care unit with increasing maternal weight class (<0.001), even after adjusting for age, parity, marital status, prenatal visits, current tobacco use, type of labor, mode of delivery, and birthweight. CONCLUSION There were no demonstrable differences in composite adverse maternal or neonatal outcomes between Hispanic and non-Hispanic obese women. However, newborns of non-Hispanic obese women were more likely to be transferred to the neonatal intensive care unit with increasing maternal BMI.
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Affiliation(s)
- Irene A Stafford
- Department of Obstetrics and Gynecology, The University of Texas Health Science Center/McGovern Medical School, Houston, TX, USA
| | - Mark A Turrentine
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | | | - Ahmed S Z Moustafa
- Department of Obstetrics and Gynecology, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Alexandra Berra
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
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Nsereko E, Moreland PJ, Dunlop AL, Nzayirambaho M, Corwin EJ. Consideration of Cultural Practices When Characterizing the Vaginal Microbiota Among African and African American Women. Biol Res Nurs 2020; 23:91-99. [PMID: 32666817 DOI: 10.1177/1099800420940788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This manuscript considers intravaginal practices prevalent among African and African-American women, with the aim of providing a framework for how these practices may affect vaginal health and the vaginal microbiota, and consequently, impact pregnancy outcomes. Intravaginal practices are influenced by traditional socio-cultural beliefs and gender norms, with prominent practices including intravaginal insertion of substances (herbs and traditional medicines), intravaginal cleansing (douching), and anatomical modification of the female organs (labia elongation and female genital mutilation). Common motivations for such practices included hygiene, prevention of infection, enhancement of sexual pleasure, and compliance with societal or cultural norms. The use of soaps and other chemicals for vaginal douching has been reported to reduce diversity of the vaginal microbiota and lower pH, thus increasing the chances of bacterial vaginosis, but the evidence is minimal. The practice of vaginal insertion of natural or other substances is associated with physical abrasions, disruption of the vaginal flora, bacterial vaginosis, and HIV and other infections, but effects on pregnancy outcomes and the vaginal microbiota are unclear. Finally, female genital mutation has been reported to have immediate and prolonged physiological and psychological effects, including frequent infections and chronic inflammation, but similar to most other practices, consequences for preterm birth remain understudied and for the vaginal microbiota, unknown. Overall, findings identify the need for additional research, focusing on how these common practices influence both birth outcomes and the vaginal microbiota, so that nurses, midwives, physicians, and other providers worldwide are better equipped to assess and care for pregnant women.
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Gibbins KJ, Pinar H, Reddy UM, Saade GR, Goldenberg RL, Dudley DJ, Drews-Botsch C, Freedman AA, Daniels LM, Parker CB, Thorsten V, Bukowski R, Silver RM. Findings in Stillbirths Associated with Placental Disease. Am J Perinatol 2020; 37:708-715. [PMID: 31087311 PMCID: PMC6854286 DOI: 10.1055/s-0039-1688472] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Placental disease is a leading cause of stillbirth. Our purpose was to characterize stillbirths associated with placental disease. STUDY DESIGN The Stillbirth Collaborative Research Network conducted a prospective, case-control study of stillbirths and live births from 2006 to 2008. This analysis includes 512 stillbirths with cause of death assignment and a comparison group of live births. We compared exposures between women with stillbirth due to placental disease and those due to other causes as well as between women with term (≥ 37 weeks) stillbirth due to placental disease and term live births. RESULTS A total of 121 (23.6%) out of 512 stillbirths had a probable or possible cause of death due to placental disease by Initial Causes of Fetal Death. Characteristics were similar between stillbirths due to placental disease and other stillbirths. When comparing term live births to stillbirths due to placental disease, women with non-Hispanic black race, Hispanic ethnicity, lack of insurance, or who were born outside of the United States had higher odds of stillbirth due to placental disease. Nulliparity and antenatal bleeding also increased risk of stillbirth due to placental disease. CONCLUSION Multiple discrete exposures were associated with stillbirth caused by placental disease. The relationship between these factors and utility of surveillance warrants further study.
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Affiliation(s)
| | - Halit Pinar
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Uma M. Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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Beck AF, Edwards EM, Horbar JD, Howell EA, McCormick MC, Pursley DM. The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families. Pediatr Res 2020; 87:227-234. [PMID: 31357209 PMCID: PMC6960093 DOI: 10.1038/s41390-019-0513-6] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/04/2019] [Indexed: 02/06/2023]
Abstract
Racism, segregation, and inequality contribute to health outcomes and drive health disparities across the life course, including for newborn infants and their families. In this review, we address their effects on the health and well-being of newborn infants and their families with a focus on preterm birth. We discuss three causal pathways: increased risk; lower-quality care; and socioeconomic disadvantages that persist into infancy, childhood, and beyond. For each pathway, we propose specific interventions and research priorities that may remedy the adverse effects of racism, segregation, and inequality. Infants and their families will not realize the full benefit of advances in perinatal and neonatal care until we, collectively, accept our responsibility for addressing the range of determinants that shape long-term outcomes.
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Affiliation(s)
- Andrew F Beck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of General & Community Pediatrics and Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Erika M Edwards
- Vermont Oxford Network, Burlington, VT, USA.
- Department of Pediatrics, Robert Larner, MD, College of Medicine, University of Vermont, Burlington, VT, USA.
- Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, VT, USA.
| | - Jeffrey D Horbar
- Vermont Oxford Network, Burlington, VT, USA
- Department of Pediatrics, Robert Larner, MD, College of Medicine, University of Vermont, Burlington, VT, USA
| | - Elizabeth A Howell
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marie C McCormick
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - DeWayne M Pursley
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Rammah A, Whitworth KW, Han I, Chan W, Symanski E. Time-Varying Exposure to Ozone and Risk of Stillbirth in a Nonattainment Urban Region. Am J Epidemiol 2019; 188:1288-1295. [PMID: 31111863 DOI: 10.1093/aje/kwz095] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 11/12/2022] Open
Abstract
In a racially and ethnically diverse urban area (Harris County, Texas) with historic nonattainment O3 levels, we obtained birth and fetal death records from 2008-2013 and estimated maternal residential O3 concentrations from conception until delivery using inverse-distance interpolation from the local air monitoring network. We examined multipollutant models (with fine particulate matter and nitrogen dioxide) and effect measure modification by race/ethnicity and length of gestation. We found a 9% (95% confidence interval (CI): 1, 18) increased stillbirth risk associated with a 3.6-parts-per-billion increase in O3 exposure. The risk was higher among women with pregnancies of <37 gestational weeks (hazard ratio (HR) = 1.13, 95% CI: 1.04, 1.23) compared with women with pregnancies of longer gestation (HR = 1.05, 95% CI: 0.87, 1.27) and among Hispanic women (HR = 1.14, 95% CI: 1.02, 1.27). We also conducted a case-crossover analysis and detected no associations with short-term exposure. To our knowledge, this study is the first to use time-to-event analyses to examine stillbirth risk associated with time-varying prenatal ozone (O3) exposure over pregnancy. Our findings indicate that maternal O3 exposure over pregnancy is associated with stillbirth risk and that Hispanic women and women with shorter pregnancies might be at particular risk.
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Affiliation(s)
- Amal Rammah
- Epidemiology, Human Genetics and Environmental Sciences, the University of Texas Health Science Center at Houston
- Southwest Center for Occupational and Environmental Health, the University of Texas Health Science Center at Houston
| | - Kristina W Whitworth
- Epidemiology, Human Genetics and Environmental Sciences, the University of Texas Health Science Center at Houston
- Southwest Center for Occupational and Environmental Health, the University of Texas Health Science Center at Houston
| | - Inkyu Han
- Epidemiology, Human Genetics and Environmental Sciences, the University of Texas Health Science Center at Houston
- Southwest Center for Occupational and Environmental Health, the University of Texas Health Science Center at Houston
| | - Wenyaw Chan
- Department of Biostatistics and Data Science, the University of Texas Health Science Center at Houston
| | - Elaine Symanski
- Epidemiology, Human Genetics and Environmental Sciences, the University of Texas Health Science Center at Houston
- Southwest Center for Occupational and Environmental Health, the University of Texas Health Science Center at Houston
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Hauck FR. The Healthy Immigrant Effect: Improved Reproductive Health Outcomes Among African Refugee Women Compared with U.S.-Born Women. J Womens Health (Larchmt) 2019; 28:739-740. [DOI: 10.1089/jwh.2019.7706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Fern R. Hauck
- Department of Family Medicine, University of Virginia, Charlottesville, Virginia
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VanOtterloo LR, Morton CH, Seacrist MJ, Main EK. Quality Improvement Opportunities Identified Through Case Review of Pregnancy-Related Deaths From Cardiovascular Disease. J Obstet Gynecol Neonatal Nurs 2019; 48:263-274. [PMID: 30998902 DOI: 10.1016/j.jogn.2019.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To analyze quality improvement opportunities (QIOs) identified through review of cases of maternal death from cardiovascular disease (CVD) by the California Pregnancy-Associated Mortality Review committee. DESIGN Qualitative descriptive design using thematic analysis. SAMPLE A total of 269 QIOs identified from 87 pregnancy-related deaths from CVD in California from 2002 to 2007. METHODS We coded and thematically organized the 269 QIOs using three of the four domains commonly applied in quality improvement initiatives for maternal health care: Readiness, Recognition, and Response. Data did not include reporting issues, so the Reporting domain was excluded from the analysis. RESULTS The most prevalent theme within the Readiness domain was the care of women in a facility or a department within a facility that was not equipped to handle the severity of their CVD conditions. For Recognition, a common theme was an underappreciation of the severity of illness, including high-risk factors and clinical warning signs, which led to inaccurate diagnoses, such as anxiety or asthma, and missed diagnoses of CVD. The lack of recognition of CVD led to delays in treatment or inaccurate treatment, the leading themes in the Response domain. CONCLUSION Identification of CVD or its risk factors during pregnancy can lead to timely, multidisciplinary approaches to management and birth in facilities that offer appropriately trained health care professionals and appropriate equipment. Maternal mortality can be reduced if signs and symptoms of CVD in women are recognized early and treatment modalities are implemented quickly during pregnancy, childbirth, and the postpartum period.
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Wheeler S, Pryor K, Antczak B, Truong T, Murtha A, Seed P. The relationship of cervical microbiota diversity with race and disparities in preterm birth. J Neonatal Perinatal Med 2019; 11:305-310. [PMID: 30198877 DOI: 10.3233/npm-17111] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Pregnant non-Hispanic blacks (NHB) have increased vaginal microbiome diversity compared to non-Hispanic whites (NHW) which may contribute to increased preterm birth. Cervical microbiome diversity is poorly characterized in pregnancy, therefore our objective was to correlate cervical microbiota diversity with cervico-vaginal inflammation by race and delivery timing. STUDY DESIGN Pregnant women were recruited in the first and second trimesters. A sterile cervical swab and saline lavage were collected at a single time point. Using 16S rRNA sequencing, Chao1 and Shannon Diversity (SDI) indicies were measured and compared by race and delivery timing (preterm vs. term delivery). Cervico-vaginal inflammatory markers were also compared by race and delivery timing. Spearman correlation coefficients between cervical microbiome diversity and cervico-vaginal inflammatory markers were calculated. RESULTS Of the 51 subjects, 39 (76%) were NHB and 12 (24%) were NHW. Cervical microbiota SDI was significantly higher in NHB compared to NHW (0.5 vs. 0.1; p = 0.03). However, there were no difference in Chao1 diversity or cervico-vaginal inflammatory markers by race or delivery timing. CONCLUSION Our findings suggest the cervical microbiota diversity during pregnancy differs by race. Larger cohort studies will further determine if altered cervical diversity is part of the pathogenesis of PTB and explains race disparities.
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Affiliation(s)
- Sarahn Wheeler
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Katherine Pryor
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Brian Antczak
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics, Biostatistics Core, Duke University School of Medicine, Durham, NC, USA
| | - Amy Murtha
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Patrick Seed
- Department of Pediatrics, Division of Infectious Diseases, Northwestern Feinberg School of Medicine, Chicago, IL, USA
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Auger N, Bilodeau-Bertrand M, Costopoulos A. Emerging Lingo-Cultural Inequality in Infant Autopsy in Quebec, Canada. J Immigr Minor Health 2018; 21:230-236. [PMID: 29774511 DOI: 10.1007/s10903-018-0756-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We investigated trends in infant autopsy for Francophones and Anglophones in Quebec, Canada. Using death certificates, we extracted 8214 infant deaths between 1989 and 2013. We computed rates of non-autopsy by language, socioeconomic disadvantage, age at death, and period. Using Kitagawa's method, we decomposed non-autopsy rates over time for both language groups. Infant non-autopsy rates increased from 38.6 to 56.2 per 100 for Francophones, and from 41.2 to 57.2 per 100 for Anglophones, between 1989-1995 and 2008-2013. Trends in English-speakers were driven by socioeconomically disadvantaged Anglophones, and were accelerated by a larger proportion of deaths in this group over time. For French-speakers, rates increased in all socioeconomic groups. The increase in non-autopsy rates was larger at early neonatal ages for both languages. These findings suggest that disadvantaged Anglophones are less likely to use infant autopsy over time, and that rates can be improved by targeting early neonatal deaths.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, 900 Saint-Denis, Montreal, QC, H2X 0A9, Canada. .,Institut national de santé publique du Québec, 190 Crémazie E. Blvd., Montreal, QC, H2P 1E2, Canada.
| | - Marianne Bilodeau-Bertrand
- University of Montreal Hospital Research Centre, 900 Saint-Denis, Montreal, QC, H2X 0A9, Canada.,Institut national de santé publique du Québec, 190 Crémazie E. Blvd., Montreal, QC, H2P 1E2, Canada
| | - André Costopoulos
- Department of Anthropology, University of Alberta, 13-15 HM Tory Building, Edmonton, AB, T6G 2H4, Canada
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Paul DA, Goldstein ND, Locke R. Delaware Infant Mortality. Dela J Public Health 2018; 4:24-31. [PMID: 34466974 PMCID: PMC8389118 DOI: 10.32481/djph.2018.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- David A Paul
- Clinical Leader, Women and Children's Service Line; Chair, Pediatrics, Christiana Care Health System; Professor, Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University; Governor Appointed Chair, Delaware Healthy Mother and Infant Consortium
| | - Neal D Goldstein
- Clinical Leader, Women and Children's Service Line; Chair, Pediatrics, Christiana Care Health System; Professor, Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University; Governor Appointed Chair, Delaware Healthy Mother and Infant Consortium
- Infectious Disease Epidemiologist, Christiana Care Health System; Assistant Research Professor, Department of Epidemiology & Biostatistics, Drexel University Dornsife School of Public Health
- Attending Critical Care Neonatologist, Christiana Care Health System; Professor, Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University
| | - Robert Locke
- Attending Critical Care Neonatologist, Christiana Care Health System; Professor, Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University
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The contribution of gestational age, area deprivation and mother's country of birth to ethnic variations in infant mortality in England and Wales: A national cohort study using routinely collected data. PLoS One 2018; 13:e0195146. [PMID: 29649290 PMCID: PMC5896919 DOI: 10.1371/journal.pone.0195146] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/16/2018] [Indexed: 02/03/2023] Open
Abstract
Objectives We aimed to describe ethnic variations in infant mortality and explore the contribution of area deprivation, mother’s country of birth, and prematurity to these variations. Methods We analyzed routine birth and death data on singleton live births (gestational age≥22 weeks) in England and Wales, 2006–2012. Infant mortality by ethnic group was analyzed using logistic regression with adjustment for sociodemographic characteristics and gestational age. Results In the 4,634,932 births analyzed, crude infant mortality rates were higher in Pakistani, Black Caribbean, Black African, and Bangladeshi infants (6.92, 6.00, 5.17 and 4.40 per 1,000 live births, respectively vs. 2.87 in White British infants). Adjustment for maternal sociodemographic characteristics changed the results little. Further adjustment for gestational age strongly attenuated the risk in Black Caribbean (OR 1.02, 95% CI 0.89–1.17) and Black African infants (1.17, 1.06–1.29) but not in Pakistani (2.32, 2.15–2.50), Bangladeshi (1.47, 1.28–1.69), and Indian infants (1.24, 1.11–1.38). Ethnic variations in infant mortality differed significantly between term and preterm infants. At term, South Asian groups had higher risks which cannot be explained by sociodemographic characteristics. In preterm infants, adjustment for degree of prematurity (<28, 28–31, 32–33, 34–36 weeks) fully explained increased risks in Black but not Pakistani and Bangladeshi infants. Sensitivity analyses with further adjustment for small for gestational age, or excluding deaths due to congenital anomalies did not fully explain the excess risk in South Asian groups. Conclusions Higher infant mortality in South Asian and Black infants does not appear to be explained by sociodemographic characteristics. Higher proportions of very premature infants appear to explain increased risks in Black infants but not in South Asian groups. Strategies targeting the prevention and management of preterm birth in Black groups and suboptimal birthweight and modifiable risk factors for congenital anomalies in South Asian groups might help reduce ethnic inequalities in infant mortality.
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Quality measures in high-risk pregnancies: Executive Summary of a Cooperative Workshop of the Society for Maternal-Fetal Medicine, National Institute of Child Health and Human Development, and the American College of Obstetricians and Gynecologists. Am J Obstet Gynecol 2017; 217:B2-B25. [PMID: 28735702 DOI: 10.1016/j.ajog.2017.07.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/14/2017] [Indexed: 01/07/2023]
Abstract
Providers perceive current obstetric quality measures as imperfect and insufficient. Our organizations convened a "Quality Measures in High-Risk Pregnancies Workshop." The goals were to (1) review the current landscape regarding quality measures in obstetric conditions with increased risk for adverse maternal or fetal outcomes, (2) evaluate the available evidence for management of common obstetric conditions to identify those that may drive the highest impact on outcomes, quality, and value, (3) propose measures for high-risk obstetric conditions that reflect enhanced quality and efficiency, and (4) identify current research gaps, improve methods of data collection, and recommend means of change.
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20
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Maternal exposure to childhood maltreatment and risk of stillbirth. Ann Epidemiol 2017; 27:459-465.e2. [PMID: 28755869 DOI: 10.1016/j.annepidem.2017.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/30/2017] [Accepted: 07/06/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE To determine the association between maternal exposure to childhood maltreatment (CM) and risk of stillbirth (fetal death at or after 20 weeks' gestation). METHODS Population-based case-control study from the Stillbirth Collaborative Research Network (SCRN) conducted in 2006-2008, and the follow-up study, SCRN-Outcomes after Study Index Stillbirth (SCRN-OASIS), conducted in 2009 in the United States. Cases (n = 133) included women who experienced a stillbirth, excluding stillbirths attributed to genetic/structural or umbilical cord abnormalities and intrapartum stillbirths. Controls (n = 500) included women delivering a healthy term live birth (excluding births less than 37 weeks gestation, neonatal intensive care unit admission, or death). CM exposure was measured using the Childhood Trauma Questionnaire, administered during the SCRN-OASIS study. Dichotomized scores for five subscales of CM (physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse) and an overall measure of CM exposure were analyzed using logistic regression. RESULTS Generally, there was no association between CM and stillbirth, except for the emotional neglect subscale (OR: 1.93; 95% CI: 1.17, 3.19). CONCLUSIONS Childhood neglect is understudied in comparison to abuse and should be included in the future studies of associations between CM and pregnancy outcomes, including stillbirth.
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Abstract
Since the police-involved deaths of Michael Brown and Freddie Gray, activists have argued for connecting police violence with reproductive justice. We argue that systematic violence, including police violence, should be evaluated in relation to reproductive health outcomes of individual patients and communities. Beyond emphasizing the relationship between violence and health outcomes, both qualitative and epidemiologic data can be used by activists and caregivers to effectively care for individuals from socially marginalized communities.
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In Reply. Obstet Gynecol 2017; 129:1140-1141. [DOI: 10.1097/aog.0000000000002085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Harville EW, Miller KS, Knoepp LR. Racial and social predictors of longitudinal cervical measures: the Cervical Ultrasound Study. J Perinatol 2017; 37:335-339. [PMID: 28079869 DOI: 10.1038/jp.2016.240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/04/2016] [Accepted: 11/14/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate whether the racial and socioeconomic disparities are present in adverse cervical parameters, and, if so, when such disparities develop. STUDY DESIGN A prospective cohort study was conducted. 175 women with a prior preterm birth had up to four endovaginal ultrasounds between gestational weeks 16 and 24 (Cervical Ultrasound Trial of the MFMU). Each sociodemographic factor (race/ethnicity, marital status, insurance funding and education) was examined as a predictor of short cervix or U/funnel shape, using multiple logistic and linear regression. Changes in the cervical length and shape across pregnancy and after pressure were also examined. RESULTS The strongest associations were seen between race and government-funded insurance and short cervix and U shape per funneling (race and length <25 mm per funnel: adjusted odds ratio (OR) 5.52, 2.24 to 13.63; government-funded insurance and length <30 mm per funnel: adjusted OR 3.10, 1.34 to 7.15). Changes in cervical length were not associated with sociodemographics. CONCLUSION African-American race and, to a lesser extent, insurance funder, are associated with cervical length and shapes that have been associated with preterm birth, and those properties are present largely early in pregnancy.
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Affiliation(s)
- E W Harville
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - K S Miller
- Department of Biomedical Engineering, Tulane University School of Science and Engineering, New Orleans, LA, USA
| | - L R Knoepp
- Department of Obstetrics and Gynecology, Ochsner Clinic, New Orleans, LA, USA
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Amegah AK, Näyhä S, Jaakkola JJK. Do biomass fuel use and consumption of unsafe water mediate educational inequalities in stillbirth risk? An analysis of the 2007 Ghana Maternal Health Survey. BMJ Open 2017; 7:e012348. [PMID: 28174221 PMCID: PMC5306511 DOI: 10.1136/bmjopen-2016-012348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Numerous studies have explored the association between educational inequalities and stillbirth but most have failed to elaborate how low educational attainment leads to an increased risk of stillbirth. We hypothesised that use of biomass fuels and consumption of unsafe water related to low educational attainment could explain the stillbirth burden in Ghana attributable to socioeconomic disadvantage. METHODS Data from the 2007 Ghana Maternal Health Survey, a nationally representative population-based survey were analysed for this study. Of the10 370 women aged 15-49 years interviewed via structured questionnaires for the survey, 7183 primiparous and multiparous women qualified for inclusion in the present study. RESULTS In a logistic regression analysis that adjusted for age, area of residence, marital status and ethnicity of women, lower maternal primary education was associated with a 62% (OR=1.62; 95% CI 1.04 to 2.52) increased lifetime risk of stillbirth. Biomass fuel use and consumption of unsafe water mediated 18% and 8% of the observed effects, respectively. Jointly these two exposures explained 24% of the observed effects. The generalised additive modelling revealed a very flat inverted spoon-shaped smoothed curve which peaked at low levels of schooling (2-3 years) and confirms the findings from the logistic regression analysis. CONCLUSIONS Our results show that biomass fuel use and unsafe water consumption could be important pathways through which low maternal educational attainment leads to stillbirths in Ghana and similar developing countries. Addressing educational inequalities in developing countries is thus essential for ensuring household choices that curtail environmental exposures and help improve pregnancy outcomes.
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Affiliation(s)
- A Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Simo Näyhä
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
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Relations between neighbourhood socioeconomic status and birth outcomes are mediated by maternal weight. Soc Sci Med 2017; 175:143-151. [DOI: 10.1016/j.socscimed.2016.12.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/24/2016] [Accepted: 12/28/2016] [Indexed: 12/22/2022]
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Masho SW, Cha S, Chapman DA, Chelmow D. Understanding the role of violence as a social determinant of preterm birth. Am J Obstet Gynecol 2017; 216:183.e1-183.e7. [PMID: 27729255 DOI: 10.1016/j.ajog.2016.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 08/27/2016] [Accepted: 10/03/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Preterm birth is one of the leading causes of infant morbidity and mortality. Although major strides have been made in identifying risk factors for preterm birth, the complexities between social and individual risk factors are not well understood. OBJECTIVE This study examines the association between neighborhood youth violence and preterm birth. STUDY DESIGN A 10-year live birth registry data set (2004 through 2013) from Richmond, VA, a mid-sized, racially diverse city, was analyzed (N = 27,519). Data were geocoded and merged with census tract and police report data. Gestational age at birth was classified as <32 weeks, 32-36 weeks, and term ≥37 weeks. Using police report data, youth violence rates were calculated for each census tract area and categorized into quartiles. Hierarchical models were examined fitting multilevel logistic regression models incorporating randomly distributed census tract-specific intercepts assuming a binary distribution and a logit link function. RESULTS Nearly a fifth of all births occurred in areas with the highest quartiles of violence. After adjusting for maternal age, race/ethnicity, education, paternal presence, parity, adequacy of prenatal care, pregnancy complications, history of preterm birth, insurance, and tobacco, alcohol, and drug use, census tracts with the highest level of violence had 38% higher odds of very preterm births (adjusted odds ratio, 1.38; 95% confidence interval, 1.06-1.80), than census tracts with the lowest level of violence. CONCLUSION There is an association between high rate of youth violence and very preterm birth. Findings from this study may help inform future research to develop targeted interventions aimed at reducing community violence and very preterm birth in vulnerable populations.
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Affiliation(s)
- Saba W Masho
- Division of Epidemiology, Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University in Richmond, Richmond, VA; Department of Obstetrics and Gynecology, Medical Center, Virginia Commonwealth University in Richmond, Richmond, VA; Institute for Women's Health, Virginia Commonwealth University in Richmond, Richmond, VA.
| | - Susan Cha
- Division of Epidemiology, Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University in Richmond, Richmond, VA
| | - Derek A Chapman
- Division of Epidemiology, Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University in Richmond, Richmond, VA; Center on Society and Health, Virginia Commonwealth University in Richmond, Richmond, VA
| | - David Chelmow
- Department of Obstetrics and Gynecology, Medical Center, Virginia Commonwealth University in Richmond, Richmond, VA
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Carnitine palmitoyltransferase 1A P479L and infant death: policy implications of emerging data. Genet Med 2017; 19:851-857. [PMID: 28125087 DOI: 10.1038/gim.2016.202] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 11/14/2016] [Indexed: 01/24/2023] Open
Abstract
Carnitine palmitoyltransferase 1 isoform A (CPT1A) is a crucial enzyme for the transport of long-chain fatty acids into the mitochondria. The CPT1A p.P479L variant is found in high frequencies among indigenous populations residing on the west and north coasts of Alaska and Canada and in northeast Siberia and Greenland. Epidemiological studies have reported a statistical association between P479L homozygosity and infant death in Alaska Native and Canadian Inuit populations. Here, we review the available evidence about the P479L variant and apply to these data the epidemiological criteria for assessing causal associations. We found insufficient evidence to support a causal association with infant death and, further, that if a causal association is present, then the genotype is likely to be only one of a complex set of factors contributing to an increased risk of infant death. We conclude that additional research is needed to clarify the observed association and to inform effective preventative measures for infant death. In light of these findings, we discuss the policy implications for public health efforts because policies based on the observed association between P479L homozygosity and infant death data are premature.Genet Med advance online publication 26 January 2017.
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Improving Maternal and Infant Child Health Outcomes with Community-Based Pregnancy Support Groups: Outcomes from Moms2B Ohio. Matern Child Health J 2017; 21:1130-1138. [DOI: 10.1007/s10995-016-2211-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Brown KK, Lewis RK, Baumgartner E, Schunn C, Maryman J, LoCurto J. Exploring the Experience of Life Stress Among Black Women with a History of Fetal or Infant Death: a Phenomenological Study. J Racial Ethn Health Disparities 2016; 4:484-496. [PMID: 27406594 DOI: 10.1007/s40615-016-0250-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/28/2016] [Accepted: 05/31/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Disparate birth outcomes among Black women continue to be a major public health problem. Whereas prior research has investigated the influence of stress on Black women's birth outcomes, few studies have explored how stress is experienced among Black women across the life course. The objectives of this study were to describe the experience of stress across the life course among Black women who reported a history of fetal or infant death and to identify stressful life events (SLE) that may not be represented in the widely used SLE inventory. METHODS Using phenomenological, qualitative research design, in-depth interviews were conducted with six Black women in Kansas who experienced a fetal or infant death. RESULTS Analyses revealed that participants experienced multiple, co-occurring stressors over the course of their lives and experienced a proliferation of stress emerging in early life and persisting into adulthood. Among the types of stressors cited by participants, history of sexual assault (trauma-related stressor) was a key stressful life event that is not currently reflected in the SLE inventory. CONCLUSION Our findings highlight the importance of using a life-course perspective to gain a contextual understanding of the experiences of stress among Black women, particularly those with a history of adverse birth outcomes. Further research investigating Black women's experiences of stress and the mechanisms by which stress impacts their health could inform efforts to reduce disparities in birth outcomes. An additional focus on the experience and impact of trauma-related stress on Black women's birth outcomes may also be warranted.
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Affiliation(s)
- Kyrah K Brown
- Public Health Performance Division, Sedgwick County Health Department, 1900 E. 9th Street, Wichita, KS, 67208, USA.
| | - Rhonda K Lewis
- Department of Psychology, Wichita State University, 1845 Fairmount St, Wichita, KS, 67260-0034, USA
| | - Elizabeth Baumgartner
- Kansas Infant Death and SIDS Network, Inc., 1148 S. Hillside Street, Suite 10, Wichita, KS, 67211, USA
| | - Christy Schunn
- Kansas Infant Death and SIDS Network, Inc., 1148 S. Hillside Street, Suite 10, Wichita, KS, 67211, USA
| | - J'Vonnah Maryman
- Department of Psychology, Wichita State University, 1845 Fairmount St, Wichita, KS, 67260-0034, USA
| | - Jamie LoCurto
- Department of Psychology, Wichita State University, 1845 Fairmount St, Wichita, KS, 67260-0034, USA
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Auger N, Costopoulos A, Naimi AI, Bellingeri F, Vecchiato L, Fraser WD. Comparison of stillbirth rates by cause among Haitians and non-Haitians in Canada. Int J Gynaecol Obstet 2016; 134:315-9. [PMID: 27262940 DOI: 10.1016/j.ijgo.2016.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/26/2016] [Accepted: 05/06/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare rates of stillbirth among Haitians and non-Haitians in Canada. METHODS A retrospective cohort study was performed using data on all stillborn and live-born singletons weighing at least 500 g in the province of Quebec, Canada, from 1981 to 2010. Stillbirth rates were computed, and hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for Haitians relative to non-Haitians. The main outcome measure was stillbirth by cause of death. RESULTS Data for 9657 stillbirths (124 Haitian) and 2 414 751 live births (17 165 Haitian) were included. Stillbirth rates were higher for Haitians than non-Haitians (7.17 [95% CI 5.91-8.43] vs 3.96 [95% CI 3.88-4.04] per 1000 births), particularly for cord prolapse (adjusted HR 1.87, 95% CI 1.10-3.18) and placental abruption (adjusted HR 2.84, 95% CI 1.95-4.15). Haitians had higher risks of stillbirth due to cord prolapse and abruption at every week of pregnancy. Risks were not elevated for stillbirth due to congenital anomaly, a cause less responsive to urgent intervention. CONCLUSION Stillbirth rates among Haitians are disproportionately high in Canada, particularly fetal death due to cord prolapse and placental abruption. The potential to reduce stillbirth rates through optimal emergency care in vulnerable minorities requires further investigation.
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Affiliation(s)
- Nathalie Auger
- Institut national de santé publique du Québec, Montreal, QC, Canada; University of Montreal Hospital Research Centre, Montreal, QC, Canada.
| | | | - Ashley I Naimi
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Fulvia Bellingeri
- Institut national de santé publique du Québec, Montreal, QC, Canada; University of Montreal Hospital Research Centre, Montreal, QC, Canada
| | | | - William D Fraser
- Department of Obstetrics and Gynecology, University of Sherbrooke Hospital Research Centre, Quebec, QC, Canada
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Blackmore ER, Putnam FW, Pressman EK, Rubinow DR, Putnam KT, Matthieu MM, Gilchrist MA, Jones I, O’Connor TG. The Effects of Trauma History and Prenatal Affective Symptoms on Obstetric Outcomes. J Trauma Stress 2016; 29:245-52. [PMID: 27276162 PMCID: PMC4902169 DOI: 10.1002/jts.22095] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 02/22/2016] [Accepted: 02/26/2016] [Indexed: 12/14/2022]
Abstract
Prenatal maternal mood may inform the adverse obstetric outcomes seen in disadvantaged populations. The contribution of having a trauma history is not well studied. We examined the impact of trauma exposure and mood symptoms on obstetric outcomes in 358 women. Women with antecedent trauma were more likely to have a history of depression, odds ratio = 2.83, 95% confidence interval [1.81, 4.42], were younger at their first pregnancy, 18.86 years versus 20.10 years, and had a higher number of previous pregnancies, 2.01 versus 1.54, compared to those with no trauma exposure. Women with prenatal anxiety had significantly smaller babies than nonanxious women, 3,313.17 g, (SD = 441.58) versus 3,429.27 g, (SD = 437.82) Trauma history magnified the effects of maternal prenatal mood on birthweight; the moderating effect was limited to those who first experienced a trauma under 18 years of age. Childhood trauma exposure increased vulnerability for low birthweight delivery associated with prenatal mood disturbance. Screening pregnant women for trauma history and current mood symptoms is indicated.
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Affiliation(s)
- Emma Robertson Blackmore
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA,Department of Psychiatry, University of Florida, Jacksonville, Florida, USA
| | - Frank W Putnam
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Eva K Pressman
- Department of Obstetrics & Gynecology, University of Rochester Medical Center, Rochester, New York, USA
| | - David R Rubinow
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Karen T Putnam
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Monica M Matthieu
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
| | - Michelle A Gilchrist
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Ian Jones
- Department of Psychological Medicine, Cardiff University, Cardiff, Wales
| | - Thomas G O’Connor
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA,Wynne Center for Family Research, University of Rochester Medical Center, Rochester, New York, USA
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Abstract
The purposes of this study were to describe changes in perinatal nurse (n = 70) and physician (n = 88) perceptions of teamwork and safety climate after implementing a 6-month Crew Resource Management training program and compare responses between nurses and physicians. The Teamwork and Safety Climate Survey was administered prior to and 1 year after the intervention. There were significant improvements in nurse and physician perceptions of teamwork and safety climate; however, physicians perceived teamwork more positive than nurses.
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Roche NE, Abdul-Hakeem F, Davidow AL, Thomas P, Kruse L. The Epidemiology of Infant Mortality in the Greater Newark, New Jersey Area: A New Look at an Old Problem. J Natl Med Assoc 2016; 108:45-53. [PMID: 26928488 DOI: 10.1016/j.jnma.2015.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
REVIEW This research had institutional review board approval from the University of Medicine and Dentistry of New Jersey and the State of New Jersey Department of Health and Senior Services. IRB #0120110286 BACKGROUND: The death rate during the first year of life, or infant mortality rate (IMR), is a key indicator of a nation's health. Many factors affect IMR in the United States, including race and ethnicity. The 2020 U.S. Healthy People IMR target goal has been revised to 6.0 deaths per 1,000 births. In 2006, the IMR in New Jersey was 5.5 deaths per 1,000 births, ranging from 4.4 for Caucasians, to 11.5 for African Americans. OBJECTIVE This study is designed to determine whether IMRs vary by zip code in the greater Newark region and identify maternal/infant characteristics associated with elevated IMRs. METHODS A descriptive study was conducted using New Jersey Department of Health (NJDOH) birth certificate data and U.S. Census data by zip code in the greater Newark area. IMRs were analyzed by zip code and by characteristics of mothers and infants. RESULTS IMRs vary by zip code of residence. The lowest and highest IMRs were in zip codes 07105 and 07102, respectively, both located within the city of Newark. Maternal characteristics associated with high IMR, in multivariable analysis, include: lack of prenatal care, single marital status, and non-Hispanic black race. Demographic characteristics associated with high IMRs were: low mean household income and a large percentage of the population living below poverty level. CONCLUSIONS Race/ethnicity, marital status, and zip code of residence show significant impact upon infant mortality. Poverty and race/ethnicity are associated with increased IMRs and track to ZIP code.
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Affiliation(s)
- Natalie E Roche
- Department of Obstetrics, Gynecology and Women's Health, Rutgers New Jersey Medical School.
| | - Fatimah Abdul-Hakeem
- Department of Preventive Medicine and Community Health, Rutgers New Jersey Medical School
| | - Amy L Davidow
- Department of Preventive Medicine & Community Health, Rutgers New Jersey Medical School
| | - Pauline Thomas
- Department of Preventive Medicine and Community Health, Rutgers New Jersey Medical School
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Wilms FF, Vis JY, Oudijk MA, Kwee A, Porath MM, Scheepers HCJ, Spaanderman MEA, Bloemenkamp KWM, Bolte AC, Bax CJ, Cornette JMJ, Duvekot JJ, Nij Bijvanck BWA, Eijck JV, Franssen MTM, Sollie KM, Vandenbussche FPHA, Woiski MD, van der Post JAM, Bossuyt PMM, Opmeer BC, Mol BWJ, van Baaren GJ. The impact of fetal gender and ethnicity on the risk of spontaneous preterm delivery in women with symptoms of preterm labor. J Matern Fetal Neonatal Med 2016; 29:3563-9. [PMID: 26911700 DOI: 10.3109/14767058.2016.1139566] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate the relation among fetal gender, ethnicity, and preterm labor (PTL) and preterm delivery (PTD). METHODS A secondary analysis was performed of a prospective cohort study including women with symptoms of PTL between 24 and 34 weeks. The proportion of women carrying a male or female fetus at the onset of PTL was calculated. Gestational age at delivery and risk of PTD of both fetal genders was compared and interaction of fetal gender and maternal ethnicity on the risk of PTD was evaluated. RESULTS Of the 594 included women, 327 (55%) carried a male fetus. Median gestational age at delivery in women pregnant with a male fetus was 37 5/7 (IQR 34 4/7-39 1/7) weeks compared with 38 1/7 (IQR 36 0/7-39 5/7) weeks in women pregnant with a female fetus (p = 0.032). The risk of PTD did not differ significantly. In Caucasians, we did find an increased risk of PTD before 37 weeks in women pregnant with a male fetus (OR 1.9 (95% CI 1.2-3.0)). CONCLUSIONS The majority of women with PTL are pregnant with a male fetus and these women deliver slightly earlier. Race seems to affect this disparity.
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Affiliation(s)
- Femke F Wilms
- a Department of Obstetrics & Gynecology , Máxima Medical Center , Veldhoven , Netherlands
| | - Jolande Y Vis
- b Department of Clinical Chemistry & Haematology , University Medical Center Utrecht , Utrecht , the Netherlands
| | - Martijn A Oudijk
- c Department of Obstetrics & Gynecology , University Medical Center Utrecht , Utrecht , Netherlands
| | - Anneke Kwee
- c Department of Obstetrics & Gynecology , University Medical Center Utrecht , Utrecht , Netherlands
| | - Martina M Porath
- a Department of Obstetrics & Gynecology , Máxima Medical Center , Veldhoven , Netherlands
| | - Hubertina C J Scheepers
- d Department of Obstetrics & Gynecology , Maastricht University Medical Center , Maastricht , Netherlands
| | - Marc E A Spaanderman
- d Department of Obstetrics & Gynecology , Maastricht University Medical Center , Maastricht , Netherlands
| | - Kitty W M Bloemenkamp
- e Department of Obstetrics & Gynecology , Leiden University Medical Center , Leiden , Netherlands
| | - Antoinette C Bolte
- f Department of Obstetrics & Gynecology , VU University Medical Center , Amsterdam , Netherlands
| | - Caroline J Bax
- f Department of Obstetrics & Gynecology , VU University Medical Center , Amsterdam , Netherlands
| | - Jérôme M J Cornette
- g Department of Obstetrics & Gynecology , Erasmus University Medical Center , Rotterdam , Netherlands
| | - Johannes J Duvekot
- g Department of Obstetrics & Gynecology , Erasmus University Medical Center , Rotterdam , Netherlands
| | | | - Jim van Eijck
- h Department of Obstetrics & Gynecology , Isala Clinics , Zwolle , Netherlands
| | - Maureen T M Franssen
- i Department of Obstetrics & Gynecology , University Medical Center Groningen , Groningen , Netherlands
| | - Krystyna M Sollie
- i Department of Obstetrics & Gynecology , University Medical Center Groningen , Groningen , Netherlands
| | - Frank P H A Vandenbussche
- j Department of Obstetrics & Gynecology , Radboud University Hospital Nijmegen , Nijmegen , Netherlands
| | - Mallory D Woiski
- j Department of Obstetrics & Gynecology , Radboud University Hospital Nijmegen , Nijmegen , Netherlands
| | - Joris A M van der Post
- k Department of Obstetrics & Gynecology , Academic Medical Center , Amsterdam , Netherlands
| | - Patrick M M Bossuyt
- l Clinical Research Unit, Academic Medical Center , Amsterdam , Netherlands , and
| | - Brent C Opmeer
- l Clinical Research Unit, Academic Medical Center , Amsterdam , Netherlands , and
| | - Ben W J Mol
- m The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide , Adelaide , Australia
| | - Gert-Jan van Baaren
- k Department of Obstetrics & Gynecology , Academic Medical Center , Amsterdam , Netherlands
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Lorch SA, Enlow E. The role of social determinants in explaining racial/ethnic disparities in perinatal outcomes. Pediatr Res 2016; 79:141-7. [PMID: 26466077 DOI: 10.1038/pr.2015.199] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 08/23/2015] [Indexed: 11/09/2022]
Abstract
In the United States, there continue to be significant racial/ethnic disparities in preterm birth (PTB) rates, infant mortality, and fetal mortality rates. One potential mediator of these disparities is social determinants of health, including individual socioeconomic factors; community factors such as crime, poverty, housing, and the racial/ethnic makeup of the community; and the physical environment. Previous work has identified statistically significant associations between each of these factors and adverse pregnancy outcomes. However, there are recent studies that provide new, innovative insights into this subject, including adding social determinant data to population-based datasets; exploring multiple constructs in their analysis; and examining environmental factors. The objective of this review will be to examine this recent research on the association of each of these sets of social determinants on racial/ethnic disparities PTB, infant mortality, and fetal mortality to highlight potential areas for targeted intervention to reduce these differences.
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Affiliation(s)
- Scott A Lorch
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth Enlow
- Department of Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
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Ralston SJ, Farrell RM. The Ethics of Access: Who Is Offered a Cesarean Delivery, and Why? Hastings Cent Rep 2015. [PMID: 26215717 DOI: 10.1002/hast.476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Addressing reproductive health disparities as a healthcare management priority: pursuing equity in the era of the Affordable Care Act. Curr Opin Obstet Gynecol 2015; 26:531-8. [PMID: 25379769 DOI: 10.1097/gco.0000000000000119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To summarize the newest available evidence on maternal and reproductive health disparities, and to describe elements of the Affordable Care Act most likely to impact these disparities. RECENT FINDINGS Significant racial and ethnic disparities in maternal and reproductive health outcomes have persisted in recent years, contributing to poor outcomes and increasing costs. Pregnancy-related mortality ratios are up to three times higher in Black women compared with non-Hispanic White women, with the risk of severe maternal morbidity also significantly higher in Black and Hispanic women. Unintended pregnancy is twice as likely in minority women. Insurance status, socioeconomic status, and broader social determinants of health are implicated in these disparities. Coverage changes associated with the Affordable Care Act may provide some opportunities to reach communities most at risk. Delivery innovation, payment reform, and further public financing of key services are examples of further management approaches that can be used to address reproductive health disparities. SUMMARY The Affordable Care Act offers important opportunities to address persistent reproductive health disparities, but significant gaps remain. Efforts must be made to reduce the negative outcomes and high financial and human costs associated with disparities in reproductive health.
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Vanderbilt AA, Wright MS, Brewer AE, Murithi LK, Coney P. Increasing Knowledge and Health Literacy about Preterm Births in Underserved Communities: An Approach to Decrease Health Disparities, a Pilot Study. Glob J Health Sci 2015; 8:83-9. [PMID: 26234992 PMCID: PMC4804064 DOI: 10.5539/gjhs.v8n1p83] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 05/17/2015] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Health disparities can negatively impact subsets of the population who have systematically experienced greater socioeconomic obstacles to health. For example, health disparities between ethnic and racial groups continue to grow due to the widening gap in large declines in infant and fetal mortality among Caucasians compared to Black non-Hispanic or African Americans. According to the American Congress of Obstetricians and Gynecologists, preterm birth remains a leading cause of infant morbidity and mortality. The purpose of our study is to determine if the computer-based educational modules related to preterm birth health literacy and health disparity with a pre-test and post-test can effectively increase health knowledge of our participants in targeted underserved communities within the Richmond-metro area. METHODS This was a pilot study in the Richmond-Metro area. Participants were required to be over the age of 18, and had to electronically give consent. Descriptive statistics, means and standard deviations, and Paired t-tests were conducted in SPSS 22.0. RESULTS There were 140 participants in the pilot study. P<.05 was set as significant and all four modules had a P<.000. The males were not significant with modules: Let's Talk Patient & Provider Communication P<.132 and It Takes a Village P<.066. Preterm birth status yes all of the findings were statistically significant P<.000. Preterm birth status no Let's Talk Patients & Provider Communication was not significant P<.106. CONCLUSION Overall, researchers found that with a strong research methodology and strong content relevant to the community, the participants demonstrated an increase in their knowledge in health literacy and preterm birth.
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Nerlander LM, Callaghan WM, Smith RA, Barfield WD. Short interpregnancy interval associated with preterm birth in U S adolescents. Matern Child Health J 2015; 19:850-8. [PMID: 25062997 PMCID: PMC5547434 DOI: 10.1007/s10995-014-1583-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A short interpregnancy interval (IPI) is a risk factor for preterm delivery among women of reproductive age. As limited data exist concerning adolescents, we aimed to examine the association between short IPIs and preterm birth among adolescents using a majority of US births. Using 2007-2008 US natality data, we assessed the relationship between IPIs <3, 3-5, 6-11, and 12-17 months and moderately (32-36 weeks) and very (<32 weeks) preterm singleton live births among mothers <20 years, relative to IPIs 18-23 months. Adjusted odds ratios (aORs) and 95 % confidence intervals (95 % CIs) adjusted for maternal race, age, previous preterm deliveries, marital status, smoking and prenatal care were determined from a multivariable multinomial logistic regression model. In 2007-2008, there were 85,077 singleton live births to women aged <20 who had one previous live birth, 69 % of which followed IPIs ≤18 months. Compared with IPIs 18-23 months, short IPIs were associated with moderately preterm birth for IPIs <3 months (aOR 1.89, 95 % CI 1.70-2.10), 3-5 months (aOR 1.33, 95 % CI 1.22-1.47), and 6-12 months (aOR 1.11, 95 % CI 1.02-1.21). IPIs <3 and <6 months were also associated with very preterm birth, with aORs of 2.52 (95 % CI 1.98-3.22) and 1.68 (95 % CI 1.35-2.10) respectively. Many adolescent mothers with repeat births have short IPIs, and shorter IPIs are associated with preterm birth in a dose-dependent fashion. Increasing adolescent mothers' use of effective contraception postpartum can address both unintended adolescent births and preterm birth.
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Affiliation(s)
- Lina M Nerlander
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA,
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Effects of Advanced Maternal Age and Race/Ethnicity on Placental Weight and Placental Weight/Birthweight Ratio in Very Low Birthweight Infants. Matern Child Health J 2015; 19:1553-8. [DOI: 10.1007/s10995-014-1662-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
To investigate the association between maternal pre-pregnancy obesity, race/ethnicity and prematurity. Retrospective cohort study of maternal deliveries at a single regional center from 2009 to 2010 time period (n = 11,711). Generalized linear models were used for the analysis to estimate an adjusted odds ratio with 95% confidence interval of the association between maternal pre-pregnancy obesity, race/ethnicity and prematurity. Analysis controlled for diabetes, chronic hypertension, previous preterm birth, smoking and insurance status. The demographics of the study population were as follows, race/ethnicity had predominance in the White/Non-Hispanic population with 60.1%, followed by the Black/Non-Hispanic population 24.2%, the Hispanic population with 10.3% and the Asian population with 5.4%. Maternal pre-pregnancy weight showed that the population with a normal body mass index (BMI) was 49.4%, followed by the population being overweight with 26.2%, and last, the population which was obese with 24.4%. Maternal obesity increased the odds of prematurity in the White/Non-Hispanic, Hispanic and Asian population (aOR 1.40, CI 1.12-1.75; aOR 2.20, CI 1.23-3.95; aOR 3.07, CI 1.16-8.13, respectively). Although the Black/Non-Hispanic population prematurity rate remains higher than the other race/ethnicity populations, the Black/Non-Hispanic population did not have an increased odds of prematurity in obese mothers (OR 0.87; CI 0.68-1.19). Unlike White/Non-Hispanic, Asian and Hispanic mothers, normal pre-pregnancy BMI in Black/Non-Hispanic mothers was not associated with lower odds for prematurity. The odds for mothers of the White/Non-Hispanic, Hispanic and Asian populations, for delivering a premature infant, were significantly increased when obese. Analysis controlled for chronic hypertension, diabetes, insurance status, prior preterm birth and smoking. Obesity is a risk factor for prematurity in the White/Non-Hispanic, Asian and Hispanic population, but not for the Black/Non-Hispanic population. The design and evaluation of weight-based maternal health programs that aggregate race/ethnicity may not be sufficient. The optimal method to address maternal pre-pregnancy and intra-pregnancy weight-related health disorders may need to be stratified along race/ethnicity adjusted strategies and goals. However, a more global preventative strategy that encompasses the social determinants of health may be needed to reduce the higher rates of prematurity among the Black/Non-Hispanic population.
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Salm Ward TC, Ngui EM. Factors Associated with Bed-Sharing for African American and White Mothers in Wisconsin. Matern Child Health J 2014; 19:720-32. [DOI: 10.1007/s10995-014-1545-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Application of a Mixed Methods Approach to Identify Community-Level Solutions to Decrease Racial Disparities in Infant Mortality. J Racial Ethn Health Disparities 2014. [DOI: 10.1007/s40615-014-0008-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Masho SW, Munn MS, Archer PW. Multilevel factors influencing preterm birth in an urban setting. URBAN, PLANNING AND TRANSPORT RESEARCH 2014; 2:36-48. [PMID: 25045595 PMCID: PMC4100720 DOI: 10.1080/21650020.2014.896223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Saba W Masho
- Division of Epidemiology, Department of Family Medicine and Population Health, Department of Obstetrics and Gynecology and Institute of Women's Health, Virginia Commonwealth University
| | - Meaghan S Munn
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University
| | - Phillip W Archer
- Associate Professor, Department of Natural Sciences and Director, Minority Health Research Institute and Initiative, Virginia Union University
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Dunkel Schetter C, Schafer P, Lanzi RG, Clark-Kauffman E, Raju TNK, Hillemeier MM. Shedding Light on the Mechanisms Underlying Health Disparities Through Community Participatory Methods: The Stress Pathway. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2013; 8:613-33. [PMID: 26173227 PMCID: PMC4505627 DOI: 10.1177/1745691613506016] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Health disparities are large and persistent gaps in the rates of disease and death between racial/ethnic and socioeconomic status subgroups in the population. Stress is a major pathway hypothesized to explain such disparities. The Eunice Kennedy Shriver National Institute of Child Health and Human Development formed a community/research collaborative-the Community Child Health Network-to investigate disparities in maternal and child health in five high-risk communities. Using community participation methods, we enrolled a large cohort of African American/Black, Latino/Hispanic, and non-Hispanic/White mothers and fathers of newborns at the time of birth and followed them over 2 years. A majority had household incomes near or below the federal poverty level. Home interviews yielded detailed information regarding multiple types of stress such as major life events and many forms of chronic stress including racism. Several forms of stress varied markedly by racial/ethnic group and income, with decreasing stress as income increased among Caucasians but not among African Americans; other forms of stress varied by race/ethnicity or poverty alone. We conclude that greater sophistication in studying the many forms of stress and community partnership is necessary to uncover the mechanisms underlying health disparities in poor and ethnic-minority families and to implement community health interventions.
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Affiliation(s)
| | | | | | - Elizabeth Clark-Kauffman
- Section for Child and Family Health Studies, North Shore University Health System, Evanston, Illinois
| | - Tonse N K Raju
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland
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Dehlendorf C, Harris LH, Weitz TA. Disparities in abortion rates: a public health approach. Am J Public Health 2013; 103:1772-9. [PMID: 23948010 PMCID: PMC3780732 DOI: 10.2105/ajph.2013.301339] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2013] [Indexed: 12/23/2022]
Abstract
Women of lower socioeconomic status and women of color in the United States have higher rates of abortion than women of higher socioeconomic status and White women. Opponents of abortion use these statistics to argue that abortion providers are exploiting women of color and low socioeconomic status, and thus, regulations are needed to protect women. This argument ignores the underlying causes of the disparities. As efforts to restrict abortion will have no effect on these underlying factors, and instead will only result in more women experiencing later abortions or having an unintended childbirth, they are likely to result in worsening health disparities. We provide a review of the causes of abortion disparities and argue for a multifaceted public health approach to address them.
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Affiliation(s)
- Christine Dehlendorf
- Christine Dehlendorf is with the Departments of Family and Community Medicine, Obstetrics, Gynecology and Reproductive Sciences, and Epidemiology and Biostatistics at the University of California, San Francisco. Lisa H. Harris is with the Departments of Obstetrics and Gynecology and Women's Studies, University of Michigan, Ann Arbor. Tracy A. Weitz is with Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, University of California, San Francisco
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Coley SL, Aronson RE. Exploring Birth Outcome Disparities and the Impact of Prenatal Care Utilization Among North Carolina Teen Mothers. Womens Health Issues 2013; 23:e287-94. [DOI: 10.1016/j.whi.2013.06.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 06/20/2013] [Accepted: 06/21/2013] [Indexed: 11/29/2022]
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